Support Care Cancer (2014) 22 (Suppl 1):S1–S238 DOI 10.1007/s00520-014-2222-3

ABSTRACTS

S2

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Author Index A Aapro, M. mascc-0160 Aapro, M. mascc-0161 Aapro, M. mascc-0158 Aapro, M. mascc-0367 Aaronson, N.K. mascc-0138 Abasher, S. mascc-0017 Abbink, F. mascc-0185 Abdelkhalek, El mascc-0519 Abdias, A. mascc-0606 Abe, K. mascc-0378 Abernethy, A. mascc-0244 Abernethy, A.P. mascc-0416 AbisaidBaker, R. mascc-0271 Aboudagga, H. mascc-0420 Aboudi, K. mascc-0254 Abraham, I. mascc-0367 Abudari, G. mascc-0526 Aburub, A. mascc-0417 AbuZeinah, G. mascc-0253 Acar, H. mascc-0574 Acar, H. mascc-0577 Acar, H. mascc-0576 Acquavella, J. mascc-0512 Acquavella, JF mascc-0490 Adair, M. mascc-0026 Adair, M. mascc-0030 Ades, S. mascc-0304 Adeyemi, J.D. mascc-0169 AdrianaLinsdeMorais, A.L.M. mascc-0551 AdrianaLinsdeMorais, A.L.M. mascc-0553 Affronti, M.L. mascc-0215 Agarwal, A. mascc-0465 Agarwal, A. mascc-0231 Agarwal, J. mascc-0172 Aguilar, D. mascc-0591 Ahadian, H. mascc-0050 Ahmad, F. mascc-0433 Ahmad, H.E.B.A. mascc-0287 Ahmad, I. mascc-0521 Ahmadi, M. mascc-0080 Ahmadi, M. mascc-0079 Ahmed, S. mascc-0125 Ahmed, S. mascc-0417 Ahn, J.S. mascc-0008 Aiba, K. mascc-0170 Aina, O.F. mascc-0168 Ait-kaci, F. mascc-0214 Ajay, G. mascc-0085 Ajmera, A.J. mascc-0443 Aketch, W. mascc-0415 Aketch, W. mascc-0380 AkhavanKarbassi, M.H. mascc-0050 Akiba, C. mascc-0542 Akman, T. mascc-0331 Akopov, A. mascc-0055 Aktas, A. mascc-0114 Aktas, A. mascc-0027 Aktas, A. mascc-0267 Aktas, A. mascc-0115 Aktas, A. mascc-0029 Akyurek, S. mascc-0361 AlAyoubi, H. mascc-0254 Alberts, D. mascc-0463

Albrand, H. mascc-0395 Alexander, S. mascc-0560 Alfieri, S. mascc-0251 AlHarbi, K. mascc-0509 Alhazmi, N. mascc-0523 Alibhai, S. mascc-0293 Alibhai, S. mascc-0180 Alibhai, S. mascc-0301 Alibhai, S.M.H. mascc-0483 Alibhai, S.M.H. mascc-0559 Alkhalil, A.M.R.A. mascc-0254 AlKindi, S. mascc-0253 Allam, A. mascc-0245 Allam, A. mascc-0253 Allexandre, D. mascc-0033 Alloo, A. mascc-0610 AlmEl-Din, M.A. mascc-0337 AlmEl-Din, M.A. mascc-0467 Alrehili, R. mascc-0523 Alterio, D. mascc-0562 Altinok, A. mascc-0574 Altinok, A. mascc-0577 Altinok, A. mascc-0576 Altun, M. mascc-0592 AlUstwani, O. mascc-0127 Àlvar, R. mascc-0305 Alvarez, I. mascc-0453 Alves, B.C. mascc-0011 Alves, M. mascc-0119 Amadori, F. mascc-0136 AmaralMendes, R. mascc-0619 Amin, A. mascc-0125 Aminah, J. mascc-0620 Amir, E. mascc-0497 An, H.J. mascc-0366 An, H.J. mascc-0368 An, H.J. mascc-0365 An, X. mascc-0255 Anami, S. mascc-0264 Ancizar, N. mascc-0453 Andersen, B. mascc-0413 Andersen, B.L. mascc-0418 Andersen, O. mascc-0527 Andersen, O. mascc-0529 Anderson, D.M. mascc-0049 Anderson, K. mascc-0063 Anderson, K. mascc-0064 Anderson, K. mascc-0064 Ang, N.K.E. mascc-0241 Ang, S.F. mascc-0194 Ang, S.F. mascc-0200 Angelelli, L. mascc-0083 Annunziata, M. mascc-0095 Annunziata, M.A. mascc-0096 Annunziata, M.A. mascc-0118 Anstey, S. mascc-0405 AntonioRebollo, M. mascc-0597 AntonioRebollo, M. mascc-0549 Antoniou, F. mascc-0517 Antonuzzo, A. mascc-0595 Antonuzzo, A. mascc-0594 Antonuzzo, A. mascc-0593 Antonuzzo, A. mascc-0600 Antonuzzo, A. mascc-0252

Anttila, A.H.T.I. mascc-0058 Aogi, K. mascc-0264 Aouizerat, B. mascc-0154 Aouizerat, B.E. mascc-0226 Applegate, T.E.R.I. mascc-0064 Apte, S.M. mascc-0613 Arab, N. mascc-0575 Arab, N. mascc-0502 Arabyat, R. mascc-0113 AraújodaSilva, E. mascc-0061 Araz, M. mascc-0258 Arcusa-Lanza, M.A. mascc-0549 Arellano, J. mascc-0498 Arguis, P. mascc-0597 Arpaci, F. mascc-0110 Artru, P. mascc-0272 Asadilari, M. mascc-0080 Ashikaga, T. mascc-0304 Aslam, I. mascc-0113 Ata, O. mascc-0372 Ata, O. mascc-0258 Atayee, R.S. mascc-0486 Atayee, R.S. mascc-0151 Atenafu, E. mascc-0500 Athanassiadis, I. mascc-0517 Atherton, P.J. mascc-0450 Atherton, P.J. mascc-0049 Attali, P. mascc-0148 Attali, P. mascc-0150 Aubaret, C. mascc-0330 Aubaret, C. mascc-0341 Audigier-Valette, C. mascc-0272 Audigier-Vallet, C. mascc-0269 August, A. mascc-0560 Aurer, I. mascc-0265 AuroDelGiglio, A.D.G. mascc-0054 AyaladelaPeña, F. mascc-0549 Ayora, P. mascc-0575 Ayora, P. mascc-0502 Azevedo, L.R. mascc-0260 Azzam, B.A. mascc-0374 B Baba, M. mascc-0347 Badyal, D. mascc-0403 Bae, D. mascc-0090 Bae, D.S. mascc-0091 Bae, D.S. mascc-0092 Bae, S.B. mascc-0401 Baek, S. mascc-0351 Bafaloukos, D. mascc-0219 Bailey, K.G. mascc-0335 Bain, E. mascc-0153 Bain, E. mascc-0411 Bajic, J.E. mascc-0238 Bakhshi, S. mascc-0564 Balakumaran, A. mascc-0340 Balakumaran, A. mascc-0498 Baldini, S. mascc-0265 Ballard, A. mascc-0614 Ballatori, E. mascc-0083 Baltina, D. mascc-0570 Bansal, S. mascc-0165 Barasch, A. mascc-0617

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

barasch, A. mascc-0072 Barashid, A. mascc-0523 Barata, P. mascc-0583 Barata, P.C. mascc-0119 Barbier, E. mascc-0362 Barbosa, A. mascc-0119 Barbosa, R.P. mascc-0018 Barbounis, V. mascc-0166 Bardellini, E. mascc-0136 Bardellini, E. mascc-0399 Barnes, E. mascc-0541 Barnes, E. mascc-0446 Barnes, E. mascc-0468 Barnes, E. mascc-0338 Barnes, E. mascc-0441 Barnes, E. mascc-0411 Barnes, E. mascc-0531 Barnes, E. mascc-0410 Barnes, E. mascc-0455 Barnes, E. mascc-0473 Barnes, E. mascc-0472 Barnes, E. mascc-0481 Barnes, E. mascc-0464 Barone, G. mascc-0261 Barone, G. mascc-0263 Barone, G. mascc-0204 Barrera, C. mascc-0575 Barrera, C. mascc-0502 Barron, R. mascc-0512 Barron, R. mascc-0230 Barron, RL mascc-0490 Bartilol, P. mascc-0062 Barton, D.L. mascc-0049 Bartow, C. mascc-0112 Bashir, A. mascc-0253 Batarda, L. mascc-0583 Bateman, E. mascc-0098 Bateman, E. mascc-0188 Bateman, E. mascc-0186 Bearden, J.D. mascc-0049 Beasley, A. mascc-0240 Beato, C. mascc-0597 Beato, C. mascc-0549 Beaumont, J. mascc-0225 Beaumont, J. mascc-0179 Beaumont, J.L. mascc-0342 Beaumont, J.L. mascc-0075 Beaumont, J.L. mascc-0274 Bedard, G mascc-0147 Bedard, G. mascc-0192 Bedard, G. mascc-0317 Bedard, G. mascc-0177 Bedard, G. mascc-0153 Bedard, G. mascc-0447 Bedard, G. mascc-0541 Bedard, G. mascc-0435 Bedard, G. mascc-0327 Bedard, G. mascc-0446 Bedard, G. mascc-0468 Bedard, G. mascc-0132 Bedard, G. mascc-0342 Bedard, G. mascc-0337 Bedard, G. mascc-0338 Bedard, G. mascc-0422 Bedard, G. mascc-0434 Bedard, G. mascc-0423

S3

Bedard, G. mascc-0441 Bedard, G. mascc-0411 Bedard, G. mascc-0531 Bedard, G. mascc-0467 Bedard, G. mascc-0075 Bedard, G. mascc-0179 Bedard, G. mascc-0410 Bedard, G. mascc-0455 Bedard, G. mascc-0473 Bedard, G. mascc-0472 Bedard, G. mascc-0481 Bedard, G. mascc-0184 Bedard, G. mascc-0464 Bedard, G. mascc-0449 Bedard, G. mascc-0191 Bedard, G. mascc-0231 Bedard, P. mascc-0497 Bedi, D. mascc-0536 Begum, A. mascc-0254 Begum, S. mascc-0584 Bekelman, D. mascc-0332 Bektas-Kayhan, K. mascc-0592 Belkaid, M.I. mascc-0269 Benchamart, M.S. mascc-0345 Benge, S. mascc-0189 Benn, M. mascc-0486 Bennani-Baiti, N. mascc-0029 Bennani-Baiti, N. mascc-0028 Bennett, M. mascc-0405 Bensadoun, R.J. mascc-0617 Berardi, G. mascc-0605 Berardi, R. mascc-0196 Berardi, R. mascc-0195 Berbiche, D. mascc-0183 Berenberg, J.L. mascc-0445 Bergamini, C. mascc-0251 Berkane, K. mascc-0291 Berry, N.M. mascc-0152 Besen, A. mascc-0056 Besen, A. mascc-0371 Bessette, P. mascc-0307 Betticher, D. mascc-0076 Beuzeboc, P. mascc-0581 Beyzadeoglu, M. mascc-0110 Bezjak, A. mascc-0500 Bezjak, A. mascc-0494 Bhandari, R. mascc-0499 Bhandari, R. mascc-0376 Bhargava, R. mascc-0104 Bhargava, R. mascc-0444 Bhargava, R. mascc-0429 Bhargava, R. mascc-0408 Bhattacharyya, M. mascc-0580 Bias, P. mascc-0544 Bias, P. mascc-0530 Bin, J. mascc-0307 Biosca, M. mascc-0597 Biosca, M. mascc-0549 Birbilaite, S. mascc-0285 Bisson, G.S. mascc-0217 Bista, S.R. mascc-0348 Bista, S.R. mascc-0346 Blacker, S. mascc-0436 Blacker, S. mascc-0439 Blais, J. mascc-0433 Blais, N. mascc-0315

Blanco, J. mascc-0453 Blasco, A. mascc-0549 Blayney, D.W. mascc-0335 Block, V. mascc-0563 Blum, D. mascc-0603 BlumGrynberg, B. mascc-0621 Boccadoro, M. mascc-0367 Bodnar, M. mascc-0299 Bohac, C. mascc-0216 Bohac, G.C. mascc-0469 Boisnic, S. mascc-0148 Bokemeyer, C. mascc-0367 Bonan, B. mascc-0420 Bonfim, E. mascc-0217 Bonilla, Y. mascc-0549 Bopp, A. mascc-0167 Boregowda, L. mascc-0107 Boregowda, L. mascc-0134 Boregowda, L. mascc-0134 Borget, I. mascc-0341 Borget, I. mascc-0385 Borod, M. mascc-0557 Borod, M. mascc-0535 Borod, M. mascc-0534 Borre, M. mascc-0066 Borroni, M.E. mascc-0160 Borroni, M.E. mascc-0162 Borsaru, G. mascc-0265 Borta, T.M. mascc-0018 Bosani, R. mascc-0428 Boscagli, G. mascc-0261 Boscagli, G. mascc-0263 Bosi, A. mascc-0265 Bossi, P. mascc-0251 Bossi, P. mascc-0508 Bossi, P. mascc-0252 Bossi, P.* mascc-0562 Boterberg, T. mascc-0396 Bottomley, A. mascc-0342 Bottomley, A. mascc-0337 Bottomley, A. mascc-0467 Bottomley, A. mascc-0075 Bottomley, A. mascc-0225 Bottomley, A. mascc-0274 Bottomley, A. mascc-0179 Bottomley, A. mascc-0452 Botturi, A. mascc-0588 Bouillet, T. mascc-0272 Bouleuc, C. mascc-0547 Bouleuc, C. mascc-0362 Boulton, S. mascc-0215 Bourbeau, J. mascc-0494 Bowen, J. mascc-0339 Bowen, J. mascc-0188 Bowen, J.M. mascc-0302 Bozkurt, B. mascc-0372 Braakhuis, B.J.M. mascc-0406 Braakman, A. mascc-0513 Braccia, D. mascc-0437 Braccia, D. mascc-0438 Bracke, M. mascc-0396 Bracke, M. mascc-0392 Brady, A. mascc-0133 Brady, A. mascc-0193 Brakenhoff, R.H. mascc-0406 Brames, M. mascc-0097

S4

Brandis, S. mascc-0266 Brandwein, J. mascc-0559 Brasnu, D. mascc-0330 Brasnu, D. mascc-0341 Braspenning, A.M. mascc-0514 Braun, A. mascc-0340 Brauner, E. mascc-0379 Brennan, M.T. mascc-0599 Breuer, J. mascc-0300 Breunis, H. mascc-0301 Breunis, H. mascc-0559 Brinksma, A. mascc-0175 Brinksma, A. mascc-0174 Brito, G.M. mascc-0018 Broder, M. mascc-0227 Broder, M. mascc-0228 Brooker, J. mascc-0319 Broom, R. mascc-0189 Bruera, E. mascc-0270 Bruera, E. mascc-0606 Bruera, E. mascc-0618 Bruera, E. mascc-0164 Bruera, E. mascc-0165 Bruera, E. mascc-0236 Bruera, E. mascc-0284 Bruera, E. mascc-0389 Bruera, E. mascc-0282 Bruera, E. mascc-0279 Bruera, E. mascc-0462 Bruera, E. mascc-0536 Bruggeman, A. mascc-0538 Brunet, A. mascc-0565 Brunetti, I.M. mascc-0595 Brunetti, I.M. mascc-0594 Brunetti, I.M. mascc-0593 Brunetti, I.M. mascc-0600 Bu?gová, R. mascc-0093 Buadi, F.K. mascc-0427 Buchanan, A. mascc-0060 Buchanan, A. mascc-0129 Buchanan, A. mascc-0068 Buchanan, A. mascc-0422 Buchner, A. mascc-0544 Buchner, A. mascc-0530 Budrukkar, A. mascc-0172 Buffart, L.M. mascc-0406 Bugat, M.E. mascc-0336 Bugat, M.E. mascc-0334 Bugat, R. mascc-0336 Bugat, R. mascc-0334 Bugos, K. mascc-0335 Bujedo, A. mascc-0453 Bukhari, S. mascc-0523 Bulotiene, G. mascc-0285 Burgerhof, J.G.M. mascc-0174 Burney, S. mascc-0319 Burnod, A. mascc-0547 Burnod, A. mascc-0362 Burns, A.M. mascc-0408 Burz, C. mascc-0101 Bustamante, E.I. mascc-0474 Bustamante, E.I. mascc-0475 Butow, P. mascc-0614 Butrynski, J. mascc-0610 Buxo, E. mascc-0575 Buxo, E. mascc-0502

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Buzgova, R. mascc-0094 C Cadungog, M. mascc-0615 Cagetti, M.G. mascc-0399 Caglar, H.B. mascc-0574 Caglar, H.B. mascc-0577 Caglar, H.B. mascc-0576 Caissie, A. mascc-0545 CakirGokce, S. mascc-0361 Calcoen, C. mascc-0278 Calderon, C. mascc-0575 Calderon, C. mascc-0502 Calvo-Temprano, D. mascc-0597 Campana, F. mascc-0362 Campbell, B. mascc-0087 Campbell, B. mascc-0086 Campbell, F. mascc-0240 Campus, G. mascc-0399 Caniza, M. mascc-0591 Caniza, M.A. mascc-0470 Caniza, M.A. mascc-0082 Cannavale, K. mascc-0478 Cannavale, K. mascc-0471 Cannavale, K. mascc-0476 CannavaleCA, K. mascc-0479 Cantor, S. mascc-0460 Cantoreggi, S. mascc-0188 Cantoreggi, S. mascc-0186 Cantu, H. mascc-0282 Capriati, A. mascc-0265 Carabellese, B. mascc-0605 Carafizi, N. mascc-0598 Caraiscos, V. mascc-0421 Caramanti, M. mascc-0196 Carbonnelle, G. mascc-0214 Cardoso, A. mascc-0119 Carles, R. mascc-0305 Carmona, L. mascc-0475 Carmona-Bayonas, A. mascc-0575 Carmona-Bayonas, A. mascc-0597 Carmona-Bayonas, A. mascc-0549 Carola, E. mascc-0220 Caroli-Bosc, F.X. mascc-0272 CarolinaMariadaSilva, C.M.S. mascc-0551 CarolinaMariadaSilva, C.M.S. mascc-0553 Caron, H.N. mascc-0185 Carr, S. mascc-0133 Carr, S. mascc-0193 Carreño, M. mascc-0575 Carreño, M. mascc-0502 Carrino, F. mascc-0076 Carrino, F. mascc-0077 Carroll, J.D. mascc-0617 Carter, S. mascc-0377 Casao, F. mascc-0549 Cascinu, S. mascc-0196 Cascinu, S. mascc-0195 Case-Eads, S. mascc-0097 Cassel, B. mascc-0320 Castagnani, M. mascc-0196 Castillo-Deluao, C.M. mascc-0591 Cauwenbergh, G. mascc-0364 CavanaghPodesta, M. mascc-0504 Cavanna, L. mascc-0083 CaySenler, F. mascc-0331

Cella, D. mascc-0216 Cella, D. mascc-0342 Cella, D. mascc-0075 Cella, D. mascc-0225 Cella, D. mascc-0274 Cella, D. mascc-0179 Cerny, T. mascc-0603 Cervi, C. mascc-0563 Ceugnart, L. mascc-0278 Chair, S.Y. mascc-0069 Chak, J.Q. mascc-0052 Cham, M.T. mascc-0200 Cham, M.T. mascc-0139 Chan, A. mascc-0194 Chan, A. mascc-0039 Chan, A. mascc-0040 Chan, A. mascc-0200 Chan, A. mascc-0139 Chan, A. mascc-0140 Chan, C. mascc-0241 Chan, C. mascc-0019 Chan, C. mascc-0239 Chan, C. mascc-0243 Chan, C. mascc-0616 Chan, C. mascc-0242 Chan, C. mascc-0190 Chan, C.W. mascc-0200 Chan, C.W.H. mascc-0232 Chan, C.W.H. mascc-0316 Chan, C.W.H. mascc-0013 Chan, C.W.H. mascc-0069 Chan, H.Y.L. mascc-0316 Chan, J.C.Y. mascc-0013 Chan, J.C.Y. mascc-0069 Chan, K. mascc-0190 Chan, K.K.W. mascc-0448 Chan, N. mascc-0241 Chandra, L.A.L. mascc-0522 Chang, E. mascc-0227 Chang, E. mascc-0228 Chang, I. mascc-0091 Chang, T. mascc-0126 Chang, Y.C. mascc-0350 Chao, C mascc-0478 Chao, C. mascc-0479 Chao, C. mascc-0471 Chao, C. mascc-0476 Chao, J. mascc-0542 Charalambous, A. mascc-0321 Charalambous, A. mascc-0067 Charalambous, M. mascc-0067 Charette, V. mascc-0377 Charpidou, A. mascc-0280 Charpidou, A. mascc-0281 Chasen, M. mascc-0104 Chasen, M. mascc-0444 Chasen, M. mascc-0429 Chasen, M. mascc-0407 Chasen, M. mascc-0408 Chattopadhyay, P. mascc-0528 Chattopadhyay, P. mascc-0561 chaudhary, S. mascc-0564 Chay, W.Y. mascc-0194 Chay, W.Y. mascc-0200 Chay, W.Y. mascc-0139 Cheah, K.Y. mascc-0237

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Cheah, K.Y. mascc-0235 Chebolu, S. mascc-0149 Chen, C. mascc-0038 Chen, D.R. mascc-0518 Chen, M. mascc-0350 Chen, Z. mascc-0178 Cheng, D.R. mascc-0518 Cheng, D.R. mascc-0359 Cheng, H. mascc-0616 Cheng, K. mascc-0241 Cheng, K. mascc-0239 Cheng, K. mascc-0242 Cheng, S.T. mascc-0246 Cheon, P.M. mascc-0317 Cheung, A.M. mascc-0483 Cheung, W. mascc-0484 Cheung, Y.T. mascc-0194 Cheung, Y.T. mascc-0200 Cheung, Y.T. mascc-0139 Cheung, Y.T. mascc-0140 Chevalier, D. mascc-0278 Chiang, A. mascc-0435 Chie, W. mascc-0467 Chie, W.C. mascc-0337 Chinnabhandar, V. mascc-0458 Chiodo, J. mascc-0433 Chisholm, G. mascc-0164 Chisholm, G. mascc-0165 Chisholm, G. mascc-0389 Chisholm, G. mascc-0282 Chisholm, G. mascc-0279 Chisholm, G. mascc-0462 Chisholm, G.B. mascc-0236 Chiu, L. mascc-0132 Chiu, L. mascc-0342 Chiu, L. mascc-0337 Chiu, L. mascc-0338 Chiu, N. mascc-0132 Chiu, N. mascc-0342 Chiu, N. mascc-0337 Chiu, N. mascc-0338 Choi, C. mascc-0090 Choi, D.R. mascc-0401 Choi, I. mascc-0333 Choi, K.C. mascc-0069 Choi, Y. mascc-0202 Chong, C.J.Y. mascc-0052 Chou, B. mascc-0229 Chou, HsiuLing mascc-0360 Chow, E mascc-0147 Chow, E. mascc-0192 Chow, E. mascc-0567 Chow, E. mascc-0448 Chow, E. mascc-0317 Chow, E. mascc-0177 Chow, E. mascc-0153 Chow, E. mascc-0447 Chow, E. mascc-0541 Chow, E. mascc-0435 Chow, E. mascc-0327 Chow, E. mascc-0446 Chow, E. mascc-0468 Chow, E. mascc-0132 Chow, E. mascc-0117 Chow, E. mascc-0121 Chow, E. mascc-0342

S5

Chow, E. mascc-0337 Chow, E. mascc-0338 Chow, E. mascc-0322 Chow, E. mascc-0414 Chow, E. mascc-0422 Chow, E. mascc-0434 Chow, E. mascc-0423 Chow, E. mascc-0441 Chow, E. mascc-0404 Chow, E. mascc-0402 Chow, E. mascc-0411 Chow, E. mascc-0328 Chow, E. mascc-0465 Chow, E. mascc-0545 Chow, E. mascc-0457 Chow, E. mascc-0456 Chow, E. mascc-0531 Chow, E. mascc-0467 Chow, E. mascc-0075 Chow, E. mascc-0225 Chow, E. mascc-0274 Chow, E. mascc-0179 Chow, E. mascc-0325 Chow, E. mascc-0410 Chow, E. mascc-0452 Chow, E. mascc-0455 Chow, E. mascc-0473 Chow, E. mascc-0472 Chow, E. mascc-0481 Chow, E. mascc-0184 Chow, E. mascc-0323 Chow, E. mascc-0326 Chow, E. mascc-0454 Chow, E. mascc-0464 Chow, E. mascc-0449 Chow, E. mascc-0191 Chow, E. mascc-0231 Chow, K.M. mascc-0019 Chow, K.M. mascc-0013 Chow, T. mascc-0232 Christensen, J. mascc-0398 ChristofferJohansen, C.J. mascc-0099 Christopoulos, A. mascc-0280 Chu, D. mascc-0075 Chu, D. mascc-0225 Chu, D. mascc-0274 Chu, L.L. mascc-0352 Chu, M. mascc-0190 Chui, W.K. mascc-0194 Chui, W.K. mascc-0139 Chung, H. mascc-0567 Chung, H. mascc-0317 Chung, H. mascc-0177 Chung, K.S. mascc-0128 Chung, K.S. mascc-0143 Chung, V. mascc-0542 ChungEun, L. mascc-0375 Churruca, C. mascc-0453 Ciafone, D. mascc-0414 Ciesielski, P. mascc-0571 Ciesielski, P. mascc-0586 Çiftçibasi, E. mascc-0592 Cimpianu, M. mascc-0101 Ciuffreda, L. mascc-0083 Ciutto, L. mascc-0557 Ciutto, L. mascc-0535

Ciutto, L. mascc-0534 Clance, M. mascc-0493 Clemons, J. mascc-0493 Cmelak, A.J. mascc-0112 Cnossen, I.C. mascc-0397 Coburn, N. mascc-0567 Cohn, R.J. mascc-0370 Cohn, R.J. mascc-0369 Colantonio, I. mascc-0083 Coller, J. mascc-0339 Collins, A.J. mascc-0512 Collins, AJ mascc-0490 Conlon, M. mascc-0477 Conroy, S. mascc-0035 Conti, G. mascc-0399 Cooper, B. mascc-0226 Cooper, B. mascc-0154 Copel, L. mascc-0547 Corey-Lisle, P. mascc-0469 Cotinaut, L. mascc-0220 Coveney, J. mascc-0152 Covens, A. mascc-0307 Cox, D. mascc-0222 Craddock, K.J. mascc-0454 Cramarossa, G. mascc-0567 Cramp, F. mascc-0426 Cranston, C. mascc-0444 Crawford, G. mascc-0025 Crawford, J.C. mascc-0548 Crawford, J.C. mascc-0546 Crosthwaite, K. mascc-0413 Crosthwaite, K. mascc-0418 Cruz, F. mascc-0018 Cruz, F.M. mascc-0011 Crvenkova, S. mascc-0045 Cubero, D. mascc-0061 Cubero, D.I.G. mascc-0011 Cuijpers, P. mascc-0393 Culleton, S. mascc-0545 Culos-Reed, N. mascc-0559 Cunningham, D. mascc-0033 Cure, H. mascc-0272 Currow, D. mascc-0244 Currow, D. mascc-0349 Custódio, M. mascc-0583 CustodioCabello, S. mascc-0504 Czerwiec, F.C. mascc-0433 D D’Olimpio, J.T. mascc-0445 Dalakou, E. mascc-0283 Dalal, S. mascc-0536 Dalle, E. mascc-0400 Dalton, J.T. mascc-0548 Dalton, J.T. mascc-0546 daLuz, R. mascc-0583 Damaj, L. mascc-0269 D'Amico, F. mascc-0605 DamilaChristinaTrufelli, D.C.T. mascc-0054 Damore-Petingola, D. mascc-0477 Damrongrajasak, W. mascc-0084 Danbolt, L.J. mascc-0218 Danchaivijitr, P. mascc-0127 Daniel, C. mascc-0581 DaniellePatriciaCerqueiraMacedo, D.P.C.M. mascc-0551

S6

DaniellePatriciaCerqueiraMacedo, D.P.C.M. mascc-0553 Danis, J. mascc-0547 Danis, J. mascc-0362 Danjoux, C. mascc-0541 Danjoux, C. mascc-0446 Danjoux, C. mascc-0468 Danjoux, C. mascc-0441 Danjoux, C. mascc-0411 Danjoux, C. mascc-0531 Danjoux, C. mascc-0410 Danjoux, C. mascc-0455 Danjoux, C. mascc-0473 Danjoux, C. mascc-0472 Danjoux, C. mascc-0481 Danjoux, C. mascc-0464 Danklou, J. mascc-0400 Dardeno, M. mascc-0391 Darmani, N. mascc-0149 Darviri, C. mascc-0566 DAS, J. mascc-0522 Dauchy, S. mascc-0409 Daudt, H.M.L. mascc-0425 Daudt, H.M.L. mascc-0424 Daudt, H.M.L. mascc-0431 Davies, A. mascc-0060 Davies, A. mascc-0129 Davies, A. mascc-0068 Davies, A. mascc-0354 Davies, A. mascc-0422 Davis, J. mascc-0078 Davis, J. mascc-0398 Davis, M. mascc-0240 Davis, M. mascc-0032 Davis, M. mascc-0033 Davis, M. mascc-0034 Day, R. mascc-0078 De, R. mascc-0580 DeAngelis, C. mascc-0567 DeAngelis, C. mascc-0448 Deangelis, C. mascc-0317 DeAngelis, C. mascc-0177 DeAngelis, C. mascc-0328 DeAngelis, C. mascc-0179 Debiais, F. mascc-0565 deBont, E.S.J.M. mascc-0174 deBree, R. mascc-0406 deBree, R. mascc-0397 Defachelles, A.S. mascc-0214 Dégi, C. mascc-0101 Dégi, C. mascc-0100 delaCruz, M. mascc-0270 delacruz, M. mascc-0284 delacruz, M. mascc-0389 DeLaCruz, M. mascc-0536 delaHaba, I. mascc-0597 delaRosa, A. mascc-0606 Delbarre, M. mascc-0214 Delbey, S. mascc-0386 DelFabbro, E. mascc-0320 Delgado-Guay, M. mascc-0282 Delgado-Guay, M. mascc-0279 DelGiglio, A. mascc-0011 delGiglio, A. mascc-0018 DelGiglio, A. mascc-0061 Demirbas, S. mascc-0110

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Demirci, F. mascc-0372 Deng, J. mascc-0612 Deng, J. mascc-0602 Deng, J. mascc-0105 Deng, J. mascc-0112 Deng, J. mascc-0070 Denhaerynck, K. mascc-0367 Denis, J.L. mascc-0176 Dennis, K. mascc-0571 Dennis, K. mascc-0317 Dennis, K. mascc-0177 Dennis, K. mascc-0586 Dennis, K.* mascc-0567 denpoya, A. mascc-0355 Dent, R. mascc-0139 Dent, R. mascc-0140 Dent, R.A. mascc-0194 Dent, R.A. mascc-0200 dePaula, L. mascc-0061 Deray, G. mascc-0581 Derbyshire, A. mascc-0059 DeRyck, T. mascc-0396 DeRyck, T. mascc-0392 Desai, H. mascc-0270 Desjardins, A. mascc-0215 Desrosiers, M.P. mascc-0469 Desti, C. mascc-0261 Desti, C. mascc-0263 Dev, R. mascc-0164 Dev, R. mascc-0165 Dev, R. mascc-0536 Devereaux, A. mascc-0537 Devigne, A. mascc-0089 deVries, J. mascc-0048 deWolf-Linder, S. mascc-0603 Dhillon, H. mascc-0614 DiCarlo, S. mascc-0379 Dickman, A. mascc-0354 DiCristina, C. mascc-0286 DiCristo, C. mascc-0261 DiCristo, C. mascc-0263 Didwaniya, N. mascc-0389 Dieperink, K. mascc-0382 Dietrich, M mascc-0558 Dietrich, M. mascc-0221 Dietrich, M.S. mascc-0123 Dietrich, M.S. mascc-0612 Dietrich, M.S. mascc-0602 Dietrich, M.S. mascc-0105 Dietrich, M.S. mascc-0112 Dietrich, M.S. mascc-0070 DiGiacomo, M. mascc-0318 DiGiovanni, J. mascc-0075 Digiovanni, J. mascc-0225 DiGiovanni, J. mascc-0274 Dijkstra, P.U. mascc-0135 Dilhuydy, M.S. mascc-0272 Dillaha, L. mascc-0463 DiMari, A. mascc-0419 Dimitrovska, A. mascc-0045 diPalma, M. mascc-0383 diTomasso, J. mascc-0557 diTomasso, J. mascc-0535 diTomasso, J. mascc-0534 Divers, J. mascc-0488 Dockter, T. mascc-0049

Dodo, M. mascc-0572 Dodo, M. mascc-0516 Dogan, O. mascc-0056 Dolai, T.K. mascc-0580 Dolendo, M. mascc-0591 Dollman, J. mascc-0152 Domen, K. mascc-0012 Domínguez, A. mascc-0597 Dominguez, J.A. mascc-0617 Donahue, E. mascc-0469 Dong, F.D. mascc-0524 Donovan, K. mascc-0294 Donovan, K.A. mascc-0613 Doolan, E.L. mascc-0370 Doolan, E.L. mascc-0369 Doshi, S. mascc-0078 Doucet, S. mascc-0315 Dr.Baumann, W. mascc-0578 Dr.Hermes-Moll, K. mascc-0578 Dranitsaris, G. mascc-0222 Drew, D. mascc-0369 Drewa, T.A. mascc-0299 Drodge, C.S. mascc-0308 Dryden, T. mascc-0319 Dubey, C. mascc-0076 Dubey, C. mascc-0077 Ducrocq, J.L. mascc-0292 Dudgeon, D. mascc-0500 Dudgeon, D. mascc-0494 Duke, S. mascc-0405 Dunn, L. mascc-0226 Dunn, L. mascc-0154 Dupas, G. mascc-0106 Duprez, F. mascc-0392 Dupuis, L.L. mascc-0459 Dupuis, L.L. mascc-0560 Durand, J.B. mascc-0271 Durbano, S. mascc-0559 Dyck, M. mascc-0288 E Eboras, Y. mascc-0615 EchavarríaDíaz-Guardamino, I. mascc-0504 Eckhoff, L. mascc-0250 Eden, G.L. mascc-0237 Eden, G.L. mascc-0235 Eden, G.L. mascc-0238 Edwards, B. mascc-0113 Edwards, J. mascc-0189 Eerenstein, S.E. mascc-0397 Eicher, M. mascc-0076 Eicher, M. mascc-0077 Einhorn, L. mascc-0097 Elaidi, R. mascc-0420 ElHada, A mascc-0519 Elklit, A. mascc-0131 Ellidokuz, H. mascc-0331 elOsta, B. mascc-0057 elOsta, L. mascc-0057 elOsta, N. mascc-0057 El-Safy, E mascc-0519 Elshiekh, A. mascc-0287 Elting, L.S. mascc-0487 Emara, S. mascc-0526 Emmenegger, U. mascc-0328 Enami, A. mascc-0264

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Enric, J. mascc-0305 Epstein, J.B. mascc-0123 Epstein, J.B. mascc-0617 epstein, J.B. mascc-0072 Erdem, G. mascc-0110 Escalante, C. mascc-0426 Escalante, C.P. mascc-0271 Espinosa, J. mascc-0549 Estfan, B. mascc-0027 Estfan, B. mascc-0267 Estfan, B. mascc-0029 Eto, K. mascc-0163 Ewertz, M. mascc-0250 Eziada, S.A.A.D. mascc-0253 Eziada, S.A.A.D. mascc-0254 F Faez, L. mascc-0597 Fagerlie, S. mascc-0182 Fahl, W. mascc-0124 Fairchild, A. mascc-0337 Fairchild, A. mascc-0308 Fairchild, A. mascc-0414 Fairchild, A. mascc-0467 Fairchild, A.M. mascc-0155 Falcone, A. mascc-0595 Falcone, A. mascc-0594 Falcone, A. mascc-0593 Falcone, A. mascc-0600 Falcou, M.C. mascc-0362 Fallai, C. mascc-0251 Fallai, C. mascc-0562 Fan, G. mascc-0194 Fan, G. mascc-0200 Fan, G. mascc-0139 Fan, J. mascc-0284 Fares, B.F. mascc-0374 Fares, F.F. mascc-0374 Faria, C. mascc-0394 Faria, C. mascc-0227 Faria, C. mascc-0228 Faria, C. mascc-0222 Farman, H. mascc-0428 Farsi, F. mascc-0623 Farsi, F. mascc-0409 Farsi, F. mascc-0565 Farsi, F. mascc-0336 Farsi, F. mascc-0334 Fatigoni, S. mascc-0083 Fatiregun, O. mascc-0169 Faust, N. mascc-0309 Faust, N. mascc-0493 Fava, S. mascc-0083 Fearon, K. mascc-0244 Federico, M. mascc-0265 Feldstain, A. mascc-0429 Feldstain, A. mascc-0407 Feldstain, A. mascc-0408 FelipeMeloCruz, F.M.C. mascc-0054 Fenton, G. mascc-0441 Feo, B. mascc-0234 Fernandes, D. mascc-0539 Fernandez, G. mascc-0500 Fernandez-Avilés, F. mascc-0575 Fernandez-Avilés, F. mascc-0502 FernándezSuárez, H. mascc-0621

S7

Ferrell, B. mascc-0542 Ferrer, J. mascc-0282 Ferrini, C. mascc-0196 Fetterly, T. mascc-0377 Fielding, F. mascc-0034 Filho, G. mascc-0552 Filipe, F. mascc-0583 Filler, K. mascc-0426 Filova, A. mascc-0094 Findlay, M. mascc-0189 Fiordoliva, I. mascc-0196 Fischer, M. mascc-0115 Fischer, S. mascc-0332 Fisher, M. mascc-0230 Fisher, M.D. mascc-0233 Fitch, M. mascc-0293 Fitch, M. mascc-0180 Fitz, A. mascc-0114 Fitzgerald, P. mascc-0582 Fizazi, K. mascc-0340 Flahiff, C. mascc-0215 Flaiban, C. mascc-0095 Flank, J. mascc-0560 Flank, J.* mascc-0459 Flannery, M. mascc-0311 Flannery, M. mascc-0445 Fleer, J. mascc-0175 Fleischer, A.C. mascc-0105 Flória-Santos, M. mascc-0260 Flynn, J. mascc-0418 Fond, G. mascc-0006 Fonfa, A. mascc-0579 Fonseca, F. mascc-0061 Fonseca, L.L.A. mascc-0011 Font, C. mascc-0575 Font, C. mascc-0502 FontPuig, C. mascc-0597 FontPuig, C. mascc-0549 Foran, J. mascc-0335 Forges, F. mascc-0337 Forges, F. mascc-0467 Forman, N. mascc-0463 Forman, S. mascc-0542 Foster, N. mascc-0007 Fournier, M.A. mascc-0315 Franco, D. mascc-0220 Francoletti, M. mascc-0195 Frau, B. mascc-0083 Freeman, M. mascc-0215 Freytes, C.O. mascc-0289 Friedman, H.S. mascc-0215 Friend, J. mascc-0244 Frisbee-Hume, S. mascc-0282 Frisbee-Hume, S. mascc-0279 Fritz, G. mascc-0167 Froelund, J.C. mascc-0248 Frydenberg, M. mascc-0319 Fu, J. mascc-0348 Fu, Q. mascc-0388 Fullman, L. mascc-0240 Fung, O.W.M. mascc-0069 Furfari, A mascc-0147 Furuhata, T. mascc-0163 G GachigiKamau, P. mascc-0062

Gagliese, L. mascc-0421 Gagnon, B. mascc-0417 Galiti, D. mascc-0517 Galiti, D. mascc-0219 Galitis, E. mascc-0517 Galitis, E. mascc-0166 Gallardo, E. mascc-0549 Gallego, C. mascc-0575 Gallego, C. mascc-0502 Gan, Y.X. mascc-0039 Gan, Y.X. mascc-0040 Gandhi, G. mascc-0522 Gandhi, G. mascc-0521 Ganem, G mascc-0272 Ganguly, B. mascc-0580 Ganul, A. mascc-0145 GarmingLegert, K. mascc-0599 Gartshore, K. mascc-0461 Gascón, P. mascc-0367 Ge, L. mascc-0242 Geater, S.L. mascc-0432 Gehrke, F.S. mascc-0011 George, K. mascc-0477 George, M. mascc-0487 George, M. mascc-0271 Gerasin, A. mascc-0055 Geuke, M. mascc-0108 Geursen, A. mascc-0189 Ghanem, I. mascc-0549 Ghatage, P. mascc-0307 Ghestem, F. mascc-0278 GhodratyJabloo, V. mascc-0301 Ghosh, S. mascc-0308 Ghosh, S. mascc-0414 Ghosh-Laskar, S. mascc-0172 Ghuman, S. mascc-0065 Giampieri, R. mascc-0195 Gibbons, K. mascc-0348 Gibson, R.J. mascc-0302 Gilbert, J. mascc-0112 Gilbert, L. mascc-0307 Gill, P. mascc-0203 Gill, P. mascc-0049 GilsaaHansen, D. mascc-0131 Ginocchi, L. mascc-0595 Ginocchi, L. mascc-0594 Ginocchi, L. mascc-0593 Ginocchi, L. mascc-0600 Giordano, G. mascc-0605 Giotis, A. mascc-0328 Gkiozos, I. mascc-0280 Gkiozos, I. mascc-0281 Glare, P. mascc-0349 Glaser, L.A. mascc-0433 Gleich, L. mascc-0244 Gligorov, J. mascc-0581 Glowacka, I. mascc-0306 Glushko, N.L. mascc-0265 Gobert, G. mascc-0278 Goforth, H. mascc-0034 Goldstein, L. mascc-0542 Goldstein, R. mascc-0494 Goldwasser, F. mascc-0581 Gomes, F. mascc-0583 Gomez, J. mascc-0453 Gomez, S. mascc-0082

S8

Gonçalves, S.S. mascc-0552 Gonçalves, S.S. mascc-0550 Gonçalves, S.S. mascc-0569 Gonçalves, S.S. mascc-0506 Gonçalves, S.S. mascc-0491 Good, P. mascc-0348 Good, P. mascc-0346 Gorbach, O. mascc-0145 Gordon, N. mascc-0111 Gordon, P. mascc-0032 Gornitzka, J. mascc-0181 Gough, K. mascc-0087 Gough, K. mascc-0086 Gralla, R. mascc-0438 Gralla, R. mascc-0162 Gralla, R. mascc-0161 Gralla, R. mascc-0158 Gralla, R.J. mascc-0548 Gralla, R.J. mascc-0159 Gralla, R.J. mascc-0433 Gramling, R.E. mascc-0525 Granata, R. mascc-0251 Grandner, M. mascc-0489 Granot, T. mascc-0428 Granot, T. mascc-0111 Graul-Conroy, A. mascc-0124 Greco, A. mascc-0562 Green, S. mascc-0286 Greillier, L. mascc-0272 Gretz, S. mascc-0225 Grigoriou, K. mascc-0205 Grigoriou, K. mascc-0207 Grigoriou, K. mascc-0210 Grigoriou, K. mascc-0212 Grinevich, Y.U. mascc-0145 Groen, W.G. mascc-0138 Gromcakova, L. mascc-0604 Gromcakova, L. mascc-0589 Grosicki, S. mascc-0265 Gross, J. mascc-0034 Grossman, D. mascc-0436 Grossman, D. mascc-0439 Grothey, A. mascc-0450 Gu, D.R. mascc-0518 Gu, D.R. mascc-0359 Gu, F. mascc-0010 Gu, F.* mascc-0009 Guarino, G. mascc-0379 Guazzelli, C.A. mascc-0018 Guido, V.H. mascc-0065 Guilhaume, M.N. mascc-0547 Guillou, A. mascc-0330 Guillou, A. mascc-0341 Gulamhusein, H. mascc-0483 Gunn, B. mascc-0562 Guo, Q.G. mascc-0524 Guo, Y. mascc-0462 Gupta, A. mascc-0458 Gupta, A.K. mascc-0458 Gupta, D. mascc-0016 Gupta, N. mascc-0127 Gupta, S. mascc-0144 Gupta, T. mascc-0172 Guru, K. mascc-0485 Guru, K. mascc-0496 Gushiken, F. mascc-0289

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Guth, D. mascc-0357 H Haas, M. mascc-0182 Hacini, M. mascc-0269 Haddad, P. mascc-0245 Haile, D. mascc-0289 Hakki, S. mascc-0372 Hall, S. mascc-0137 Hall, S. mascc-0354 Hamaguchi, Y. mascc-0264 Hammel, J. mascc-0113 Han, H.S. mascc-0401 Hancock, M.L. mascc-0548 Hancock, M.L. mascc-0546 Hannon, B. mascc-0290 Hannon, B. mascc-0288 Hans, S. mascc-0330 Hardy, J. mascc-0543 Hardy, J. mascc-0349 Hardy, J. mascc-0348 Hardy, J. mascc-0346 Harti, S. mascc-0364 Hartmann, B. mascc-0505 Hartogh, M.D. mascc-0192 Hashmi, S. mascc-0427 Hassali, M. mascc-0014 Hassan, A. mascc-0245 Hassan, A. mascc-0253 Hassan, A. mascc-0254 Hassan, B. mascc-0014 Hasséus, B. mascc-0599 Hatanaka, K. mascc-0163 Hatoum, H. mascc-0127 Hatzopoulos, A. mascc-0207 Hatzopoulos, A. mascc-0212 Hawley, P. mascc-0352 Hawryluk, E. mascc-0609 Hawyley, P. mascc-0422 Haywood, A. mascc-0348 Haywood, A. mascc-0346 Hazenberg, M.D. mascc-0108 Healy, P. mascc-0215 Heavey, S.F. mascc-0538 Heavey, S.F. mascc-0486 Heckler, C. mascc-0445 Heckler, C.E. mascc-0540 Hedley, M.L. mascc-0387 Hedley, M.L. mascc-0384 Hegarty, J. mascc-0081 Heij, H. mascc-0185 Heike, Y. mascc-0554 Heimgartner, J. mascc-0427 Hein, M. mascc-0542 Heinig, K. mascc-0357 Heintz, A. mascc-0182 Henderson, S. mascc-0020 Hennequin, M. mascc-0057 Henninger, C. mascc-0167 Henriques-Filho, G.A.T.M. mascc-0569 Henriques-Filho, G.A.T.M. mascc-0568 Henriques-Filho, G.A.T.M. mascc-0506 Henry, D.H. mascc-0340 Henry, R.J.W. mascc-0059 Henry, S.C. mascc-0059 Heo, S.J. mascc-0128

Heo, S.J. mascc-0143 Hera, M. mascc-0208 Hera, M. mascc-0211 Heras, P. mascc-0205 Heras, P. mascc-0207 Heras, P. mascc-0210 Heras, P. mascc-0209 Heras, P. mascc-0212 Heras, P. mascc-0208 Heras, P. mascc-0211 Heras, P. mascc-0206 Herlong, F. mascc-0113 Hernando, A. mascc-0575 Hernando, A. mascc-0502 Hernando, J. mascc-0549 HerndonII, J.E. mascc-0215 Herr, F. mascc-0437 Herr, F. mascc-0438 Herve, C. mascc-0303 Herve, C. mascc-0330 Herve, C. mascc-0341 Herve, C. mascc-0336 Herve, C. mascc-0334 Hesketh, P.J. mascc-0161 Hesketh, P.J. mascc-0158 Hesketh, P.J. mascc-0159 Hettler, D. mascc-0292 Hidaka, A. mascc-0264 Higaki, K. mascc-0264 Higgins, B. mascc-0307 Hindenburg, H.J. mascc-0358 Hinder, V. mascc-0189 Hira, N. mascc-0314 hira, N. mascc-0355 Hisham, M. mascc-0287 Ho, H.K. mascc-0194 Ho, H.K. mascc-0200 Ho, H.K. mascc-0139 Ho, R. mascc-0190 Ho, S. mascc-0368 Hobbs, K. mascc-0614 Hodgson, S. mascc-0431 Hoeppli, C. mascc-0076 Hoeppli, C. mascc-0077 Hoffman, K. mascc-0078 Hoffman, K. mascc-0460 Hogan, W.J. mascc-0427 Holden, L. mascc-0153 Holden, L. mascc-0541 Holden, L. mascc-0446 Holden, L. mascc-0468 Holden, L. mascc-0322 Holden, L. mascc-0441 Holden, L. mascc-0411 Holden, L. mascc-0545 Holden, L. mascc-0531 Holden, L. mascc-0410 Holden, L. mascc-0455 Holden, L. mascc-0473 Holden, L. mascc-0472 Holden, L. mascc-0481 Holden, L. mascc-0323 Holden, L. mascc-0454 Holden, L. mascc-0464 Holden, L. mascc-0449 Holden, L. mascc-0231

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Holloman, C. mascc-0413 Holloman, C. mascc-0418 Holst, J.J. mascc-0505 Holt, K.A. mascc-0131 Hong, Y.S. mascc-0008 honma, T. mascc-0355 Hoover-Regan, M.L. mascc-0124 Hopkinson, J. mascc-0405 Hoque, M. mascc-0065 Horaiya, K. mascc-0378 Horn, J. mascc-0240 Hosie, A. mascc-0156 Hoskin, P. mascc-0447 Hoskins, P. mascc-0307 Hosokawa, R. mascc-0572 Hosokawa, R. mascc-0516 Hosokawa, R. mascc-0223 Hotwani, C. mascc-0172 Hou, L. mascc-0010 Hou, L.L. mascc-0009 Hou, M. mascc-0467 Hou, M.F. mascc-0337 Hou, W.K. mascc-0246 Houghton, D. mascc-0240 Howarth, G.S. mascc-0237 Howarth, G.S. mascc-0235 Howarth, G.S. mascc-0234 Howarth, G.S. mascc-0238 Howell, D. mascc-0497 Howell, D. mascc-0500 Howell, D. mascc-0494 Howell, M. mascc-0180 Hoy, S. mascc-0240 Hsu, T. mascc-0542 Huang, I. mascc-0146 Hubbard, S. mascc-0469 Hubert, K. mascc-0377 Hughes, J. mascc-0405 Hui, D. mascc-0164 Hui, D. mascc-0165 Hui, D. mascc-0236 Hui, D. mascc-0536 Hullihen, B. mascc-0267 Hung, L.H. mascc-0350 Hunter, S. mascc-0216 Hunter, S. mascc-0469 Hurria, A. mascc-0542 Husain, A. mascc-0500 Hussain, A. mascc-0498 Husson, O. mascc-0048 Hutchinson, M.R. mascc-0238 Hutchinson, T.E. mascc-0149 Hutin-Brissot, A. mascc-0563 Hwang, K. mascc-0333 Hyatt, A. mascc-0319 HyeMyung, J. mascc-0375 I Iacono, M. mascc-0419 Ibrahim, E mascc-0519 Iemmolo, S. mascc-0419 Ihenacho, I. mascc-0536 Iijima, W. mascc-0516 Iire, L. mascc-0088 Ikegame, K. mascc-0012 Ilozumba, O. mascc-0294

S9

Imai, H. mascc-0329 Imai, H. mascc-0324 Imbimbo, M. mascc-0251 Inci, F. mascc-0258 Ip, W.Y. mascc-0316 Iredale, R. mascc-0203 Isaacs, R. mascc-0189 Isenring, E. mascc-0037 Isenring, E. mascc-0087 Isenring, E. mascc-0086 Ishak, F. mascc-0377 Ishii, T. mascc-0329 Ishii, T. mascc-0324 Ishitobi, M. mascc-0347 Ismail, R. mascc-0229 Isobe, H. mascc-0163 Ito, E. mascc-0572 Ito, E. mascc-0516 Ito, T. mascc-0347 Iwamoto, M. mascc-0347 Iwanaga, I. mascc-0163

Johansen, J. mascc-0363 Johansson, P. mascc-0599 John, L. mascc-0380 Johnson, D.B. mascc-0049 Johnson, K.M. mascc-0470 Johnson, K.M. mascc-0082 Johnston, M.A. mascc-0548 Johnston, M.A. mascc-0546 Jones, J.M. mascc-0497 Jones, R. mascc-0413 Jones, R. mascc-0418 Jordan, K. mascc-0265 Jordan, K. mascc-0162 Jordan, K. mascc-0158 José, L. mascc-0305 Jouannaud, C. mascc-0581 Jovenin, N. mascc-0292 Jovenin, N. mascc-0336 Jovenin, N. mascc-0334 Judin, G. mascc-0312 Jumnani, D. mascc-0485

J Jackson, L.K. mascc-0123 Jackson, L.K. mascc-0112 Jackson, L.K. mascc-0070 Jacobsen, J. mascc-0527 Jacobsen., P.B. mascc-0294 Jacquot, J. mascc-0214 Jakkoju, R. mascc-0078 Jakucs, J. mascc-0265 Jamal, N. mascc-0328 Jamani, R. mascc-0322 Jameson, M.B. mascc-0189 Jamshir, S. mascc-0379 Jané, E. mascc-0312 Jané, E. mascc-0313 Janelsins, M. mascc-0445 Jang, J.S. mascc-0401 Janini, D. mascc-0033 Jansen, F. mascc-0513 Jansen, F. mascc-0510 Jansen, F. mascc-0514 Jansen, F. mascc-0393 Janus, N. mascc-0581 Jaro?ová, D. mascc-0093 Jatoi, A. mascc-0007 Javid, J. mascc-0521 Jean-Pierre, P. mascc-0489 Jeffery, M. mascc-0189 Jegina, K. mascc-0604 Jenkinson, R. mascc-0465 Jensen, B. mascc-0066 Jensen, J.B. mascc-0066 Jensen, M.B. mascc-0250 Jensen, P.T. mascc-0131 Jeong, J.H. mascc-0373 Jesus-Garcia, R. mascc-0337 Jesus-Garcia, R. mascc-0467 Ji, Y. mascc-0304 Jimenez, R. mascc-0414 Jiménez-Fonseca, P. mascc-0597 Jiménez-Fonseca, P. mascc-0549 Jin, J.Y. mascc-0171 Jingjie, X. mascc-0548 Joerger, M. mascc-0603

K K.Bouzid, K.B. mascc-0291 Kadoya, T. mascc-0264 Kadri, M. mascc-0509 Kagawa, M. mascc-0264 Kaida, K. mascc-0012 Kainis, E. mascc-0283 Kallay, E. mascc-0101 Kalyani, N. mascc-0172 Kamal, N. mascc-0519 Kamath, J. mascc-0273 Kamen, C. mascc-0311 Kamen, C. mascc-0445 Kamen, C.S. mascc-0525 Kamigaki, S. mascc-0264 Kamioner, D.S. mascc-0623 Kamps, W.A. mascc-0175 Kanda, T. mascc-0378 Kang, H. mascc-0286 Kang, H. mascc-0202 Kang, J.H. mascc-0171 Kang, J.H. mascc-0236 Kang, S.S. mascc-0373 Kang, Y. mascc-0366 Kang, Y. mascc-0368 Kang, Y.K. mascc-0373 Kansra, V. mascc-0398 Karadurmus, N. mascc-0110 Karagoz, G. mascc-0592 Karakaya, B. mascc-0258 Karanes, C. mascc-0542 Karapetis, C. mascc-0339 Karatsu, F. mascc-0314 KarinB.Dieperink, K.B.D mascc-0099 Karthaus, M. mascc-0160 Kasera, C. mascc-0415 Kasera, C. mascc-0380 Kasperova, S. mascc-0573 Kataoka, T. mascc-0482 Kato, T. mascc-0572 Kato, T. mascc-0516 Kazakov, N. mascc-0055 Kearsley, J. mascc-0156 Keaveney, S.K. mascc-0089

S10

Kee, Y.C. mascc-0194 Keech, J. mascc-0445 Keefe, D. mascc-0098 Keefe, D. mascc-0189 Keefe, D. mascc-0188 Keefe, D. mascc-0186 Kellett, U. mascc-0020 Kenmotsu, H. mascc-0329 Kenmotsu, H. mascc-0324 Kerschgens, C. mascc-0266 Kerschgens, C. mascc-0120 Kevork, N. mascc-0436 Kevork, N. mascc-0439 Kfoury, M. mascc-0330 Kfoury, M. mascc-0341 Khalid, I. mascc-0509 Khan, I. mascc-0528 Khan, I. mascc-0561 Khan, L. mascc-0435 Khan, L. mascc-0410 Khan, S. mascc-0534 Khan, S. mascc-0421 Khranovska, N. mascc-0145 Khurana, N.I.T.A. mascc-0522 Kiagia, M. mascc-0280 Kiagia, M. mascc-0283 Kiagia, M. mascc-0281 Kikuchi, Y. mascc-0520 Kikuchi, Y. mascc-0554 Kilgour, R.D. mascc-0557 Kilgour, R.D. mascc-0535 Kilgour, R.D. mascc-0534 Kim, B. mascc-0090 Kim, B.G. mascc-0091 Kim, B.G. mascc-0092 Kim, C. mascc-0365 Kim, G.M. mascc-0365 Kim, H. mascc-0366 Kim, H. mascc-0368 Kim, H. mascc-0365 Kim, H.J. mascc-0401 Kim, H.J. mascc-0401 Kim, H.K. mascc-0171 Kim, H.S. mascc-0366 Kim, I. mascc-0368 Kim, J. mascc-0078 Kim, J. mascc-0333 Kim, J. mascc-0008 Kim, J. mascc-0624 Kim, J. mascc-0390 Kim, J.H. mascc-0401 Kim, J.S. mascc-0501 Kim, J.S. mascc-0503 Kim, K. mascc-0333 Kim, K. mascc-0202 Kim, K.P. mascc-0008 Kim, M. mascc-0090 Kim, M. mascc-0092 Kim, M.K. mascc-0091 Kim, S. mascc-0501 Kim, S. mascc-0503 Kim, S. mascc-0333 Kim, S. mascc-0624 Kim, S. mascc-0390 Kim, S.H. mascc-0164 Kim, S.Y. mascc-0351

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Kim, T.W. mascc-0008 Kim, Y. mascc-0366 Kim, Y. mascc-0366 Kim, Y. mascc-0202 Kimura, M. mascc-0329 Kimura, M. mascc-0324 Kingsley, P. mascc-0403 Kishor, K. mascc-0499 Kiss, N. mascc-0087 Kiss, N. mascc-0086 Kissow, H. mascc-0505 Kitely, C. mascc-0494 KjerholtMette, M. mascc-0015 KlausK.Andersen, K.K.A. mascc-0099 Klein, G. mascc-0098 Kloskowski, T. mascc-0299 Knoop, A.S. mascc-0250 Knoth, R. mascc-0394 Knoth, R. mascc-0227 Knoth, R. mascc-0228 Ko, E. mascc-0333 Ko, Y.H. mascc-0171 Kobayashi, N. mascc-0170 Kobayashi, T. mascc-0378 Kober, K. mascc-0154 Kober, K.M. mascc-0226 Köck-Hódi, S. mascc-0298 Köck-Hódi, S. mascc-0295 Koczwara, B. mascc-0152 Koczywas, M. mascc-0542 Kodama, N. mascc-0012 Koh, C. mascc-0242 Koh, S.J. mascc-0501 Koh, S.J. mascc-0503 Koh, S.J. mascc-0401 Koller, M. mascc-0295 Komatsu, Y. mascc-0163 Komurcu, S. mascc-0110 Komurcu, S. mascc-0331 Kondo, K. mascc-0170 Kong, B. mascc-0368 Kong, B.H. mascc-0366 Kose, F. mascc-0056 Kose, F. mascc-0371 Kose, K. mascc-0361 Koseki, T. mascc-0572 Koseki, T. mascc-0516 Kostadinova, L. mascc-0045 Koumarianou, A. mascc-0566 Koutinos, G. mascc-0517 Koutsoukis, E. mascc-0377 Koutsoukos, K. mascc-0166 Koyama, T. mascc-0378 Krakowski, I. mascc-0336 Krakowski, I. mascc-0334 Kreder, H.J. mascc-0465 Kreilgaard, M. mascc-0527 Kreit, P. mascc-0292 Kremer, L.C.M. mascc-0492 Kriegel, I. mascc-0623 Krishnasamy, M. mascc-0087 Krishnasamy, M. mascc-0086 Krissensen, G. mascc-0189 Kristensen, C.A. mascc-0527 Kristensen, C.A. mascc-0529 Kritikos, K. mascc-0207

Kritikos, K. mascc-0212 Krommidas, G. mascc-0281 Kropf, S. mascc-0077 Krull, K. mascc-0146 Krzyzanowska, M. mascc-0293 Krzyzanowska, M. mascc-0180 Kucuk, N. mascc-0574 Kucuk, N. mascc-0577 Kucuk, N. mascc-0576 Kucukmorkoc, E. mascc-0574 Kucukmorkoc, E. mascc-0577 Kucukmorkoc, E. mascc-0576 Kudo, M. mascc-0163 Kueng, M. mascc-0077 Kuijpers, W. mascc-0138 Kumar, A. mascc-0458 Kumar, A. mascc-0467 Kumar, D. mascc-0412 kumar, L. mascc-0564 Kumar, S. mascc-0304 KumarV, S. mascc-0539 Kuniyoshi, R.K. mascc-0011 Kurihara, M. mascc-0378 Kurtz, J.E. mascc-0395 Kust, D. mascc-0353 Kutuk, T. mascc-0361 Kuznecova, G. mascc-0589 Kuznecova, G. mascc-0589 Kuznecovs, I. mascc-0604 Kuznecovs, I. mascc-0570 Kuznecovs, I. mascc-0589 Kuznecovs, S. mascc-0604 kuznecovs, S. mascc-0570 Kuznecovs, S. mascc-0589 Kvigne, K.J. mascc-0218 Kwan, T. mascc-0190 Kwatra, G. mascc-0403 Kwon, K. mascc-0202 Kwong, K. mascc-0019 L Lacaze, M. mascc-0383 Lacey, J. mascc-0157 Lacey, J. mascc-0156 Ladjroud, A.L. mascc-0291 Lagman, R. mascc-0034 Lahoti, A. mascc-0271 Lai, Y.H. mascc-0622 Laia, G. mascc-0305 Lakiss, S. mascc-0057 Lam, C.G. mascc-0470 Lam, H. mascc-0192 Lam, H. mascc-0448 Lam, H. mascc-0447 Lam, H. mascc-0132 Lam, H. mascc-0342 Lam, H. mascc-0337 Lam, H. mascc-0338 Lam, H. mascc-0434 Lam, H. mascc-0465 Lam, H. mascc-0075 Lam, H. mascc-0225 Lam, H. mascc-0274 Lam, H. mascc-0179 Lam, H. mascc-0449 Lam, K. mascc-0467

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Lampton, L.L. mascc-0237 Lampton, L.L. mascc-0235 Lampton, L.L. mascc-0238 Lane, K. mascc-0431 Langeberg, W. mascc-0230 Langede, J. mascc-0108 Lao, N. mascc-0177 Lao, N. mascc-0117 Lao, N. mascc-0121 Lao, N. mascc-0179 Laplaige, P. mascc-0272 Laresn, S.L. mascc-0374 Larionova, V. mascc-0073 Larkin, D. mascc-0426 Larocque, G. mascc-0310 Latter, S. mascc-0405 Lau, K.M. mascc-0246 Launay-Vacher, V. mascc-0581 Laustsen, S. mascc-0066 Lauzon, N. mascc-0541 Lauzon, N. mascc-0322 Lauzon, N. mascc-0411 Lauzon, N. mascc-0410 Lauzon, N. mascc-0323 Lauzon, N. mascc-0454 Lauzon, N. mascc-0449 Lavoratore, S. mascc-0459 Lawlor, P.G. mascc-0119 Lawsin, C. mascc-0614 Lawson, D.M. mascc-0452 Le, L. mascc-0290 Le, L. mascc-0288 Leach, C. mascc-0294 LeandroLuongodeMatos, L.L.M. mascc-0054 Lebel, S. mascc-0407 Leblanc, E. mascc-0400 LeBlanc, T.W. mascc-0416 LeBoeuf, N. mascc-0611 LeBoeuf, N.R. mascc-0610 LeBoeuf, N.R. mascc-0609 Lechner, B. mascc-0192 Lechner, B. mascc-0153 Lechner, B. mascc-0327 Lechner, B. mascc-0441 Lechner, B. mascc-0411 Lechner, B. mascc-0328 Lechner, B. mascc-0457 Lechner, B. mascc-0456 Lechner, B. mascc-0225 Lechner, B. mascc-0325 Lechner, B. mascc-0410 Lechner, B. mascc-0323 Lechner, B. mascc-0326 Lechner, B. mascc-0454 Lechner, B. mascc-0449 Lechner, B. mascc-0231 Lee, B. mascc-0059 Lee, C. mascc-0343 Lee, C. mascc-0344 Lee, D. mascc-0184 Lee, D.J. mascc-0423 Lee, D.T.F. mascc-0232 Lee, H. mascc-0202 Lee, J. mascc-0343 Lee, J. mascc-0344 Lee, J.A. mascc-0200

S11

Lee, J.A. mascc-0139 Lee, J.E. mascc-0368 Lee, J.E. mascc-0373 Lee, J.J. mascc-0351 Lee, J.L. mascc-0008 Lee, J.L. mascc-0401 Lee, J.Y. mascc-0008 Lee, J.Y. mascc-0091 Lee, J.Y. mascc-0092 Lee, K.H. mascc-0401 Lee, L. mascc-0090 Lee, M. mascc-0294 Lee, N.R. mascc-0401 Lee, S. mascc-0142 Lee, S. mascc-0143 Lee, S. mascc-0365 Lee, S.H. mascc-0128 Lee, Y.L. mascc-0350 Leemans, C.R. mascc-0406 Leemans, C.R. mascc-0397 Leemans, C.R. mascc-0510 Leemans, C.R. mascc-0514 Leemans, C.R. mascc-0393 Lefebvre, D. mascc-0400 Lefebvre, G. mascc-0278 Lefebvre, G. mascc-0386 Lefebvre, G. mascc-0400 LeGallou, K. mascc-0563 Leighl, N. mascc-0293 Leighl, N. mascc-0180 Leino-Kilpi, H. mascc-0088 Leitz, L. mascc-0424 Lemarchand, C. mascc-0148 Lemarchand, C. mascc-0150 Lemonde, M. mascc-0596 Lera, A.T. mascc-0018 Lerner, T. mascc-0018 Leroux, N. mascc-0400 Leroy, P. mascc-0303 Leroy, P. mascc-0330 Leroy, P. mascc-0341 Leroy, P. mascc-0336 Leroy, P. mascc-0334 Lervat, C. mascc-0214 Lester, J. mascc-0413 Lester, J. mascc-0418 Letarte, N. mascc-0315 Leung, A. mascc-0545 Leung, D.Y.P. mascc-0232 Leung, D.Y.P. mascc-0316 Lewis, J. mascc-0318 Li, M. mascc-0582 Li, S mascc-0490 Li, S. mascc-0512 Li, X. mascc-0394 Li, X. mascc-0230 Li, Z. mascc-0146 Liao, S. mascc-0126 Liauw, W. mascc-0156 Licitra, L. mascc-0251 Liede, A. mascc-0498 Lien, K. mascc-0545 Lieverst, J. mascc-0185 Lim, D. mascc-0542 Lim, D. mascc-0039 Lim, D. mascc-0040

Lim, E. mascc-0242 Lim, H.G. mascc-0201 Lima, R. mascc-0217 Lima, R. mascc-0102 Lima, R.A.G. mascc-0106 Lima, T.A.S. mascc-0260 Lima-Neto, R.G. mascc-0552 Lima-Neto, R.G. mascc-0550 Lima-Neto, R.G. mascc-0569 Lima-Neto, R.G. mascc-0568 Lima-Neto, R.G. mascc-0555 Lima-Neto, R.G. mascc-0556 Lima-Neto, R.G. mascc-0506 Lima-Neto, R.G. mascc-0491 Lin, M.K.Y. mascc-0316 Linardou, E. mascc-0219 Linder, S. mascc-0460 Lindkær-Jensen, S.L.J. mascc-0374 Lindsay, S. mascc-0443 Ling, W.M. mascc-0069 Lipp, E. mascc-0215 Lipton, A. mascc-0340 Liru, M. mascc-0415 Liru, M. mascc-0380 Lis, C. mascc-0016 LisbethRosenbekMinet, L.R.M. mascc-0099 Lisi, G. mascc-0071 Liska, C. mascc-0310 LisWagner, L.W. mascc-0099 Litton, J. mascc-0536 Liu, D. mascc-0270 Liu, D. mascc-0284 Liu, D.R. mascc-0518 Liu, J mascc-0490 Liu, J. mascc-0512 Liu, J.W. mascc-0364 Lizeaga, G. mascc-0453 Lo, C. mascc-0288 Lo, S.K. mascc-0194 Lo, S.K. mascc-0139 Lobb, L. mascc-0156 Lobchuk, M.M. mascc-0537 Loblaw, A. mascc-0435 LobodeMena, M. mascc-0504 Locati, L.D. mascc-0251 Lochray, F. mascc-0435 Locke, S.C. mascc-0416 Loeffen, E.A.H. mascc-0492 Loftus, S. mascc-0286 Logan, R. mascc-0339 Logan, R.M. mascc-0302 Logie, N. mascc-0414 Loiselle, C. mascc-0109 Loiselle, C.G. mascc-0533 Longo, C. mascc-0497 Lopes-Júnior, L.C. mascc-0217 Lopes-Júnior, L.C. mascc-0102 Lopez, J. mascc-0312 Lopez, J. mascc-0313 Loprinzi, C.L. mascc-0049 Lorhan, S. mascc-0425 Lorhan, S. mascc-0424 Lorhan, S. mascc-0431 Loscalzo, M. mascc-0542 Low, X.H. mascc-0039 Low, X.H. mascc-0040

S12

Lowson, E. mascc-0405 Lu, M. mascc-0271 Luan, Y.H. mascc-0461 Lubberding, S. mascc-0393 Lucarelli, A. mascc-0195 Lucchesi, M. mascc-0595 Lucchesi, M. mascc-0594 Lucchesi, M. mascc-0593 Lucchesi, M. mascc-0600 lucchiari, C. mascc-0588 Ludwig, H. mascc-0367 Lukacs, I. mascc-0101 Luo, R. mascc-0487 Luporsi, E. mascc-0395 Luther, A.N.I.L. mascc-0376 Luthra, R. mascc-0230 Lutrino, S.E. mascc-0083 Lymn, K.A. mascc-0237 Lymn, K.A. mascc-0235 Lymn, K.A. mascc-0234 Lyng, G. mascc-0150 M Ma, B. mascc-0337 Ma, J.D. mascc-0538 Ma, J.D. mascc-0486 Ma, J.D. mascc-0151 Maccaroni, E. mascc-0195 MacDonald, K. mascc-0367 Macêdo, D. mascc-0569 Macêdo, D.* mascc-0568 Macêdo, D.P.C. mascc-0552 Macêdo, D.P.C. mascc-0550 Macêdo, D.P.C. mascc-0555 Macêdo, D.P.C. mascc-0556 Macêdo, D.P.C. mascc-0506 Macêdo, D.P.C. mascc-0491 Mackenzie, C. mascc-0152 MacKintosh, D. mascc-0133 MacKintosh, D. mascc-0193 MacKintosh, J. mascc-0133 Madhukumar, P. mascc-0194 Madhukumar, P. mascc-0200 Madridano, O. mascc-0597 Maessen, D. mascc-0356 Maggi, C.A. mascc-0265 Mahovlich, S. mascc-0424 Mais, K. mascc-0240 Maiya, A. mascc-0539 Majdan, M. mascc-0307 Majorana, A. mascc-0136 Majorana, A. mascc-0399 Mak, S.S.S. mascc-0069 Malgouzou, M. mascc-0220 Malila, N.E.A. mascc-0058 Mallinson, P. mascc-0352 Maloney, A.M. mascc-0459 Mamzer-Bruneel, M.F. mascc-0303 Mandal, S. mascc-0580 Mandrelle, K. mascc-0376 Mangenot, M. mascc-0214 Mani, P. mascc-0528 Mani, P. mascc-0561 Mank, A.P. mascc-0108 mannion, K. mascc-0612 Mannion, K. mascc-0112

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Manoor, U. mascc-0496 Manzano, J.G. mascc-0487 Manzyuk, L. mascc-0073 MárciadeMeloRodrigues, M.M.R. mascc-0551 MárciadeMeloRodrigues, M.M.R. mascc-0553 Marcucci, F. mascc-0195 Margolies, L. mascc-0311 Marioli, A. mascc-0283 Marliot, G. mascc-0386 Marliot, G. mascc-0400 Márquez-Rodas, I. mascc-0504 Marre, A. mascc-0272 Marszalek, A. mascc-0299 Martell, R. mascc-0398 Martell, R. mascc-0387 Martell, R. mascc-0384 Martell, R. mascc-0391 Martin, M. mascc-0340 Martin, P. mascc-0349 Martínez, J. mascc-0549 MartínezdeCastro, E. mascc-0549 Martinez-Puig, D. mascc-0234 MartínJiménez, M. mascc-0504 Martins, S. mascc-0061 Marx, W. mascc-0037 Mashtoub, S. mascc-0237 Mashtoub, S. mascc-0235 Mashtoub, S. mascc-0234 Mashtoub, S. mascc-0238 Masroor, M. mascc-0521 Massey, D. mascc-0432 Masuda, N. mascc-0264 Masuda, N. mascc-0347 Masuda, Y. mascc-0329 Masuda, Y. mascc-0324 Masuko, H. mascc-0163 Masuoka, K. mascc-0378 Mathias, S.D. mascc-0233 Matsunami, N. mascc-0264 Matsuoka, J. mascc-0130 Matzka, M. mascc-0295 Maunsell, E. mascc-0183 May, C. mascc-0405 Mayer, C. mascc-0477 Mayer, H. mascc-0224 Mayer, H. mascc-0173 Mayer, H. mascc-0300 Mayer, H. mascc-0298 Mayer, H. mascc-0295 Mayer, J. mascc-0265 Mayo, B. mascc-0188 Mayo, B. mascc-0186 Mayo, N. mascc-0417 Mayo, S. mascc-0494 McCarthy, A. mascc-0037 McCarthy, D. mascc-0125 McCullough, R. mascc-0187 McDonald, R mascc-0147 McDonald, R. mascc-0153 McDonald, R. mascc-0327 McDonald, R. mascc-0446 McDonald, R. mascc-0468 McDonald, R. mascc-0422 McDonald, R. mascc-0434

McDonald, R. mascc-0423 McDonald, R. mascc-0441 McDonald, R. mascc-0411 McDonald, R. mascc-0531 McDonald, R. mascc-0455 McDonald, R. mascc-0473 McDonald, R. mascc-0472 McDonald, R. mascc-0481 McDonald, R. mascc-0184 McDonald, R. mascc-0464 McDonald, R. mascc-0191 McDonald, R. mascc-0231 McGarvey, N. mascc-0469 mcGowan, C. mascc-0240 McKavanagh, D. mascc-0037 McLoone, J.K. mascc-0369 McPherson, C.J. mascc-0537 McSherry, F. mascc-0215 Mead, K. mascc-0339 Meisenberg, B. mascc-0309 Meisenberg, B. mascc-0493 Mellado, B. mascc-0575 Mellado, B. mascc-0502 Mellemgaard, A. mascc-0363 Mello, T.B. mascc-0106 MeloCruz, F. mascc-0061 Mertsoylu, H. mascc-0056 Merx, M. mascc-0167 Messier, C. mascc-0315 Miaskowski, C. mascc-0226 Miaskowski, C. mascc-0154 Michallet, M. mascc-0395 Michiels, E.M. mascc-0185 Mickeviciene, V. mascc-0285 Migliorati, C. mascc-0166 Migliorati, C.A. mascc-0123 Mikkelsen, T. mascc-0382 Milakovic, M. mascc-0192 Milakovic, M. mascc-0448 Milakovic, M. mascc-0465 Milakovic, M. mascc-0191 Milito, G. mascc-0071 Miller, E. mascc-0215 Miller, M. mascc-0152 min, D.O.N.G. mascc-0178 Minami, S. mascc-0163 Minchew, J. mascc-0215 Minden, M. mascc-0421 Minn, H. mascc-0088 Mir, A. mascc-0521 Mir, O. mascc-0581 Mir, R. mascc-0522 Mirabile, A. mascc-0083 Mirabile, A. mascc-0562 Miralda, B. mascc-0335 Miranda, D.O. mascc-0260 Mirjalili, N. mascc-0050 Mischitelle, A. mascc-0421 Mitchell, W.M. mascc-0151 Mitsuda, M. mascc-0329 Mitsuda, M. mascc-0324 Miyagishima, T. mascc-0163 Mizuochi, K. mascc-0378 Modiano, M. mascc-0384 Mogensen, O. mascc-0131 Mogensen, S. mascc-0527

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Mogensen, S. mascc-0529 Mohammad, A. mascc-0529 Mohan, M.P. mascc-0607 Mohan, M.P. mascc-0608 Mohile, S. mascc-0445 Mohile, S.G. mascc-0525 Mohsen, H. mascc-0245 Mok, T. mascc-0432 Molani, P. mascc-0261 Molani, P. mascc-0263 Molasiotis, A. mascc-0321 Molassiotis, A mascc-0200 Molassiotis, A. mascc-0500 Molony, J. mascc-0512 Molony, JT mascc-0490 Mols, F. mascc-0048 Mondéjar, R. mascc-0549 Monette, J. mascc-0180 Moraes, V.L.L. mascc-0550 Moraes, V.L.L. mascc-0555 Moraes, V.L.L. mascc-0556 Morag, A. mascc-0428 Morais, J.A. mascc-0557 Morais, J.A. mascc-0535 Morais, J.A. mascc-0534 Morais, V.L.L. mascc-0491 Morash, R. mascc-0310 Moreira, A.C. mascc-0619 Moreno, C. mascc-0575 Moreno, C. mascc-0502 Moreno, H. mascc-0279 Morere, J.F. mascc-0581 Morgado, M. mascc-0165 Morgese, F. mascc-0196 Mori, K. mascc-0329 Mori, K. mascc-0324 Mori, M. mascc-0304 Mori, T. mascc-0223 Morimoto, M. mascc-0347 Morimoto, T. mascc-0264 Morishita, S. mascc-0012 Morita, E. mascc-0329 Morita, E. mascc-0324 Morita, S. mascc-0347 Morrow, G. mascc-0311 Morrow, G.R. mascc-0445 Morrow, G.R. mascc-0540 Morrow, P. mascc-0230 Morrow, P.K. mascc-0512 Morrow, P.K. mascc-0229 Morrow, PK mascc-0490 MoyaOrtega, B. mascc-0504 Muallaoglu, S. mascc-0056 Mudireddy, M. mascc-0271 Mueller, U. mascc-0544 Mueller, U. mascc-0530 Muenzberg, M. mascc-0367 MufidM.ElMistiri, M. mascc-0254 Mugellini, E. mascc-0076 Mugellini, E. mascc-0077 Mukhopadhyay, S. mascc-0584 Mukhopadhyay, S. mascc-0403 Mukkada, S. mascc-0591 Mulder, R.L. mascc-0492 Mullins, C.D. mascc-0498 Munhoz, B.A. mascc-0011

S13

Munk, P. mascc-0352 MuñozMartín, A. mascc-0504 Murakami, H. mascc-0329 Murakami, H. mascc-0324 Murphy, B. mascc-0221 Murphy, B. mascc-0558 Murphy, B.A. mascc-0123 Murphy, B.A. mascc-0612 Murphy, B.A. mascc-0602 Murphy, B.A. mascc-0105 Murphy, B.A. mascc-0112 Murphy, B.A. mascc-0070 Murphy, D. mascc-0319 Murphy, G. mascc-0610 Murray-Brown, F. mascc-0213 Murthy, V. mascc-0172 Musa, I. mascc-0035 Musch, R. mascc-0356 Mustian, K. mascc-0426 Mustian, K. mascc-0311 Mustian, K. mascc-0445 Muzzatti, B. mascc-0096 Muzzatti, B. mascc-0095 Muzzatti, B. mascc-0118 N Na, I. mascc-0202 Nademanee, A. mascc-0542 Nagasaki, E. mascc-0170 Nagy, Z. mascc-0265 Nair, R.G. mascc-0617 Naito, T. mascc-0329 Naito, T. mascc-0324 Nakajima, J. mascc-0163 Nakamura, M. mascc-0163 Nakayama, T. mascc-0347 Namer, M. mascc-0336 Namer, M. mascc-0334 Narducci, F. mascc-0400 Narui, H. mascc-0314 narui, H. mascc-0355 Nascimento, L.C. mascc-0217 Nascimento, L.C. mascc-0106 Nathan, P. mascc-0459 Nathwani, N. mascc-0542 Natsis, V. mascc-0205 Natsis, V. mascc-0207 Natsis, V. mascc-0210 Natsis, V. mascc-0209 Natsis, V. mascc-0212 Natsis, V. mascc-0208 Natsis, V. mascc-0211 Natsis, V. mascc-0206 Navari, R. mascc-0387 Negmeldin, R. mascc-0254 Nematollahi, M. mascc-0596 Ness, J. mascc-0493 Neves, R. mascc-0556 Neves, R.P. mascc-0552 Neves, R.P. mascc-0550 Neves, R.P. mascc-0569 Neves, R.P. mascc-0568 Neves, R.P. mascc-0555 Neves, R.P. mascc-0506 Neves, R.P. mascc-0491 Ng, R. mascc-0194

Ng, R. mascc-0200 Ng, R. mascc-0139 Ng, R. mascc-0140 Ng, S.M. mascc-0246 Ng, T. mascc-0139 Ng, T. mascc-0140 Ng, T.R.D. mascc-0194 Ng, T.R.D. mascc-0200 Ng, W.T. mascc-0069 Ngan, H. mascc-0190 Ngo, A. mascc-0462 Nguyen, E. mascc-0571 Nguyen, E. mascc-0586 Nguyen, H. mascc-0197 Nguyen, J. mascc-0545 Nguyen, J. mascc-0075 Nguyen, J. mascc-0225 Nguyen, J. mascc-0274 Nguyen, P. mascc-0007 Nguyen, P. mascc-0292 Niarou, V. mascc-0205 Niarou, V. mascc-0210 Niarou, V. mascc-0208 Nicholas, L. mascc-0404 Nicholas, L. mascc-0402 Nickolich, M.S. mascc-0416 Nicolatou-Galitis, O. mascc-0517 Nicolatou-Galitis, O. mascc-0219 Nicolatou-Galitis, O. mascc-0166 Nicolussi, A.C. mascc-0256 Nicolussi, A.C. mascc-0257 Nicolussi, A.C. mascc-0275 Nielsen, T. mascc-0015 Nielson, D. mascc-0560 Niermann, K. mascc-0221 Niermann, K. mascc-0112 Niharika, D. mascc-0585 Nikolaidi, A. mascc-0166 Nikulina, V. mascc-0145 Nishimura, S. mascc-0264 Nolte, T. mascc-0309 Nomura, M. mascc-0347 Noonan, B. mascc-0081 Norris, R. mascc-0346 North, R. mascc-0189 Nosov, D. mascc-0073 Noujeim, M.E. mascc-0123 Nousiainen, M.T. mascc-0465 Novotny, P. mascc-0450 Nowacka, K. mascc-0306 Nowacki, A. mascc-0029 Nowacki, M. mascc-0306 Nowacki, M.S. mascc-0299 Nunes, M.D.R. mascc-0217 Nygaard, A. mascc-0529 O Oba, K. mascc-0163 Oberholzer, R. mascc-0603 O'Brien, D. mascc-0432 Obuya, S. mascc-0415 Obuya, S.A. mascc-0380 O'Byrne, K.J. mascc-0432 O'Callaghan, C. mascc-0319 Ochoa, J. mascc-0282 Ogasawara, Y. mascc-0170

S14

Ogawa, H. mascc-0012 Ogawa, T. mascc-0554 Oguda, J. mascc-0415 Ogunti, R. mascc-0536 Ogur, R. mascc-0110 Oguzkurt, L. mascc-0371 Oh, J. mascc-0078 Oh, P. mascc-0559 Oh, S. mascc-0142 Oh, S. mascc-0401 Ohashi, T. mascc-0329 Ohashi, T. mascc-0324 Ohlig, J. mascc-0167 Ohno, S. mascc-0264 Ojha, R.P. mascc-0470 Ojha, R.P. mascc-0082 Okamura, H. mascc-0482 Okayama, T. mascc-0329 Okayama, T. mascc-0324 Okino, L. mascc-0256 Okishiro, M. mascc-0347 Okuyama, S. mascc-0332 Olagunju, A. mascc-0169 Olagunju, A.T. mascc-0168 Olagunju, T.O. mascc-0168 Oldenburg, H.S.A. mascc-0138 OlfredHansen, O.H. mascc-0099 Oliveira, M.M. mascc-0018 Oliveira, S. mascc-0583 Olsen, K. mascc-0497 Olson, K. mascc-0426 Olver, I. mascc-0198 O'Mahony, M. mascc-0081 Omaña, C.J. mascc-0313 Omar, K. mascc-0305 Ong, P.S. mascc-0052 Ong, Y.Y. mascc-0200 Ono, A. mascc-0329 Ono, A. mascc-0324 Ono, M. mascc-0572 Onofri, A. mascc-0196 Onofri, A. mascc-0195 Onukwugha, E. mascc-0498 Ooi, W.S. mascc-0194 Ooi, W.S. mascc-0200 Ooi, W.S. mascc-0139 Orel, V. mascc-0145 Orlandi, E. mascc-0251 Orlandi, E. mascc-0562 Ortner, P. mascc-0357 Osburg, S. mascc-0578 Oshima, K. mascc-0347 Otero-Candelera, R. mascc-0597 Othman, S. mascc-0014 Oudard, S. mascc-0581 Oudard, S. mascc-0330 Oudard, S. mascc-0341 Oudard, S. mascc-0420 Overgaard, B. mascc-0248 Overman, M. mascc-0271 Owens, G.O. mascc-0524 Oyakawa, T. mascc-0329 Oyakawa, T. mascc-0324 Ozaydin, S. mascc-0110 Özbek, C. mascc-0592 Ozturk, M. mascc-0110

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Ozyilkan, O. mascc-0056 Ozyilkan, O. mascc-0371 Ozyilkan, O. mascc-0331 P P, J. mascc-0412 Page, J. mascc-0230 Page, J.H. mascc-0478 Page, J.H. mascc-0479 Page, J.H. mascc-0471 Page, J.H. mascc-0476 Page, J.H. mascc-0512 Paisan, A. mascc-0453 Pakpour, A.H. mascc-0452 Pal, S. mascc-0542 Palesh, O. mascc-0426 Palma, C.G.L. mascc-0018 Palmano, K. mascc-0189 Palmas, M. mascc-0160 Palmas, M. mascc-0161 Palmas, M. mascc-0158 Palmas, M. mascc-0159 Panagiotarakou, M. mascc-0283 Pang, C.K. mascc-0243 Pang, C.K. mascc-0069 Panmeesub, B. mascc-0084 Pant, M.C. mascc-0412 Paolucci, V. mascc-0196 Papadopoulos, A. mascc-0210 Papadopoulou, E. mascc-0219 Papasotiriou, I. mascc-0219 Papoila, A.L. mascc-0119 Parahym, A. mascc-0551 Parahym, A. mascc-0553 Parahym, A.M.R.C. mascc-0552 Parahym, A.M.R.C. mascc-0550 Parahym, A.M.R.C. mascc-0569 Parahym, A.M.R.C. mascc-0568 Parahym, A.M.R.C. mascc-0555 Parahym, A.M.R.C. mascc-0556 Parahym, A.M.R.C. mascc-0506 Parahym, A.M.R.C. mascc-0491 Parent, D. mascc-0292 Park, E. mascc-0365 Park, I. mascc-0236 Park, J. mascc-0333 Park, J. mascc-0202 Park, K. mascc-0201 Park, S. mascc-0624 Park, S. mascc-0390 Park, S.J. mascc-0008 Park, W.S. mascc-0142 Park, Y. mascc-0343 Park, Y. mascc-0344 Park, Y.J. mascc-0368 Park, Y.S. mascc-0171 Park, Y.S. mascc-0008 ParmarCalislar, M. mascc-0461 Parot-Monpetit, A. mascc-0563 Pasdera, A. mascc-0595 Paszat, L. mascc-0483 Patel, C. mascc-0034 Patel, K. mascc-0016 Patel, S. mascc-0354 Paul, C. mascc-0305 Paul, D. mascc-0437

Paul, S. mascc-0226 Paul, S. mascc-0154 Paula, J.M. mascc-0256 Paula, J.M. mascc-0257 Paula, J.M. mascc-0275 Pearce, A. mascc-0377 Pedersen, J. mascc-0505 PedroJoséRolimNeto, P.J.R.N. mascc-0551 PedroJoséRolimNeto, P.J.R.N. mascc-0553 Pena, E. mascc-0606 Penel, N. mascc-0214 Peoples, A. mascc-0311 Peoples, A.R. mascc-0540 Peppone, L. mascc-0445 Peppone, L.J. mascc-0540 Perazzo, F. mascc-0061 Pereira, J. mascc-0429 Perez, D. mascc-0189 PérezRamírez, S. mascc-0504 Peria, F.M. mascc-0260 Perry, S. mascc-0111 Pesevska, M. mascc-0045 Pessi, M.A. mascc-0261 Pessi, M.A. mascc-0263 Pessi, M.A. mascc-0204 Peters, K. mascc-0215 Petersen, J. mascc-0527 Petersen, J. mascc-0529 Petrcich, W. mascc-0537 Petree, J. mascc-0335 Petsersen, A.K. mascc-0066 Phelip, J.M. mascc-0272 Philip, J. mascc-0349 Piana, G. mascc-0399 Pierantoni, C. mascc-0195 Pietkun, K. mascc-0306 Pietkun, K. mascc-0299 Pietra, C. mascc-0188 Pietra, C. mascc-0186 Pili, R. mascc-0127 Pinkerton, A. mascc-0543 Piyabandidgool, P. mascc-0084 Plasencia, J. mascc-0597 Plate, S. mascc-0573 Platt, A. mascc-0034 Plews, E. mascc-0098 Plews, E. mascc-0186 Plow, E. mascc-0033 Pokrywczynska, M. mascc-0299 Polimeni, A. mascc-0399 Pollard, S. mascc-0189 Polsoni, S. mascc-0136 Poma, A. mascc-0398 Poma, A. mascc-0387 Poma, A. mascc-0384 Poma, A. mascc-0391 Pompa, G. mascc-0379 Poon, M. mascc-0192 Poon, M. mascc-0567 Poon, M. mascc-0448 Poon, M. mascc-0317 Poon, M. mascc-0177 Poon, M. mascc-0447 Poon, M. mascc-0132 Poon, M. mascc-0342 Poon, M. mascc-0338

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Poon, M. mascc-0404 Poon, M. mascc-0402 Poon, M. mascc-0184 Pope, A. mascc-0290 Pope, A. mascc-0288 Popovic, M mascc-0147 Popovic, M. mascc-0192 Popovic, M. mascc-0448 Popovic, M. mascc-0317 Popovic, M. mascc-0177 Popovic, M. mascc-0153 Popovic, M. mascc-0446 Popovic, M. mascc-0468 Popovic, M. mascc-0132 Popovic, M. mascc-0117 Popovic, M. mascc-0121 Popovic, M. mascc-0342 Popovic, M. mascc-0338 Popovic, M. mascc-0422 Popovic, M. mascc-0434 Popovic, M. mascc-0423 Popovic, M. mascc-0441 Popovic, M. mascc-0404 Popovic, M. mascc-0402 Popovic, M. mascc-0465 Popovic, M. mascc-0531 Popovic, M. mascc-0075 Popovic, M. mascc-0225 Popovic, M. mascc-0274 Popovic, M. mascc-0179 Popovic, M. mascc-0452 Popovic, M. mascc-0455 Popovic, M. mascc-0277 Popovic, M. mascc-0276 Popovic, M. mascc-0473 Popovic, M. mascc-0472 Popovic, M. mascc-0481 Popovic, M. mascc-0184 Popovic, M. mascc-0464 Popovic, M. mascc-0191 Popovic, M. mascc-0231 Popovic, M.P. mascc-0268 Porta, F. mascc-0136 Portman, D.G. mascc-0613 Porwit, A. mascc-0454 Pose, K. mascc-0335 Pouliot, J.F. mascc-0307 Powers, A. mascc-0394 Powers, A. mascc-0227 Powers, A. mascc-0228 Prabha, S. mascc-0107 Prabhu, K.R. mascc-0485 Prado, C.M. mascc-0548 Prashant, S. mascc-0032 Pravettoni, G. mascc-0588 Preetha, M. mascc-0139 Pristupa, A.S. mascc-0265 Probyn, L. mascc-0322 Probyn, L. mascc-0323 Proctor, J. mascc-0189 Provencher, D. mascc-0307 PS, H. mascc-0607 PS, Satheeshkumar mascc-0607 PS, Satheeshkumar. mascc-0608 Puerta, A. mascc-0597 Pulenzas, N. mascc-0192

S15

Pulenzas, N. mascc-0448 Pulenzas, N. mascc-0177 Pulenzas, N. mascc-0153 Pulenzas, N. mascc-0447 Pulenzas, N. mascc-0327 Pulenzas, N. mascc-0117 Pulenzas, N. mascc-0121 Pulenzas, N. mascc-0414 Pulenzas, N. mascc-0441 Pulenzas, N. mascc-0411 Pulenzas, N. mascc-0328 Pulenzas, N. mascc-0457 Pulenzas, N. mascc-0456 Pulenzas, N. mascc-0075 Pulenzas, N. mascc-0225 Pulenzas, N. mascc-0274 Pulenzas, N. mascc-0179 Pulenzas, N. mascc-0325 Pulenzas, N. mascc-0410 Pulenzas, N. mascc-0323 Pulenzas, N. mascc-0326 Pulenzas, N. mascc-0454 Pulenzas, N. mascc-0449 Pulenzas, N. mascc-0231 Pumo, V. mascc-0419 Puts, M. mascc-0596 Puts, M. mascc-0293 Puts, M. mascc-0180 Puts, M. mascc-0301 Puzzo, E. mascc-0419 Q Qian, Y. mascc-0498 qu, L. mascc-0178 Quinn, B. mascc-0259 Quinn, B. mascc-0240 Quittet, P. mascc-0269 Quittet, P. mascc-0272 Qushmaq, I.A. mascc-0509 R R.Feghir, R.F. mascc-0291 Raber-Durlacher, J.B. mascc-0072 Raber-Durlacher, J.E. mascc-0617 Raber-Durlacher, J.E. mascc-0108 Radhakrishnan, N. mascc-0458 Radina, E. mascc-0026 Radina, E. mascc-0030 Rafaqat, R. mascc-0023 Rafaqat, R. mascc-0022 Rafaqat, R. mascc-0021 Raina, V. mascc-0564 Raisch, D. mascc-0113 Ramchandani, A. mascc-0549 RamettaGiuliano, S. mascc-0419 Rana, F.N. mascc-0049 Randazzo, D.M. mascc-0215 Ranjan, T. mascc-0215 Rao, J. mascc-0388 Raphael, M.F. mascc-0185 Raphaelis, S. mascc-0173 Rapoport, B. mascc-0387 Rashi, C. mascc-0109 Rasmussen, A. mascc-0374 Rathod, S. mascc-0172 Rauck, R. mascc-0463

Ravagnani, F. mascc-0263 Ray, P.C. mascc-0521 Ray-Coquard, I. mascc-0581 Razis, E. mascc-0166 Reddy, A. mascc-0270 Reddy, A. mascc-0389 Reddy, S. mascc-0270 ReginaldoGonçalvesdeLimaNeto, R.G.L.N. mascc-0551 ReginaldoGonçalvesdeLimaNeto, R.G.L.N. mascc-0553 Rego, E.M. mascc-0265 Reguart, N. mascc-0575 Reguart, N. mascc-0502 Reich, M. mascc-0409 Reid, K. mascc-0037 Reiner, M. mascc-0230 RejanePereiraNeves, R.P.N. mascc-0551 RejanePereiraNeves, R.P.N. mascc-0553 Renault-Tessier, E. mascc-0547 Resteghini, C. mascc-0251 Revta, C. mascc-0486 Rey, J.B. mascc-0581 Rey, J.B. mascc-0292 Rezk, J. mascc-0123 Rha, S. mascc-0343 Rha, S. mascc-0344 Rhondali, W. mascc-0282 Rhoten, B. mascc-0026 Rhoten, B. mascc-0030 Ribeiro, C. mascc-0583 Ribera, J.M. mascc-0265 Ribi, K. mascc-0076 Ricci, S. mascc-0595 Ricci, S. mascc-0594 Ricci, S. mascc-0593 Ricci, S. mascc-0600 Richards, A. mascc-0339 Richardson, A. mascc-0405 Richardson, M.N. mascc-0271 Ridner, S. mascc-0221 Ridner, S. mascc-0026 Ridner, S. mascc-0030 Ridner, S.H. mascc-0612 Ridner, S.H. mascc-0602 Ridner, S.H. mascc-0105 Ridner, S.H. mascc-0112 Ridner, S.H. mascc-0070 Rieber, A. mascc-0282 Riley, E. mascc-0240 Rimedio, A. mascc-0562 Rinaldi, S. mascc-0195 Rini, B. mascc-0033 Ripamonti, C. mascc-0251 Ripamonti, C. mascc-0508 Ripamonti, C. mascc-0252 Ripamonti, C.I. mascc-0261 Ripamonti, C.I. mascc-0263 Ripamonti, C.I. mascc-0204 Ristic, D. mascc-0265 Rizel, S. mascc-0111 Rizk, N.R. mascc-0089 Rizzi, G. mascc-0160 Rizzi, G. mascc-0162 Rizzi, G. mascc-0161 Rizzi, G. mascc-0158

S16

Rizzi, G. mascc-0159 Roberge, D. mascc-0183 Roberge, D. mascc-0176 RobertPartyka, RP mascc-0249 Roccaro, S. mascc-0419 Rodin, G. mascc-0421 Rodin, G. mascc-0582 Rodri´guez, A. mascc-0417 Rodrigues, I. mascc-0386 Rodrigues, M.M. mascc-0556 Rodriguez, R. mascc-0478 Rodriguez, R. mascc-0479 Rodriguez, R. mascc-0471 Rodriguez, R. mascc-0476 Rodriguez, R. mascc-0313 Roeland, E.J. mascc-0538 Roeland, E.J. mascc-0486 Roeland, E.J. mascc-0151 Rohn, R. mascc-0400 Roila, F. mascc-0083 Roila, F. mascc-0252 Rolim-Neto, P.J. mascc-0552 Rolim-Neto, P.J. mascc-0550 Rolim-Neto, P.J. mascc-0569 Rolim-Neto, P.J. mascc-0568 Rolim-Neto, P.J. mascc-0555 Rolim-Neto, P.J. mascc-0556 Rolim-Neto, P.J. mascc-0506 Rolim-Neto, P.J. mascc-0491 Romero, M. mascc-0508 Ronald, C. mascc-0179 Roodbol, P.F. mascc-0175 Roodbol, P.F. mascc-0174 Roquemore, J. mascc-0164 Ros, C. mascc-0312 Roscoe, J. mascc-0445 Roscoe, J.A. mascc-0540 Rosello, A. mascc-0312 Rosello, A. mascc-0313 Rosello, J. mascc-0312 Rosello, J. mascc-0313 Rosenthal, D. mascc-0562 Rosenthall, L. mascc-0557 Rosenthall, L. mascc-0535 Rossi, G. mascc-0160 Rossi, G. mascc-0162 Rossi, G. mascc-0161 Rossi, G. mascc-0158 Rossi, G. mascc-0159 Rotich, J. mascc-0062 Rouby, P. mascc-0272 Rouleau, T. mascc-0377 Roulet, V. mascc-0150 Rouley, V. mascc-0148 Rovinelli, F. mascc-0196 Roy, S. mascc-0499 Ruggeri, B. mascc-0083 Rugo, H. mascc-0160 RupérezBlanco, A.B.. mascc-0504 Rusanov, A. mascc-0055 Rushing, C.N. mascc-0416 Rushton, M. mascc-0310 Russi, E. mascc-0562 Rybicki, L. mascc-0114 Rybicki, L. mascc-0027 Rybicki, L. mascc-0115

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Rybicki, L. mascc-0032 Rydall, A. mascc-0421 Ryoo, B.Y. mascc-0373 Ryu, M.H. mascc-0373 S S, V. mascc-0412 S, Y.O.O.N. mascc-0008 S.Aziez, S.A. mascc-0291 S.Sami, S.S. mascc-0291 Sachdev, J. mascc-0376 Sachdeva, A. mascc-0458 Saeedi, A.A. mascc-0509 Saevarsson, C.W. mascc-0181 Sagara, Y. mascc-0264 Sagawa, T. mascc-0163 Sahgal, A. mascc-0541 Sahgal, A. mascc-0435 Saito, M. mascc-0130 Saji, S. mascc-0264 Sakji, I. mascc-0386 Sakji, I. mascc-0400 Sala, M. mascc-0562 Saleh, S. mascc-0287 Sali, A. mascc-0037 Saligan, L. mascc-0426 Samim, P. mascc-0599 Samsa, G.P. mascc-0416 Samson, B. mascc-0176 Samuel, S. mascc-0539 Sanad, R mascc-0519 Sanderman, R. mascc-0175 Sanderman, R. mascc-0174 Sandoval, N. mascc-0474 Sanford, T. mascc-0034 SangHee, K. mascc-0375 SanMiguel-Arregui, M. mascc-0389 Sansom-Daly, U.M. mascc-0370 Santi, P. mascc-0061 Santini, D. mascc-0195 Santos, M.F. mascc-0217 Santos-Oliveira, R. mascc-0074 Santos-Silva, A.R. mascc-0123 Saraykar, S. mascc-0460 Saraykar, S. mascc-0113 Sarimiye, F.O. mascc-0168 Sarkar, D. mascc-0528 Sarkar, D. mascc-0561 Sasaki, E. mascc-0378 Sasaki, K. mascc-0163 Sasaki, T. mascc-0163 Satoh, T. mascc-0337 Saunders, D. mascc-0377 Sauvajot, C. mascc-0330 Sauvajot, C. mascc-0341 Savinelli, F. mascc-0269 Savini, A. mascc-0196 Sawada, N. mascc-0256 Sawada, N. mascc-0257 Sawada, N. mascc-0275 Sawada, N.O. mascc-0587 Saxena, A. mascc-0522 Saxena, A. mascc-0521 Scachkova, O. mascc-0145 Scartoni, S. mascc-0265 Schechter, T. mascc-0560

Schep, G. mascc-0048 Schilling, J. mascc-0358 Schilling, J. mascc-0357 Schimmer, A. mascc-0421 Schnadig, I. mascc-0384 Schofield, P. mascc-0319 Schoot, R.A. mascc-0185 Schuler, M.H. mascc-0432 Schuren, N. mascc-0618 Schuurhuis, J.M. mascc-0135 Schwartzberg, L. mascc-0384 Schwartzberg, L. mascc-0160 Schwartzberg, L. mascc-0161 Scott, J. mascc-0189 Scotte, F mascc-0272 Scotte, F. mascc-0303 Scotté, F. mascc-0581 Scotté, F. mascc-0330 Scotté, F. mascc-0341 Scotté, F. mascc-0385 Scotté, F. mascc-0336 Scotté, F. mascc-0334 Scotté, F. mascc-0420 Seccareccia, D. mascc-0436 Seccareccia, D. mascc-0439 Sedef, A. mascc-0056 Segal, R. mascc-0310 Selle, F. mascc-0581 Senn, B. mascc-0173 Seo, B. mascc-0202 Seo, S.H. mascc-0373 Sequist, L.V. mascc-0432 Seymour, J. mascc-0035 Sezer, A. mascc-0056 Sgouros, J. mascc-0166 Shankar, A. mascc-0499 Shankar, A. mascc-0376 Shapiro, C. mascc-0413 Sharka, R. mascc-0523 Sharma, A. mascc-0564 Sharples, K.J. mascc-0189 Shayne, M. mascc-0540 Shebl, A mascc-0519 Sheehan, P. mascc-0153 Sheehan, P. mascc-0411 Sheehan, P. mascc-0328 Sheehan, P. mascc-0410 Sheehan, P. mascc-0231 Shenkman, E. mascc-0146 Sherief, L. mascc-0287 Sherief, L. mascc-0519 Sheu, J. mascc-0611 Sheu, J. mascc-0610 Sheu, J. mascc-0609 Shibuta, K. mascc-0264 Shibuya, H. mascc-0163 Shih, H. mascc-0414 Shim, B.Y. mascc-0401 Shimada, T. mascc-0170 Shin, D. mascc-0202 Shin, D.B. mascc-0008 Shin, S. mascc-0236 Shin, S. mascc-0284 Shin, S. mascc-0389 Shin, S.W. mascc-0401 Shinde, S. mascc-0032

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Shinde, S. mascc-0620 Shintaku, W.H. mascc-0123 Shiota, K. mascc-0264 Shklovskiy-Kordi, N. mascc-0590 Shore, N. mascc-0340 Shrotriya, S. mascc-0027 Shrotriya, S. mascc-0267 Shrotriya, S. mascc-0029 Shrotriya, S. mascc-0028 Shun, S. mascc-0622 Shuster, L.T. mascc-0049 Shwe, M. mascc-0194 Shwe, M. mascc-0039 Shwe, M. mascc-0040 Shwe, M. mascc-0200 Shwe, M. mascc-0139 Sicard, J. mascc-0292 Sidani, S. mascc-0500 Sidani, S. mascc-0494 Siddiqi, T. mascc-0542 Sigaard, L. mascc-0181 Sikorova, L. mascc-0094 Sikorová, L. mascc-0093 Sills, E. mascc-0354 Silva, C. mascc-0506 Silva, C. mascc-0491 Silva, C.M. mascc-0552 Silva, C.M. mascc-0550 Silva, C.M. mascc-0569 Silva, C.M. mascc-0568 Silva, C.M. mascc-0555 Silva, C.M. mascc-0556 Silva, M.C.M. mascc-0217 Silva, M.C.M. mascc-0102 Silva, O.B. mascc-0506 SilvaBisson, G. mascc-0260 Sim, J.H. mascc-0401 Siminska, J. mascc-0306 Simonelli, C. mascc-0265 Simpson, A. mascc-0189 Sinclair, V. mascc-0026 Sinclair, V. mascc-0030 Singh, C. mascc-0144 Singh, D. mascc-0058 Singh, S. mascc-0412 Sinha, S. mascc-0528 Sinha, S. mascc-0561 Sirbilantze, T. mascc-0205 Sirbilantze, T. mascc-0207 Sirbilantze, T. mascc-0210 Sirbilantze, T. mascc-0209 Sirbilantze, T. mascc-0212 Sirbilantze, T. mascc-0208 Sirbilantze, T. mascc-0211 Sirbilantze, T. mascc-0206 Sit, J. mascc-0019 Sit, J. mascc-0616 Skilton, R. mascc-0203 Skoro, N. mascc-0320 Sloan, J.A. mascc-0450 Sloan, J.A. mascc-0049 Small, S.G. mascc-0548 Small, S.G. mascc-0546 Smit, J.H. mascc-0406 Smith, C. mascc-0221 Smith, D. mascc-0542

S17

Smith, M.R. mascc-0340 Smith, P. mascc-0405 Smith-Stoner, M. mascc-0311 Snegovoy, A. mascc-0073 So, W. mascc-0019 So, W. mascc-0616 So, W.K.W. mascc-0069 Soga, Y. mascc-0223 Sohn, J.H. mascc-0128 Soliman, H. mascc-0435 Somarriba, M.M. mascc-0470 Son, C. mascc-0414 Søndergaard, I. mascc-0066 Song, J. mascc-0271 Song, S. mascc-0343 Song, S. mascc-0344 Sonis, S. mascc-0150 Sonobe, H.M. mascc-0257 Soohyeon, L. mascc-0375 Sørensen, B. mascc-0382 Sørlie, V.M. mascc-0218 Soror, M. mascc-0526 Sosa, R mascc-0490 Sosa, R. mascc-0512 Soubeyran, P. mascc-0395 Soupos, N. mascc-0166 Sovenko, V. mascc-0145 Spanjaard, L. mascc-0185 Spano, J.P. mascc-0581 Spielmann, M. mascc-0269 Spijkervet, F.K.L. mascc-0135 Spina, M. mascc-0265 Springall, E. mascc-0180 Stamataki, Z. mascc-0321 Steca, P. mascc-0562 Stein, A. mascc-0542 Stein, K. mascc-0294 SteinbjørnHansen, S.H. mascc-0099 Steiner, M.S. mascc-0548 Steiner, M.S. mascc-0546 Steinmetz, A. mascc-0571 Stella, P.J. mascc-0049 Stemmer, S.M. mascc-0428 Stemmer, S.M. mascc-0111 Stephenson, J.J. mascc-0233 Stern, Y. mascc-0428 Stevens, J. mascc-0420 Stevens, K. mascc-0612 Stewart, R.E. mascc-0175 Stijnen, T. mascc-0185 Stinson, J. mascc-0567 Stinson, J. mascc-0317 Stinson, J. mascc-0177 St-Jean, L.A. mascc-0315 Stokman, M.A. mascc-0135 Stopeck, A. mascc-0340 Stout, R. mascc-0413 Stout, R. mascc-0418 Strasser, F. mascc-0603 Stringer, A. mascc-0188 Stringer, A. mascc-0186 Strohmenger, L. mascc-0399 Stryker, S. mascc-0512 Stryker, WS mascc-0490 Su, C. mascc-0466 Suarez-Almazor, M.E. mascc-0487

Sudour-Bonnange, H. mascc-0214 Sue, K. mascc-0375 Suenaga, H. mascc-0572 Sugazaki, M. mascc-0572 Sugimori, N. mascc-0378 Sulkers, E. mascc-0175 Sulkers, E. mascc-0174 Suman, S. mascc-0078 Summers, Y. mascc-0321 SUN, D.S. mascc-0171 Sung, L. mascc-0560 Sung, M.K. mascc-0373 Supe, S. mascc-0496 Suppasun, K. mascc-0084 Surbone, A. mascc-0096 Surbone, A. mascc-0419 Surbone, A. mascc-0095 Surbone, S. mascc-0118 Sut, P. mascc-0574 Sut, P. mascc-0577 Sut, P. mascc-0576 Sutradhar, R. mascc-0483 Suwannapong, K. mascc-0511 Suzuki, K. mascc-0170 Sveindottier, K. mascc-0527 Sveindottier, K. mascc-0529 Svergun, N. mascc-0145 Svetec, B. mascc-0353 Svintsytskiy, V. mascc-0145 Swami, N. mascc-0290 Swami, N. mascc-0288 Sweeney, M.P. mascc-0354 Sym, S.J. mascc-0008 Syrigos, K. mascc-0280 Syrigos, K. mascc-0283 Syrigos, K. mascc-0281 Syrigos, K. mascc-0566 Szeto, C. mascc-0377 Szumacher, E. mascc-0441 T Taira, T. mascc-0329 Taira, T. mascc-0324 Takahashi, M. mascc-0264 Takahashi, T. mascc-0329 Takahashi, T. mascc-0324 Takakura, Y. mascc-0378 Takanen, S. mascc-0562 Tamahara, T. mascc-0572 Tamahara, T. mascc-0516 Tan, L.T.M. mascc-0239 Tan, S.W.O. mascc-0051 Tan, S.Y. mascc-0139 Tan, Y.P. mascc-0200 Tan, Y.P. mascc-0139 Tanaka, I. mascc-0314 Tanco, K. mascc-0284 Tanco, K. mascc-0389 Tanda, N. mascc-0516 Tanriverdi, O. mascc-0331 Tantoy, I. mascc-0154 Tanuma, A. mascc-0329 Tanuma, A. mascc-0324 Tapscott, B. mascc-0180 Tapuni, A. mascc-0346 Tarangini, D. mascc-0458

S18

Tateyama, M. mascc-0163 Tavakoli-Ardakani, M. mascc-0507 Tawa, M. mascc-0611 Taylor, A. mascc-0286 Taylor, P. mascc-0321 Taylor, R.P. mascc-0548 Taylor, R.P. mascc-0546 Taylor, S. mascc-0078 Taylor, T. mascc-0459 Tejani, M. mascc-0525 Tejani, M. mascc-0311 Telli, M.L. mascc-0335 Temel, J. mascc-0244 Tenge, C. mascc-0380 Teramoto, M. mascc-0615 TerezinhaSalles, T.J.M.S. mascc-0551 Terstreip, S. mascc-0049 Terzyk, A.P. mascc-0299 Thackray, J. mascc-0560 ThaianaAragãoSantana, T.A.S. mascc-0054 Thakkar, D. mascc-0458 Thanarajasingam, G. mascc-0450 Thanasilp, S. mascc-0511 Thanasilp, S. mascc-0197 Thavarajah, N. mascc-0322 Thavarajah, N. mascc-0411 Thavarajah, N. mascc-0457 Thavarajah, N. mascc-0456 Thavarajah, N. mascc-0325 Thavarajah, N. mascc-0410 Thavarajah, N. mascc-0323 Thavarajah, N. mascc-0326 Thavarajah, N. mascc-0454 Thavarajah, N. mascc-0449 Thery, J.C. mascc-0581 Thibault, C. mascc-0420 Thibault, I. mascc-0435 Thielen, J. mascc-0049 Thirlwell, S. mascc-0613 Thomas, S. mascc-0267 Thomas, S. mascc-0028 Thompson, M. mascc-0240 Thong, M. mascc-0048 Tiberi, M. mascc-0196 Tilak, T. mascc-0564 Timilshina, N. mascc-0559 Tissing, W.E. mascc-0175 Tissing, W.J. mascc-0185 Tissing, W.J.E. mascc-0492 Tissing, W.J.E. mascc-0174 Tjulandin, S. mascc-0073 Tkaczuk, K. mascc-0498 Toftdal-SørensenOle, O.T.S. mascc-0015 Toh, M.R. mascc-0140 Tokunaga, S. mascc-0347 Tomlinson, G. mascc-0559 Toneti, B.F. mascc-0256 Toneti, B.F. mascc-0257 Toneti, B.F. mascc-0275 Tonini, G. mascc-0195 Torniai, M. mascc-0196 Tornoe, K.A. mascc-0218 Toro, J.J. mascc-0289 TorresPérez-Solero, G. mascc-0504 Torres-Vigil, I. mascc-0606 Touati, N. mascc-0183

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Touati, N. mascc-0176 Tougeron, D. mascc-0563 Tourangeau, A. mascc-0293 Tourani, J.M. mascc-0336 Tourani, J.M. mascc-0334 Tournigand, C. mascc-0336 Tournigand, C. mascc-0334 Toussaint, S. mascc-0563 Trager, S. mascc-0220 Trakoolngamden, B. mascc-0345 Tralongo, P. mascc-0419 Treldal, C. mascc-0527 Treldal, C. mascc-0529 Treleaven, J. mascc-0240 Tremblay, D. mascc-0183 Tremblay, D. mascc-0176 Tresch, E. mascc-0278 Tresch, E. mascc-0386 Trindade, A. mascc-0119 Trindade, A. mascc-0583 Tripault, L. mascc-0330 Tripault, L. mascc-0341 Trochon-Joseph, V. mascc-0148 Trochon-Joseph, V. mascc-0150 Trufelli, D. mascc-0061 Tsagkouli, S. mascc-0280 Tsagkouli, S. mascc-0281 Tsai, K. mascc-0126 Tsang, A. mascc-0571 Tsang, A. mascc-0586 Tsao, M. mascc-0448 Tsao, M. mascc-0447 Tsao, M. mascc-0541 Tsao, M. mascc-0446 Tsao, M. mascc-0468 Tsao, M. mascc-0441 Tsao, M. mascc-0411 Tsao, M. mascc-0328 Tsao, M. mascc-0465 Tsao, M. mascc-0531 Tsao, M. mascc-0410 Tsao, M. mascc-0455 Tsao, M. mascc-0473 Tsao, M. mascc-0472 Tsao, M. mascc-0481 Tsao, M. mascc-0464 Tseng, L. mascc-0467 Tseng, L.M. mascc-0337 Tsimafeyeu, I. mascc-0073 Tsimicalis, A. mascc-0533 Tsimpoukis, S. mascc-0166 Tsitsi, T. mascc-0067 Tsovou, Z. mascc-0566 Tsubota, M. mascc-0347 Tsuji, T. mascc-0378 Tsurutani, J. mascc-0347 Tsyp, N. mascc-0145 Tual, V. mascc-0420 Tuca, A. mascc-0575 Tuca, A. mascc-0502 Tuke, S. mascc-0339 Turcotte, A. mascc-0176 Turner, M. mascc-0367 Twardowski, P. mascc-0542 Tzaninis, D. mascc-0517

U Ueno, K. mascc-0482 Ulas, M. mascc-0371 Ünür, M. mascc-0592 Uomori, T. mascc-0130 Urban, L. mascc-0391 urita, G. mascc-0355 Uyterlinde, W. mascc-0038 V Vaartio-Rajalin, H. mascc-0088 Vadhan-Raj, S. mascc-0340 Vainchtock, A. mascc-0385 Valentine, B. mascc-0064 vandePoll-Franse, L. mascc-0048 vanderWesthuizen, M. mascc-0425 vandeWetering, M. mascc-0185 vandeWetering, M.D. mascc-0492 VandeWiele, T. mascc-0396 VandeWiele, T. mascc-0392 vanHarten, W.H. mascc-0138 Vanhoecke, B. mascc-0396 Vanhoecke, B. mascc-0392 Vanlancker, E. mascc-0396 Vanlemmens, L. mascc-0565 Vanlemmens, L. mascc-0272 vanNieuwenhuizen, A.J. mascc-0406 vanOmmen, C.H. mascc-0185 vanUden-Kraan, C.F. mascc-0513 vanUden-Kraan, C.F. mascc-0397 vanUden-Kraan, C.F. mascc-0510 vanUden-Kraan, C.F. mascc-0514 vanUden-Kraan, C.F. mascc-0393 vanZwieten, V. mascc-0510 Varnerin, N. mascc-0033 Vasile, E. mascc-0595 Vasile, E. mascc-0594 Vasile, E. mascc-0593 Vasile, E. mascc-0600 Vassiliou, V. mascc-0337 Vassiliou, V. mascc-0467 Vassos, D. mascc-0283 VeraLúciaLinsdeMorais, V.L.L.M. mascc-0553 Verdonck-deLeeuw, I.M. mascc-0513 Verdonck-deLeeuw, I.M. mascc-0406 Verdonck-deLeeuw, I.M. mascc-0397 Verdonck-deLeeuw, I.M. mascc-0510 Verdonck-deLeeuw, I.M. mascc-0514 Verdonck-deLeeuw, I.M. mascc-0393 Verma, S. mascc-0307 Vicente, M.A. mascc-0597 Victoria, S. mascc-0273 Vidal, M. mascc-0536 Vieillard, M. mascc-0565 Vigano, A. mascc-0557 Vigano, A. mascc-0535 Vigano, A. mascc-0534 Vimalathithan, V. mascc-0107 Vincenzi, B. mascc-0195 Vinod, R. mascc-0085 Virella, D. mascc-0119 Virizuela, J. mascc-0549 Vissink, A. mascc-0135 Vitetta, L. mascc-0037 Vlahovic, G. mascc-0215 Vol, H. mascc-0459

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Volk, R. mascc-0460 Volovat, C. mascc-0544 Volovat, C. mascc-0530 vonBultzingslowen, I. mascc-0599 VonHoff, D. mascc-0463 Vorobyova, L. mascc-0145 Vriens, J. mascc-0060 Vriens, J. mascc-0129 Vruwink, J. mascc-0427 Vulpe, H. mascc-0447 Vvedenskaia, E. mascc-0297 W Wade, J.L. mascc-0445 Waghorn, M. mascc-0060 Waghorn, M. mascc-0129 Waghorn, M. mascc-0068 Wakasugi, T. mascc-0012 Wakeda, T. mascc-0554 Wakefield, C.E. mascc-0370 Wakefield, C.E. mascc-0369 Walker, P. mascc-0618 Wallner, M. mascc-0224 Wallner, M. mascc-0295 Walsh, D. mascc-0114 Walsh, D. mascc-0027 Walsh, D. mascc-0267 Walsh, D. mascc-0115 Walsh, D. mascc-0029 Walsh, D. mascc-0028 Walton, S. mascc-0431 Wan, R.W.M. mascc-0069 Wan-Chow-Wah, D. mascc-0180 Wang, J.B. mascc-0255 Wang, K. mascc-0127 Wang, Y. mascc-0484 Wanger, T. mascc-0007 Wangnum, K. mascc-0084 Warde, P. mascc-0483 Wardill, H.R. mascc-0302 Warr, D. mascc-0307 Warr, D.G. mascc-0448 Wartlick, F. mascc-0167 Watson, A. mascc-0610 Wazneh, L. mascc-0533 Weaver, E. mascc-0098 Webber, K. mascc-0129 Weikel, D. mascc-0443 Wells, N. mascc-0558 Wells, N. mascc-0602 Wells, N. mascc-0105 Weluchio, B. mascc-0380 Wen, S. mascc-0078 Wentlandt, K. mascc-0436 Wentlandt, K. mascc-0439 Were, A.P. mascc-0380 Were, P. mascc-0415 Werengowska-Ciecwierz, K. mascc-0299 Weru, J. mascc-0047 West, D. mascc-0113 Wettlin, J. mascc-0474 Wettlin, J. mascc-0475 Wheeler, G. mascc-0087 Wheeler, G. mascc-0086 White, A. mascc-0319 White, I. mascc-0339

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White, I. mascc-0186 White, L. mascc-0156 Whitford, H. mascc-0198 Whittaker, A.L. mascc-0234 Wierick, E. mascc-0357 Wignall, A. mascc-0098 Wignall, A. mascc-0186 Williams, J. mascc-0389 Williams, J. mascc-0282 Williams, J. mascc-0279 Williams, J.L. mascc-0236 Williams, L. mascc-0216 Williams, P.M. mascc-0599 Williams, S. mascc-0319 Williamson, C. mascc-0335 Winn, S. mascc-0613 Wirth, A. mascc-0087 Wirth, A. mascc-0086 Wisniewski, M. mascc-0299 Witte, B.I. mascc-0513 Witte, B.I. mascc-0510 Witte, B.I. mascc-0514 Wittman, T. mascc-0109 Wollank, C. mascc-0298 Wong, C.S. mascc-0567 Wong, D. mascc-0437 Wong, D. mascc-0438 Wong, E mascc-0147 Wong, E. mascc-0153 Wong, E. mascc-0447 Wong, E. mascc-0541 Wong, E. mascc-0435 Wong, E. mascc-0327 Wong, E. mascc-0446 Wong, E. mascc-0468 Wong, E. mascc-0132 Wong, E. mascc-0342 Wong, E. mascc-0338 Wong, E. mascc-0322 Wong, E. mascc-0414 Wong, E. mascc-0422 Wong, E. mascc-0434 Wong, E. mascc-0423 Wong, E. mascc-0441 Wong, E. mascc-0411 Wong, E. mascc-0465 Wong, E. mascc-0531 Wong, E. mascc-0467 Wong, E. mascc-0452 Wong, E. mascc-0455 Wong, E. mascc-0473 Wong, E. mascc-0472 Wong, E. mascc-0481 Wong, E. mascc-0184 Wong, E. mascc-0464 Wong, E. mascc-0449 Wong, E. mascc-0191 Wong, E. mascc-0231 Wong, E.M.L. mascc-0232 Wong, K. mascc-0541 Wong, M. mascc-0194 Wong, M. mascc-0200 Wong, M. mascc-0139 Wong, P. mascc-0585 Wong, S. mascc-0317 Wong, S. mascc-0177

Wong, W. mascc-0414 Wong, W.H. mascc-0242 Wongsa, O. mascc-0084 Woo, I.S. mascc-0171 Woodman, R.J. mascc-0152 Woodring, S. mascc-0215 Wootten, A. mascc-0319 Workentin, K. mascc-0436 Workentin, K. mascc-0439 Wouters, M.W.J.M. mascc-0138 Wozniak, B. mascc-0098 Wozniak, B. mascc-0186 Wu, J. mascc-0270 Wu, J. mascc-0284 Wu, Q.S. mascc-0388 Wu, W.Y. mascc-0350 Wu, X. mascc-0277 WU, X. mascc-0276 WU, X.W. mascc-0268 Wu, Y.L. mascc-0432 X xiangyuan, W.U. mascc-0178 xiaokun, M. mascc-0178 Xu, H. mascc-0478 Xu, H. mascc-0479 Xu, H. mascc-0471 Xu, H. mascc-0476 Xu, L. mascc-0478 Xu, L. mascc-0479 Xu, L. mascc-0471 Xu, L. mascc-0476 XY, L.I. mascc-0178 Y Yadav, P. mascc-0522 Yadav, P. mascc-0521 Yadav, S.P. mascc-0458 Yahagi, Y. mascc-0170 Yamaguchi, M. mascc-0347 Yamanaka, T. mascc-0264 Yamauchi, S. mascc-0012 Yamazaki, S. mascc-0572 Yanagisawa, T. mascc-0347 Yang, H.S. mascc-0350 Yang, J.C.H. mascc-0432 Yang, S. mascc-0202 Yano, S. mascc-0170 Yao, K.G. mascc-0350 Yap, K. mascc-0052 Yap, K. mascc-0039 Yap, K. mascc-0040 Yap, K.Y. mascc-0051 Yap, Y.S. mascc-0194 Yap, Y.S. mascc-0139 Yates, P. mascc-0349 Yavas, C. mascc-0372 Yavas, G. mascc-0372 Yavuzsen, T. mascc-0331 Yazicioglu, O. mascc-0592 Yeh, L. mascc-0020 Yellowlees, A. mascc-0437 Yennu, S. mascc-0426 Yennu, S. mascc-0284 Yennurajalingam, S. mascc-0270 Yeung, S. mascc-0536

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Yeung, Y. mascc-0582 Yim, Y.M. mascc-0233 Yip, C. mascc-0448 Yip, C. mascc-0117 Yip, C. mascc-0121 Yip, C. mascc-0404 Yip, C. mascc-0402 Yip, C. mascc-0465 Yokoyama, R. mascc-0163 Yonemoto, N. mascc-0130 Yong, C. mascc-0498 Yong, W.S. mascc-0194 Yong, W.S. mascc-0200 Yong, W.S. mascc-0139 Yool, A.J. mascc-0237 Yoon, D. mascc-0624 Yoon, D. mascc-0390 Yoon, S.Y. mascc-0401 Yoshida, E. mascc-0572 Yoshidome, K. mascc-0347 Yu, B.W.L. mascc-0069 Yu, S.Y. mascc-0388 Yuen, D. mascc-0421 Yuki, S. mascc-0163 Yun, H.J. mascc-0401 Yun, L. mascc-0483 Yurikusa, T. mascc-0223 Yusoff, Z. mascc-0014

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Z Zakaria, K. mascc-0528 Zakaria, K. mascc-0561 Zaki, N. mascc-0125 Zakin, L. mascc-0148 Zakin, L. mascc-0150 Zalpour, A. mascc-0271 Zambrano, S. mascc-0025 Zandonai, A.P. mascc-0587 Zatarain, L. mascc-0221 Zazulina, V. mascc-0432 Zegarski, W. mascc-0306 Zelunka, E. mascc-0459 Zeng, L. mascc-0567 Zeng, L. mascc-0447 Zeng, L. mascc-0541 Zeng, L. mascc-0342 Zeng, L. mascc-0322 Zeng, L. mascc-0545 Zerilli, F. mascc-0083 Zhang, D.R. mascc-0518 Zhang, L. mascc-0192 Zhang, L. mascc-0448 Zhang, L. mascc-0317 Zhang, L. mascc-0177 Zhang, L. mascc-0541 Zhang, L. mascc-0435 Zhang, L. mascc-0446 Zhang, L. mascc-0468

Zhang, L. mascc-0337 Zhang, L. mascc-0411 Zhang, L. mascc-0465 Zhang, L. mascc-0531 Zhang, L. mascc-0467 Zhang, L. mascc-0410 Zhang, L. mascc-0455 Zhang, L. mascc-0473 Zhang, L. mascc-0472 Zhang, L. mascc-0481 Zhang, L. mascc-0464 Zhang, X. mascc-0268 Zheng, R.Z. mascc-0524 Zhong, W. mascc-0149 Zhou, K. mascc-0340 Zhou, W. mascc-0433 Zidan, A.M.A.L. mascc-0287 Zimmermann, C. mascc-0421 Zimmermann, C. mascc-0290 Zimmermann, C. mascc-0436 Zimmermann, C. mascc-0439 Zimmermann, C. mascc-0288 Zingerman, B.V. mascc-0590 Zontanos, M. mascc-0280 Zuberi, M. mascc-0521 Zuercher, S. mascc-0077 Zvirbule, Z. mascc-0573 Zwaan, C.M. mascc-0286 Zwaan, C.M. mascc-0185

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MASCC-0014 Anemia ANEMIA AND THROMBOCYTOPENIA IN SOLID CANCER PATIENTS

B. Hassan1, Z. Yusoff1, M. Hassali2, S. Othman1 1 clinical pharmacy, Universiti Sains Malaysia, pinang, Malaysia; 2 Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, pinang, Malaysia Background and Aims Introduction: Anemia and thrombocytopenia are two of the major detrimental side effects of the malignant disease itself and/or the chemotherapy, leading to impairment of function in all tissues and organs of cancer patients and associated with serious stress and both have a great negative effect on cancer patients quality of life (QOL). Objectives: This present study works on to evaluate the effectiveness of treatment guidelines used for anemia and thrombocytopenia and to determine the association between anemia and thrombocytopenia onset and severity with different chemotherapeutics regimens and doses used in the treatment of several solid cancers. Methods: This is a retrospective observational study was conducted on 875 solid cancer patients who were admitted to a government (Penang Hospital/Malaysia) in the period between 2003 and 2009. Results Effectiveness of standard anemia and thrombocytopenia treatment guidelines were not sufficient because correction of anemia and thrombocytopenia was just temporary. Moreover, FEC, 5-FU+5FU, FOLFOX, Docetaxel and Cisplatin+ 5-FU regimens have strong association and correlation with both anemia and thrombocytopenia onset and severity. However the associations and correlations with both anemia and thrombocytopenia severity were stronger than those with the onset. Different doses of 5-FU, cyclophosphamide, docetaxel and cisplatin play a critical role in anemia and thrombocytopenia onset and severity. Conclusion: Monitoring and determination of hemoglobin and platelets levels for cancer patients who will treat with FEC, 5-FU+5-FU, FOLFOX, Docetaxel, Cisplatin+5-FU specifically with high doses must be emphasized and focused. Moreover, thrombocytopenia and erythropoietin must be used as a cornerstone treatment.

MASCC-0581 Anemia PREVALENCE OFANEMIA AND CHRONIC KIDNEY DISEASE (CKD) IN CANCER PATIENTS, AND POTENTIAL INTER-RELATIONSHIPS

V. Launay-Vacher1, N. Janus1, I. Ray-Coquard2, P. Beuzeboc3, C. Daniel3, J. Gligorov4, F. Selle4, F. Goldwasser5, O. Mir5, J.P. Spano6, J.C. Thery6, J.B. Rey7, C. Jouannaud8, J.F. Morere9, S. Oudard10, G. Deray11, F. Scotté10 1 Service ICAR, GH Pitié-Salpêtrière, Paris, France; 2Medical Oncology, Centre Léon Bérard, Lyon, France; 3Medical Oncology, Institut Curie, Paris, France; 4 Medical Oncology, Hôpital Tenon, Paris, France; 5Medical Oncology, Hôpital Cochin, Paris, France; 6Medical Oncology, GH Pitié-Salpêtrière, Paris, France; 7Clinical Pharmacy, Institut Jean Godinot, Reims, France; 8Medical Oncology, Institut Jean Godinot, Reims, France; 9Medical Oncology, Hôpital Avicenne, Bobigny, France; 10Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France; 11Nephrology, GH Pitié-Salpêtrière, Paris, France Background and Aims Anemia in cancer patients is often, if not only, considered as chemotherapy-induced anemia (CIA). However, CKD which may

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induce renal anemia, is also highly prevalent in solid-tumour patients. The results of 3 clinical studies we conducted (IRMA-1, IRMA-2 and MARS) were pooled. In all 3, the methods and staff were the same to define anemia and CKD and determine their prevalence. Methods Anemia was defined as Hb <10 g/dL. Patients were classified according to the ESMO definition. CKD was defined according to the KDIGO and the glomerular filtration rate estimated with the MDRD formula, as recommended. Results 10’753 patients were included in total. Mean/median age was 58.8/ 59.0 years. Female: 63.9 %. Main cancers were breast (4’123), colorectal (1’520), lung (1’013), ovarian (649), and prostate (525). 12.2 % of the patients had a Hb<10 g/dL and 11.6 % had CKD (MDRD<60). The mean Hb was slightly but significantly lower in CKD patients: 11.5 vs 12.0 g/dL, p=0.0001) and the prevalence of Hb<10 was nearly twice and significantly higher in CKD patients: 21.3 % vs 11.1 %, p=0.0001. Prevalence 10≤Hb<12 8≤Hb<10 Hb<8

MDRD≥60 36.4 % 9.8 % 1.3 %

MDRD<60 34.8 % 17.6 % 3.7 %

Conclusions The prevalence of anemia in our patients was higher in cancer patients with CKD, suggesting that renal anemia may be present in addition to other cancer-related causes. This observation is of importance since, although the treatments are the same (IV iron and erythropoiesisstimulating agents), the doses and schedules may vary between CIA and renal anemia.

MASCC-0476 Anemia TREATMENT PATTERNS FOR ANEMIA AMONG BREAST CANCER PATIENTS TREATED WITH CHEMOTHERAPY IN 2000–2013

H. Xu1, L. Xu2, J.H. Page1, K. Cannavale3, R. Rodriguez4, C. Chao3 1 Center for Observational Research, Amgen Inc, Los Angeles, USA; 2 Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 3Department of research and evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 4 Department of Hematology Oncology, Kaiser Permanente Southern California, Los Angeles, USA Background and Aims It is unclear how management of chemotherapy induced anemia (CIA) has evolved over time given the changes in the US prescribing information, reimbursements, and the implementation of a risk evaluation and mitigation strategy (REMS) for the use of erythropoiesis-stimulating agents (ESAs). We therefore conducted this study to describe treatment trends and current treatment patterns for CIA in 2000–2013. Methods Incident breast cancer patients (n=3374) who developed grade II-IV CIA (hemoglobin (Hb) <10 g/dL) were identified from Kaiser Permanente Southern California Health Plan. We estimated the proportions of anemia episodes with ESA use and red blood cell (RBC) transfusion and the hemoglobin concentrations within 7 days prior

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to ESA and transfusion in three calendar periods: January 2000-Dec 2006 (P1), Jan 2007-24 March 2010 (P2), 25 March 2010-June 2013 (P3). Differences between calendar periods were assessed for proportions treated and for hemoglobin concentration prior to CIA treatment. Results Proportion of anemia episodes with ESA use decreased from 2006 to 2013 (25 % in P1, 20 % in P2, and 4 % in P3). Increased trend of transfusion use was observed over time (4 % in P1, 8 % in P2, and 12 % in P3), with the most evident changes observed in grade 3+ anemia (Hb<8 g/dl) episodes (10 % in P1, 41 % in P2, and 56 % in P3). We observed significant lower Hb concentrations (g/dL) prior to ESA use and no differences in Hb concentrations prior to transfusion use. Conclusions This study indicates that along with the decreased utilization of ESA, utilization of RBC transfusion has increased significantly over time in Kaiser Permanente health care system.

MASCC-0478 Anemia RISK OF CHEMOTHERAPY INDUCED ANEMIA IN BREAST CANCER PATIENTS

H. Xu1, L. Xu2, K. Cannavale2, J. Page1, R. Rodriguez3, C. Chao2 1 Center for Observational Research, Amgen Inc, Los Angeles, USA; 2 Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 3Department of Hematology Oncology, Kaiser Permanente Southern California, Los Angeles, USA

Background and Aims Chemotherapy induced anemia (CIA) is a common chemotherapy complication that can cause clinically important symptoms, leading to reduced quality of life. Yet, little data exist on the burden of CIA in current oncology practice. We estimated the incidence and severity of CIA in breast cancer patients receiving chemotherapy. Methods Incident breast cancer patients who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). Patients who had anemia before chemotherapy (i.e., diagnosis of inherited anemia or hemoglobin measurement <10 g/dl within 3 months of chemotherapy) were excluded. All clinical data were collected from health plan’s electronic medical records. Incidence proportions of patients developing CIA were calculated for overall and by CIA severity and morphological type, as well as by stage at cancer diagnosis, chemotherapy regimen and cycle. Results Of 2,374 breast patients included, 2,048 (86 %) patients developed anemia during the course of chemotherapy (61 % grade I, 33 % grade II, 5 % grade III and <1 % grade IV, normocytic 89 %, macrocytic 7 %, microcytic 4 %). The risk of grade II–IV CIA (Hb <10 g/dL) increased from 33 % in stage 1 to 52 % in stage 4 breast cancer. CIA incidence proportion increased over cycles, and declined after cycle 5 or 6 for the most common regimens (TC, AC->T, and TCH). (Figure 1)

Figure 1. Incidence proportion of chemotherapy induced anemia by chemotherapy regimen and cycle Conclusions The risk of CIA (Hb <10 g/dL) is high in breast cancer patients. Careful attention to anemia management is needed when planning chemotherapy.

MASCC-0479 Anemia TREATMENT PATTERNS FOR ANEMIA AMONG PATIENTS WITH NON-HODGKIN LYMPHOMA (NHL) TREATED WITH CHEMOTHERAPY IN 2000–2013

C. Chao1, L. Xu1, J.H. Page2, K. CannavaleCA1, R. Rodriguez3, H. Xu2 1 Department of research and evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 2Center for Observational Research, Amgen Inc, Los Angeles, USA; 3Department of Hematology Oncology, Kaiser Permanente Southern California, Los Angeles, USA Background and Aims It is unclear how management of chemotherapy induced anemia (CIA) has evolved over time given the changes in the US prescribing information, reimbursements, and implementation of a risk evaluation and mitigation strategy (REMS) for the use of erythropoiesis-stimulating agents (ESAs). We described treatment trends and current treatment patterns for CIA in 2000 to 2013. Methods Incident NHL patients (pts) who developed grade II–IV CIA (hemoglobin. Results The observed anemia episodes were 313 (213 pts) in P1, 144 (102 pts) in P2, and 140 (106 pts) in P3. Proportion of anemia episodes with ESA use

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decreased from 2006 to 2013 (P1: 34 %; P2: 22 %; and P3: 6 %). Increased trend of transfusion use was observed (P1:12 %; P2: 22 %; and P3:27 %), with the most evident changes observed in grade IV (Hb). Conclusions Our study indicates that along with the decreased utilization of ESA, utilization of RBC transfusion has increased significantly over time.

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elaboration of a score-card to evaluate oncological services; 4) Communication and; 5) Identification of guidelines to implement integral care. Conclusions Nevertheless a national health policy aligned with a national research policy for cancer must be implemented trying to follow the scheme (figure 1) of Mellstedt [3] in order to achieve the best solution. In this case, the alignment can bring profits for both sides :Research and Control of Cancer.

MASCC-0471 Anemia

MASCC-0466 Basic Research

INCIDENCE OF CHEMOTHERAPY INDUCED ANEMIA IN NON-HODGKIN LYMPHOMA PATIENTS

C. Chao1, L. Xu1, K. Cannavale1, J.H. Page2, R. Rodriguez1, H. Xu2 1 Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 2Center for Observational Research, Amgen Inc, Los Angeles, USA Background and Aims Chemotherapy induced anemia (CIA) is a common chemotherapy complication that can cause clinically important symptoms, leading to reduced quality of life. Changes in the US prescription information have led to decreased utilization of erythropoiesis-stimulating agents. Yet, little data exist on the burden of CIA in current oncology practice. We therefore conducted this study to estimate the incidence and severity of CIA among non-Hodgkin lymphoma (NHL) patients . Methods Incident NHL cases who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). Patients who had anemia before chemotherapy (i.e., inherited anemia or hemoglobin measurement. Conclusions Absence of VEGF within the gastric carcinoma tissue despite its high-level expression can suggest that either VEGF protein is somehow quickly eliminated into the blood stream, or other pathomechanisms are involved. Lack of VEGF protein in gastric cancer tissue and high plasma concentrations of that protein presumes the VEGF transfer from cancer tissue to blood.

MASCC-0074 Basic Research CANCER IN BRAZIL: POLICIES AND DATA

R. Santos-Oliveira1 1 Faculty of Pharmacy, Zona Oeste Estadual University, Rio de Janeiro, Brazil

TANSHINONE IIA COULD INHIBIT HUMAN GASTRIC CARCINOMA AGS CELLS THROUGH DECREASING BCL-XL, TCPC AND MCL-1 BUT INCREASING BAX EXPRESSIONS

C. Su1 Surgery, Changhua Christian Hospital, Changhua, Taiwan

1

Background and Aims Tanshinone IIA (Tan-IIA; C19H18O3), a phenanthrenequinone derivative extracted from Danshen, Salviae Miltiorrhizae Radix, possesses anti-tumor activity in many cancer cells. It was well documented that Tan-IIA exerted powerful inhibitory effects in gastric cancer cells SGC7901 with time- and dose-dependent. These reports suggest that Tanshinone IIA may serve as an effective adjunctive reagent in the treatment of gastric cancer. However, the molecular mechanisms that cause Tan-IIA to induce apoptosis in gastric cancer have not been clarified. In our previous studies showed that Tan-IIA can inhibit the growth of pancreatic cancer BxPC 3 cells by decreasing protein expression of TCTP, MCL 1 and Bcl xL. In the present study, we investigated the effects of Tan-IIA in human gastric cancer AGS cells. Methods In the present study we evaluated the cytotoxicity of Tan-IIA in human gastric carcinoma AGS cells by MTT assay. The protein expression of TCTP, MCL 1 and Bcl xL, TNF-α, Caspase-8, Caspase-3, Bax and betaactin in AGS cells was measured by Western blotting. The protein expression of Caspase-3 was detected by immunocytochemical (I.C.C) staining. The cell cycle was analyzed by FACS. Results The results showed that Tan-IIA could inhibit the proliferation of AGS cells with time and dose dependent. The protein expressions of TNF-α, Caspase-8, Caspae-3 and Bax were increased, but Bcl-xl, TCPC and Mcl1 were decreased in AGS cells were treated with Tan-IIA. Conclusions These finding indicate that Tan-IIA can inhibit the proliferation of AGS cells through inducing apoptosis in vitro. The chemotherapeutic potential of Tan-IIA for human gastric cancer warrants further study.

MASCC-0521 Background and Aims Cancer is one of the most important disease in the world. Billions of dollars are used every year in prevention and treatment around the world. However, as a plague, the number just increase each day. In this study we discussed the Brazilian policy for cancer. Also, we gave some data about cancer in Brazil. Methods A review of the literature using some criteria of Systematic Review was conducted. The legislation of Brazil related to Cancer was systematically studied and summarized. Results To achieve good resultshas been proposed five points to control cancer: 1) Partnership integration: development of a portal dedicated to integral care; 2) Diagnosis quality: elaboration of guidelines to help diagnosis; 3) Care quality:

Basic Research EPIGENETIC SIGNATURES OF RASSF1 AND PTEN GENES AS POTENTIAL CANDIDATES FOR TARGETING EPITHELIAL OVARIAN CANCER

M. Zuberi1, I. Ahmad1, A. Mir1, J. Javid1, P. Yadav1, M. Masroor1, G. Gandhi1, P.C. Ray1, A. Saxena1 1 Biochemistry, Maulana Azad Medical College and LN Hospital, Delhi, India Background and Aims Ovarian cancer is a fatal gynaecological cancer and a major cause of cancer-related mortality worldwide. Tumour suppressor genes (TSGs) are

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wild-type alleles of genes which play primary regulatory roles in diverse cellular activities, and whose loss of function contributes to the development of cancer. The present study aimed to investigate the methylation status in promoter region of RASSF1 gene and differential DNA methylation pattern of PTEN gene in Epithelial ovarian cancer patients in North India. Methods Fifty patients and 20 healthy controls were recruited in the study. Isolation of genomic DNA from peripheral blood and methylation -specific PCR (MSP) were applied. Results Seventeen out of 50 patients (34.0 %) were found to be methylated for RASSF1 gene, while methylation of the PTEN gene occurred in 8 of 50 cases (16.0 %). A statistically significant result was obtained (p=0.01) for RASSF1 gene that correlated with the patients clinico pathological features. However, no association could be established with the PTEN gene and the patients’ clinical history. Conclusions Hypermethylation of RASSF1 gene in blood DNA from ovarian cancer patients might offer an exposition for early diagnosis of the malignancy. This study might be extrapolated further for possible epigenetic therapies targeting epigenetically dysregulated genes in ovarian cancer. A better understanding of the epigenetic changes in ovarian cancer will contribute to the improvement of patient outcomes.

MASCC-0291 Bone Health EFFICACY OF ZOLEDRONIC ACID FOR ALGERIAN PATIENTS WITH BONE METASTASES FROM BREAST CANCER

K. Berkane1, R.F. R. Feghir1, S.A. S. Aziez1, A.L. A. Ladjroud1, S.S. S. Sami1, K.B. K. Bouzid1 1 Medical Oncology, Pierre & Mary Curie Center, Algiers, Algeria Background and Aims Introduction of zoledronic acid improved the management of breast cancer with bone metastases. Bone metastases is a cause of significant morbidity. The current study aimed to examine the impact of zoledronic acid in terms of renal toxicity, pain control and health quality of life on Algerian patients with bone metastases from breast cancer. Methods One hundred sixty-two Patients>18 years of age with radiological evidence of bone metastases stratified according to positive estrogen receptor (ER) progesterone receptor (PR), HER2 status were included and who assigned for zoledronic acid (4 mg every 4 weeks via 15 min intravenous infusion). Results Results were expressed as median values and correlation of pathologic parameters were performed using analysis of variants. Any p value<0,05 was considered significant. Patients are ranged in age 18 to 79 years. The most frequently involved area was the spine followed by ribs end pelvic bone. Significant correlation between location of bone pain and evidence metastases was observed . We evaluate the effects of zoledronic acid on renal function (creatininemia, serum ions fluctuations including hypocalcemia). Significant clinically relevant analgesic effect of treatment reduce bone pain in 72 % patients. Conclusions This study confirm the high quality of life and safety of zoledronic acid in algerian women with bone metastases receiving zoledronic acid.

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MASCC-0383 Bone Health SAFETY OF HOME SETTING ADMINISTRATION OF ZOLEDRONATE IN CANCER PATIENTS

M. di Palma1, M. Lacaze1 1 ambulatory department, Institute Gustave Roussy, villejuif, France Background and Aims Zoledronate is an IV bisphosphonate, indicated for the prevention of skeletal related events in cancer patients with bone metastases. Initially used in day hospital, zoledronate was authorized in France in home care. At this time some cases of renal insufficiency were reported, because home care health professionals were not used to it. Therefore we decided to implement a specific protocol for these patients. Methods Patients who had to receive zoledronate at home were seen in consultation by a nurse of the Coordination for Home Care. This is a service in our institution aimed to organize complex home treatments in collaboration with home care professionals (ie chemotherapy). Each patient had the day before zoledronate perfusion a blood test (calcemia, creatinin) and a phone call from the nurse, to adapt (if needed) dosage of zoledronate. Results We reviewed the files of 104 patients, 75 % female, age 27–87 (mean 61); 71 % had significant pain, mean delay between diagnosis of bone metastases and zoledronate initiation was 12 months. Patients received 1 to 64 injections (mean 26); in 90 % of patients initial dose was 4 mg, 12 % required further dose reduction. Jaw bone necrosis occurred in 4 patients, after 11, 17, 26 and 43 cycles. 2 patients experienced grade 2 renal toxicity, one related to chemotherapy, the other possibly to zoledronate. Conclusions Home based use of zoledronate is safe. As the knowledge of this drug by home care health professionals has increased, this protocol is restricted to patients at higher risk of toxicity (age over 75, renal impairment).

MASCC-0557 Bone Health THE RELATIONSHIPS BETWEEN BONE MINERAL DENSITY AND CLINICAL CORRELATES OF CANCER CACHEXIA

J. di Tomasso1, L. Ciutto2, L. Rosenthall3, R.D. Kilgour4, J.A. Morais5, M. Borod6, A. Vigano7 1 Clinical Nutrition, McGill University Health Centre, montreal, Canada; 2 Clinical Nutrition, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 3Radiology, McGill University Health Centre, Montreal, Canada; 4Concordia University Exercise Science, McGill Nutrition and Performance Laboratory, Montreal, Canada; 5Geriatric Medicine McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada; 6Palliative and Supportive Care, McGill University Health Centre, Montreal, Canada; 7Palliative and Supportive Care McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada Background and Aims Introduction: Autoimmune, digestive, and gastrointestinal disorders with elevated inflammatory responses are associated with

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osteoporosis. To date, no human studies have documented the relationships between bone mineral density (BMD) and biomarkers of cancer cachexia. Objectives: To determine if BMD is associated with clinical correlates of cachexia in advanced cancer patients. Methods: Whole body BMD and total fat mass were measured using dual energy x-ray absorptiometry (DXA). Appendicular skeletal muscle index (ASMI) was calculated according to Kilgour et al. (2010). Handgrip strength (HGS) was measured by dynamometry. Results: One hundred and twenty five patients with advanced cancer, mostly with gastrointestinal and pulmonary tumors were included in the analysis (Table 1). Significant correlations (Spearman’s p<0.05) were found between BMD and CRP, ASMI, total fat mass and HGS (Table 2).

MASCC-0535 Bone Health RELATIONSHIPS BETWEEN BONE MINERAL DENSITYAND CLINICAL CORRELATES OF CANCER CACHEXIA

J. di Tomasso1, L. Ciutto2, L. Rosenthall3, R.D. Kilgour4, J.A. Morais5, M. Borod6, A. Vigano7 1 Clinical Nutrition, McGill University Health Centre, Montreal, Canada; 2 Centre Hospitalier Universitaire Vaudois, McGill Nutrition and Performance Laboratory, Lausanne, Switzerland; 3Radiology, McGill University Health Centre, Montreal, Canada; 4Concordia University Exercise Science, McGill Nutrition and Performance Laboratory, Montreal, Canada; 5Geriatric Medicine McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada; 6Palliative and Supportive Care, McGill University Health Centre, Montreal, Canada; 7Palliative and Supportive Care McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada

Table 1. Demographic information N=125 Age BMI Gender Diagnosis

CCS

Males Females GI NSCLC Others NC

Mean ± SD 62.4±12.2 23.5±5.2 n 75 50 85 24 16 31

% 60 40 68 19 13 25

PC C RC

33 47 14

26 38 11

(years) (kg/m2)

GI gastrointestinal; NSCLC non-smaill cell lung cancer; CCS cancer cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; C cachectic patients; RC refractory cachectic patients; BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; HGS hand grip strength

Table 2. Correlations with bone mineral density

CRP ASMI Fat mass HGS

p value 0.038 0.004 0.001 0.001

Spearman 0.204 0.253 0.387 0.551

BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; HGS hand grip strength Conclusions Decreased BMD is associated with clinical correlates of cancer cachexia. Effective anti-cancer-cachexia therapies may help maintain BMD and reduce complications of osteoporosis.

Introduction Autoimmune, digestive, and gastrointestinal disorders with elevated inflammatory responses are associated with osteoporosis. To date, no human studies have documented the relationships between bone mineral density (BMD) and biomarkers of cancer cachexia. Objectives To determine if BMD is associated with clinical correlates of cachexia in advanced cancer patients. Methods Whole body BMD and total fat mass were measured using dual energy xray absorptiometry (DXA). Appendicular skeletal muscle index (ASMI) was calculated according to Kilgour et al. (2010). Handgrip strength (HGS) was measured by dynamometry. Results One hundred and twenty five patients with advanced cancer, mostly with gastrointestinal and pulmonary tumors were included in the analysis (Table 1). Significant correlations (Spearman’s p<0.05) were found between BMD and CRP, ASMI, total fat mass and HGS (Table 2). Table 1. Demographic information N=125 Age BMI

(years) (kg/m2)

Gender Diagnosis

CCS

Males

Mean ± SD 62.4±12.2 23.5±5.2 n 75

% 60

Females GI NSCLC Others NC PC C RC

50 85 24 16 31 33 47 14

40 68 19 13 25 26 38 11

GI gastrointestinal; NSCLC non-small cell lung cancer; CCS cancer cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; C cachectic patients; RC refractory cachectic patients; BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; HGS hand grip strength

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Table 2. Correlations with bone mineral density

CRP ASMI Fat mass HGS

p value 0.038 0.004 0.001 0.001

Benefit of Denosumab Versus ZA on Time to First On-study SRE Spearman 0.204 0.253 0.387 0.551

BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; HGS hand grip strength

Conclusions Decreased BMD is associated with clinical correlates of cancer cachexia. Effective anti-cachectic therapies may help maintain BMD and reduce complications of osteoporosis. Effective anti-cachectic treatments, which can also improve BMD, could potentially reduce the risk of complications secondary to osteoporosis in advanced cancer patients.

Baseline characteristic Axial bone metastases (n=1,422) Appendicular bone metastases (n=753) Axial & appendicular bone metastases (n=1,695) ≥2 bone metastases (n=2,234) <2 bone metastases (n=3,489) Visceral metastases (n=2,341) No visceral metastases (n=3,382) uNTx ≥43.5 nmol/mmol (n=2,553) uNTx <43.5 nmol/mmol (n=2,553)

HR (95 % CI) 0.83 (0.70,1.00) 0.78 (0.61,0.99) 0.83 (0.71,0.97)

P-value 0.046 0.042 0.022

0.81 (0.71,0.93) 0.84 (0.74,0.94) 0.80 (0.69,0.93) 0.84 (0.75,0.94) 0.86 (0.76,0.98) 0.75 (0.65,0.86)

0.003 0.003 0.003 0.002 0.028 <0.001

Conclusions: Denosumab significantly delayed SREs versus ZA regardless of patients’ baseline characteristics.

MASCC-0219 Bone Health

MASCC-0340 Bone Health BENEFIT OF DENOSUMAB VERSUS ZOLEDRONIC ACID FOR PREVENTION OF SKELETAL-RELATED EVENTS IN SUBGROUPS OF PATIENTS WITH METASTATIC BONE DISEASE

A. Lipton1, K. Fizazi2, A. Stopeck3, D.H. Henry4, M.R. Smith5, N. Shore6, M. Martin7, S. Vadhan-Raj8, K. Zhou9, A. Balakumaran9, A. Braun9 1 Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, USA; 2Institut Gustave Roussy, University of Paris Sud, Villejuif, France; 3Arizona Cancer Center, University of Arizona, Tucson, USA; 4 Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, USA; 5, Massachusetts General Hospital Cancer Center, Boston, USA; 6 , Carolina Urologic Research Center, Myrtle Beach, USA; 7, Hospital Universitario San Carlos, Madrid, Spain; 8, The University of Texas MD Anderson Cancer Center, Houston, USA; 9, Amgen Inc., Thousand Oaks, USA Background and Aims: There is an interest in identifying patients who may benefit most from receiving bone-targeted agents (BTAs). Previous analyses showed denosumab was superior to zoledronic acid (ZA) for preventing SREs (pathologic fracture, radiation or surgery to bone, spinal cord compression) regardless of pain symptoms or SRE status at baseline. We evaluated additional baseline characteristics to identify specific patient subgroups that could benefit from BTAs. Methods: Randomized (1:1) patients with metastatic bone disease received SC denosumab 120 mg and IV placebo (n=2,862) or IV ZA 4 mg (adjusted for CrCl) and SC placebo Q4W (n=2,861) in three double-blinded phase 3 studies. Time to first SRE and time to first-and-subsequent SREs were evaluated by baseline variables including location and number of bone metastases, presence of visceral metastases, and uNTx levels above or below the median (43.5 nmol/mmol). Results: Denosumab significantly delayed time to first SRE versus ZA in all subgroups. Similar results were observed for time to first-andsubsequent SREs.

MARKERS OF ANGIOGENESIS AND INFLAMMATION IN PATIENTS WITH SOLID TUMORS RECEIVING TARGETED THERAPYAND/OR ZOLEDRONIC ACID

D. Galiti1, E. Papadopoulou2, O. Nicolatou-Galitis2, I. Papasotiriou3, E. Linardou4, D. Bafaloukos4 1 Oral Diagnosis, University of Athens, Athens, Greece; 2Hospital Dentistry, University of Athens, Athens, Greece; 3Biochemistry Department, ‘Paidon-Agia Sofia’ Hospital, Athens, Greece; 41st Oncology Department, ‘Metropolitan’ Hospital, Athens, Greece Background and Aims Introduction: Antiangiogenesis inhibition and inflammation through targets, such as VEGF and IL-17 is thought to be associated with jaw osteonecrosis. Objectives: We evaluate VEGF and IL-17 in serum and crevicular fluid in patients, who received targeted therapies and/or zoledronic acid. Methods: Twenty-five solid cancer patients were studied. Fifteen received bevacizumab alone (9) or combined with zoledronic acid (6) or temsirolimus (1). Ten patients received zoledronic acid alone (9) or combined with everolimus (1). VEGF and IL-17 were investigated in the baseline examination and 6 months later. Serum was collected from 21 patients and crevicular fluid from 23 in the first point and from 6 patients (serum) and 5 patients (crevicular fluid) in the 2nd point. VEGF and IL17 were measured by quantitative ELISA kits. Results: At baseline patients had good oral hygiene; one had ONJ stage I; no osteonecrosis was observed during the study period. Serum VEGF was similar in patients with bevacizumab alone or combined with zoledronic acid, while it was significantly lower (P=0.003) when compared to zoledronic acid alone or combined with everolimus. VEGF was not detected in the crevicular fluid. IL17 remained unchanged in all groups and study points, either in serum or crevicular fluid. Conclusions: The stronger VEGF inhibition in bevacizumab versus zoledronic acid, without additive inhibition effect and without increased risk of osteonecrosis, may denote that antiangiogenesis plays little role in osteonecrosis. The good oral health of patients may have resulted to the stable values of IL-17. More patients are needed to confirm these results.

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MASCC-0517 Bone Health DENTAL EXTRACTIONS AS PART OF THE MANAGEMENT STRATEGY IN PATIENTS WITH SOLID CANCERS AND PRE-EXISTING OSTEONECROSIS OF THE JAW STAGE 2

I. Athanassiadis1, E. Galitis2, D. Galiti3, F. Antoniou4, G. Koutinos5, D. Tzaninis6, O. Nicolatou-Galitis7 1 Oncology Department, Mitera Hospital-Hygiea, Athens, Greece; 2Clinic of Orofacial Pain Dental School, University of Athens, Athens, Greece; 3 Clinic of Oral Diagnosis and Radiology Dental School, University of Athens, Athens, Greece; 4Oncology Department, Elenas Venizelou Hospital, Athens, Greece; 5Oncology Department, Aghios Savvas Hospital, Athens, Greece; 6Oncology Department, Hygeia Hospital, Athens, Greece; 7Clinic of Hospital Dentistry Dental School, University of Athens, Athens, Greece Introduction. Dental extractions and poor oral health have been associated with increased risk of osteonecrosis of the jaw (ONJ). Objective. We evaluated the clinical course of 28 extractions of teeth with poor periodontal health in cancer patients and pre-existing ONJ stage 2. Report of cases. Four women with breast (3) and thyroid cancer (1) presented, between June 2013 to November 2014, with severe pain, numbness and ONJ stage 2. Pain, swelling and tooth mobility, followed by dental extraction or tooth exfoliation had preceded the development of ONJ. Radiolucency with densities characterized the ONJ lesions as seen with panoramic radiographs and Cone Beam Computed Tomography, while periodontal ligament widening of the teeth near or within the ONJ lesions was observed. All patients had received zoledronic acid (6 – 36 injections) alone (2) or combined with bevacizumab (1) or sunitininb (1). Three patients had received standard chemotherapy. Results Twenty-eight dental extractions were performed under antibiotics, combined with ozone oil applications. Regression of pain and numbness was achieved within 2 weeks. Post-extraction healing was observed in 27 sockets, covered by oral mucosa, while asymptomatic exposed bone remained in one socket after 2 months of follow up. Pre-existing ONJ regressed to stage 1. Conclusion. The high healing rate of dental extractions (27/28), in patients with pre-exisitng ONJ stage 2, does not support the causal relationship of dental extractions with ONJ. Dental extractions of teeth with poor periodontal health, near or within ONJ areas, may be a good management strategy in such patients to control local infection and ONJ.

MASCC-0166 Bone Health GINGIVAL AND PERIODONTALTOXICITY AND OSTEONECROSIS IN PATIENTS RECEIVING TARGETED THERAPIES ALONE OR COMBINED WITH ZOLEDRONIC ACID: A CASE-SERIES AND CLINICAL IMPLICATIONS

O. Nicolatou-Galitis1, E. Razis2, E. Galitis3, S. Tsimpoukis4, K. Koutsoukos5, J. Sgouros6, N. Soupos7, A. Nikolaidi8, V. Barbounis9, C. Migliorati10 1 Dental School, University of Athens, Athens, Greece; 23rd Oncology Department, Hygeia Hospital, Athens, Greece; 3Department of Orofacial Pain, Dental School University of Athens, Athens, Greece; 4Department of Internal Medicine, 3. Oncology Unit 3rd Sotiria Hospital, Athens, Greece; 5Department of Clinical Therapeutics, Alexandra Hospital Medical School, Athens, Greece; 63rd Department of Medical Oncology,

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General Oncology Hospital of Kifissia “Agioi Anargyroi”, Athens, Greece; 72nd Internal Medicine-Oncology Unit, General Oncology Hospital of Kifissia “Agioi Anargyroi”, Athens, Greece; 8Oncology department, Mitera Hospital-Hygeia, Athens, Greece; 93rd Oncology Department, Metropolitan Hospital, Athens, Greece; 109. Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center College of Dentistry, Tennessee, USA Introduction. Local tissue infection or localized periodontitis are considered risk factors for osteonecrosis of the jaw (ONJ) in patients on targeted therapies and/or antiresorptives. However, evidence of this association is lacking. Objective. We present the clinical data of possible association of gingival and periodontal toxicity and ONJ in 8 patients with solid tumors, who received targeted therapies, as monotherapy or in combinations with zoledronic acid. Report of cases. Eight patients with solid tumors (mean age 46.5) presented with gingival pain, bleeding, gingival necrosis, and/or localized periodontitis, and/or exposed periodontal bone. Two patients received bevacizumab alone, one bevacizumab and zoledronic acid, one bevacizumab and temsirolimus, one bevacizumab, temsirolimus and zoledronic acid, and 3 everolimus and zoledronic acid. The duration of symptoms was 1–2 weeks (6 patients) and 8 and 11 weeks (2 patients). Results: Diagnosis was consistent with necrotizing ulcerative gingivitis (1 patient) and ONJ stage 0 (5 patients). ONJ stage 0 and 2 (two sites) and ONJ stage 2 were diagnosed in two patients with long-term symptoms. Antibiotics and/or dental extractions led to healing (5 patients with symptoms of short duration) or symptom alleviation (2 patients). One patient with ONJ 0 progressed to stage 2, following tooth self-exfoliation. Conclusions. Gingival and periodontitis-like toxicity may represent early clinical stages of ONJ. Early recognition can lead to successful treatment and prevent progression to advanced ONJ stages. Awareness among health care professionals working in oncology is important for the early recognition and management of this toxicity. Further research is needed to confirm this hypothesis.

MASCC-0192 Bone Health INTERNATIONAL PATTERNS OF PRACTICE FOR THE TREATMENT OF PAINFUL BONE METASTASES WITH PALLIATIVE RADIOTHERAPY FROM 1993 TO 2013

M. Popovic1, M.D. Hartogh2, L. Zhang1, M. Poon1, H. Lam1, G. Bedard1, N. Pulenzas1, B. Lechner1, M. Milakovic1, E. Chow1 1 Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Radiotherapy, University Medical Center Utrecht Utrecht University, Utrecht, Netherlands Background and Aims Past randomized controlled trials and meta-analyses have affirmed that single and multiple fraction radiotherapy provide an equally efficacious response in the palliation of painful uncomplicated bone metastases (UBM). However, historical patterns show a preference for multiple fractions. Globally, we aimed to determine the current patterns of practice in this setting. Methods A literature search was conducted on Ovid MEDLINE and Ovid EMBASE. Studies were included if they disclosed patterns of practice either through hypothetical cases or patient data and were published between 1993 and 2013. Weighted analysis of variance was conducted for binary predictors while weighted linear regression analysis was performed for continuous parameters.

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Results Nine hypothetical case studies and 13 actual patterns of practice articles were included from 301 search results. Radiation oncologists prescribed dose fractionations ranging from 3Gy×1 to 2Gy×30, with a median of 3Gy×10, for the palliation of UBM. Actual data demonstrated a weak, non-significant, negative linear relationship between the use of single fraction radiotherapy and the year of treatment (Figure 1). Geographical location, anatomical site, type of practice and presence of oligometastases were key predictors of prescription patterns.

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demographic and clinical factors and an SRE was examined using Cox proportional hazards model, accounting for death as a competing risk. Results Of 7,278 older women with metastatic BC (median age: 77), 3,729 (51 %) developed any SRE during a mean follow-up of 637 days. The proportions of patients who had RAD, FRAC, BS, and SCC were: 35 %, 30 %, 9 %, and 4 %. The mean (median) time from diagnosis to first SRE was 214 (63) days. Of the 3,729 women with at least 1 SRE, 2,627 (70 %) experienced a subsequent SRE. Potential SRE risk factors included baseline estrogen receptor/progesterone receptor positive status, nonHispanic white race and pre-existing osteoporosis and osteoarthritis. Conclusions In this analysis, half of metastatic BC patients experienced at least one SRE, in whom 70 % experienced a subsequent SRE. The most common SREs were RAD and FRAC. Additional research is needed to identify the role of clinical and demographic factors in explaining the risk of subsequent SREs.

MASCC-0244 Cachexia

Conclusions There was an overall global reluctance to practice evidence-based medicine by employing single fractions in the treatment of painful UBM. Prescription patterns have not changed considerably in the last two decades and are influenced by factors related to the radiation oncologist, patient, radiotherapy centre, published evidence and personal beliefs.

MASCC-0498 Bone Health PREVALENCE OF AND FACTORS ASSOCIATED WITH SKELETAL-RELATED EVENTS IN OLDER UNITED STATES WOMEN DIAGNOSED WITH METASTATIC BREAST CANCER

A. Hussain 1 , C. Yong 2 , K. Tkaczuk 1 , Y. Qian 3 , J. Arellano 3 , A. Balakumaran4, A. Liede5, C.D. Mullins2, E. Onukwugha2 1 Department of Medicine, University of Maryland School of Medicine, Baltimore MD, USA; 2Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore MD, USA; 3Global Health Economics, Amgen Inc., Thousand Oaks CA, USA; 4Medical, Amgen Inc., Thousand Oaks CA, USA; 5Center for Observational Research, Amgen Inc., Thousand Oaks CA, USA Background and Aims One in two women with metastatic breast cancer (BC) experience skeletal-related events (SREs); however, there is limited data regarding baseline risk factors associated with an SRE. We estimated the prevalence of SREs and identified factors associated with SREs among older women with metastatic BC. Methods Using the linked SEER (Surveillance, Epidemiology, and End Results) and Medicare data, we identified women aged 66+ with incident metastatic BC diagnosed during 2000–2009. Post-diagnosis SREs identified included radiation therapy (RAD), fractures (FRAC), bone surgery (BS), and spinal cord compression (SCC). The association between patient

ANAMORELIN PHASE III CLINICALTRIAL PROGRAM (ROMANA) FOR THE TREATMENT OF ANOREXIA-CACHEXIA IN NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS: BASELINE CHARACTERISTICS

D. Currow1, A. Abernethy2, K. Fearon3, L. Gleich4, J. Friend5, J. Temel6 1 Palliative and Supportive Services, Flinders University, Adelaide, Australia; 2Department of Medicine, Duke University, Durham, USA; 3 Surgical Oncology, Western General Hospital, Edinburgh, United Kingdom; 4Medical Affairs, Medpace Inc., Cincinnati, USA; 5R&D, Helsinn Therapeutics Inc., Bridgewater, USA; 6Department of Medicine, Massachussets General Hospital, Boston, USA Background and Aims Cancer anorexia-cachexia, a frequent multifactorial syndrome involving altered metabolism and loss of lean body mass (LBM), is associated with increased morbidity and mortality. Anamorelin HCl (ANAM) is a new, oral, selective ghrelin receptor agonist. ROMANA 1 and ROMANA 2 are double-blind, placebo-controlled, randomized (2:1 ANAM vs. placebo) phase III trials assessing ANAM safety/efficacy in Stage III/IV NSCLC patients with cachexia (≥5 % weight loss within prior 6 months or BMI< 20 kg/m2). ROMANA 3 is their safety extension study. Methods In ROMANA 1 and 2, patients receive 100 mg ANAM or placebo once daily for 12 weeks. Co-primary endpoints are the change from baseline in LBM (measured by DXA) and in muscle strength (measured by handgrip strength [HGS]). Secondary endpoints include change in body weight, overall survival, and quality of life (FACIT-F, FAACT). ROMANA 1 only additionally assesses population pharmacokinetics. Patients who complete ROMANA 1 or 2 with ECOG≤2 are eligible for additional 12-week treatment in ROMANA 3. Results ROMANA 1 and ROMANA 2 enrolled 484 and 495 patients, respectively. These are mainly Stage IV NSCLC patients (76.1 %; 70.5 %) with ECOG=1 (69.8 %; 66.5 %), weight loss ≤10 % (61.8 %; 52.3 %), baseline LBM and HGS lower than values commonly observed in healthy adults or patients without weight loss. As of January 2014, ROMANA 3 enrolled 510 patients mainly with ECOG=1 (71.9 %).

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Conclusions After completing 12-week treatment in ROMANA 1 or 2, the majority of patients maintained an eligible performance score and chose to continue in the optional extension study. Efficacy and safety results are awaited.

MASCC-0534

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Table 1. Demographic information N=125 Age BMI Gender

Cachexia Diagnosis CANCER CACHEXIA STAGING: FROM THEORY TO CLINICAL PRACTICE

L. Ciutto1, J. di Tomasso2, R.D. Kilgour3, S. Khan4, J.A. Morais5, M. Borod6, A. Vigano7 1 Clinical Nutrition, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 2Clinical Nutrition, McGill University Health Centre, montreal, Canada; 3Concordia University Exercise Science, McGill Nutrition and Performance Laboratory, Montreal, Canada; 4McGill Nutrition and Performance Laboratory, McGill Nutrition and Performance Laboratory, Montreal, Canada; 5Geriatric Medicine McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada; 6 Palliative and Supportive Care, McGill University Health Centre, Montreal, Canada; 7Palliative and Supportive Care McGill University Health Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada Background and Aims Based upon specific criteria, cancer cachexia stages (CCS) including noncachexia (NC), pre-cachexia (PC), cachexia (CC) and refractory cachexia (RC). However, their clinical relevance and utility have yet to be confirmed. To determine the association between CCS and survival, hospitalization and quality of life (QOL) according to two sets of specific criteria. Methods Patients were classified according to two methods, Set 1 (7criteria) and Set 2 (5criteria), illustrated in Figure 1. Kaplan-Meier survival curves were determined for each method (Figure 2). Comparisons were made of select measures across CCS using ANOVA (Table 1). Results

CCS

(years) (kg/m2) Males Females GI NSCLC Others NC PC C RC

Mean ± SD 62.4±12.2 23.5±5.2 n 75 50 85 24 16 31 33 47 14

% 60 40 68 19 13 25 26 38 11

GI gastrointestinal; NSCLC non-small cell lung cancer; CCS cancer cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; C cachectic patients; RC refractory cachectic patients; BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; HGS hand grip strength

Figure 2. Kaplan Meier survival curves for the different cancer cachexia stages

Figure 1 Sets of classification criteria and methods for CCS

Two-hundred and seventy five patients were included in the analysis. Both sets of criteria similarly predicted survival (Figure 2). Set 2 found more significant differences across CCS than Set 1 with respect to QOL, fatigue and, total hospitalization (Table 1). Set 2 identified differences among ESAS appetite scores across all CCS. Conclusions Both sets of criteria were able to classify patients into meaningful CCS. Criteria included in Set 2 are simpler and more readily available in a clinical practice. These results confirm the clinical usefulness of the aPGSGA for profiling nutritional and functional characteristics in advanced cancer patients.

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MASCC-0320 Cachexia PREVALENCE OF CACHEXIA AMONG PATIENTS WITH SOLID AND HEMATOLOGICAL MALIGNANCIES AT A NATIONAL CANCER INSTITUTE (NCI) DESIGNATED CANCER CENTER DURING THE 12 MONTHS PRECEDING DEATH

E. Del Fabbro1, N. Skoro2, B. Cassel3 1 HematologyOncology and Palliative Care, Virginia Commonwealth University, Richmond, USA; 2Massey Cancer Center, Virginia Commonwealth University, Richmond, USA; 3Hematology Oncology and Palliative Care, Virginia Commonwealth University, Richmond, USA Background and Aims A consensus definition characterizes cancer cachexia as a multifactorial syndrome with loss of lean body mass and progressive functional impairment. The core criterion for diagnosis is weight loss >5 %; or a Body Mass Index (BMI) <20 with weight loss >2 %. Because obesity is common in the general population, cancer cachexia may be under-recognized. Objectives: To determine the prevalence of cachexia among solid (SC) and hematological cancer (HC) decedents using weight loss and BMI criteria, at a NCI center. Methods Retrospective review of 1,891 adult cancer decedents with ≥2 weight measures during the 12 months before death. Height, weight, body mass index, albumin were analyzed relative to death. Descriptive statistics and odds ratios calculated. Results Eight months prior to death, 52 % n=289 were overweight or obese by BMI. 41 % n=42 of patients with HC had >5 % weight loss compared to 27 % n=114 with SC (OR=1.93, 95 % CI 1.23–3.02).Hypoalbuminemia was more common in HC (42 % vs 29 %). At 6 months, 36 % n=192 with SC and 40 % n=46 with HC had weight loss consistent with cachexia. In the final month of life, HC were less likely to have experienced weight loss (OR 0.65, CI 0.48–0.89) than SC, and more SC had an underweight BMI (17 %, n=142 vs 6 %, n=12, OR 3.23, CI 1.76–5.95). Conclusions More than half the decedents had overweight or obese BMI’s 8 months prior to death. Depending on the interval to death, the prevalence of weight loss consistent with cachexia varies between HC and SC patients.

MASCC-0548 Cachexia INCREASE IN SKELETAL MUSCLE AS MEASURED BY COMPUTERIZED TOMOGRAPHY IN NON-SMALL CELL LUNG CANCER PATIENTS RECEIVING ENOBOSARM

C.M. Prado1, X. Jingjie1, M.L. Hancock2, J.C. Crawford3, R.J. Gralla4, M.A. Johnston2, S.G. Small2, R.P. Taylor2, J.T. Dalton2, M.S. Steiner2 1 Department of Nutrition Food and Exercise Sciences, Florida State University, Tallahassee, USA; 2Medical Affairs, GTx Inc., Memphis, USA; 3George Barth Geller Professor for Research in Cancer, Duke University Medical Center, Durham, USA; 4Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, USA Background and Aims Computerized tomography (CT) is a state-of-the-art technique providing direct assessment of skeletal muscle (SM), a critical component of lean body mass (as measured by other techniques such as DXA). SM loss observed among patients with non-small cell lung cancer (NSCLC) is associated with poorer prognostic outcomes. Here, we investigate the efficacy of an anabolic agent in promoting SM gain in patients with stage III or IV NSCLC.

Methods SM was assessed by quantitative analysis of CT images from participants enrolled in two Phase 3 trials of enobosarm, a nonsteroidal, selective androgen receptor modulator (SARM). Patients were randomized to placebo or enobosarm (3 mg/day) at initiation of first-line standard platinum doublet chemotherapy (Power1= platinum+taxane or Power2= platinum+non-taxane) and continued through day-147. SM change is reported from baseline to day-84 and day-147. Results Enobosarm was associated with significant SM (whole body basis) gains. In Power1, the median change in SM from baseline to day-84 differed (p<0.0001) between enobosarm (+0.5 kg, n=103) and placebo patients (-0.3 kg, n=107) and was more pronounced at day-147 (+0.1 kg and −0.8 kg; p<0.0001). Similarly, in Power2, median change in SM from baseline to day-84 differed (p=0.03) between enobosarm (+0.3 kg, n=101) and placebo patients (−0.2 kg, n=99) and was again more pronounced at day147 (+0.5 kg and −0.3 kg; p=0.003). SM gain ≥1 kg at day-84 was associated with longer median survival in the enobosarm arm (+2.6 months, p=0.04). Conclusions Enobosarm promoted SM gain, and SM gain was associated with prolonged survival. CT analysis can be used as an opportunistic tool to assess body composition in clinical trials.

MASCC-0546 Cachexia ENOBOSARM, A SELECTIVE ANDROGEN RECEPTOR MODULATOR (SARM), INCREASES LEAN BODY MASS (LBM) IN ADVANCED NSCLC PATIENTS; UPDATED RESULTS OF TWO PIVOTAL, INTERNATIONAL PHASE 3 TRIALS

J.C. Crawford1, M.A. Johnston2, M.L. Hancock2, S.G. Small2, R.P. Taylor2, J.T. Dalton2, M.S. Steiner2 1 Division of Medical Oncology, Duke University Medical Center, Durham, USA; 2Medical Affairs, GTx Inc., Memphis, USA Background and Aims Cancer-induced muscle wasting is a progressive disease related symptom that is a consequence of a reduced rate of anabolic activity and increased catabolic activity. Enobosarm is a first-in-class nonsteroidal oral SARM. We report top line results for two Phase 3 clinical trials conducted for the prevention/treatment of muscle wasting in patients with NSCLC. Methods Six hundred forty-one patients (Stage III/IV NSCLC) were randomized at initiation of first-line chemotherapy; platinum + taxane {POWER1, n= 321} or platinum + non-taxane {POWER2, n=320} plus add on, consisting of either enobosarm 3 mg or placebo for 5 months. Patients were males and postmenopausal females ≥30 y, and ECOG ≤1. Coprimary endpoints (Day 84) are physical function response assessed by stair climb power (SCP) and lean body mass (LBM) as measured by DXA. Results Mixed model repeated measures (MMRM) slope analysis of coprimary endpoints: MMRM Slopes – POWER1

MMRM Slopes – POWER2

Placebo Enobosarm p-value (n=161) (n=160) −0.0773 +0.0443 0.0147

Placebo Enobosarm p-value (n=161) (n=159) −0.0245 −0.0305 0.8877

SCP (Day 84) %/day LBM (Day 84) −0.011 +0.0049 kg/day SCP (Day 147) −0.0794 −0.0191 %/day LBM (Day 147) −0.0104 +0.0014 kg/day

0.0002

−0.0044 +0.0056

0.0111

0.0492

−0.0094 +0.0052

0.6138

<0.0001 −0.0038 +0.0031

0.0028

Adverse events were similar between enobosarm/placebo subjects in both trials.

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Conclusions Overall, enobosarm was safe and well tolerated. Declines in LBM and SCP were observed in the placebo group of both trials. In POWER1 statistically and clinically meaningful differences between enobosarm and placebo were observed for SCP and LBM. In POWER2, statistically and clinically meaningful differences between enobosarm and placebo were observed for LBM.

MASCC-0603 Cachexia LENALIDOMIDE (L) IN INFLAMMATORY CANCER CACHEXIA (CC): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PROOF-OF-CONCEPT STUDY

R. Oberholzer1, D. Blum1, M. Joerger2, S. de Wolf-Linder3, T. Cerny2, F. Strasser1 1 Oncological Palliative Medicine Oncology Dept. Int. Med. & Palliative Care Cntr Dept. Int. Med. Disc., Cantonal Hospital, St.Gallen, Switzerland; 2Clinic Oncology/Hematology Dept. Int. Med., Cantonal Hospital, St.Gallen, Switzerland; 3Oncological Palliative Medicine Oncology Dept. Int. Med., Cantonal Hospital, St.Gallen, Switzerland Background and Aims CC impacts physical function, survival, quality-of-life and anticancer treatment. Inflammation is an important mediator of CC. To investigate if Lenalidomide has promising activity in patients with CC and systemic inflammation. Methods Patients (pts) with advanced solid malignancies, weight loss (≥5 %/6mts), with no or unchanged anticancer treatment (continued treatment for >4 wks), and CRP >30 mg/were treated with L 25 mg/d or CRP-guided L (5 mg starting dose, max 25 mg) or placebo (P) for 8 weeks applying biweekly dose adaption in a 1:2:2 randomization. Responders were defined as 32 % increase of lean body mass [CT-scan L4/5], and 34 kg increase of hand-grip strength [Jamar®]. Secondary endpoints included adverse events, CRP, nutritional intake, symptoms and physical functioning. Results Of 24 eligible pts 16 (12M, 4F) were included (5 mesothelioma, 2 NSCLC, 2 renal-cell carcinoma, 2 neuroendocrine tumors, 5 other). Nine pts completed 8 weeks of treatment, mean survival was 43 days. No responder was identified. CRP-guiding did not result in lower doses. Decrease of muscle mass was 1,141 cm2 (P) and 23 cm2 (L), of muscle strength 5,5 kg and 2,25 kg, increase of nutritional intake 32 kcal/d and 249 kcal/d and change of CRP +17 mg/dl and −35 mg/dl, respectively. Intervention-related adverse-events were mainly haematological toxicity and fatigue. Conclusions Treatment with Lenalidomide was feasible with close monitoring. No responder on muscle mass and strength was observed, but trends towards slower decrease. Present treatment with other anticancer drugs hampered accrual. Lenalidomid has limited potential to improve cachexia in this setting. Study support: Celgene (free study treatments [P, L], unrestricted grant); Hospital St.Gallen (grant CTU-11-006; EKSG-09/040)

MASCC-0007 Cachexia WHY DO CANCER PATIENTS DECLINE PARTICIPATION IN A LOW RISK, NON-INTERVENTIONAL CANCER-ASSOCIATED WEIGHT LOSS STUDY? CAPTURING VERBATIM, REAL-TIME COMMENTS TO INFORM INVESTIGATORS

T. Wanger1, N. Foster2, P. Nguyen3, A. Jatoi4 1 Cancer Education Program, Mayo Clinic, Rochester, USA; 2Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA; 3Department of

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Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA; Department of Oncology, Mayo Clinic, Rochester, USA

4-

Background and Aims Fewer than 5 % of cancer patients participate in clinical research. Although this paltry rate has led to extensive research on this topic, previous studies have not sought verbatim comments in a real-time, comprehensive manner to understand why patients decline. Our aim was to identify and better understand issues related to lack of participation in low risk, non-interventional cancer research. Methods This study used a low-risk, non-interventional parent study that focused on cancer-associated weight loss to understand patients’ reasons for declining research participation. A research assistant wrote down the name and verbatim reason of all patients who declined to participate. These comments with accompanying patient demographic data are the subject of this research. Results Of 334 patients, 51 (15 %) declined parent study enrollment; 3 commentrelated themes emerged: 1) a repelling sense of too much institutional research; 2) overwhelming personal health issues; and 3) a low likelihood of returning to the institution. In univariate and multivariate analyses, only age (older) and gender (female) were associated with nonenrollment. Interestingly, 41 patients with fatigue scores of 7 or worse and 26 with pain scores of 7 or worse enrolled. Conclusions Although many factors were associated with declining to participate in research, symptom severity was not. Up front education might help cancer patients better prioritize their participation in research, particularly as some patients felt overwhelmed by too much research in the institution; and for now, investigators should continue to keep asking patients for their participation.

MASCC-0221 Cachexia A LONGITUDINAL STUDY OF BODY COMPOSITION IN HEAD AND NECK CANCER PATIENTS UNDERGOING RADIATION-BASED THERAPY UTILIZING DEXA AND CT IMAGING

L. Zatarain1, C. Smith2, B. Murphy1, M. Dietrich3, S. Ridner4, K. Niermann2 1 Division of Hematology & Oncology, Vanderbilt University School of Medicine, Nashville, USA; 2Radiation Oncology, Vanderbilt University, Nashville, USA; 3Nursing Psychiatry and Biostatistics, Vanderbilt University, Nashville, USA; 4Nursing, Vanderbilt University, Nashville, USA Background and Aims Radiation in head and neck cancer (HNC) patients results in severe unintentional weight loss with lean body mass (LBM) wasting accounting for 70 % of total losses. Slice-O-Matic is computer software which utilizes routine CT imaging to assess body composition. CT imaging would be an invaluable tool in body composition analysis if: 1) LBM measurements using this software correlate with gold standard measures such as DEXA, and 2) feasible for use in head and neck region. Methods We conducted a secondary analysis of 31 HNC patients undergoing XRT. DEXA measured LBM and fat mass at baseline and 3 months post-XRT. Routine CT images of the neck acquired at the same time points were analyzed with Slice-O-Matic software to generate estimates of total LBM. We calculated cross-sectional areas (cm2) of the posterior paraspinal muscles at levels C6 and C7. LBM and skeletal muscle surface area were normalized for stature to define skeletal muscle indices (SMI).

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Results At baseline, statistically significant direct correlations were observed between DEXA LBM and both SMI C6 and C7 values (r=0.57 and 0.59 respectively, p=0.001). At 3-months post-XRT, these correlations reduced to 0.39 (C6, p= 0.034) and 0.14 (C7, p=0.464). Similarly, statistically significant direct correlations were observed between DEXA fat mass and C6 adiposity at baseline (C6, r=0.59, p=0.001) and 3 months (C6, r=0.55, p=0.002). Conclusions Although the correlations of C6 and C7 posterior paraspinal musculature with whole LBM in this HNC sample were statistically significant, they were not sufficiently strong to recommend use of the Slice-o-Matic software in this setting.

MASCC-0366 Communication HIGHER RATE OF RECEIVING PALLIATIVE SEDATION IN WHOM COMPLETED ADVANCE DIRECTIVES

H.J. An1, H.S. Kim1, B.H. Kong1, Y. Kim1, Y. Kim1, Y. Kang1, H. Kim1 1 Department of Medical Oncology & Hospice Center, Catholic University, Suwon, Korea Introduction: Advance directives (ADs) has been recently issued and gradually accepted in Korea. Palliative sedation (PS) is used in terminal cancer patients suffering from refractory symptoms. The decision for PS is usually made not by patients but by family. Since October 2012, we have recommended ADs and ask about PS to terminal cancer patients. Objectives: To find out the association between completing ADs and performing PS Methods: From October 2012 to September 2013, medical chart of 214 new patients in hospice and palliative unit was retrospectively reviewed. Results: Seventy-six patients (35.5 %) completing ADs, but ADs were not completed in patients with poor performance or family’s disagreement. Sixtyeight (31.8 %) agreed PS. The PS was actually performed in 37 (17.4 %) of 214 patients; 20/138 patients without ADs (14.5 %), 17/68 patients who agreed PS (25.0 %), none (0/8, 0 %) patients who did not agree PS on ADs. Higher trend of performing PS in patients who completed ADs comparing to patients who did not (25.0 % vs. 14.5 %, P=0.057). The decision at the time of performing PS was made by patients themselves, spouses, and son/daughters in 2.8 %, 38.9 %, and 36.1 % respectively. Among patients receiving PS and completing ADs, the decision of PS was made by same proxy written in ADs (82.4 %). Conclusions: Most patients completing AD agreed PS, and they showed higher rates of receiving PS comparing to patients without ADs. Completing ADs in advance might influence the decision making of PS for family members in a positive way.

MASCC-0451 Communication MEDICAL CARE ATTENTION AND SATISFACTION EVALUATION IN THE BREAST CANCER SERVICE AT NATIONAL CANCER INSTITUTE, MEXICO CITY (INCAN)

C. Arce-Salinas1, L. Mendoza-Galindo1, M. Navarro2, R. Caba-Tinoco3, A. Alvarado-Miranda1, G. Calderillo-Ruiz4, J.L. Aguilar-Ponce5 1 Breast Cancer, Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico; 2Integral Attention Support Center (CAAI), Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico; 3Clinical Research, Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico; 4Medical Oncology, Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico; 5Internal Medicine, Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico

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Background and Aims Introduction: Patients knowledge about their disease is highly important; it has been related with treatment adherence and satisfaction level. 44,761 consultations were given at INCan in 2012 and 44 % of them by breast cancer service. We suggest that this busy schedule is associated with shorter time consultations, patient information deficit, lower satisfaction and low quality medical care. Objectives: To identify the association between patient knowledge and the perception of medical attention. Also we evaluate our service’s quality. Methods Self-response survey was done in breast cancer patients. Demographic variables such as age, scholarship, marital status were asked in combination with diagnosis, prognosis and treatment comprehension level. Variables related with our service’s quality, global care support and waiting time before consultations were asked too. Finally, we questioned about explanations given by doctors about daily activities, diet and workout. Results Two hundred fifty-nine patients were surveyed. Median age was 50 years old (17–88); 18 % achieved university degree and 28.7 % had less than elementary education. Education level was significantly associated with diagnosis (77 vs. 88 %, p=0.032), prognosis (47 vs. 61 %, p=0.043) and treatment (58 vs. 73 % p=0.019) understanding. Although 70 % of the patients are satisfied with the medical attention, 30 % of them did not receive information about integral support given at INCan and 43 % referrers that doctors did not give enough information related to treatment care and daily activities. Conclusions Efforts to improve medical care attention have to focus in doctor-patient communication and patient knowledge to reach a greater proportion of satisfaction and better medical attention.

MASCC-0351 Communication INFLUENCE OF PSYCHOSOCIAL CONSULTATION WITH COMPREHENSIVE PSYCHOSOCIAL ASSESSMENT (CPA) ON INDENTIFYING THEIR DIFFICULTIES IN CANCER PATIENTS

S. Baek1, J.J. Lee1, S.Y. Kim1 1 Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea Background and Aims We evaluated the contributory factors to investigate the psychosocial difficulties and to determine the referral to the social worker in cancer patients. Methods From February to December 2009 we prospectively conducted the study in Gangdong Kyung Hee University Medical center, Seoul, Republic of Korea. We investigated patient’s characteristics, seven questionnaires, including financial problem, information of social system, personal care problem, psychological problem, and rehabilitation problem and their overall need of consultation. Results A total of 95 patients were enrolled. The median age was 58 years and male was 65 %. The common diseases were lung cancer and gastrointestinal cancer. Two thirds was stage IVand in the course of chemotherapy. The most common needs were to know the social system (90 %), to solve the financial (74 %), and personal care problem (70 %) according to patients but the social system (96 %), financial (65 %), and psychological problem (47 %) according to physician. The agreement of the financial problem was highest (Kappa coefficient, 0.212, p=0.035) between patients and physician. 2 or more of total count was significantly correlated with their overall need (R=0.434, p<0.0001). With the referral, 26 %, 37 % and 34 % of patients benefit from support, interview or intervention in terms of financial problem, the benefit of social system and psychosocial problem, respectively.

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Conclusions With the comprehensive psychosocial assessment, more than a third patient benefited. The assessment of the psychosocial difficulty would be considered as the sixth vital sign and be evaluated to identify the contributory factors in cancer patients for improving the quality of life.

MASCC-0285 Communication COMMUNICATION SKILLS TRAINING IN ONCOLOGY: A NEW PROJECT IN LITHUANIA

G. Bulotiene1, S. Birbilaite2, V. Mickeviciene3 1 Department of Physical Medicine and Rehabilitation, Vilnius University Institute of Oncology, Vilnius, Lithuania; 2Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania; 3Cancer Control and Prevention Center, Vilnius University Institute of Oncology, Vilnius, Lithuania Background and Aims Lithuania has not yet developed any communication skills training (CST) program for health care professionals working with cancer patients. The aims of the project were: 1) to accomplish a pilot study in order to determine the CST needs for cancer care professionals; 2) trainers group to be trained; 3) to develop a CST module, based on pilot study research results and received training in CST, for nurses, paramedics and doctors; 4) to provide CST for cancer care professionals. Methods CST needs evaluation questionnaires based on cancer research data and survey from oncologists, oncology nurses and cancer patients were prepared. 70 health-care professionals from the oncology units and 60 cancer patients have completed questionnaires. Sixteen hour CST program was developed based on CST needs evaluation results. The program offers a variety of theoretical models with special focus on handling emotions and breaking bad news in oncology. It integrates a lot of interactive methods such as self-reflection, video analysis, exercises and role-plays. Results Seventy-six percent of nurses and 53 % of doctors admitted a lack of adequate training in communication skills. At project start CST based on Swiss experience was provided for 6 trainers. In 2013–2014 we provided intensive 16 workshops for ten groups of personnel, involving 164 participants. Conclusions The new CST module is an effective tool for teaching communication skills. Future research is required to assess the impact of the CST on doctor-patient’s relationship in order to support the implementation of the CST in the national system of cancer care.

MASCC-0543 Communication CONCURRENT MEDICAL EVIDENCE (“HOT TUBBING”)

A. Pinkerton1, J. Hardy2 1 TC Beirne Law School, University of Queensland, Brisbane, Australia; 2 Palliative and Supportive Care, Mater Research Institute-The University of Queensland, Brisbane, Australia Background and Aims It is current practice in many civil trials involving medico-legal disputes for multiple expert witnesses to give evidence. Traditionally, witnesses have given evidence separately. Their assessments of disability and/or degree of permanent impairment have often been conflicting, creating a widely disparate process. There is also the potential for bias in

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circumstances where practitioners may feel pressured from advocates and litigants from whom they are briefed and receive remuneration. An alternate process is currently being trialled in some Australian jurisdictions and international counterparts. Concurrent medical evidence (“hot tubbing”) has been introduced in an attempt to reduce the problems associated with the traditional adversarial process. The concurrent model involves medical witnesses giving evidence contemporaneously in a symposium facilitated by a judge. The aim of this study was to conduct a review of “hot tubbing” as it has been used to date, to examine its feasibility. Methods An extensive search of legal websites (eg LexisNexus, Westlaw) was conducted. Local and international experts were contacted to determine their views. Results The concurrent model seems popular amongst many medical professionals who value the bipartisan professional dialogue the method facilitates. Some doctors have felt restricted and intimidated by the traditional “hired gun” adversarial process. Conversely, some legal practitioners are reluctant to adopt the model as it impedes their ability to use cross examination to full advantage. Time and cost issues are cited by proponents on both sides. Conclusions If endorsed by the legal profession, “hot tubbing” may become the standard practice. Much depends on feedback from the medical profession.

MASCC-0266 Communication REHABILITATION OF LIMITED GERMAN PROFICIENT PATIENTS IN AN OUT-PATIENT SETTING IN BERLIN

C. Kerschgens1, S. Brandis1 1 Oncology, Vivantes Rehabilitation, Berlin, Germany Background and Aims Rehabilitation serves to regain function and self-empowerment after cancer. This includes educational programs. In Patients with native languages other than German this might be a problem. Methods In 2008 all patients in our department were given a home language assessment. Patients with native languages other than German were assessed concerning their language proficiency. This was classified as ‘very good’ when the level was equivalent to that of native speakers and ‘good’ when the patient was able to understand the information given and respond to questions. It was said to be ‘poor’, when the patient was able to understand information concerning the organisation and ‘none’ when the patient was not able to understand basic information. Results In 2008, 517 patients were treated. 15,3 % spoke languages other than German as their first spoken language. Most of them, 32,9 %, spoke Turkish; 20,3 % spoke languages of the former Yugoslavia and 11,4 % spoke Russian/Ukrainian. In the assessment of language proficiency 45,6 % were assessed ‘very good’, 21,5 % ‘good’, 12,7 % ‘poor’, 20,3 % ‘none’. Combining the groups of ‘very good’ and ‘good’, this accounts for 12 patients with Turkish (out of 26), 11 Patients with languages of former Yugoslavia (out of 16) and 5 of Russia/Ukraine (out of 9); combining the groups of ‘poor’ and ‘none’ this accounts for 14 Turkish patients and 5 Patients of former Yugoslavia and 4 of Russia/Ukraine. Conclusions In our department in 2008 15,3 % of patients had languages other than German as their native language. Nevertheless during rehabilitation support has to be organized to ensure that needed information can be delivered.

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MASCC-0503 Communication COMMUNICATION FOR END-OF-LIFE CARE PLANNING AMONG PATIENTS WITH TERMINAL CANCER: A CONTEXT-ORIENTED MODEL

S.J. Koh1, S. Kim2, J.S. Kim3 1 Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Korea; 2Department of Nursing, Changwon National University, Changwon, Korea; 3Department of Nursing, Sunchon National University, Sunchon, Korea Introduction: Terminally ill patients or those with terminal cancer are often excluded in the loop of end-of-life (EOL) discussion in Korea. Further, healthcare professionals have difficulty engaging in such communication in a variety of healthcare contexts. A communication model for EOL care planning is demanding in Korea. Objectives: To solicit professional opinions on communication with terminal cancer patients and their family caregivers and to develop a communication model for EOL care planning compatible with clinical environment in Korea. Methods: Using focus group interview, six doctors and five nurses who provide EOL care for terminal cancer patients in acute hospital settings or hospice care facility from distinct provinces of Korea participated in this study. Results: Five themes emerged regarding EOL care planning that included right time, a responsible professional, preparedness for breaking bad news, content of EOL care discussion, and implementation of EOL care decisions. These themes were based for the development of a communication algorithm for EOL discussion among patients with terminal cancer (Figure 1), in which a structural communication steps for delivering a terminal prognosis was specified at the phase of preparedness beginning with determination of a patient decision-making capability, followed by a patient perception of his/her condition, a patient’s wish to know, family decision-making dynamics, and a patient’s and/or family’s readiness for EOL discussion. Conclusion: It is suggested that the proposed context-oriented communication algorithm be communication supporting guidelines for EOL discussion and accordingly, facilitate meaningful improvements in EOL care in clinical practice.

MASCC-0501 Communication COMMUNICATION FOR END-OF-LIFE CARE PLANNING AMONG KOREAN PATIENTS WITH TERMINAL CANCER: A CONTEXT-ORIENTED MODEL

S.J. Koh1, S. Kim2, J.S. Kim3 1 Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Korea; 2Department of Nursing, Changwon National University, Changwon, Korea; 3Department of Nursing, Sunchon National University, Sunchon, Korea Introduction: Terminally ill patients or those with terminal cancer are often excluded in the loop of end-of-life (EOL) discussion in Korea. Further, healthcare professionals have difficulty engaging in such communication in a variety of healthcare contexts. A communication model for EOL care planning is demanding in Korea. Objectives: To solicit professional opinions on communication with terminal cancer patients and their family caregivers and to develop a

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communication model for EOL care planning compatible with clinical environment in Korea. Methods: Using focus group interview, six doctors and five nurses who provide EOL care for terminal cancer patients in acute hospital settings or hospice care facility from distinct provinces of Korea participated in this study. Results: Five themes emerged regarding EOL care planning that included right time, a responsible professional, preparedness for breaking bad news, content of EOL care discussion, and implementation of EOL care decisions. These themes were based for the development of a communication algorithm for EOL discussion among patients with terminal cancer (Figure 1), in which a structural communication steps for delivering a terminal prognosis was specified at the phase of preparedness beginning with determination of a patient decision-making capability, followed by a patient perception of his/her condition, a patient’s wish to know, family decision-making dynamics, and a patient’s and/or family’s readiness for EOL discussion. Conclusion: It is suggested that the proposed context-oriented communication algorithm be communication supporting guidelines for EOL discussion and accordingly, facilitate meaningful improvements in EOL care in clinical practice.

MASCC-0368 Communication ONLY ONE THIRD OF TERMINAL CANCER PATIENTS COMPLETED ADVANCE DIRECTIVES IN ST. VINCENT’S HOSPITAL HOSPICE CENTER

B. Kong1, I. Kim1, J.E. Lee1, S. Ho1, Y.J. Park1, Y. Kang1, H.J. An1, H. Kim1 1 Department of Medical Oncology & Hospice center, The Catholic University of Korea St. Vincent’s Hospital, Suwon, Korea Background and Aims Introduction: To protect cancer patient’s autonomy when confronting death, the importance of advance directives (ADs) has been recently issued and gradually accepted in Korea. However, few patients signed ADs in real practice. We have introduced ADs form to patients on admission to hospice center since October 2012. Objectives: To analyze how many patients completed ADs form and patient’s preference for end-of life care and proxy. Methods: From October 2012 to September 2013, medical chart of 214 new patients was retrospectively reviewed. Results: Seventy-six (35.5 %) patients completed ADs. Seventy (90.9 %) patients completed ADs with their caregivers, while the rest singed ADs alone. Most patients did not want to receive cardiopulmonary resuscitation except one (1.3 %), and refuse dialysis except four (5.2 %) patients. Seventeen (22.1 %) patients wanted artificial nutritional supports. Sixty eight (89.5 %) agreed palliative sedation. As a proxy, patients preferred their spouses in 55.8 %, and son/ daughters in 28.6 %. The reason for not completing ADs was the poor performance of patients (59.4 %), and caregiver’s or patient’s refusal was the next. The median timing of ADs after admission was 3 (0–90) days, and duration of survival since ADs was 22 (1–340) days. Conclusions: Most patients did not want life-sustaining treatments, but some wanted artificial nutritional support. Palliative sedation was easily accepted. Considering that patient’s poor condition was the main reason of not completing ADs, earlier discussion about ADs is necessary.

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MASCC-0303 Communication EQUAL SHARING OF INFORMATION IN THE CONTEXT OF PERSONALIZED MEDICINE IN ONCOLOGY

P. Leroy1, M.F. Mamzer-Bruneel2, C. Herve2, F. Scotte3 1 Supportive Care in Cancer Unit, Hôpital Européen Georges-Pompidou, Paris, France; 2Departement of medical ethics, Paris Descartes University, Paris, France; 3Supportive Care in Cancer Unit, Hôpital Européen Georges Pompidou, Paris, France Background and Aims The development of personalized medicine in oncology requires not only a better understanding of the mechanisms of carcinogenesis, but also identification of prognostic biomarkers and targeted therapies in order to more accurately assess the management of patients. This includes an equal sharing of knowledge among clinicians, research programs and patients. Methods We attempted to identify the key participants in the care management of personalized medicine so that an equal sharing of information could be made between patients and caregivers. The objective was to guide action and development in the field of research and clinical practice. Results In the Cancer Research for Personalized Medicine (CARPEM) organization, two distinct multidisciplinary committees were created: the patient committee and the interface committee. Personalized medicine enabled these two committees to establish a feedback exchange, first with a more citizen ethics approach and second a medical ethics approach. We also evaluated the care pathway which involved various oncology experts. Once the care pathway was established, we assessed the experts who routinely participate in the interface group, i.e. radiologists, pathologists, biologists etc. Conclusions The results of our study showed that there were many ethical problems linked with the emergence of personalized medicine and patient information. The equal sharing of patient-caregiver information would improve the quality of cancer patient care management .

MASCC-0309 Communication WHO SPEAKS FOR THE PATIENT? MISMATCH BETWEEN ‘EMERGENCY CONTACTS’ AND ‘HEALTH CARE AGENTS’ IN THE MEDICAL RECORD

N. Faust1, T. Nolte1, B. Meisenberg1 1 DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, USA Background and Aims Integrating goals of care discussions into the care plans of oncology patients is receiving increasing attention. Hospitalization often indicates a deterioration in clinical status which affords goals of care discussions. When patients cannot speak for themselves, crucial conversations need to be held with Health care agents (HCAs). We sought to determine if the electronic medical record (EMR) accurately defined the authorized health care agent HCA) or desired spokesperson. Methods Forty-two randomly selected oncology inpatients were asked who they would choose to be their HCA or spokesperson in case of a medical crisis. Queries were made only in private when no family members or friends were present. We then reviewed the EMR ‘emergency contacts’ to see if the desired HCA or spokesperson was also the emergency contact (EC).

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Results All 42 patients had been admitted for symptom management. No patient refused participation. Fifteen of the 42 (36 %), designated a person different than the one identified as the EC. Conclusions The EC and HCA are distinct roles. EC information is gathered by non-clinical clerical personnel without the training to explain the distinction. Some patients describe EC as the person to call for transportation problems; others as the person to call for clinical deterioration but not necessarily as a spokesperson or decision maker. Further, it is not part of routine nursing practice to review this information. Hospital processes should be amended to include explicit questioning about HCA, in addition to EC, in order to facilitate goals of care discussions.

MASCC-0585 Communication USE OF CHECKLIST TO IMPROVE COMMUNICATION IN MULTIDISCIPLINARY CARE OF CANCER PATIENTS

D. Niharika1, P. Wong2 1 Medicine, University of California San Francisco, San Francisco, USA; 2 Nursing, University of California San Francisco, San Francisco, USA Background and Aims Cancer patients who are admitted for chemotherapy are cared for by multidisciplinary teams. This creates confusion and leads to miscommunication or no communication between many providers. We sought to create a solution that will allow us to delineate expectations, encourage communication and improve education. Methods We created a checklist to be filled out by providers at each point in patient care to ensure care of the patients and reducing adverse outcomes. The checklist is divided in to three separate parts. The first part is filled out by the primary outpatient oncology provider who is expected to fill in the details of treatment during admission. The second part is filled out by admitting oncology provider who meets with the medicine residency team and goes over the second part of the checklist. This improves communication between the services and is also an excellent opportunity for education. Third part of the checklist is filled out by primary team at time of discharge. This includes any complications, prophylaxis, anti nausea medications and outstanding laboratory or imaging results. Results We rolled out the checklist as we had two adverse events related to poor communication. Over the last 4 months we have 12 completed checklists. We have not noted any adverse events. There was also higher satisfaction among the medicine and family practice residents. Conclusions Checklists have shown to be a significant way of reducing errors in medicine as well as in other industries. Checklist can be an important tool in patients receiving chemotherapy and may reduce adverse outcomes.

MASCC-0525 Communication COPING WITH UNCERTAINTY: A QUALITATIVE STUDY OF 36 PALLIATIVE CARE CONSULTATIONS AMONG PATIENTS WITH ADVANCED CANCER

M. Tejani1, C.S. Kamen2, S.G. Mohile1, R.E. Gramling3 1 Hematology/Oncology, University of Rochester Medical Center, Rochester, USA; 2Cancer Control, University of Rochester Medical Center, Rochester, USA; 3Palliative Care, University of Rochester Medical Center, Rochester, USA

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Background and Aims Palliative care consultation can reduce emotional distress and improve quality of life (QOL) for cancer patients. Uncertainty about the future can lead to distress, loss of sense of control and lower QOL for patients. Little is known about how palliative care providers help cancer patients manage uncertainty. Methods We performed qualitative analysis of audio recorded inpatient palliative care consultations among adult cancer patients referred for ‘goals of care’ or ‘end of life planning.’ Each transcript was read as a whole and then line by line to code direct and indirect expressions of uncertainty. Excerpted segments dealing with uncertainty about the future were analyzed by an experienced qualitative research working group. Results Thirty-six consultations were analyzed: 53 % men, median age 62. Multiple expressions of uncertainty were identified – 121 by patients/families and 66 by providers. Sixty-two percent were centered on uncertainty in predicting an individual patient’s trajectory. Palliative care providers coped with this type of uncertainty in three main ways: (a) reiteration of what was certain at time of consultation (e.g. ‘we will not let you suffer’); (b) utilizing uncertainty to promote hope and faith (e.g. ‘nobody knows how long you are going to survive ’) and (c) reassurance of providing consensus at next visit (eg. ‘we will put our heads together and come up with exact options.’) Conclusions Uncertainty is prevalent during consultations with cancer patients. Palliative care providers use distinct methods to help patients to manage what is inherently uncertain about their future. Communication skills training for providers could build on these strategies.

MASCC-0258 Communication 2 ASSESSMENT OF DEPRESSION, ANXIETY, AND SELF-ESTEEM IN FEMALE PATIENTS WHO UNDERWENT SURGERY DUE TO BREAST, THYROID, COLORECTAL OR OVARIAN CANCER

O. Ata1, B. Karakaya2, M. Araz1, F. Inci1 1 Medical Oncology, Selcuk University, Konya, Turkey; 2Internal Medicine, Selcuk University, Konya, Turkey Background and Aims A wide variety of emotional and behavioral reactions occur in a cancer patients starting from the diagnosis through all treatment stages and afterwards. An individual’s psychologic response to cancer is influenced by several aspects of the cancer. A person’s ability to manage diagnosis and treatment commonly changes over the course of the illness and depends on medical, psychologic, and social factors. Aim of this study is assessment of depression, anxiety, and self-esteem in female patients who are in remission after completed primary surgery and adjuvant treatment of different cancer types Methods In this study, anxiety, depression and self-esteem were assessed using the Hospital Anxiety and Depression Scale and Rosenberg Self-Esteem Scale in 120 cancer survivors and in 30 healthy people used as control group. The t-test and Chi-square test were used for statistical analysis. Results While no statistically significant difference was found between the depression and anxiety scales of the patients and the control group, selfesteem was seen to markedly decrease in the patients. When anxiety, depression and self-esteem were compared by cancer types, no statistically significant difference was found in terms of depression, but there was a difference between the diseases in terms of anxiety and self-esteem. Anxiety and depression was low but self-esteem was high in the patients with papillary thyroid cancer.

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Conclusions Depression and anxiety may not be higher in cancer survivor patients than normal population, but self-esteem is generally lower in cancer survivor patients than normal population related to consequence of cancer surgery that impact on physical appearance.

MASCC-0157 Communication 2 RECOGNISING GRIEF IN ONCOLOGY PATIENTS AND THEIR CAREGIVERS. VIEWPOINT: THE ROLE OF THE DOCTOR

J. Lacey1 Oncology and Supportive Care, St George Private Hospital, Sydney, Australia 1

Background and Aims As people live longer with a diagnosis of incurable cancer and all its uncertainty, researchers remind us to consider anticipatory grief. Both patient and family can be grieving — a process that may begin at any time from the moment of a cancer diagnosis. Recognizing and addressing the psychological distress of patients and their families often falls to the oncologist or palliative care physician. When it comes to patient grief, how do we diagnose this and differentiate it from other complaints? Which patients are more susceptible? How do we identify the family with anticipatory grief? Methods An exploratory presentation looking at the literature around anticipatory grief, based on an invited peer viewpoint published in the Journal of Supportive Oncology in 2011 . This presentation looks at the impact of the study by Kacel, Gao, and Prigerson, and other studies of anticipatory grief and how, as physicians, the doctor-patient and doctor care-giver relationship is crucial to well being and reducing suffering. Results Raising awareness around anticipatory grief has the potential to reduce long term morbidity. Conclusions Clinicians have the opportunity to aid in reducing post loss and potentially pre-loss suffering. We need to identify those patients and family members who are at risk of developing PGD, think about the possibility of anticipatory grief, refer those requiring intervention, and refer early to palliative care (hospice) as it improves bereavement outcome. We need to be aware of the significant positive impact good patient–doctor, parent– doctor, and family–doctor communication can have on reducing PGD and long-term morbidity.

MASCC-0232 Communication 2 CHINESE ELDERS NEED SUPPORT IN SEEKING AND SCAN NING BEHAVIORS OF INFORMATION REGARDING COLORECTAL CANCER SCREENING TESTS

D.Y.P. Leung1, T. Chow1, E.M.L. Wong1, C.W.H. Chan1, D.T.F. Lee1 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China Introduction Colorectal cancer (CRC) is one of the most common types of cancer in both men and women in Hong Kong. Cancer-related information acquisition can happen via active and purposeful seeking, but may also happen less purposively via routine use of media and interactions with other people (scanning).

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Objectives To examine levels of seeking and scanning behaviors regarding information for CRC screening and associated demographic factors in Chinese elders in Hong Kong. Methods A convenience sample of 260 community-dwelling adults aged≥60 and cognitively intact was recruited. Information seeking and scanning behaviors of CRC screening behaviors in the past 12 months via six sources were measured by self-reports. Bivariate analyses identified their demographic associated factors. Results The mean age of the respondents was 77.2±8.01 years, 59.2 % were female, and 67.3 % had no formal/primary education. Both the levels of seeking (0.09±0.47) and scanning (0.49±0.97) behaviors for CRC screening tests were low. Scanning behaviors was associated significantly and positively with education (r=0.193, p=0.002) and household income (r=0.185, p=0.003) and negatively with age (r=−0.344, p<0.001) while seeking behaviors was associated positively with education (r=0.221, p<0.001) and negatively with age (r=−0.152, p=0.017). Conclusions The low levels of both scanning and seeking behaviors for CRC screening tests information in this elderly sample suggests a need to provide professional support to further promote effective health communication in this group. Healthcare professionals could focus their support on CRC screening tests to elders who very old and had low educational level.

MASCC-0259 Communication 2 THE ROLE OF STORYTELLING IN PERSON CENTRED CARE

B. Quinn1 1 Cancer, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom Background and Aims Amidst the advances being made in medicine and medical technology, previous studies reveal that people facing illness need the practitioner to engage with and to be sensitive to their humanity. This study was based on the premise that a central component of being human is the ability to engage with one’s story and to make sense of that reality. It is this ability to create and make sense of story that makes humanity unique. Methods This study explored people’s perceptions of living with cancer by inviting them to engage with telling their story through in depth interviews. Through the medium of storytelling and their own search for meaning, each participant was asked to recall their experiences, including for some, the reality of moving towards their death. Results Participants spoke of many profound life issues that had influenced their experience of living and dealing with cancer, the treatments they had to undergo and the care they received. All of the participants were able to describe times when those caring for them had not always heard their concerns. A key finding from the study was the recognition that attending to storytelling in clinical practice is sometimes overlooked and yet it can act as a doorway into understanding the needs of the person living with cancer. Conclusions The study suggests that educating and supporting the clinical team to engage with and be attentive to the story of those they care for, has a central role to play in showing compassion and delivering person centred care.

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MASCC-0265 Complications FEBUXOSTAT HEAD TO HEAD VERSUS ALLOPURINOL ACHIEVES A HIGHER SERUM URIC ACID (SUA) CONTROL IN TUMOR LYSIS SYNDROME (TLS) PREVENTION: RESULTS OF FLORENCE PIVOTAL STUDY

K. Jordan1, M. Spina2, Z. Nagy3, J.M. Ribera4, M. Federico5, I. Aurer6, G. Borsaru7, A.S. Pristupa8, A. Bosi9, S. Grosicki10, N.L. Glushko11, D. Ristic12, J. Jakucs13, J. Mayer14, E.M. Rego15, S. Baldini16, S. Scartoni16, C. Simonelli16, A. Capriati16, C.A. Maggi16 1 Department of Oncology and Hematology, Martin Luther University Halle-Wittenberg, Halle, Germany; 2Divisione di Oncologia Medica A, National Cancer Institute, Aviano, Italy; 31.st Department of Medicine, Semmelweis University Medical School, Budapest, Hungary; 4 Department of Hematology, ICO-Hospital Germans Trias i Pujol Jose Carreras Research Institute UAB, Badalona, Spain; 5Department of Diagnostic Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy; 6Division of Hematology, University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia; 7Hematology Department, “Coltea” Clinical Hospital, Bucharest, Romania; 8Hematology Department, Ryazan regional Clinical Hospital, Ryazan, Russia; 9Hematology Unit, Azienda Ospedaliero Universitaria Careggi University of Firenze, Firenze, Italy; 10Oddzial Hematologiczny, ZSM, Chorzow, Poland; 11Hematology Department, Ivano- Frankivsk Regional Clinical Hospital, Ivano- Frankivsk, Ukraine; 12 Department of Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; 13Department of Hematology, Pandy Kalman Megyei Korhaz, Gyula, Hungary; 14Department of Internal MedicineHematooncology, University Hospital Brno, Brno, Czech Republic; 15 Department of Internal Medicine Division of Hematology/Oncology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil; 16Clinical Research, Menarini Ricerche, Firenze, Italy Background and Aims TLS and renal events risk increases with sUA level, thus sUA control improvement is a key element in TLS prevention. Objectives: To determine whether Febuxostat achieves a higher sUA control than Allopurinol while preserving renal function in patients with hematologic malignancies at intermediate to high TLS risk. Methods In this phase III study 346 patients stratified for TLS risk grade and baseline sUAwere 1:1 randomized to Febuxostat or Allopurinol starting from 2 days prior chemotherapy (CT) for 7–9 consecutive days. Treatment was blinded, dose level was upon investigator’s choice among low/ standard/high daily doses containing Allopurinol 200/300/600 mg or fixed Febuxostat 120 mg. Primary endpoints: sUA area under curve (AUC sUA 1−8), serum creatinine change from baseline to Day 8. Secondary endpoints: response rate (sUA≤7.5 mg/dL from CTonset to Day 8), laboratory and clinical TLS incidence and safety. Results Study population (82.1 % of patients at intermediate TLS risk; 87.6 % baseline sUA≤7.5 mg/dl) was allocated to standard dose in 82.7 % of patients. Mean AUC sUA1−8 for Febuxostat and Allopurinol was 514.0± 225.71 and 708.0±234.42 mgxh/dl (p<0.0001). Mean serum creatinine change for Febuxostat and Allopurinol was −0.83±26.98 % and −4.92± 16.70 % (p=0.0903). No differences among secondary efficacy endpoints. Adverse events at least possibly drug-related occurred in 6.4 % of patients in each arm. Conclusions In the largest adult trial performed in TLS prevention, Febuxostat achieved a significant superior sUA control with one fixed dose in comparison to Allopurinol with comparable renal function preservation and safety profile.

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The onset of hyponatremia (serum sodium <135 mEq/l) during the treatment in 14 out of the 62 patients was significantly related to a worsened median overall survival (7,93 vs 13,48 months; p=0.0069). (Figure 1)

MASCC-0196 Complications HYPONATREMIA IS A PREDICTOR OF CLINICAL OUTCOME FOR MALIGNANT PLEURAL MESOTHELIOMA

R. Berardi1, M. Caramanti1, I. Fiordoliva1, F. Morgese1, A. Savini1, V. Paolucci1, M. Torniai1, C. Ferrini1, M. Tiberi1, M. Castagnani1, F. Rovinelli1, A. Onofri1, S. Cascinu1 1 Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy Background and Aims Hyponatremia is one of the most common electrolyte disorders associated with tumor-related conditions. Several clinical, histological and serum factors were found to influence prognosis in mesothelioma, but, to date, there are no studies focusing prognostic role of hyponatremia in this tumor. The aim of this study is to assess the predictive and the prognostic role of hyponatremia in malignant pleural mesothelioma. Methods We retrospectively analysed 62 consecutive patients with advanced or metastatic malignant pleural mesothelioma. Results Patients characteristics are summarized in table 1. Table 1. Patients characteristics. Characteristics Age =60 >60 Sex male female Smoking yes no Asbestos exposure yes no PS at diagnosis (ECOG) 0 1 2 3 Staging locally advanced metastatic Histology epithelioid sarcomatoid desmoplastic biphasic unknown

Number of patients (%) Total number=62 (100 %) 14 (22.6 %) 48 (77.4 %) 49 (79 %) 13 (21 %)

The occurence of hyponatremia during first line chemotherapy (cut-off 135 and 130 mEq/l) was significantly associated to a shorter median PFS (p=0.0214). Results were also similar in subgroup receiving a second line treatment. At multivariate analysis, including haemoglobin and sodium level at the beginning of first line chemotherapy, age, gender, smoking habit, job exposure and performance status, only hyponatremia resulted an independent factor (p=0.029). Hyponatremia also resulted a predictive factor both in first-line chemotherapy, being related to poorer response to pemetrexed-based chemotherapy (p=0.047) and in second-line chemotherapy (p=0.044). Conclusions To our knowledge this is the first in study to evaluate the association of hyponatremia on outcome of malignant pleural mesothelioma patients. Early detection, close monitoring and management of hyponatremia are recommended since they might improve the patient’s prognosis.

37 (59.7) 25 (40.3 %)

MASCC-0339 41 (66.1 %) 21 (33.9 %) 33 (53.2 %) 24 (38.7 %) 4 (6.5 %) 1 (1.6 %) 51 (82.3 %) 11 (17.7 %) 42 (67.7 %) 9 (14.5 %) 1 (1.6 %) 5 (8.1 %) 5 (8.1 %)

All patients received a first line Pemetrexed-based chemotherapy. A second-line chemotherapy was administered to 31 patients.

Complications IMMUNE GENETIC VARIABILITY IS ASSOCIATED WITH RISK OF SEVERE GASTROINTESTINALTOXICITY IN PATIENTS TREATED WITH FLUOROURACIL

J. Bowen1, I. White2, S. Tuke3, R. Logan4, A. Richards5, K. Mead5, C. Karapetis6, J. Coller1 1 Medical Sciences, University of Adelaide, Adelaide, Australia; 2 Medicine, University of Adelaide, Adelaide, Australia; 3Mathematical Sciences, University of Adelaide, Adelaide, Australia; 4Dentistry, University of Adelaide, Adelaide, Australia; 5Medical Oncology, Flinders Medical Centre, Adelaide, Australia; 6Medicine, Flinders University, Adelaide, Australia Background and Aims The incidence of severe gastrointestinal toxicity (GIT) following fluorouracil treatment is common and can result in poor clinical outcomes. Currently there is no diagnostic marker to predict GIT risk. Given the key role of inflammation in GIT development, we conducted an immune-pathway targeted approach to uncover genetic variation associated with toxicity. Objectives: Uncover associations between genetic variability in innate immune signaling, specifically Toll/Interleukin-1 receptor (TIR), on the severity of GIT in patients treated with fluorouracil.

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Methods Adults treated with 5-fluorouracil or capecitabine were invited to participate in the study. GIT data was collected from case note review. Genomic DNA was isolated from saliva and analysed for 21 TIR pathway alleles using a customised Sequenom MassArray assay. A general linear model of toxicity was created that included logistic regression with stepwise addition of factors including SNPs and patient characteristics. Receiver operator characteristic curves (ROC) determined the performance of the model in predicting GIT. Results Thirty four patients participated in the study, of which 10 had severe GIT (Grade≥3 NCI CTCAE or necessitating a dose reduction). The model that included genetic variability in TLR2 (rs1800629) and TNF (rs3804100) (individual variant P = 0.049 and 0.33, respectively) and cancer type was best related to severe GIT, such that the ROC % area under the curve from this model was 87.3 %. Conclusions Conclusions: This pilot study has shown that TLR2 with TNF variant genotype is predictive of severe GIT. This study is ongoing in a larger patient population and will be validated in a prospective trial.

MASCC-0045 Complications MANAGEMENT OF COMPLICATIONS IN MULTIPLE MYELOMA (MM)

A. Dimitrovska1, S. Crvenkova1, M. Pesevska1, L. Kostadinova1 1 Limphoma and sarcoma, Institute of Radiotherapy and Oncology, Skopje, Macedonia Background and Aims The aim of the work is to examine the impact of supportive therapy on the performance status and treatment outcome of pts suffering from MM. Methods Histories of 124 pts with symptomatic MM were retrospectively reviewed. Clinical signs, radiological and laboratory findings and the kind of supportive therapy were analyzed. Results The pain was the most dominant clinical sign in 84 % of pts. It was successfully managed by anti-tumor therapy, radiotherapy (RT) plus corticosteroids and only 15 (14 %) pts continued to take analgetics after completing the chemotherapy (CT). Osteolytic bone destructions were treated with bisphosphonates and 78 % responded well. The most prominent complication of bone disease was vertebral collapse secondary to osteolytic lesions found in 78 (63 %) pts. RT and/or surgery ensured good palliation and relieved the pain in 85 % of pts. Hypercalcemia was present in 45 (36 %) pts and was normalized with prompt rehydration, corticosteroids and i.v. bisphosphonates. Renal impairment, seen in 37 % of pts at presentation was reversible in 75 % (34/46) after administration of i.v. fluids and CT. Only 3 patients were sent for dialysis at the time of diagnosis. Anemia was present in 65 % (81/124) and hemoglobin was less than 8 g/dl in 7 % of patients. After a 3–6 months erythropoietin treatment a response rate of 77 % (62/81) was achieved. 10 % of MM pts required antibiotics due to repeated bacterial infections. Conclusions Our results confirmed that efficient management of disease and therapyinduced complications in MM improve patients’ well being and probably prolong the survival rate.

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MASCC-0601 Complications CLINICAL DETERIORATION IN THE AMBULATORY SETTING – WHEN IS IT TIME TO ACT?

A. Fitzgerald1, J. Manning1, J. Campbell1 1 Clinical Services, Icon Cancer Care, Brisbane, Australia Background and Aims Clinical deterioration is not selective and occurs across the cancer trajectory. Recognising and promptly responding to its occurrence can be the difference between life or death for the patients in our care. Icon Cancer Care is Australia’s largest private provider of haematology and oncology day services in the outpatient ambulatory care setting with 6 day hospitals located in two states across Australia. In an acute ambulatory setting monitoring a patients progress is vital in ensuring any clinical deterioration is recognised early and treated appropriately. Methods Following a coordinated national consultation, Icon Cancer Care has developed a unique advanced track and trigger nursing observation chart for the ambulatory setting which adheres to the National Healthcare standard set for Australia. This chart allows the nursing staff to monitor patients more effectively for clinical deterioration and encourages early intervention should clinical deterioration occur. Results Track and trigger nursing observation chart developed for specific use in the acute ambulatory cancer care setting. Conclusions This paper will explore the initial research undertaken and discuss the difficulties in the development and trial process of this track and trigger nursing observation chart within an acute ambulatory cancer care setting.

MASCC-0412 Complications STUDY TO RETROSPECTIVELYANALYSE THE EFFECT OF PRE-RADIOTHERAPY COUNSELLING IN HEAD AND NECK CANCER PATIENTS GIVEN RADIOTHERAPY

D. Kumar1, M.C. Pant2, S. Singh2, J. P1, V. S1 1 radiotherapy, jipmer, pondicherry, India; 2radiotherapy, kgmc, lucknow, India Background and Aims Introduction- Toxicities are an unwanted side effects of the radiation treatment and measures taken to reduce them forms an integral part of supportive care for the patients undergoing radiation therapy. Objective-To analyse the effect of pre-RT counselling on radiotherapy induced toxicities (skin, mucosal, upper GI) and weight changes, if any in patients who undergo radiotherapy. Methods Material and methods-110 Head and neck cancer patients who had received radiotherapy were analysed for the radiation induced skin, oral mucosa and upper gastrointestinal reactions and weight changes developed during radiotherapy. RTOG toxicity criteria was used for documenting the toxicities and weight changes during treatment were categorised into mild (<5 % wt. loss of baseline), moderate (5–10 %) and severe as (>10 %). Results were analysed statistically using chi square test for trend. Results Results-80 (72.72 %) patients had received counselling prior to start of radiotherapy and 30 (27.27 %) patients had skipped the pre-RT counselling due to unknown causes.7 patients defaulted during treatment (2 from counselled and 5 from non counselled patients). Thus 78 counselled and 25 not counselled were analysed. The counselled patients had developed less

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skin, mucosal and upper GI toxicity when compared to the non counselled patients and also significant difference was observed in weight parameters. The results were found to be statistically significant, depicting a strong association of pre-RT counselling in reducing the radiotherapy induced toxicities and weight changes in patients taken up for radiotherapy. Conclusions Conclusion- An effective, planned Pre-radiotherapy counselling plays an utmost role in reducing the morbidities associated with radiotherapy treatment and also improves patient compliance.

MASCC-0071 Complications ENDOSPONGE : TREATMENT OF ANASTOMOTIC LEAKS

G. Milito1, G. Lisi1 1 General Surgery, Policlinico Tor Vergata Roma, Roma, Italy Background and Aims Endoluminal vacuum therapy using Endosponge is a new endoscopic method to treat extraperitoneal anastomotic leakage following low anterior resections or Hartmann“s stump leakage in the lesser pelvis, at an early stage and with no reintervention. It is realized a continuous drainage of the secretion and the sponge cleans away the fibrin coatings, reduces in size and cleans the cavity. Methods Between January 2005 and December 2013, 12 patients with anastomotic leakage following low anterior resection and neoadjuvant radiochemotherapy were treated with transrectal VAC. They were prospectively evaluated. Results Stapled straight end to end colorectal anastomoses were performed in all patients between 3 and 7 cm above the anal verge, a protective ileostomy was performed in every patients. The diagnosis of anastomotic leakage was performed after a median interval of 15 days (range 7–22) the median size of the cavity was 81×46 mm. Fluid collection was drained, percutaneosly in 10 cases, surgically in 2 patients who presented with a cavity of 80× 55 mm and 85×50 respectively. The median duration of therapy was 35 days (range 16–51), with a 8–15 sponge exchanges for patient. Median healing time was 59 days (range 32–65). No intraoperative complications were recorded. 5 cases of mild anal pain successfully treated medically

Conclusions The Endosponge seems an effective minimally invasive procedure to treat extraperitoneal anastomotic leakage without reintervention reducing morbidity and mortality.

MASCC-0512 Complications CO-MORBIDITIES IN ELDERLY BREAST CANCER AND LUNG CANCER PATIENTS WHO RECEIVE CHEMOTHERAPY OF NCCN DEFINED INTERMEDIATE (10–20 %) RISK OF FEBRILE NEUTROPENIA

J.H. Page1, S. Li2, J. Molony2, R. Sosa3, R. Barron4, P.K. Morrow5, S. Stryker6, J. Liu2, A.J. Collins2, J. Acquavella7 1 Center for Observational Research, Amgen Inc., Thousand Oaks, USA; 2 Chronic Disease Research Group, University of Minnesota, Minneapolis, USA; 3Department of Medicine, Vanderbilt University, Nashville, USA; 4Global Health Economics, Amgen, Thousand Oaks, USA5Global Development, Amgen, Thousand Oaks, USA; 6Center for Observational Research, Amgen, San Francisco, USA; 7Center for Observational Research, Amgen, Thousand Oaks, USA Background and Aims Introduction: Febrile neutropenia/hospitalizations for infections (FN) are serious potential complications of myelosuppressive chemotherapy treatment in cancer patients. Previous research suggests that certain comorbidities are associated with higher risk of FN. Little is known about the comorbidity burden in elderly patients taking NCCN defined FN intermediate risk (IR) (10–20 %) chemotherapy regimens Objectives: Describe the prevalence of clinically important co-morbidities in breast cancer (BC) and lung cancer (LC) patients on chemotherapy regimens with a FN risk of 10–20 % based on NCCN guidelines. Methods The study population includes non-HMO enrollees of 20 % Medicare sample with Parts A and B coverage who had BC or LC and initiated the first course of an IR chemotherapy regimen between July 1, 2007 and November 30, 2011. Counts and proportions were estimated.

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Results During the first course, 1686 (9.6 %) patients with BC (total 17512) and 10 961 (43.1 %) patients with LC (total 25422) used an IR regimen. Of the comorbidities investigated, diabetes, thyroid disease and anemia were the most common among BC patients on IR regimens (table). The most common among LC patients were chronic obstructive pulmonary disease, atherosclerotic heart disease, and diabetes. Table. Distribution of Comorbidities in Breast Cancer or Lung Cancer patients on Chemotherapy regimens associated with intermediate risk of FN in Medicare. Breast Cancer n (%) 1,686

Lung Cancer n (%) 10,961

434 (25.7) 475 (28.2) 388 (23.0) 389 (23.1) 1,666 (98.8)

2,734 (24.9) 3,426 (31.3) 2,700 (24.6) 3,409 (31.1) 5,089 (46.4)

Characteristics Total Number Demographics Age, years 65–69 70–74 75–79 80+ Female sex Co-existing comorbidities Atherosclerotic heart disease Anemia Cardiac Arrhythmia Cerebrovascular disease Chronic obstructive lung disease Congestive heart failure

211 (12.5) 246 (14.6) 212 (12.6) 61 (3.6) 213 (12.6) 118 (7.0)

2,948 (26.9) 1,900 (17.3) 2,076 (18.9) 698 (6.4) 5,677 (51.8) 974 (8.9)

Diabetes Liver disease Osteoarthritis Peptic ulcer disease Peripheral vascular disease Other cancer Chronic renal disease Rheumatoid arthritis Thyroid disorder

389 (23.1) 14 (0.8) 192 (11.4) 12 (0.7) 124 (7.4) 108 (6.4) 111 (6.6) 38 (2.3) 258 (15.3)

2,375 (21.7) 99 (0.9) 1,036 (9.5) 112 (1.0) 1,604 (14.6) 774 (7.1) 978 (8.9) 242 (2.2) 1,174 (10.7)

Conclusions Over 20 % of elderly patients with BC or LC treated with an IR regimen have a clinically important comorbidity, previously shown to be associated with increased risk of FN.

MASCC-0269

Background and Aims Chemotherapy-induced febrile neutropenia (CIFN) is a major complication of chemotherapy. To describe the use of a G-CSF (Tevagrastim) in primary (PP) and secondary prophylaxis (SP) of CIFN in routine medical practice. Methods Prospective, observational, French cohort study of patients>18 years with hematologic malignancy (HM) or solid organ tumor (SOT). Results One hundred seventy-eight investigators (58 % oncologists, 28 % hematologists, 12 % pulmonologists) included 882 patients: mean age: 63.5 years (50 % over 65), ECOG 0 or 1: 87 %, distant metastases: 48.3 %, HM 239, lung cancer 190, other SOT: 452. The risk of CIFN was>20 % and 10–20 % in 19.5 % and 46 % of cases respectively. Tevagrastim was prescribed in PP in 78.6 % of cases. Mean dose was 0.49±0.12 IU/kg/day. Treatment modalities remained stable over time (Table 1) but differed between HM and SOT patients (Table 2). Tevagrastim was self-injected by 12.6 % of patients at the end of the study. Table 1: 1st cycle 2d cycle 3rd cycle 4th cycle 5th cycle Time between 4.2±2.6 CT and tevragrastim (days) Duration of 5.4±2.1 tevagrastim (days)

4.3±2.5

4.2±2.6

4.1±2.6

4.1±2.7

5.4±2.0

5.3±1.9

5.2±1.7

5.2±2.8

Table 2:

Time to tevagrastim administration (days) Duration of treatment (days) PP G-CSF from first cycle

HM 6.1±3.3 5.7±2.6 87.0 % 89.5 %

SOT 3.9±3.2 5.3±1.8 75.4 % 70.3 %

p <0.0001 0.031 0.0002 <0.0001

Conclusions Tevagrastim was prescribed mostly in PP, 4.2 days after chemotherapy, with a mean duration of 5.3 days.

MASCC-0565 Decision-Making

Complications

ANTICANCER DRUGS-INDUCED ARTHRALGIA: WHAT MANAGEMENT ?

USE OF A GCSF BIOSIMILAR UNDER REAL-LIFE CONDITIONS IN PRIMARY OR SECONDARY PROPHYLAXIS OF CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA: RESULTS OF THE ESTIM STUDY

L. Vanlemmens1, F. Debiais2, F. Farsi3, A. Brunet3, M. Vieillard4 1 Disspo, Centre Oscar Lambret, Lille, France; 2Rhumatologie, chu Poitiers, Poitiers, France; 3Résau Espace Santé Cancer Rhône-Alpes, Résau Espace Santé Cancer Rhône-Alpes, Lyon, France; 4Centre Oscar Lambret, Centre Oscar Lambret, Lille, France

M. Spielmann1, M. Hacini2, C. Audigier-Vallet3, P. Quittet4, L. Damaj5, M.I. Belkaid6, F. Savinelli7 1 Oncology, Institut Gustave Roussy, villejuif, France; 2Oncology, Centre hospitalier, Chambéry, France; 3Oncology, Hôpital Ste Musse, Toulon, France; 4Oncology, Hôpital St Eloi, Montpellier, France; 5Oncology, Hôpital Sud, Amiens, France; 6Oncology, Hôpital Louis Pasteur, Colmar, France; 7Oncology, Hôpital St Joseph, Paris, France

Background and Aims The musculo skeletal disorders induced by anticancer drugs are often underestimated by clinicians. Yet, they can sustainably alter quality of life of patients. The majority of available literature data concerning arthralgia related to treatment with aromatase inhibitors and taxanes.

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We found useful to work on this issue that require multidisciplinary care and support throughout the care pathway in order to elaborate recommendations for management of musculo skeletal disorders in the context of cancer. Methods The Francophone Association of Supportive Care in Oncology (AFSOS) encourages collaboration between regional cancer networks for development of reference document for clinical practice and pooling them. Professionals are encouraged to form interregional workgroups which benefit from logistical framework of Regional Cancer networks. The development of a consensus involves several steps: 1. Literature review 2. Meetings of the Workgroup: Development of a plan, complete the content, formatting. 3. Presentation of the referential in workshops during days dedicated to sharing supportive care guidelines (J2R). 4. Validation during plenary meeting. Results & A pragmatic guideline, which distinguishes the different clinical syndromes: joint, tendon, tunnel… & Approach by molecule/incidence & Presentation of symptoms: clinical presentation, duration, risk factors, predisposing factors & proposal of symptoms management : – Assessment of the severity of the symptoms – Interest of biology and imaging – Therapeutic approach: Global approach, medicamentous approach, non-medicamentous approach. Conclusions These guidelines will be made available through the AFSOS (www.afsos.fr) and the SFPO (www.sfpo.fr) website, and useable for training of both the oncological and psychiatric teams.

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development and pooling of guidelines for clinical practice. AFSOS collaborates with the French Society of Psycho-Oncology for topics regarding Psycho-Oncology. Professionals are encouraged to form interregional workgroups which benefit from logistical framework of Regional Cancer networks. The development of a consensus involves several steps: 1. Literature review; identification of existing tools 2. Meetings of the Workgroup: development of a plan, complete the content, formatting. 3. Presentation in workshops during days dedicated to sharing supportive care guidelines (J2R) 4. Validation during plenary meeting. Results Guidelines, recalling : – the impact of psychotic disorders on patient’s adjustment – the main clinical diagnosis – the differential diagnosis – Some legal aspects: informed consent, legal protection… – Practical recommendations for symptom management and coordination of care – Pharmacological considerations for the use of neuroleptics and antipsychotics in oncology Conclusions These guidelines will be made available through the AFSOS and the SFPO website, and useable for training of both the oncological and psychiatric teams.

MASCC-0623 Decision-Making LONG-TERM VENOUS ACCESS: AFSOS GUIDELINES

MASCC-0409 Decision-Making IMPROVEMENT OF COMPREHENSIVE CANCER CARE FOR PATIENTS WITH PSYCHOTIC DISORDERS

M. Reich1, S. Dauchy2, F. Farsi3 1 psychooncologie, Centre Oscar Lambret, Lille, France; 2 psychooncologie, Institut Gustave Roussy, Villejuif, France; 3Réseau Espace santé Cancer Rhône-Alpes, Réseau Espace santé Cancer Rhône-Alpes, Lyon, France Background and Aims Psychoses are a group of psychiatric conditions that are accompanied by a significant psychosocial disability that may interfere with cancer care and patient’s adjustment. Cancer mortality in psychotic patients is higher than in general population, due notably to delays in diagnosis, cumulation of cancer risk factors and difficulties in access to somatic care. To treat cancer patients with psychotic disorders is a challenge both for the oncological teams and the psychiatric teams. Common guidelines are necessary to improve carers formation and strengthen multidisciplinary care. Methods The Francophone Association of Supportive Care in cancer (AFSOS) encourages collaboration between regional cancer networks for

D.S. Kamioner1, I. Kriegel2, F. Farsi3 1 Onco hématologie, Hôpital Privé de l’Ouest Parisien, Trappes, France; 2 Anesthésie, Institut Curie, Paris, France; 3Réseau Espace Santé Cancer Rhône-Alpes, Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France

Background and Aims Repeated venipuncture is often aggressive, painful and sometimes dangerous, especially with the risk of severe extravasation during the administration of anticancer chemotherapy. Externalized central catheters (ECC) are less frequently used and currently reserved for special situations: such as short chemotherapy treatment (< 3 cycles), terminal palliative care and intensive care. Internal CC can be used for chemotherapy, infusions, transfusions, blood samples and administration of various medications or parenteral nutrition requiring repeated access to the venous system. Instructions for the device must be observed according to the rules defined by tracing items (Code of Public Health). Methods In accordance with AFSOS’ methodology, an inter-regional multidisciplinary group composed of physicians and caregivers has been setup. This latter conducted a review of the literature, defined the methodological approach and developed a work plan. As a result of this collective effort, recommendations are identified and presented during during days dedicated to sharing supportive care guidelines

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(J2R). These recommendations are discussed in workshop and approved in plenary session. Results Pragmatic guidelines to manage long-term venous devices. Conclusions The use of implanted catheters with subcutaneous chamber has grown considerably and it is important to prevent the trivialization of these techniques so as to avoid complications that can sometimes be very severe (Fig. 1).

MASCC-0563 Decision-Making MANAGEMENT OF MALIGNANT BOWEL OBSTRUCTION IN DIGESTIVE CANCERS: GUIDELINES OF THE FRENCH SUPPORTIVE CARE ASSOCIATION

S. Toussaint1, D. Tougeron2, C. Cervi3, A. Hutin-Brissot4, A. ParotMonpetit4, K. Le Gallou5, V. Block6 1 Office d’hygiène sociale, Office d’hygiène sociale, Nancy, France; 2 Gastro entérologie, chu Poitiers, Poitiers, France; 3Chirurgie digestive, Ch Camille Gérin, Châtellerault, France; 4Centre Eugène Marquis, Centre Eugène Marquis, Rennes, France; 5Hôpital privé Océane, Hôpital privé Océane, Vannes, France; 6Réseau oncolor, Réseau oncolor, Nancy, France

Background and Aims Malignant bowel obstruction (MBO) is a relatively common complication in advanced cancer patients with abdominal or pelvic malignancy. Clinical practice guidelines were developed to establish a strategy of management of malignant bowel obstruction. They were applied for a limited period of time by multidisciplinary teams, with two major goals: – optimize patient comfort – improve the management. Methods These guidelines were based on a review of previous and recent literature and expert opinion. As an example, recent studies, which confirmed the efficacy of somatostatin analogues, were included in the study. Results – Diagnosis of occlusion due to peritoneal cancer is difficult, and should be based on CT-scan. – As there is no longer strong level of evidence on therapy used, we clarified the use and combination of therapeutics such as : glucocorticoids, antiemetic agents, analgesic and antisecretory agents (anticholinergic drugs, somatostatin analogues) by referring at the story of the disease: pathology stage, WHO or Karnofsky’s grading, geriatric’s evaluation, comorbidities, nutritional status (BMI), specific therapeutic project, and patient’s wishes. – Nasogastric tube feeding is no longer used routinely and its use should be discussed on a case-by-case basis. Conclusions This proposition was carried out as a global multidisciplinary approach between teams of oncologic supportive cares and palliative cares. Guidelines have been proposed by the French supportive care association for a successful management of malignant bowel obstruction in digestive cancers.

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MASCC-0178 Decision-Making IDENTIFICATION OF PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO(NLR) IN PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA(HCC)

Z. Chen1, L.I. XY1, D.O.N.G. min1, L. qu1, M. xiaokun1, W.U. xiangyuan1 1 Onclogy Department, The third affiliated Hospital of Sun Yat-Sen University, Canton, China Introduction: Neutrophil-to-lymphocyte ratio (NLR) was considered to be an independent predictor of survival after hepatectomy in patients with HCC. No study had focused on its role in advanced HCC patients. Objectives: To assess NLR’s prognostic value and its related factors in advanced HCC patients. Methods: From September 2008 to June 2010, a total of 219 patients with advanced HCC without fever or signs of infections were analyzed. Clinicopathological parameters, including NLR, were evaluated to identify predictors of overall survival. Univariate and multivariate analyses were performed, using the Cox proportional hazards model. The best cutoff was determined with time-dependent receiver operating characteristic curve. Results: Univariate and multivariate analyses showed that NLR was an independent prognostic factor in overall survival in patients with advanced HCC. The best cutoff point of NLR was 2.58. NLR>2.58 predicted poorer overall survival (OS) compared with NLR10*10e9/L, AFP>400 ng/ml,KPS 50, without portal vein thrombus, distant metastasis and tumor size lesser than half of the liver. Conclusion: NLR is an independent prognostic factor of advanced HCC patients. Higher Baseline NLR levels indicates poorer prognosis.

MASCC-0035 Decision-Making A SURVEY OF OLDER PEOPLE’S ATTITUDES TOWARDS ADVANCE CARE PLANNING

I. Musa1, S. Conroy2, J. Seymour3 1 Geriatrics, University Hospitals of Leicester NHS trust, Leicester, United Kingdom; 2Geriatrics, University of Leicester, Leicester, United Kingdom; 3 Palliative Care, University of Nottingham, Nottingham, United Kingdom

Background and Aims Advance care planning (ACP) is a process to establish individual’s needs, preferences and goals of care but few UK studies have been conducted to ascertain public perspectives. The aim of this study was to assess the attitudes of people aged ≥65 in a large mixed urban and rural area of the UK through the development and application of a validated survey. Methods Focus groups generated the domains of questioning, building on a previously validated US survey and refining using key stakeholders. The adapted survey was then sent out to older people in Leicestershire and Nottinghamshire. Results The response rate was 34 %. The median age was 73 years and 59 % were women. Most were functionally independent, Caucasian and of Christian faith. Thirteen percent of respondents had prepared an ACP document with 4 % completing an Advance Decision to Refuse Treatment (ADRT). 5 % of respondent’s stated that they had been offered an opportunity to talk about

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ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Eighty five percent preferred to just have a discussion rather than write anything down. Levels of trust were higher for families than for professionals with 35 % of respondents being worried that doctors would stop treatment too soon if they had an ACP. Only 33 % would be interested in talking about ACP if sessions were available. Conclusions Although most respondents were in favour of Advance Care Planning, a relative minority had actively engaged. Preferences were for informal discussions with family and friends rather than professionals.

MASCC-0306

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0078 Decision-Making SIGNIFICANCE OF AGE AND COMORBIDITY IN THE MANAGEMENT DECISION-MAKING IN EARLY STAGE PROSTATE CANCER

J. Oh1, J. Davis2, K. Hoffman3, S. Wen4, S. Taylor5, S. Doshi1, R. Jakkoju1, S. Suman1, R. Day6, J. Kim7 1 Dept. of General Internal Medicine, UT MD Anderson Cancer Center, Houston, USA; 2Dept. of Urology, UT MD Anderson Cancer Center, Houston, USA; 3Dept. of Radiation Oncology, UT MD Anderson Cancer Center, Houston, USA; 4Dept. of Biostatistics, UT MD Anderson Cancer Center, Houston, USA; 5Dept. of Tumor Registry, UT MD Anderson Cancer Center, Houston, USA; 6Epidemiology, School of Public Health UT Health Science Ctr at Houston, Houston, USA; 7Dept. of GU Medical Oncology, UT MD Anderson Cancer Center, Houston, USA

Decision-Making PALLIATIVE SURGERY IN ADVANCED COLORECTAL CANCER. WHAT WE SHOULD KNOWABOUT DECISION MAKING?

M. Nowacki1, K. Pietkun2, K. Nowacka2, J. Siminska2, I. Glowacka3, W. Zegarski3 1 Tissue Engineering Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 2Rehabilitation Clinic Department of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 3Surgical Oncology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland Background and Aims The number of yearly performed colorectal cancer surgeries with non-curative character is still growing. But as it has been mentioned by many authors the term paliative is very often used subjectively. The decision-making procedure is still very controversional and not fully described. The aim of our work was the systemic collection of current published opinions and recommendations related to the decision-making process of palliative surgery in patients with advanced stage of colorectal cancer. Methods In our study we have systemically and critically analyzed scientific data published in the last 10 years, fully relating to the subject of potential palliative surgery interventions which could be performed in patients with the end stage colorectal cancer. In this study we have especially analyzed the detailed indications, surgical procedures types, their potential effects and benefits or their side effects and complications. Results There are now some clear guidelines relating to the palliative surgery procedures including interventional management of patients with advanced colorectal cancer. But their use is still problematic and not so popular, especially in non-specialized colorectal cancer units. In our work we have presented the proper specific indicators of conduct and observation times. Conclusions The term palliative surgery should be used only when the performed procedure is based onto the latest and currently existing recommendations and schemes created by the relevant and representativesurgical oncology associations and societies. Paliative surgery interventions should be always undertaken only in very specific cases when there are clinical indications.

Background and Aims Comorbidities, associated with all-cause mortality, should be an important factor in prostate cancer (PC) management decision making. This study aimed to describe the relationship between the severity of comorbidities and management decision-making of clinically localized prostate cancer. Methods Two hundred twenty-six patients with clinically localized Prostate Cancer (PC), enrolled in a prospective cohort study of Active Surveillance (AS) between 2/1/2006-12/31/2008, were compared to 592 PC patients, identified by chart review, who received active treatment (AT), matched by clinical stage (T1/T2), prostate-specific antigen (PSA) level (<10 ng/mL), Gleason score (7 [3+4] or less), and inclusion of AS option during management discussion. Severity of comorbidities was scored using Adult Comorbidity Evaluation 27 index. Multivariate logistic regression was used. Results Moderate/severe comorbidities were present in 52 (23.0 %) in AS group and 128 (21.6 %) in AT group (p=0.74). Older age was the only covariate associated with AS (p<0.001). Higher clinical stage and Gleason score 7 (p <0.0001), white race (p 0.008), family history of PC in first-degree relative (p 0.015), and higher baseline PSA (p 0.029) were associated with higher likelihood of receiving AT. Conclusions In previous studies comorbidities has been associated with mortality in prostate cancer patients. However, in this study, the decision for AS versus ATwas associated to clinicopathologic risk features and family history of PC, while severity of comorbidities was not a significant factor. Despite our study limitations, findings underscore the need for real-time measurement of comorbidities and the importance of better integration of comorbidities in management decision making in patients with prostate cancer.

MASCC-0460 Decision-Making “JUST BEAR WITH IT”: MEN’S EXPERIENCES WITH SIDE EFFECTS OF SHORT-TERM ANDROGEN DEPRIVATION THERAPY FOR INTERMEDIATE-RISK PROSTATE CANCER

R. Volk1, S. Cantor2, S. Linder1, S. Saraykar1, K. Hoffman3 1 General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; 2Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA; 3Radiation Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, USA

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims Optimal management of men who receive external beam radiation therapy for intermediate-risk prostate cancer remains uncertain. The addition of short-term androgen deprivation therapy (ADT) to dose-escalated radiation therapy has been suggested, but men are often reluctant to accept ADT because of its impact on quality of life. As an initial step toward developing decision support interventions for men with intermediate-risk prostate cancer, we explored men’s experiences with short-term ADT. Methods Semi-structured interviews were conducted with 11 patients 54–72 years of age nearing completion of a 6-month course of ADT at a large comprehensive cancer center. The interviews addressed six treatmentrelated side-effects: hot flashes, fatigue, weight gain, loss of libido, erectile dysfunction, and change in body image. Results Men reported frequent daily hot flashes soon after initiating treatment that varied from mild to feeling ‘like a big jolt or electric shock.’ Men reported lower energy and needing more sleep. Some men used the treatment period as time to increase their physical fitness. Overall men did not differentiate loss of libido from erectile dysfunction. Others described the mechanical nature of manipulating an erection or taking medications for erectile dysfunction as unpleasant, while expressing concerns that they ‘use it or lose it.’ Men who were sexually active before treatment expressed a hope-filled expectation that functioning would return after treatment was completed. Conclusions The side effects of ADT, while bothersome, appear to be manageable. For sexually active men, loss of libido and erectile dysfunction are distressing and they expect function will fully return after treatment.

MASCC-0020 Decision-Making MAKING DECISIONS IN COMPLICATED SITUATIONS FOR ADOLESCENTS WITH CANCER AND THEIR FAMILIES

L. Yeh1, S. Henderson2, U. Kellett2 1 Nursing, Kang Ning Junior College of Medical care and Management, Taipei City, Taiwan; 2Nursing, Griffith UNiversity, Bribsane, Australia Introduction The adolescent with cancer and their family had to confront long term life-threatening therapy and follow-up procedures. While the sick adolescent was moving in and out of the hospital, waiting and receiving diagnosis and undergoing treatment periods, the parents and family members needed to make decisions to maintain sick adolescent’s safety and progress through the course of the treatment. Aims This study explores the processes undertaken by family members in making decisions for adolescents with cancer within the Taiwanese society. Methods Seven families (27 participants) were recruited from a medical hospital in Taiwan. Data were collected by qualitative interviews and analysed following Strauss and Corbin’s Grounded theory methodology. Results Making decisions in complicated situations was instigated to confront the broken chain of family life of the adolescent with

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cancer and their family before any intervention could be undertaken. It was clear from the data that parents and their sick adolescent first needed to make decisions in complicated situations, such as choosing a hospital, living in a paediatric ward, treatment strategies and schooling. It is noteworthy that the sick adolescent and their family needed support from different sources as a way of confronting the broken chain of family life. Conclusions This goal supports families to regain harmony when life threatens family life balance. The findings have implications for Taiwanese families in perceiving, adjusting to and fulfilling the altered relationships associated with caring for an adolescent with cancer at home.

MASCC-0619 Dental Care ORAL MANIFESTATIONS FOLLOWING TREATMENT OF CANCER OF THE GI TRACT- A RETROSPECTIVE OBSERVATIONAL STUDYAT THE HOSPITAL OF S. TEOTÓNIO

A.C. Moreira1, R. Amaral Mendes2 1 Institute of Health Sciences - Department of Oral Medicine and Oral Oncology, The Catholic University of Portugal, Viseu, Portugal; 2Institute of Health Sciences - Department of Oral Medicine and Oral Oncology, The Catholic University of Portugal and University of Michigan, Viseu, Portugal Background and Aims The overall incidence of cancer has increased substantially over the last decades. The oral cavity is one of the locations where side effects usually occur, namely mucositis, changes in salivary glands, rampant caries, bleeding caused by blood dyscrasias, osteoradionecrosis and osteochemonecrosis. Purpose: To assess the main oral manifestations of cancer treatment. Methods A retrospective observational study was performed. Records from patients undergoing chemotherapy in the Hospital of S.Teotónio, Viseu, were retrieved from the Hospital files and reviewed. Patients were observed and questionnaires were applied. Tumor type, stage, therapeutic regimens, and oral manifestations were determined. Statistical analysis was performed using SPSS 18.0. Fisher’s exact test and the correlation matrix were used to check the existence of correlation between the variables. Data were considered statistically significant if p<0.05. Results A sample of 30 patients was assessed. Half of them (n=15) were diagnosed with stage IV cancer. The most common tumor was colorectal, affecting 63.3 % (n=19). The most frequent treatment protocols were Folfox (40 %, n=12) and Folfiri (20 %, n=6), both administered for colorectal tumor. On average, each patient presented 1.87 (± 1.22) oral manifestations, with xerostomia being the most common, followed by oral mucositis. From the study sample, 30 % (n=9) underwent oral monitorization although only 4 patients (13.3 %) have been advised to visit their dentist. Conclusions Assessment and subsequent monitorization of the oral status before, during and after cancer treatment is of utmost importance in order to reduce the side effects and improve overall quality of life of cancer patients.

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MASCC-0592 Dental Care DENTAL SCREENING OVERVIEW OF 187 HEAD-NECK ONCOLOGY PATIENTS; A RETROSPECTIVE STUDY

K. Bektas-Kayhan1, G. Karagoz1, C. Özbek1, O. Yazicioglu2, E. Çiftçibasi2, M. Altun3, M. Ünür1 1 Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkey; 2Restorative Dentistry, Istanbul University Faculty of Dentistry, Istanbul, Turkey; 3Radiation Oncology, Istanbul University Institude of Oncology, Istanbul, Turkey Background and Aims Dental health and rehabilitation is getting more important in head-neck oncology patients as the outcome of cancer therapy improves. The current knowledge supports the pretherapy dental management, especially before radiotherapy, according to prevent unfavorable outcomes such as osteonecrosis. Methods Data of head-neck patients referred to Istanbul University Faculty of Dentistry for pretreatment dental assesment between June 2006– December 2013 were reviewed. Results The study group consists of 187 (50 female and 137 male) patients with mean age of 50.01. Excluding one patient who treated only with surgery, all other patients were underwent radiation therapy. In dental assesment 5.9 % (n=8) of the patients were found to be edentolous. 74.6 % (n=138) of the patients needed to have periodontal scaling. Dental extractions were planned for 63.1 % (n=118) of the patients. The total number of extractions was calculated as 354 and mean was 2.27. Restorative and endodontic treatments were calculated as %16.8 (n=31) and 2.7 % (n=5) respectively. Conclusions The anectodal statement that head neck oncology patients had poor oral health at the time of oncologic diagnosis was assessed in this retrospective review and found to reflect facts for this study population. The long term follow up after appropriate pretherapy dental management is required to prevent risk of osteonecrosis for this group of patients.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

them were within 2 month after surgery and two of them spent more than 1 year after surgery. We measured the distance between upper and lower incisors and evaluated the efficiency after 6 month opening training. Results Patients with in 2 month showed improvement of mouth opening. The mean of improvement was 20.3 mm in this group after 6 month. The other group did not indicated improvement.

Conclusions The device we used in this report could be useful for the patients just after surgery. However, it could not work for long-term patients.

MASCC-0607 Dental Care

MASCC-0572 Dental Care MOUTH OPENING TRAINING DEVICE FOR TRISMUS AFTER SURGERY OF HEAD AND NECK CANCER

E. Yoshida1, R. Hosokawa1, M. Dodo1, H. Suenaga1, M. Sugazaki1, T. Kato1, T. Tamahara1, M. Ono2, E. Ito1, S. Yamazaki2, T. Koseki1 1 Graduate School of Dentistry, Tohoku University, Sendai, Japan; 2 University Hospital, Tohoku University, Sendai, Japan Background and Aims Trismus is one of severe side effects after surgery in head and neck region. Patients after cancer therapy complain many problems related to trismus such as eating, drinking, talking, and keeping oral hygiene. Therefore trismus make Quality of Life of patient deteriorated substantially. Mouth opening training is critical for prevent trismus. Thus several Jaw-opening devices have been developing. These deices basically develop hinge movement of mandible. Aim of this report is to evaluate new device, which can induce complex movements of mandible. Methods The opening device we used is Kaikun (Tokyo Shizai, Tokyo, Japan). This device develops complex movements because of two shell shapes (Figure). We applied this device for five patients after surgery. Three of

REFLECTORY TRISMUS IN HEAD AND NECK CANCER AND PRECANCEROUS PATIENTS

S. PS1, M.P. Mohan1, H. PS2 1 Oral Medicine, Mar Baselios Dental College, Cochin, India; 2Oral Medicine, Government Dental College, Calicut, India Background and Aims Objective: To assess the restricted mouth opening in patients undergoing treatment for head and neck cancers and precancers BACKGROUND: cancers of the retromolar area, buccal mucosa, and posterior oral cavity would trigger the reflexes for the restricted mouth opening. Patients with oral pre cancer and cancer can develop restricted mouth opening because of the lesion present and due to biological cancer treatment. Methods Patients diagnosed as precancers and cancers clinically and histopathologically were assessed for the maximal mouth opening and restricted mouth opening. These patients had undergone assessment at regular intervals for the next 6 months when undergoing treatment. Assessed together with risk factors including quality of life for the prediction of trismus after treatment in patients with cancer of the head and neck. It was a longitudinal study of 90 patients accepted for primary treatment who attended the Oral medicine clinic of a tertiary referral centre.

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Results In precancers and cancers of the posterior oral cavity had a significant restricted mouth opening at baseline, these subset of patients were more prone to post treatment restricted mouth opening. In every patient, mouth opening decreased after treatment. Tumor location, tumor size, and alcohol consumption had independent effects on mouth opening. Conclusions Cancers and precancers of the retromolar area, buccal mucosa, and posterior oral cavity would trigger the reflexes present in the maxillofacial area, which resulted in restricted mouth opening at baseline. And post operative radiotherapy of maxillary and mandibular tumor involvement is the highest contributing risk factors in such patients.

MASCC-0305 Dental Care 2 PROSTHETIC OBTURATOR AS ALTERNATIVE TREATMENT: A CASE REPORT

R. Carles1, R. Àlvar1, K. Omar1, G. Laia1, C. Paul1, J. Enric1, L. José1 1 Dentistry, University of Barcelona, Barcelona, Spain Background and Aims The head and neck cancer represents 5 % of the total tumor pathologies and the most frequent cause is tobacco and alcohol abuse. The most common is oral squamous cell carcinoma (90 %). These tumors tend to be aggressive and with a high growth potential in areas where surgery leaves large consequences, both functionally and aesthetically and psychologically, that if not solved, quality of life of patients will decrease. A rewarding solution for rehabilitation in patients with maxillary defects are prosthetic obturators. Most tumors requieres either a partial or radical maxillectomy. The amount of soft palate included in ressections is variable and depends on the site and extension of the tumor. Postsurgical maxillary defects predispose the patients to hypernasal speech, fluid leakage into the nasal cavity, impaired masticatory function, and, in some patients, various degrees of cosmetic deformity. The oral disabilities, are minimized or eliminated almost immediately with obturation. The maxillary resection prostheses also reduces the cosmetic deformity by suppling the missing teeth and by properly supporting the upper lip and cheek. Methods Review of the literature apropos of a case report. Results Fifty year old patient who has an exophytic lesion in the right tonsillar region and lateroposterior oropharyngeal wall. After biopsy, injury T2N0 invasive squamous carcinoma was diagnosed. After the surgical resection, the patient has a defect in the soft palate and pharyngeal wall lateroposterior issue making a prosthetic obturator. Conclusions If there are teeth or alveolar ridge after the resection that provides support, stability and retention, for the obturator prostheses, then, surgical reconstruction should be reconsidered.

MASCC-0123

S47 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; 2Oral Medicine Services Otolaryngology and Head and Neck Surgery, City of Hope National Medical Center Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center, Los Angeles, USA; 3 College of Dentistry Dept of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Sciences Center, Memphis, USA; 4 Division of Dentistry Dept of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, USA; 5Dept of Oral and Maxillofacial Radiology, University of Texas Health Science Center San Antonio, San Antonio, USA; 6Dept of Oral Diagnosis, University of Campinas (UNICAMP) Piracicaba Dental School, Piracicaba, Brazil; 7Dept of Biostatistics Schools of Medicine and Nursing, Vanderbilt University Medical Center, Nashville, USA

Background and Aims Data pertaining to the prevalence, severity and optimal management of oral health complications from Head and Neck Cancer (HNC) and its treatment is critical but lacking. This is partly due to lack of standardized tools that capture key oral health outcomes (OHO) pertinent to the HNC population. Methods Based on a literature review and panel of experts, we undertook development of an Oral Health Evaluation Tool (OHET) and Panoramic Radiograph Evaluation Tool (PRET) for use in clinical trials, clinical databases and routine dental care. The tools were tested in a pilot trial of 50 HNC patients treated with chemoradiotherapy. All patients received an oral health assessment by the study dentist, salivary flow, inter-incisal opening measurements and a panoramic radiograph. Data was collected using OHET and PRET. Results The dentist found both tools easy to use. Upon data review by the expert panel, minor modifications were made to the OHET to ensure clarity and consistency of captured data. PRET underwent significant modifications following preliminary testing by two dental oncologists and two dental radiologists. Of the 20 original PRET questions, 13 had high concordance (>97 % agreement) and were retained in unmodified format. Two items were deleted, one item added and five items modified. Conclusions The combined use of OHET and PRET provides a comprehensive, reproducible, inexpensive and easy tool to capture data on oral health status. Further testing in a larger patient population is ongoing. These tools have the potential to reduce subjectivity, increase sensitivity, and improve monitoring for adverse OHOs.

MASCC-0142 Dental Care 2 PALLIATIVE DENTAL CARE FOR METASTATIC BREAST CANCER PATIENTS DURING ACTIVE ANTICANCER TREATMENT

S. Oh1, W.S. Park1, S. Lee2 1 Advanced general dentistry, Yonsei University College of Dentistry, Seoul, Korea; 2Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Dental Care 2 DEVELOPMENT OF TOOLS FOR THE ORAL HEALTH AND PANORAMIC RADIOGRAPH EVALUATION OF HEAD AND NECK CANCER PATIENTS: A METHODOLOGIC STUDY

L.K. Jackson1, J.B. Epstein2, C.A. Migliorati3, J. Rezk4, W.H. Shintaku3, M.E. Noujeim5, A.R. Santos-Silva6, M.S. Dietrich7, B.A. Murphy1

Background and Aims To investigate the dental status of MBC patients during anticancer therapy, the palliative dental procedures, demographic and clinical data as potential risk factors for development of dental problems. Methods A total of 67 MBC patients underwent dental examination during active anticancer treatment from Mar 2012 to Decr 2013. Through critical

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pathway, MBC patients were treated by palliative dental procedures considering their disease control status and anticancer treatment schedule. Results The median age was 54 years and the time between MBC diagnosis to dental consultation was 65 months. Fifty-four patients (79.4 %) had bone metastasis and 48 (70.6 %) had received at least one infusion of bisphosphonate therapy. Although well controlled status in HR positive and HER2 positive subtype, TNBC patients showed disease progressive status at the time of dental consultation. The frequent dental problems were periodontitis (N=46, 68.7 %) and dental caries (N = 35, 52.2 %), root rest (N = 17, 25.4 %) and pericoronitis (N =7, 10.4 %), respectively. A total of 19 patients couldn’t have any dental procedure due to poor medical condition, 6 patients had palliative coronectomy and 1 patient had received temporary denture for symptom control and could continue their anticancer treatment schedule. Conclusions In order to meet the need for dental care in MBC patients, early dental intervention is most important to maximize efficacy and minimize cost. We consider the characteristics of breast cancer subtype when the dental treatment strategy was set up. The effective consultation system between medical oncologist and dentist is encouraged to improve quality care for MBC patients.

MASCC-0136 Dental Care 2 HANDBOOK FOR THE MANAGEMENT OF ORAL COMPLICATIONS IN PEDIATRIC CANCER PATIENTS

A. Majorana1, E. Bardellini1, F. Amadori1, S. Polsoni2, F. Porta3 1 oral pathology, University of Brescia, Brescia, Italy; 2oral Hygiene, University of Brescia, Brescia, Italy; 3Pediatrics, Spedali Civili di Brescia, Brescia, Italy Background and Aims INTRODUCTION: While early diagnosis and advances in cancer therapy for children continue to improve resulting in higher survival rate, oral complications remain a significant cause of morbidity and potential mortality. Cancer therapy-related oral complications are common consequences in paediatric patients undergoing chemotherapy, myeloablative chemotherapy prior hematopoietic stem cells transplantations, or radiation therapy for head and neck cancers or solid tumours. OBJECTIVES: The aim of this study is to create a handbook for management of the common oral complications and simple guide lines useful for pediatric cancer patients and caregiver during hospitalization. Methods METHODS: A pool of specialists (dentists, oral hygienists, paediatrics, nurses, psychologists) have collected data available in Literature about oral complications in children and have created a simple guide which, through short phrases and colourful pictures and drawings, can explain to children the management of oral complication, during and after therapy. The handbook has been translated in four different languages (English, Spanish, Russian and Arabic). Results RESULTS: The Authors show the English and Spanish version of the handbook distributed to children and caregivers in the Paediatric Oncology Department of Spedali Civili di Brescia, (Italy). Conclusions CONCLUSIONS: The distribution of media, like a colourful handbook, to pediatric cancer patients can help them to deal with the therapy and to better bear the hospitalization, increasing the patient’s quality of life.

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MASCC-0312 Dental Care 2 AUTOFLUORESCENCE AND DIAGNOSTIC ACCURACY OF LESIONS OF ORAL MUCOSA. A PILOT STUDY

A. Rosello1, J. Rosello1, G. Judin1, C. Ros1, E. Jané1, J. Lopez1 1 Oral Medicine, University of Barcelona, Barcelona, Spain Background and Aims The purpose of this study was to determine if the use of autofluorescence techniques for the diagnosis of lesions of the oral mucosa are effective and will enhance the ability to make the diagnosis early. Methods We carries out a pilot study in 60 patients. A control group consisting of 30 patients without mucosal pathology and a study group comprising 30 patients with known clinical history for mucosal pathology. Both groups were examined by a specialist in oral medicine and by a general dental clinician who used direct visualization through Velscope® system. Results The general dental clinician did an over-diagnostic on two different occasions, confirming the error with the use of Velscope®. He also performed an infra-diagnostic on one occasion, even with the help of this technology. The sensitivity and specificity for the expert were 1 (95 % CI: 0.884 to 1). The inexpert diagnostic showed a sensitivity of the 0,53 (95 % CI: 0.343 to 0.717) which is not significantly improve do with the use of Velscope® obtaining a sensitivity of 0,49 (95 % CI: 0.406 to 0.773) and a specificity of 0.80 (95 % CI: 0.614 to 0.923). The sample was composed by a small group, it does not fully represent a general population and extrapolation of the data should be done carefully. Conclusions No clinical benefits were obtained using this Velscope® device.

MASCC-0135 Dental Care 2 EVIDENCE FOR PRE-RADIATION ELIMINATION OF ORAL FOCI IN HEAD AND NECK CANCER PATIENTS TO PREVENT ORAL SEQUELAE: A SYSTEMATIC REVIEW

J.M. Schuurhuis1, M.A. Stokman1, P.U. Dijkstra1, A. Vissink1, F.K.L. Spijkervet1 1 Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), Groningen, Netherlands Background and Aims Pre-radiotherapy oral screening of head-neck cancer (HNC) patients is aimed at identifying oral foci in order to prevent post-radiation sequelae, such as osteoradionecrosis. The evidence for its effectiveness is not clear. This systematic review aims to determine available evidence for the efficacy of pre-radiation elimination or maintenance of oral foci in preventing oral sequelae. Methods A broad search was conducted in MEDLINE and EMBASE for papers published up to October 2013. No language filters were applied. Papers on HNC patients subjected to pre-radiotherapy oral screening, (chemo) radiation and dental follow-up were included. Results Nineteen studies, predominantly retrospective studies (n=16), with a great heterogeneity in patient groups, oral screening techniques, and definitions of oral foci and eliminations techniques were found. Most papers lack details on how dental screening was performed and what was considered as an oral focus. The included articles were not conclusive on the efficacy of elimination or maintenance of oral foci with regard to the occurrence of oral sequelae post-radiotherapy.

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Conclusions After systematically reviewing the literature, it is still unclear what the efficacy is of pre-radiation elimination of oral foci, and whether preradiation elimination of foci is mandatory and what to consider as an oral focus.

MASCC-0561 Drug Interactions RECOMBINANT IMMUNO- VIROSOME DIRECTED TARGET CELL SPECIFIC PRO-DRUG ACTIVATING GENE SUICIDE APPROACH TO COMBAT CANCER

I. Khan1, K. Zakaria1, P. Mani1, D. Sarkar2, P. Chattopadhyay3, S. Sinha4 1 Biochemistry, All India Institute of Medical Science, Delhi, India; 2 Biochemistry, University of Delhi South Campus, Delhi, India; 3 Biochemistry, University of Delhi South Campus, Delhi, India; 4 Biochemistry, National Brain Research Centre Manesar, Gurgaon, India Background and Aims Developing a therapeutic modality that specifically targets the neoplastic cells has long been an elusive goal in cancer therapeutics. This necessitates the need for the development of therapeutic modality which specifically targets tumour cells. Aim: To develop a novel tumour targeting therapeutic approach based on recombinant Sendai Immuno-virosomes Methods Placental like Alkaline Phosphatase (PLAP) is an onco-fetal antigen, ectopically expressed in wide range of tumours and consequently its promoter is active only such neoplastically transformed cells. We used PLAP promoter either alone or in combination with tumour specific NFKB based enhancer system for driving the expression of yeast cytosine deaminase and thereby activate the inactive pro-drug 5-FC specifically inside tumour cells. Tumour specific activation to active cytotoxic agent 5-FU addressed one level of non-specificity, which was improved further by using PLAP scFv based engineered Sendai virosomes as vehicular system for cell specific delivery of the cargo. Results Gene suiciding inducing therapeutic constructs packaged & delivered by chimeric virosomal mediated vehicular traffic were able to induce efficient cytotoxicity specifically inside the PLAP positive in vitro models and not in non-PLAP cell lines. This demonstrates both the cell specific delivery as well as tumour specific expression of such therapeutic modalities. These therapeutic constructs specifically activated the apoptotic pathways in PLAP expressing cell lines and not in non-PLAP cells as demonstrated by caspase assay and expression signatures of various pro and anti-apoptotic genes. Conclusions Recombinant Sendai virosomal vehicular traffic combined with tumour activated expression can pave the way for combating wide range of aggressive tumours.

MASCC-0523 Education ASSESSMENT OF KNOWLEDGE, ATTITUDE AND BEHAVIOR ABOUT HEAD AND NECK CANCER (HNC) IN ADULT JEDDAH POPULATION, AND EVALUATION OF EFFECTIVENESS OF EDUCATIONAL INTERVENTION (PILOT STUDY)

R. Alrehili1, R. Sharka1, A. Barashid1, N. Alhazmi1, S. Bukhari1 1Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

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Background and Aims Head and neck cancer (HNC) in Saudi Arabia is the fifth commonest cancer in males and the sixth among females (year 2002). These cancers are more common in men over the age of 50, however, recent reports shows dramatic increase in incidence in younger population. The 5-year survival rate remained terribly low; only 50 %. HNC is considered a lifestyle disease. Major underlying risk factors include: smoking, use of smokeless tobacco, alcohol intake, viral etiology, exposure to UV light, and dietary factors. Methods : A pretested questionnaire was administered to a convenient random sample of patients attending Government hospitals. The questionnaire assessed knowledge and perception of oral cancer as well as habits known to be risk factors. Results 68.3 % have heard of “oral cancer” but feel they don’t know enough about it or nothing at all (43.6 % and 50.8 % respectively). 78 % did not feel oral ulcers are early signs of HNC although 50.2 % feel that swelling or inflation of the neck is an early sign. The main source of their information was found from the internet or TV program rather than schools or family doctor. 90.2 % said their dentist informed them about oral cancer but only 71.4 % actually carried out an oral examination. Conclusions Accumulating evidence shows that the public is poorly informed about HNC. Lack of public awareness is considered a potent barrier for early detection. In a country where tobacco use is rampant, this poses a very serious health concern.

MASCC-0272 Education RESULTS OF THE FRENCH NATIONAL PANACH SURVEY COMPARING PATIENTS’ VS. ONCOLOGISTS’ PERCEPTION OF SUPPORTIVE CARE IN CANCER

T. Bouillet1, P. Artru2, C. Audigier-Valette3, F.X. Caroli-Bosc4, H. Cure5, M.S. Dilhuydy6, G. Ganem7, L. Greillier8, P. Laplaige9, A. Marre10, J.M. Phelip11, P. Quittet12, P. Rouby13, L. Vanlemmens14, F. Scotte15 1 oncology, hôpital avicenne, bobigny, France; 2onco-gastroenterology, Hopital Privé Jean Mermoz, lyon, France; 3pneumology, CHITS Toulon, toulon, France; 4gastro-enterology, chu, angers, France; 5 oncology, Institut Jean Godinot, reims, France; 6 hematology, Groupe hospitalier Sud Hôpital Haut-Lévêque, bordeaux, France; 7 oncology, Centre Jean Bernard, le mans, France; 8oncology, CHU Hopital Nord, marseille, France; 9oncology, Polyclinique, blois, France; 10oncology, ch, rodez, France; 11 gastroenterology, chu, saint-etienne, France; 12 hematology, chu, montpellier, France; 13 psycho-oncology, Institut Gustave Roussy, villejuif, France; 14 oncology, Centre Oscar Lambret, lille, France; 15oncology, Hôpital Européen Georges Pompidou, paris, France Background and Aims Though supportive care forms part of the overall management of cancer patients, little or no data compare how such care is perceived by patients and oncologists. Our objective was to understand patients’ vs. oncologists’ perception of supportive care, fatigue, depression and other disorders associated with cancer and its treatments. Methods A 43-item self-completion questionnaire was sent by postal mail to 2,632 French oncologists. Simultaneously, a 29-item ‘mirror’ questionnaire was sent to patients undergoing cancer treatment.

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Results

MASCC-0057 Education Physicianestimated frequency

Patientreported frequency

% of patients with symptom who mention it to their oncologist

Fatigue

73 %

86 %

87 %

Sleep disturbances

NA

81 %

37 %

Anxiety/depression

39 %

37 %

51 %

Affective disorders/ marital-relationship issues

55 %

NA

38 %

Four hundred fourteen oncologists (16 %) and 118 patients completed a questionnaire from September to December 2013. While 42 % of the patients think that adverse effects of treatments are unavoidable, and even demonstrate their efficacy (18 %), 50 % think that they can be reduced by supportive treatments. Eighty four percent of the oncologists give equal importance to supportive care and cancer treatment. Oncologists reckon that cancer-related disorders are frequent in patients. However, few patients spontaneously mention them to their physician. Conclusions Though fatigue is rather well managed with supportive care, other symptoms (depression, sleep disturbances, affective disorders) should be further investigated by oncologists to enable their patients to speak out and ask for the management of such symptoms.

MASCC-0025 Education LONG-TERM INFLUENCES OF UNDERGRADUATE TRAINING IN PALLIATIVE CARE: A QUALITATIVE STUDY ON THE PERSPECTIVE OF JUNIOR DOCTORS

G. Crawford1, S. Zambrano1 1 Palliative Care/Mary Potter Hospice, University of Adelaide, North Adelaide, Australia Background and Aims There is a growing need for medical practitioners to have basic knowledge and skills in palliative care. Palliative care attachments during undergraduate medical education are aimed at preparing students to deal with end of life issues. The value and effectiveness of these undergraduate attachments in the long-term have remained understudied. This qualitative study explored the long-term impact of undergraduate palliative care attachments from the perspective of junior doctors. The study aimed to understand how the attachments prepared them to face the challenges of dealing with death and dying. Methods Data from in-depth, one-on-one, semi-structured interviews was analysed through Thematic Analysis. Consistent with qualitative methodology, sampling ceased at data saturation with nine participants. Results Three main themes were identified: 1) a contrasting experience with death, 2) from apprehension to gaining a sense of control, and 3) gaining perspective in the practice of medicine. The first theme describes the differences that participants found between palliative care and the acute care context. The second theme relates to the skills and knowledge acquired during the attachments. Finally, the third theme highlights how the skills gained had an impact beyond the palliative care setting and their importance in general medical practice. Conclusions Working with patients at the end of life is part of the professional lives of all medical practitioners and appropriate preparation is essential. In the transition to junior doctors, undergraduate palliative care attachments offer invaluable skills that become relevant early in the junior doctors’ career.

BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAW: AWARENESS AND LEVEL OF KNOWLEDGE OF LEBANESE PHYSICIANS

L. el Osta1, B. el Osta2, S. Lakiss3, M. Hennequin4, N. el Osta5 1 Public Health, Faculty of Medicine Saint-Joseph University, Beyrouth, Lebanon; 2Hematology-Oncology, Georgia Regents University, GA, USA; 3Faculty of Medicine, Faculty of Medicine Saint-Joseph University, Beyrouth, Lebanon; 4Equipe d’Accueil (EA4847) - Centre de Recherche en Odontologie Clinique (CROC), School of Dentistry Auvergne University, Clermont-Ferrand, France; 5Prosthodontics, School of Dentistry Saint-Joseph University, Beyrouth, Lebanon Background and Aims Bisphosphonate-induced osteonecrosis of the jaw (ONJ) is a potentially destructive complication, particularly encountered in oncology. It is supposed that awareness and good knowledge of this disease by physicians are important factors of its early detection, effective management and prevention. This study aims to evaluate the level of knowledge among a sample of Lebanese physicians with regard to this complication. Methods An observational cross-sectional study was conducted at Hôtel-Dieu de France university hospital between January 2013 and June 2013. Data were collected through a self-administered questionnaire distributed to 190 eligible physicians in the departments involved in prescribing bisphosphonates and in managing the ONJ. Results A total of 136 valid responses were obtained (response rate:71.6 %). More than half of the participants (63.2 %) were treating patients with bisphosphonates: the most prescribed form being the weekly oral bisphosphonates for osteoporosis followed by the zoledronate several times yearly for oncologic bone disorders. Almost one-third of the participants (37.5 %) were unaware of bisphosphonate-related ONJ. Furthermore, the level of knowledge was relatively poor: the mean score of all participants was 12.42±10.08; while 56.6 % had a global score more than 16 over 30. There were statistically significant associations between the level of knowledge and physician’s specialty (−p-value<0.0001), bisphosphonates prescription (−p-value= 0.039), form of bisphosphonate prescribed (−p-value=0.050), examining patients already on bisphosphonate (−p-value=0.047), having observed (−p-value=0.004) and treated (−p-value=0.002) exposed necrotic bone of the jaw among patients. Conclusions Our study showed a deficient knowledge regarding this uncommon complication. Thus, training strategies to increase the awareness among physicians are required.

MASCC-0428 Education DEVELOPING AND IMPLEMENTING GUIDELINES FOR TREATING PATIENTS WITH ORALLY-ADMINISTERED ANTI-CANCER DRUGS IN THE HOME-CARE SETTING: EXPERIENCE OF A LARGE CANCER CENTER

T. Granot1, Y. Stern2, H. Farman3, R. Bosani4, S.M. Stemmer5, A. Morag6 1 Breast Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; 2 G.I.Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; 3Head and Neck Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; 4 Urooncology Unit, Davidoff Cancer Institute, Petah-Tikva, Israel;

Support Care Cancer (2014) 22 (Suppl 1):S1–S238 5 Deputy of Oncology Institute, Davidoff Cancer Institute, Petah-Tikva, Israel; 6Head Nurse of Davidoff Cancer Institute, Davidoff Cancer Institute, Petah-Tikva, Israel

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Increases in knowledge and competence were as follows: Educational Objective

Background and Aims The ongoing trend of using orally-administered instead of intravenouslyadministered anti-cancer drugs improves patients’ quality-of-life and reduces costs. However, as this trend facilitates transition of patients to the home-care setting, issues such as compliance, patient monitoring, and addressing adverse events (AEs), become more challenging. Thus, this trend requires remodeling patient care and the communication between the ambulatory care staff and the patients. Aim: to describe the development and implementation of guidelines related to the treatment of cancer patients with orally-administered drugs in a large cancer center. Methods Guideline development included several steps such as identifying safety issues, performing a literature review, evaluating the number of patients treated with orally-administered drugs, developing patient capabilities assessment tool, and creating relevant documents (eg, information and contacts orders for each treatment and checklists/follow up sheets for the staff). Results Guidelines were developed and implemented among 2013–2014. At present, the ambulatory care nurses proactively monitor the treatment of approximately 50 patients (per week), who are being treated at home. The monitoring is performed by phone/email and includes confirming appropriate drug handling and administration (eg, issues related to storage, dosage, drug-drug interactions, and drug-food interactions), follow-up on blood tests, assessment of symptoms, and hospitalization, if needed. Guidelines implementation improved compliance and decreased the rates of AEs (eg, renal failure) and hospitalizations (will be presented). Conclusions Developing and implementing guidelines for managing patients treated with orally-administered anti-cancer drugs was associated with improved patient care and represents the commitment of the oncology staff to patients’ quality-of-life and safety.

MASCC-0182 Education INFLUENCE OF CERTIFIED CONTINUING EDUCATION ON PHYSICIAN, NURSE, AND PHARMACIST KNOWLEDGE AND COMPETENCE IN CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV)

M. Haas1, A. Heintz1, S. Fagerlie1 1 Certified Medical Education, Educational Concepts Group, Atlanta, USA Background and Aims Despite significant progress in the prevention and treatment of CINV, results remain suboptimal. An estimated 70–80 % of patients undergoing chemotherapy experience CINV. Review of clinical trial results and discussion regarding appropriate incorporation into therapeutic decision making is necessary to provide the highest quality patient care. Methods Forty independent continuing education activities were held within medical communities across the USA. During each activity, participants were asked a series of case-based questions to assess baseline knowledge, competence, and identify practice patterns. Assessments were repeated after each activity to determine change. Documented changes and barriers to implementation were captured via a 6-week electronic survey. Results A total of 332 oncology physicians, nurses, and pharmacists participated in the program. The number of patients cared for each month ranged from 1 to 10 to>40 %; representing a potential impact of 11,000 patient lives.

Identify patient- and treatment-specific parameters that enable personalized therapy decisions Incorporate guidelinebased approaches for the prevention and management of CINV Design optimal prevention and management strategies for treatment-related CINV Increase awareness of agents in development for the treatment and/or prevention of CINV

% Correct Pre-Education 57 %

% Correct Post-Education 88 %

41 %

61 %

54 %

79 %

10 %

69 % Data from 6-week responses will be presented.

Data on practice pattern assessment and 6-week responses will be presented. Conclusions The data suggest educating healthcare professionals on clinical trial results along with discussion of translation of this information into patient care increases knowledge and competence in CINV management.

MASCC-0065 Education CERVICAL CANCER SCREENING AMONG UNIVERSITY STUDENTS IN SOUTH AFRICA: A THEORY BASED STUDY

M. Hoque1, S. Ghuman2, V.H. Guido3 1 Graduate School of Business and Leadership, University of KwaZuluNatal, Durban, South Africa; 2Department of Community Health Studies, Durban University of Technology, Durban, South Africa; 3Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium Background: Cervical cancer is a serious public health problem in South Africa. Even though the screening is free in health facilities in South Africa, the Pap smear uptake is very low. Aims: The purpose of the study is to investigate the knowledge and beliefs of university female students in South Africa. Methods: A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, and screening history. Results: The average age of 440 students was 20.39 years (SD= 1.71 years). About two-thirds (63 %) of the students had sexual intercourse before. Regarding cervical cancer, 55.2 % (n=243) ever heard about it. Results indicated that only 15 % (22/147) of the students who ever had sex and heard about cervical cancer had done the Pap test. Pearson correlation analysis showed that cervical cancer knowledge had a significantly negative relationship with barriers to cervical cancer screening. Susceptibility and seriousness score were significantly moderately correlated with benefit and motivation score as well as barrier score. Self-efficacy score had also a moderate correlation with benefit and motivation score. Students having had a Pap test had significantly lower score in barriers to be screened compared to students who did not have a Pap test. Conclusion: This study showed that educated women in South Africa lack complete information on cervical cancer and its risk factors. Students having had a Pap test had significantly lower barriers to cervical cancer screening than those students who had not have had a Pap test.

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MASCC-0596 Education DOES THE USE OF MASCC ORAL AGENT TEACHING TOOL (MOATT) IN OLDER ADULTS WITH CANCER IMPROVE MEDICATION SELF-EFFICACYAND ADHERENCE?

M. Lemonde1, M. Puts2, M. Nematollahi3 1 Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Canada; 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; 3Medical Oncology, Stronach Regional Cancer Centre, New Market, Canada

Background and Aims Adherence is crucial to obtain optimal treatment outcomes. Nonadherence to oral chemotherapy and/or hormonal therapy has been shown to negatively affect cancer outcomes, such as higher recurrence rates and shorter survival. The purpose of this study is to contribute to available evidence-based interventions to promote adherence to oral cancer agents in older adults diagnosed with cancer. The study aims are: 1) To evaluate the feasibility of using the MOATT in face-to-face education with in older cancer patients to support patient’s selfreported medication adherence and self-reported medication understanding and use self-efficacy scale. 2) To examine the efficacy of the use of the MASCC Oral Agent Teaching Tool (MOATT) in older adults with cancer on medication adherence compared to usual care. 3) To evaluate the feasibility of the Medication Understanding and Use Self-Efficacy Scale in the context of patient education for older adults with cancer. Methods An exploratory phase II quasi-experimental study. Sample and setting We plan to recruit 60 (30 in the control group and 30 in the intervention group) older adults aged 65 years and older with cancer diagnosis as many of the treatments for these older adults involve complex regimens with oral agents at the Stronach Regional Cancer Center, Southlake Regional Health Centre in Newmarket, Ontario, Canada. Data analysis and interpretation Repeated measures ANOVA will be used to examine if the intervention was effective in improving medication adherence and self-efficacy. Results Will be discussed in the meeting Conclusions N/A

MASCC-0073 Education RUSSIAN SUPPORTIVE CARE IN CANCER: TWO YEAR PROGRESS REPORT

A. Snegovoy1, S. Tjulandin2, L. Manzyuk1, V. Larionova3, D. Nosov2, I. Tsimafeyeu4 1 out-patients chemotherapy, N.N.Blokhin Russian Oncological Science Center, Moscow, Russia; 2clinical pharmacology, N.N.Blokhin Russian Oncological Science Center, Moscow, Russia; 3hematology, N.N.Blokhin Russian Oncological Science Center, Moscow, Russia; 4director, Russian Societ of Clinical Oncology, Moscow, Russia

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Background and Aims Cancer treatment in Russia is developing rapidly into the targeted era, thus requiring parallel development in Supportive Care. The Russian Society of Clinical Oncology (RUSSCO) has set up a Supportive Care Group to increase expertise in Supportive Care and to produce Russian Supportive Care Recommendations. To report on the first 2 years of the RUSSCO Supportive Care Group. Methods Training has been carried out via web seminars, touring visits and via sessions at major Russian Oncology meetings. Recommendations have been tailored to the Russian situation with expert advice and collaboration with MASCC and ASCO experts. Results There is an increased level of Supportive Care knowledge among Russian Oncologists, and a corresponding increase in implementation of that knowledge in clinical practice. Russian Recommendations have been created for: Anaemia, Emesis, Bone Metastases, Febrile Neutropenia, Hepatitis reactivation, Hepatotoxicity, Cardiovascular toxicity, Skin toxicity from EGFRi, nutrition, organ failure, thromboembolic complications, and extravasation. Annual updates of these guidelines are planned, as well as expansion to include new topics. Conclusions Ongoing collaboration with MASCC and other Societies is seen highly desirable. Tailoring Recommendations or Guidelines to local needs is vital. Education is key to implementation. Once a critical mass is achieved it can serve as a platform for expansion and for clinical trial development.

MASCC-0378 Education PROMOTION OF CANCER REHABILITATION IN JAPAN: THE CAREER (CANCER REHABILITATION EDUCATIONAL PROGRAM FOR REHABILITATION TEAMS) PROJECT

T. Tsuji1, K. Mizuochi2, T. Koyama3, Y. Takakura4, T. Kobayashi5, K. Horaiya6, T. Kanda7, N. Sugimori8, E. Sasaki9, K. Masuoka10, K. Abe11, M. Kurihara12 1 Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Rehabilitation Medicine, Yokohama City University Hospital, Yokohama, Japan; 3Department of Rehabilitation, Tokyo Metropolitan Geriatric Hospital and Institue of Gerontology, Tokyo, Japan; 4School of Physical Therapy, Faculty of Health and Medical Care Saitama Medical University, Saitama, Japan; 5Faculty of Health Care Sciences, Chiba Prefectual University of Health Sciences, Chiba, Japan; 6Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; 7Department of Rehabilitation Medicine, Shizuoka Cancer Center Hospital, Suntogun, Japan; 8Rehabilitation Center, Tokyo Medical University Hospital, Tokyo, Japan; 9Graduate School, Wakayama Medical University, Wakayama, Japan; 10Nursing department, Hiroshima City General Rehabilitation Center, Hiroshima, Japan; 11 Graduate School of Nursing, Chiba University, Chiba, Japan; 12 Nursing department, National Cancer Center Hospital East, Kashiwa, Japan Background and Aims: Cancer rehabilitation resources are insufficient in Japan. In 2006, the National Cancer Control Act was approved. As part of its measures, the Cancer Rehabilitation Educational Program for Rehabilitation Teams (CAREER), which is a cancer rehabilitation training workshop project commissioned by the Ministry of Health, Labour and Welfare, was launched in 2007. The aim of this study was to evaluate the effect of the CAREER workshop.

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Methods: The purpose of the CAREER workshop is to develop medical care professionals who have the necessary knowledge and skills to work together as a team across different disciplines when practicing cancer rehabilitation. Participants in a team of 4 people include a doctor, a nurse, and two rehabilitation therapists (PT, OT, SLHT). There were around 200 participants comprising 50 doctors, 50 nurses, and 100 therapists at each workshop. The workshop was conducted over 2 days of lectures, group work, practice, and demonstration. We analyzed the demographic data of all participants. Results: We performed a total of 28 workshops over the 4 years from 2010 to 2013. Five thousand two hundred sixty-one medical professionals participated. 304 (76.6 %) of 397 designated cancer care hospital facilities nationwide were represented. After completing the CAREER workshop, 197 facilities (49.6 %) have obtained the Cancer Patient Rehabilitation fee from the national health insurance system. Conclusions: The survey demonstrated that many cancer rehabilitation professionals have been educated and medical facilities have been developed by the CAREER workshop. Efforts will continue to equalize cancer medical services and improve the QOL of cancer patients.

MASCC-0088 Education TOWARDS RESOURCE-PROMOTING, CONTEXTUAL PATIENT EDUCATION – CANCER PATIENTS’ KNOWLEDGE EXPECTATIONS AND THE SIGNIFICANT FACTORS AFFECTING THESE EXPECTATIONS DURING THE ILLNESS TRAJECTORY

H. Vaartio-Rajalin1, H. Leino-Kilpi1, L. Iire2, H. Minn2 1 Nursing Science, University of Turku, Turku, Finland; 2Oncologic clinic, Turku University Hospital, Turku, Finland Background and Aims Cancer is today seen as a chronic illness that impacts multiple aspects of an individual’s life, including possible cognitive deterioration with an effect on self-confidence and independence. These new perspectives should be reflected within patient education practices. The study aimed to explicate adult cancer patients’ knowledge expectations (the content and meaning of information in light of empowerment) and to identify the significant factors affecting these expectations during the illness trajectory. Methods A mixed methodology study: patients’ knowledge expectations were assessed through focus group interviews (n=37) and in-depth interviews (n=16) in a sample of actual and former patients with cancer. In order to identify factors connected with patients’ knowledge expectations, a survey was conducted among patients at two university hospitals (n=332) using the Expected Knowledge of Hospital Patients® instrument. Results On the basis of interview datasets, nine categories describing patients’ knowledge expectations in light of empowerment were identified. The survey data supported these categories and the identified personal, situational and clinical factors affecting the patients’ knowledge expectations during the illness trajectory. Conclusions Patient education seem to be focused into beginning of illness trajectory and into routine education about bio-physiological facts, when cancer patients are expecting individual, resource-promoting knowledge about self-care in order to enact into cancer management as equal partners. Inattentiveness for the different personal, situational and clinical factors affecting patient’s knowledge expectations during care process have negative consequences for patient education outcomes and thus also to the patients’ quality of life.

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MASCC-0360 Fatigue THE EFFECTS OF TAIWAN VERSION OF ENERGY CONSERVATION AND ACTIVITY MANAGEMENT (T-ECAM) ON FATIGUE IN PATIENTS WITH BREAST CANCER UNDERGOING CHEMOTHERAPY: DEVELOPMENT AND TEST

H. Chou1 1 Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan Background and Aims Fatigue has been described as the most frequent and distressing problem of breast cancer patients who undergoing chemotherapy. The purpose of the study was to evaluate the effectiveness of Taiwan version energy conservation and activity management (T-ECAM) intervention on fatigue among patients with breast cancer. Methods The study’s aim was to evaluate the effectiveness of T-ECAM intervention, which is a randomized controlled trial. Qualified subjects who have been recruited from one medical center of oncology are randomly assigned into an experimental group (64 subjects) or control group (64 subjects). T-ECAM intervention is a 3-week intervention developed for breast cancer patients. All participants had evaluated with instruments of fatigue, after T-ECAM intervention, and follow three times. The statistical methods include repeat measure analysis. Results The findings of the study were (1) Although the T-ECAM group had lower fatigue scores in the second cycle of chemotherapy than the control group, the difference was statistically significant; (2) As for the long-term pattern of fatigue in lung cancer patients who underwent chemotherapy, the fatigue associated with chemotherapy peaked after treatment and remained elevated 1 week after each cycle of chemotherapy, and was observed to gradually diminish over time but never reached baseline values. Conclusions These findings will help health care providers to understand fatigue patterns over time. They also can improve quality of care and fatigue management strategies for breast cancer patients undergoing chemotherapy.

MASCC-0485 Fatigue PREVALENCE OF FATIGUE AMONG CANCER PATIENTS RECEIVING VARIOUS ANTI-CANCER THERAPIES AND ITS IMPACT ON QUALITY OF LIFE - A CROSS-SECTIONAL STUDY

K. Guru1, D. Jumnani1, K.R. Prabhu1 1 Physiotherapy, Srinivas College of Physiotherapy & Research Center, Mangalore, India Background and Aims Fatigue is disabling and continuous phenomenon in cancer patients during and after various anticancer treatments which can continue for many years after treatment and has profound effect on the life quality. There is growing evidence to show that cancer related fatigue (CRF) due to various anticancer treatment. However, determining its severity is still underestimated among the cancer patients those who are suffering with this distressing symptom. and its association with quality of life (QOL).

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Aim was to find out the prevalence of rate of fatigue and its relative impact on QOL in cancer patients receiving radiotherapy, chemotherapy and concurrent radio-chemotherapy. Methods This Cross Sectional observational study included a total 121 cancer patients receiving radiotherapy, chemotherapy and concurrent chemo-radiation with the age group of above 15 years who fulfilled the inclusion criteria. All the patients were assessed for severity of fatigue using Brief Fatigue Inventory and QOL by using FACT-G while they were receiving the anti-cancer therapies as an in-patient in the cancer centers. Results The severity of fatigue was more in chemotherapy (98.30 %) and concurrent chemo-radiation (78.57 %) as compare to radiotherapy (45 %). Moderate correlations were exhibited between fatigue due to radiotherapy and QOL (r=−0.71, p<0.01, respectively). Conclusions Severity of fatigue was found more after chemotherapy and concurrent chemo-radiation therapy while impact on QOL was more after the radiotherapy.

MASCC-0497 Fatigue ASSESSMENT OF THE IMPACT OF CANCER-RELATED FATIGUE ON BREAST CANCER SURVIVORS

J.M. Jones1, C. Longo2, K. Olsen3, P. Bedard4, E. Amir4, D. Howell5 1 Cancer Survivorship, Princess Margaret Cancer Centre, Toronto, Canada; 2Health Services Management, McMaster University, Hamilton, Canada; 3Nursing, University of Alberta, Edmonton, Canada; 4Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada; 5 Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Canada Background and Aims Cancer-related fatigue (CRF) is a well documented symptom following breast cancer (BrCa) treatments. The purpose of the current study was to examine and compare the social functioning, work absenteeism and presenteeism, and the use of health and supportive care services between breast cancer survivors with and without CRF. Methods One-time cross-sectional survey. Preliminary data analyses were conducted on a sample of n=236 early stage (0-III) BrCa survivors (1–5 years post-treatment). Fatigue was measured using the FACT-F. Those with (≤34) and without (>34) significant CRF were compared on the Social Difficulties Inventory (SDI-21); WHO Health and Work Performance Questionnaire; and Health Service Utilization Questionnaire. Results Ninety-two (38.7 %) met the cut-off for CRF. Those with and without CRF did not differ on age, time since treatment, or treatments received. Respondents with CRF had higher levels of social difficulties: SD-16 Total (p < 0.0001), Everyday living (p < 0.0001), Money matters (p<0.001), and Self and others (P<0.0001). Those with CRF were more likely to be unemployed (p=0.039) or on medical leave (p<0.0001); reported lower levels of absolute presenteeism (p<0.0001); and higher use of physician (p=0.043), hospital (p=0.025), allied health (p=0.007) and psychosocial (p<0.0001) services. Conclusions CRF was related to higher levels of social difficulties and health care utilization and less work productivity. These finding help to personify the impact of CRF and highlights the need for active screening procedures and interventions which include these outcomes. Full data set (n=300) and analyses will be presented.

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MASCC-0226 Fatigue GENE EXPRESSION PROFILING OF EVENING FATIGUE IN WOMEN UNDERGOING CHEMOTHERAPY FOR BREAST CANCER

K.M. Kober1, L. Dunn2, S. Paul1, B. Cooper1, C. Miaskowski1, B.E. Aouizerat1 1 School of Nursing, University of California, San Francisco, USA; 2 School of Medicine, University of California, San Francisco, USA Background and Aims Cancer-related fatigue (CRF) is a common and debilitating symptom that occurs in patients undergoing treatment. A major impediment to the development of effective treatments is a lack of understanding of the mechanisms underlying CRF, which can be identified by evaluating patterns of gene expression associated with CRF. Our aim was to correlate phenotypic and gene expression differences with severity of evening CRF. Methods Data and sample collection was completed for 44 patients undergoing chemotherapy for breast cancer. CRF was measured using the Lee Fatigue Scale (LFS) and used to identify subgroups of women with lower (LFS< 5.6, n=19) and higher (LFS>5.6, n=25) evening CRF. Total RNA was extracted from blood and gene expression was measured using the Illumina HumanHT-12 microarray. Results Compared to the lower evening fatigue group, patients in the higher evening fatigue group reported a lower functioning, a higher comorbidity score, and a lower number of prior cancer treatments (all p<0.05). One gene was up-regulated (p<0.05) and 11 genes were down-regulated (all p<0.001) in the higher evening fatigue group. Gene set analysis revealed 24 down-regulated and 94 simultaneously up and down perturbed pathways between the two evening fatigue groups. Transcript Origin Analysis found differential expression originated from monocytes and dendritic cell types. Query of public data sources found 18 experiments (e.g., exhaustive exercise, sickness behavior) with similar expression profiles. This comprehensive set of analyses revealed that inflammation is associated with evening fatigue severity. Conclusions These results suggest that the mechanisms that underlie CRF in oncology patients include an inflammatory component.

MASCC-0425 Fatigue FEASIBILITY STUDY: RESTORATIVE YOGA FOR CANCER PATIENTS WITH FATIGUE ASSOCIATED WITH RADIATION AND CHEMOTHERAPY

S. Lorhan1, H.M.L. Daudt2, M. van der Westhuizen3 1 Volunteer Services, BC Cancer Agency, Victoria, Canada; 2Clinical Research Management, BC Cancer Agency, Victoria, Canada; 3 Administration, BC Cancer Agency, Victoria, Canada Background and Aims Up to 80 % of patients with cancer undergoing treatment experience fatigue. Yoga has been found to improve fatigue, quality of life, sleep quality, and cancer related distress. Restorative yoga is a modifiable, lightintensity type of yoga suitable for patients with cancer. Our primary study objective is to determine the operational feasibility of providing 2 months of weekly 90 min yoga sessions for cancer patients undergoing treatment. Secondary objectives are to observe the trends in cancer related fatigue (CRF) and quality of life (QoL) within this sample population.

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Methods We will conduct a single arm trial using a mixed methods research design at the BC Cancer Agency, Vancouver Island centre. The intervention will include restorative yoga therapy taught by volunteer instructors. Sixteen cancer patients undergoing radiation and/or chemotherapy will be recruited. CRF and QoL data will be collected at baseline, 8 weeks, and 16 weeks. Qualitative interviews will be held one and 8 weeks postintervention to explore the patients’ perceptions. Demographics will be reported using descriptive statistics. Results Patient recruitment starts in February 2014. The impact of the intervention on CRF and QoL will be evaluated using a pre- and post-intervention paired t-test. The qualitative data will be analyzed using thematic analysis and will be used in interpretation of the quantitative findings. We predict that the project will be feasible, and trends towards an increase in QoL and decrease in fatigue will be observed during the intervention. Conclusions The results will inform a future larger sample sized study.

MASCC-0426 Fatigue THE BIOLOGY OF CANCER-RELATED FATIGUE: A REVIEW OF THE LITERATURE

L. Saligan1, F. Cramp2, C. Escalante3, K. Filler1, D. Larkin4, K. Mustian5, K. Olson6, O. Palesh7, S. Yennu8 1 National Institute of Nursing Research, National Institutes of Health, Bethesda, USA; 2Health and Life Sciences, University of the West of England, Bristol, United Kingdom; 3General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; 4 Capital Region Cancer Service, The Canberra Hospital, Garran, Australia; 5School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA; 6Faculty of Nursing, University of Alberta, Edmonton, Canada; 7Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, USA; 8Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Understanding the causative mechanisms of cancer-related fatigue (CRF) is essential for its effective management. This review is being undertaken to describe proteomic and genomic biomarkers associated with CRF. Methods An initial literature query of the topic, using the keywords ‘cancer,’ ‘neoplasm,’ ‘biomarker,’ ‘immune,’ ‘inflammation,’ OR ‘fatigue’ was conducted in PubMed, Scopus, Embase, and CINAHL. Duplicates were removed and the search was refined by applying the exclusion criteria to only include articles published from 2004 to 2013, articles written in English, human adult studies, and original natural history articles (e.g. letters, literature reviews, meeting abstracts, editorials, and dissertations were excluded). Final list of articles was determined by visual examination of the titles and abstracts of the remaining articles. Articles with a sample size <50 were further excluded. Full text review of the final list of manuscripts determines biomarkers that have significant associations with CRF. Results The initial literature query yielded 11,129 articles. After duplicates were removed and exclusion criteria applied, 7,175 articles remained. Visual review of the titles left 3,811 articles for consideration. The abstracts of the remaining articles were inspected and 75 articles were selected for an ongoing full-text review. Biomarkers with significant associations with CRF were related to immune response, inflammation, metabolism, and neuroendocrine function. Covariates especially the effect of age on the association of CRF with the biomarkers will be further examined.

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Conclusions This ongoing review will describe physiologic pathways that influence CRF. Gaps in knowledge are identified and recommendations for future research are discussed.

MASCC-0256 Fatigue ACUPUNCTURE AND RELAXATION WITH GUIDED IMAGERY ON THE SYMPTOMS OF FATIGUE, DEPRESSION AND HEALTH-RELATED QUALITY OF LIFE IN CANCER PATIENTS

N. Sawada1, A.C. Nicolussi1, J.M. Paula1, L. Okino1, B.F. Toneti1 1 General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil Introduction: Complementary therapies such as acupuncture and relaxation with guided imagery have been used by cancer patients to reduce symptoms of treatment. Objective: To evaluate these therapies on symptoms of depression, fatigue and health-related quality of life (HRQoL) in cancer patients undergoing chemotherapy through instruments Quality of Life Questionnaire Core-30, Beck Depression Inventory and fatigue PIPER at the beginning (baseline) and at the end of treatment (6 months later). Methods: a nonrandomized clinical study with a control group (CG) and intervention (IG), at Ribeirão Preto-SP, Brazil. The IG received acupuncture and relaxation with guided imagery sessions, once a week and the CG only replied instruments Results: The initial sample consisted of IG=50 and CG=40 patients, and late IG=32 and CG=40. Comparing the beginning and end of treatment, the results showed that the IG had improvement in all functions and reduction of symptoms except loss of appetite, constipation and diarrhea and for CG worsened in physical, emotional, cognitive, and social functions and an increased in all symptom scales except pain. Beck Depression Inventory: the baseline data showed that most of the patients in the IG and CG were without depression and in the end, the IG exhibited reduced depression and the GC increased. In both groups, the mean total fatigue increased after the treatment. Conclusion: Comparing the IG and CG by Student’s t-test did not find statistically significant differences, but we can infer that complementary therapies have improved the functions and decreased symptoms of patients and consequently influenced to better HRQoL.

MASCC-0257 Fatigue PRESENCE OF FATIGUE IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING RADIOTHERAPY

N. Sawada1, J.M. Paula1, A.C. Nicolussi1, B.F. Toneti1, H.M. Sonobe1 1 General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil Background and Aims Head and neck cancers represent the fifth position in the list of the most common cancers. One of the most common for this type of cancer treatment is radiation therapy, with fatigue as one of their most frequent side effects. Objective To raise the frequency of fatigue symptoms in patients with head and neck cancer undergoing radiotherapy treatment at the beginning, middle and end of treatment and influence on quality of life related to health (HRQOL).

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Methods An exploratory prospective study conducted in outpatient radiation therapy in a public hospital in Ribeirão Preto - Brazil. Three instruments were used: the clinical/demographic data, the FACT H&N - Functional Assessment Cancer Therapy Head and Neck and Piper Fatigue Scale. Data analysis was quantitative, using SPSS version 15.0. Results The sample consisted of 41 patients. By analyzing the three moments of the instruments PIPER and FACT H&N, we find that the mean PIPER increased throughout the treatment, showing increased fatigue. While the mean FACT H&N decreased at the middle and end of treatment, indicating deterioration in HRQL these patients. Conclusions This study we can conclude that radiotherapy increases the symptoms of fatigue in patients with negative influence on quality of life. The presence of fatigue symptoms indicates the need for nurses to orient patients early in treatment as this possibility and plan a tour so this symptom is reduced.

MASCC-0063 Fatigue 2 INTEGRATIVE MEDICINE: APPROACHES TO MANAGEMENT OF CANCER-RELATED FATIGUE

K. Anderson1 1 Naturopathic Medicine, Cancer Treatment Centers of America, Tulsa, USA Background and Aims Cancer-related fatigue (CRF) is a distressing symptom for cancer patients impacting their function and QOL. Causal factors include physical conditions, cognitive states, pro-inflammatory cytokines, and metabolic factors. Problems associated with CRF include treatment side effects, weight changes, sleep disturbances, psychological effects, and co-morbid conditions. Methods EBM areas evaluated and discussed include: Rehabilitation Therapy: Exercise has the best non-pharmacologic evidence for managing CRF (1) especially when patients choose exercises they enjoy, receive specific implementation strategies, (1,2) and combine cognitive and spiritual elements with movement, stretching, and balance (Tai Chi, Qi Gong or Yoga). Studies confirm Qi Gong improves QOL, reduces treatment side-effects and produces anti-inflammatory benefits. (3) Mind Body Medicine: Cognitive Behavioral therapy has strong evidence in managing CRF (4) and specific self-care/coping strategies shown more effective than non-specific strategies. (5) Acupuncture: Improves QOL and CRF Naturopathic Medicine: Education on lifestyle modifications including sleep, smoking cessation, stress management, drug-drug and drugnutrient interactions along with evidence based therapies including cold laser therapy, and nutriceuticals such as Omega three fatty acids (8), American Ginseng (9), B vitamins, L-Carnitine, CoQ10 (10) and Vitamin D (11) aid in managing CRF. Nutrition: Education on managing weight changes, measuring caloric intake, fluid and electrolyte imbalances all assist in managing CRF. Small frequent meals with complex carbohydrates and protein support optimal energy levels. Results Lit review&clin exp; see above Conclusions Often part of a “symptom cluster” alongside anxiety, depression, pain, nausea and insomnia, CRF is best addressed through a mutidisciplinary integrative personalized approach.

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MASCC-0194 Fatigue 2 THE PREVALENCE, SEVERITYAND TRAJECTORY OF FATIGUE WITH PRO-INFLAMMATORY BIOMARKERS IN ASIAN BREAST CANCER PATIENTS: A PROSPECTIVE COHORT STUDY

Y. Cheung1, T.R.D. Ng1, M. Shwe1, Y.C. Kee2, H.K. Ho1, W.K. Chui1, G. Fan3, W.S. Yong4, P. Madhukumar4, W.S. Ooi5, W.Y. Chay5, R.A. Dent5, S.F. Ang5, M. Wong5, S.K. Lo5, Y.S. Yap5, R. Ng5, A. Chan1 1 Pharmacy, National University of Singapore, Singapore, Singapore; 2 Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; 3 Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore; 4Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 5Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore Background and Aims Early-stage breast cancer (ESBC) patients commonly experience cancer-related fatigue (CRF) during chemotherapy. However, the role of inflammatory biomarkers underlying CRF remains debatable. This study was conducted to identify the prevalence, severity and trajectory of fatigue in relation to pro-inflammatory cytokine level changes in ESBC patients. Methods This is a prospective cohort study conducted at the largest cancer center in Singapore. Chemotherapy-receiving ESBC patients were recruited. The Brief Fatigue Inventory (BFI) was administered and a panel of proinflammatory plasma cytokines (IL-1β, IL-4, IL-6, IL-8 and TNF-α) was evaluated using multiplex immunoassay prior to chemotherapy (T1), at midpoint (T2), and end of chemotherapy (T3). Fatigue was defined as patients whose T2 and/or T3 BFI severity score increased by 0.25 standard deviation comparing to baseline. Results Fifty-eight patients were included (mean age 49.5±8.5 years; 81 % Chinese). Overall, patients’ fatigue levels were mild but they reported more fatigue progressively from T1 to T3 [median (IQR): 1.30 (0.1–2.4) vs 1.45 (0.2–2.5) vs 1.70 (0.6–3.7), p=0.001]. From T1 to T2, patients experiencing fatigue had higher baseline levels of IL-6 [2.56 (1.07–4.58) pg/ml vs 1.85 (1.31–2.82) pg/ml; p=0.06)], IL-8 [5.80 (3.84–7.34) pg/ml vs 4.72 (2.89–6.13) pg/ml; p=0.083)] and TNF-α [1.80 (0.35–4.08) pg/ ml vs 1.51 (0.49–2.78) pg/ml; p=0.086)] (controlling for age, body mass index, cancer stage and chemotherapy regimen). No significant associations were identified with IL-1β and IL-4. Conclusions Asian ESBC patients experienced mild level of fatigue during chemotherapy. Patients with higher baseline levels of IL-6, IL-8 and TNF-α may be more likely to experience CRF.

MASCC-0011 Fatigue 2 BIOMARKERS FOR CHEMOTHERAPY INDUCED FATIGUE

F.M. Cruz1, B.A. Munhoz1, B.C. Alves1, F.S. Gehrke1, L.L.A. Fonseca1, R.K. Kuniyoshi1, D.I.G. Cubero1, A. DelGiglio1 1 Clinical Oncology, ABC Foundation School of Medicine, Santo André, Brazil Background and Aims Fatigue is a common complain in cancer patients receiving adjuvant chemotherapy. In order to further understand its mechanism and search for potential biomarkers we conducted this prospective study.

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Methods We enrolled Breast Cancer (BC) patients prior to their first adjuvant Adriamycin based chemotherapy cycle. Patients answered to the BFI and Chalder fatigue questionnaires and had their blood drawn for both plasma evaluation and of peripheral mononuclear cell fraction (PMNCF) mRNA expression of a variety of biomarkers. We evaluated FSH, LH, estradiol, DHEA, DHEAS, IL6, Il2, ILIRA, IL1β, CRP, Cortisol in the plasma and IL2, IL10, IL6, TGF-β, KLRC1, TNF, BTP, SNCA, SOD1, BLNK, PTGS2 and INF γ expression in the PMNCF. Results A total of 43 patients were enrolled in this trial, 11 patients did not have an increase in their BFI scores and were considered as controls whereas 32 had an increase in their BFI scores as compared to baseline. From the biomarkers we evaluated in the PMNCF, the only one significantly associated with fatigue was TGF-β (p=0.0343). We observed no evidence of significant associations of any plasmatic biomarkers with the development of fatigue. However when we analyzed patients with more sever fatigue, plasma IL1-RA levels correlated directly with higher fatigue scores (p=0.0136). Conclusions We conclude that Fatigue induced by chemotherapy in BC patients may have a different mechanism than that seen in long term BC survivors or that induced by radiation therapy. Future studies with expanded panels of biomarkers may shed light into the physiopathology of adjuvant chemotherapy induced fatigue.

MASCC-0217 Fatigue 2 NONPHARMACOLOGICAL INTERVENTIONS USED FOR THE MANAGEMENT OF FATIGUE AND PSYCHOLOGICAL STRESS IN CHILDREN AND ADOLESCENTS WITH CANCER

L.C. Lopes-Júnior1, E. Bonfim1, M.D.R. Nunes1, L.C. Nascimento1, M.F. Santos1, M.C.M. Silva1, G.S. Bisson1, R. Lima1 1 Maternal-Infant and Public Health, School of Nursing University of São Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil Background and Aims Cancer-related fatigue (CRF) has been described as the most stressful and prevalent symptom in pediatric oncology patients, occurring in 35.6 to 93 % of cases. Psychological stress generated during hospitalization can negatively influence the immune system through neuroendocrine and behavioral pathways. For these patients, other modalities of treatment such as Complementary Therapies (CTs) can be necessary. Objective: To identify and analyze scientific evidence about the use of CTs for the management of fatigue and psychological stress in children and adolescents with cancer. Methods We conducted an integrative literature review in which eight databases were accessed for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and Cochrane Library. Fulltext articles were included, studies in English, Spanish or Portuguese published in the last 14 years (2000 until 2013). Controlled and uncontrolled descriptors, as well as its synonyms, were crossed for location of the articles. Two researchers independently analyzed the studies. Initially, 273 articles were found. After the exclusion of duplicate articles and of those that did not match inclusion criteria, and after full reading, we obtained a final sample of nine articles. Results The nine studies were grouped into five themes: physical exercises, therapeutic touch, music therapy, massage therapy and nursing interventions & health education. Among the nine studies, six (66.6 %) showed a significant p value for CRF and/or psychological stress, evidencing that the use of CTs led to a decrease in such symptoms.

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Conclusions The use of CTs can improve symptoms of CRF and psychological stress in children and adolescents with cancer.

MASCC-0102 Fatigue 2 FATIGUE IN CHILDREN AND ADOLESCENTS WITH CANCER: EXPERIENCE OF HEALTH PROFESSIONALS

M.C.M. Silva1, L.C. Lopes-Júnior1, R. Lima1 1 Maternal-Infant and Public Health, School of Nursing University of São Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil Background and Aims Cancer-related fatigue is a common and treatable symptom that interferes deeply into many aspects of quality of life of cancer patients. In the case of Brazilian children and adolescents with cancer, it is an undernotified, undertreated symptom that is neglected by the health team, considering it as an unavoidable consequence of the disease and its treatment. Objective: To describe the experience of health professionals with knowledge, assessment and intervention in cancer-related fatigue in children and adolescents with cancer. Methods A descriptive and exploratory study with qualitative data analysis, conducted through interviews and guided by an instrument consisting of two parts: the first containing informations of the participants (age, sex, profession, years of experience in the health team and continuing education activities) and the second part with the following guiding questions: What is fatigue?, How do you identify and evaluate a child or adolescent with cancer-related fatigue?, What are you the interventions used to relieve fatigue? The study included 53 professionals (10 nurses, 33 nursing assistants, 3 physicians, 3 nutritionists, 2 psychologists and 2 physiotherapists). For data analysis we used the content analysis of inductive thematic type. Results Data were organized around three themes: knowledge of fatigue, fatigue identification and interventions for relief of fatigue. The results point to the limited knowledge of health professionals about fatigue and little investment in formal training. Conclusions Scarcity of studies on the issue in the Brazilian scenario is still a barrier to provide insight for the improvement of symptoms in patients with cancer.

MASCC-0170 Fatigue 2 CORRELATION BETWEEN FATIGUE AND REACTIVATION OF SALIVARY HHV6 AND HHV7 IN MULTIPLE MYELOMA

K. Suzuki1, N. Kobayashi2, Y. Ogasawara1, Y. Yahagi1, S. Yano1, T. Shimada1, E. Nagasaki1, K. Kondo2, K. Aiba1 1 Department of Clinical Oncology/Hematology, the Jikei University School of Medicine, Tokyo, Japan; 2Department of Virology, the Jikei University School of Medicine, Tokyo, Japan Background and Aims Fatigue often occurs in multiple myeloma patients treated with novel agents, such as bortezomib, lenalidomide, and thalidomide. Moreover, the incidence of viral infection, especially herpes zoster, increases during chemotherapy with bortezomib. We evaluated the correlation between fatigue and reactivation of salivary HHV6 and HHV7, and several biochemical parameters in multiple myeloma treated with novel agents.

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Methods We prospectively analyzed 20 of salivary sample from 8 patients with multiple myeloma treated with novel agents from May 2013 to December 2013 in our institute. We evaluated the correlation between fatigue and reactivation of salivary HHV6 and HHV7 and several laboratory data by Pearson’s product–moment correlation method. Fatigue was evaluated by Cancer Fatigue Scale (CFS) and Brief fatigue Inventory (BFI). DNA copy numbers of HHV6 and HHV7 in salivary samples were also measured using real-time PCR methods. The moderate correlation was defined as rvalue>0.4, respectively. Results The numbers of patients treated with bortezomib were 7, thalidomide 2, and lenalidomide 1, respectively. All of the patients received dexamethasone or predonisone. There is moderate correlation between CFS and DNA copy number of salivary HHV7 (r=0.443), CFS and serum level of C-reactive protein (CRP) (r=0.675), and CFS and serum level of lactate dehydrogenase (LDH) (r=0.45). DNA copy number of salivary HHV6 and complete blood count were not correlated with CFS, significantly. Conclusions There was correlation between fatigue and the reactivation of salivary HHV7, elevated level of serum CRP and LDH.

MASCC-0048 Fatigue 2 VARIATION IN FATIGUE AMONG 6011 CANCER SURVIVORS AND THE NORMATIVE POPULATION: A STUDY FROM THE POPULATION-BASED PROFILES REGISTRY

M. Thong1, O. Husson1, F. Mols1, J. de Vries1, G. Schep2, L. van de PollFranse1 1 Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands; 2Sports Medicine, Maxima Medical Center, Veldhoven, Netherlands Background and Aims Studies have shown that cancer survivors commonly experience fatigue, probably due to the disease and its treatment. However, few studies have compared the severity of fatigue among patients with different types of cancer or compared fatigue levels with a normative population. Methods Data pooled from six large cancer survivorship studies conducted through the population-based PROFILES registry. Individuals diagnosed with endometrial (EC, n=741) or colorectal cancer (CRC, n=3,878) (1998– 2007), thyroid cancer (TC, n=306) (1990–2008), Hodgkin (HL, n=150) or non-Hodgkin lymphoma (NHL, n=716) or multiple myeloma (MM, n=120) (1999–2008) were included. Participation rates for the studies ranged from 75 to 86 %. A normative population (n=2,040), representative of the Dutch population, was also assessed. All participants completed the Fatigue Assessment Scale. Results Cancer survivors were more often classified as fatigued or very fatigued (EC/CRC: 39 %; HL:40 %; NHL:43 %; MM:51 %; TC:44 %) compared with the normative population (21 %; p<0.001). MM survivors reported the highest levels of fatigue and differed significantly from EC and CRC survivors (p=0.02). Older age (>65 years) was associated with fatigue, 42 % versus 39 %; p<0.01. Females were more likely to be fatigued (p<0.01). Chemotherapy treatment was associated with more fatigue (43 % versus 39 %, p<0.01), as was comorbidity (no versus 1 versus ≥2: 26 %, 35 %, 53 %, respectively, p<0.01). Conclusions Our population-based study on a large sample of cancer survivors showed that fatigue levels vary depending on cancer type, age, gender, treatment with chemotherapy and number of comorbid conditions.

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MASCC-0220 Fatigue 2 EXPERIENCE OFAWEEKLYADAPTED PHYSICAL ACTIVITY SESSION (APA) FOR CANCER PATIENTS

S. Trager1, M. Malgouzou1, D. Franco1, L. Cotinaut1, E. Carola1 1 Oncology, Groupe Hospitalier Public du Sud de l’Oise, Senlis, France Background and Aims The APA has shown its efficiency for cancer patients by reducing tiredness and improving survival rates for some types of cancers. A regular, rather intense and framed activity is recommended. Evaluation of the efficiency of 12 weekly session of APA on tiredness and physical abilities of cancer patients. Methods Twelve group sessions of 1 h a week of gymnastics have been proposed for cancer patients suffering from fatigue, when they are under surveillance or during treatment. These sessions were conducted by physical therapists in the hospital. Two assessments were conducted (at the beginning and end of support) by PIPER scale for fatigue testing and 6-min walking to test the functional exercise capacity. Results Thirty-one patients completed the 12 sessions. The average age was 53.5 years [41–78]. Eighty-one percent (25) of patients had a localized breast cancer. Seventy-one percent of the patients (22) started the APA being processed. The intensity of the sessions was between 55 and 88 % of maximum heart rate for 87 % of patients (27). Between the beginning and the end of the program: 84 % (26) patients have improved their test 6-minute walking and 84 % (26) improved their PIPER score. Conclusions An APA of 1 h a week reduces tiredness and improves the functional capacity of the cancer patients included in this study. This modality of relieved APA is easily practicable and less expensive. The next work will only focus on metastatic patients, poorly represented in our sample.

MASCC-0216 Fatigue 2 PATIENTAND PROVIDER PERSPECTIVES ON PAIN, FATIGUE, AND OTHER SIDE EFFECTS

L. Williams1, C. Bohac2, S. Hunter3, D. Cella4 1 Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, USA; 2Global Development, Amgen Inc., Thousand Oaks, USA; 3Biostatistics, Amgen Inc., Thousand Oaks, USA; 4Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA Background and Aims In 1997, Vogelzang reported that 61 % of cancer patients indicated fatigue impacted daily life more than pain, and only 37 % of oncologists shared this perception. Our study provides an update to this estimate, which can help prioritize symptom assessment and management in the clinic. Study aims were to determine and compare perceptions of cancer patients and healthcare providers (HCPs) about the impact of fatigue and pain, and gather perspectives on which side effects concern HCPs and their patients.

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Methods A random sample of patients was recruited in the US by Harris Poll Online and Schlesinger Associates. Oncology HCPs were recruited by Food and Drug Research, Inc. and Toluna, Inc. Results From June to November 2012, 550 of 1,122 eligible patients (49 %), 400 of 533 eligible oncologists (75 %), and 400 of 617 eligible oncology nurses (64.8 %) completed a survey. 58.4 % of patients reported fatigue affected their daily life more than pain during chemotherapy versus 28.8 % of oncologists and 25.0 % of nurses. 97.5 % of patients reported experiencing fatigue and 86.2 % reported pain during chemotherapy. HCPs estimated 77.9 % of patients experienced fatigue, and 43.6 % of patients experienced pain. HCPs felt nausea/vomiting concern patients most (87.9 %) and it was the symptom most likely to be documented in the patient chart (97.4 %). Conclusions This study shows the importance of assessing side effects by direct patient report during chemotherapy. HCPs continue to underestimate the prevalence of fatigue and pain in cancer patients, a finding that should be considered in the management of treatment-related symptoms.

MASCC-0172 Geriatric Oncology DEFINITIVE RADIOTHERAPY FOR ELDERLY PATIENTS HEAD NECK SQUAMOUS CANCER: THE OUTCOMES AND PROGNOSTIC FACTORS

J. Agarwal1, S. Rathod1, T. Gupta1, S. Ghosh-Laskar1, C. Hotwani1, A. Budrukkar1, V. Murthy1, N. Kalyani1 1 Radiation Oncology, Tata Memorial Hospital, Mumbai, India Background and Aims In recent decade’s life expectancy has increased and 25 % of head neck squamous cancers (HNC) patients are aging beyond 70. Radiotherapy (RT) plays a dominant role in treatment along with interaction of comorbidity, on outcomes. This study presents patterns of presentation, treatment and prognostic factors in geriatric HNC undergoing RT in tertiary cancer over 20 years. Methods From 1991 to 2012 treatment naïve patients, > 70 years and treated with RT were retrieved in a single unit. Demographic, treatment and outcome factors were studied. Results Total 256 patients with median age 73 yrs (70–87), tobacco/ethanol habits in 75 %, co-morbidity was seen in 31 %, with median KPS being 80. The common sites were oropharynx/hypopharynx/larynx in 32,30, & 22 % respectively.Stage wise presentation Tx:T1:T2:T3:T4 was 7(3 %): 25(10 %): 88(34 %): 104(41 %): 32(12 %) and N0:N1:N2:N3 was 135(53 %): 58(22 %): 50(20 %): 13(5 %) respectively.Median radiation dose was 66Gy(IQ range 60–70) and overall treatment time was 48 days (IQ range 43–52). Conventional/altered fractionation was used for 231(90 %) and 25(10 %) patients respectively. Compliance to therapy was good with 215(84 %) completed without interruption. The incidence of grade II:III skin and mucosal toxicity was 159(62 %): 59(23) and 147(57 %): 46(18 %) respectively. Overall survival was 38 % 3 years . In Multivariate analysis primary site, Tstage, N stage radiation dose were significant prognostic factors for OS. Conclusions Radical radiation therapy offers good survival is geriatric population. Though incidence of acute treatment related toxicity is more, treatment is well tolerated. T stage, N stage and radiation dose are important prognostic factors.

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MASCC-0442 Geriatric Oncology IMPACT OF CHEMOTHERAPY DOSE INTENSITY IN THE GERIATRIC POPULATION WITH LOCALLYADVANCED BREAST CANCER TREATED IN NEOADJUVANT SETTING AT THE NATIONAL CANCER INSTITUTE, MEXICO CITY

C. Arce-Salinas1, L. Mendoza-Galindo1, G. Alamilla1, A. AlvaradoMiranda1, F.U. Lara-Medina1 1 Breast Cancer, Nacional Cancer Institute Mexico City (INCan), Mexico City, Mexico Background and Aims Introduction: Breast cancer in older women is usually undertreated; this population is considered fragile and received chemotherapy in doses below standards. Objectives: To evaluate the relation of dose intensity with complete pathological response (pCR) in geriatric patients, and its impact on survival. Methods Retrospective analysis of patients treated with neoadjuvant anthracyclines, taxanes, or combination regimen from 2005 to 2010. Case–control design with proportion 1:3. pCR was evaluated in the surgical specimen. Survival analysis was made with Kaplan-Meier method. Results Three hundred seventeen were eligible and divided into two subgroups: 79 elderly-women (>65 years-old) and 238 younger-women (<64 years-old). Median age at diagnosis was 71.7 years old (65–87) for the elderly group and 51 for the younger group (28–64). Median tumor size of 6 cm in both groups. ER+73.4 % and 62.2 %; HER2+ 16.5 % and 21.4 % and 15.4 % and 19 % were identified as triple negative, respectively (p=0.2). Most patients were treated with 8 cycles of anthracyclines and taxanes, before surgery. More cases of the elderly-women subgroup were treated <80 % anthracyclines planned dose compared with younger-women (17.3 % vs 0.4 %; P=0.000). pCR was 12.7 % in elderly group vs 23.6 % in younger group (P=0.000). DFS agreed with dose intensity: 88.4 % for doseintensity >80 % and 71.4 % for dose-intensity <80 %, both with a Logrank of 0.012. There was no difference in adverse events grade 3–4. Conclusions Breast cancer in older women has the same clinical and pathological presentation as younger women. Older group was undertreated respect to chemotherapy dose intense, with impact in pCR and disease free survival.

MASCC-0483 Geriatric Oncology BISPHOSPHONATE PRESCRIPTIONS IN MEN ON ANDROGEN DEPRIVATION THERAPY (ADT): A POPULATION-BASED ANALYSIS OF 38,955 PATIENTS OVER 17 YEARS

H. Gulamhusein1, L. Yun2, A.M. Cheung1, R. Sutradhar2, P. Warde3, L. Paszat4, S.M.H. Alibhai1 1 Medicine, University Health Network, Toronto, Canada; 2Biostatistics, Institute of Clinical Evaluative Sciences, Toronto, Canada; 3Radiation Medicine Program, University Health Network, Toronto, Canada; 4 Radiation Medicine Program, Institute of Clinical Evaluative Sciences, Toronto, Canada Background and Aims ADT is commonly used in men with prostate cancer. Side effects include osteoporosis and fragility fractures. Use of bisphosphonates has been recommended for osteoporosis, but adherence to this recommendation by clinicians is not well known. This study investigates the use of bisphosphonates to treat bone loss in men on ADT at a population level.

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Methods Linked administrative databases at the Institute for Clinical Evaluative Sciences in Ontario, Canada and the Ontario Cancer Registry were used. Thirty-eight thousand nine hundred fifty-five men age 66+ (mean age 75.9 y) with prostate cancer treated with either minimum 6 months of a luteinizing hormone-releasing hormone agent or bilateral orchiectomy in Ontario between 1995 and 2012 were identified. Bisphosphonate usage was captured through drug database claims. Annual rates per 100 personyears were calculated. Results Among all prior non-users, bisphosphonate use in the first year after starting ADT increased from 0.33 per 100 person-years during 1995–97 to 3.45 in 2010–12 (p<0.0001). Among prior non-users with osteoporosis, bisphosphonate usage increased from 0.58 to 9.32 per 100 personyears between 1995 and 97 and 2010–12 (p<0.0001); in those with prior fragility fractures, usage increased from 1.05 to 5.45 (p=.0046) over this time (Figure).

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Methods Ninety-five patients, age ≥65 with cancer and an unplanned hospitalization, and their primary caregivers, were enrolled at one institution. Caregivers completed a questionnaire about their health, social supports, Caregiver QOL-Cancer (CQOLC) index, caregiving situation, patient demographics, diagnosis, and function. Results Patients were a median age of 70 (65–91), GI malignancies/acute leukemia most common (20 %/14.7 %), 60 % had stage IV disease. Caregiver median age was 65 (29–84), 72.6 % female, 77.9 % patient’s spouse and 89.5 % live with patient. Results summarized in Table 1. Median CQOLC was comparable to those caring for hospice patients. Table 1: Summary of assessments done by caregiver Median (range)

Conclusions Although bisphosphonate use has increased over time among all older men starting ADT and among those at high risk of fracture (i.e. prior osteoporosis or fragility fracture), rates still remain very low. Further studies are needed to understand and improve this apparent gap in quality of bone health care.

Patient characteristics Physical function (MOS-physical health) Caregiver-assessed patient KPS Caregiving characteristics Caregiving hours/week Caregiving duration Professional help Perceived supports (MOS-social support survey) Caregiver characteristics Charlson comorbidity index Self-rated health

Mental Health Index-18 CQOLC

20 (0–100)* 60 % (30–100 %)* 35 h/week (0–168) 13.5 months (0–384) 0 h/week (0–99) 61.7 (0–100)*

0 (0–7) 30.5 % excellent; 48.4 % good 21.1 % fair/poor 70 (0–96.7)* 88 (22–121) (max range 0–140)*

MOS=Medical Outcomes Survey *=higher scores indicate better function/outcomes

MASCC-0542 Geriatric Oncology

Conclusions Caregivers of hospitalized older adults provide significant hours of care with little formal help. This is associated with low caregiver QOL.

QUALITY OF LIFE (QOL) OF CAREGIVERS OFADULTS, AGE 65 AND OLDER, WITH CANCER ADMITTED TO HOSPITAL

T. Hsu1, N. Nathwani2, M. Loscalzo3, B. Ferrell4, V. Chung1, J. Chao1, C. Karanes1, M. Koczywas1, S. Forman2, D. Lim1, T. Siddiqi2, A. Stein1, P. Twardowski 1 , A. Nademanee2 , S. Pal 1, M. Hein5, C. Akiba1 , L. Goldstein6, D. Smith6, A. Hurria1 1 Medical Oncology, City of Hope, Duarte, USA; 2Hematology, City of Hope, Duarte, USA; 3Patient and Family Resources, City of Hope, Duarte, USA; 4Nursing Research, City of Hope, Duarte, USA; 5Nursing, City of Hope, Duarte, USA; 6Population Sciences, City of Hope, Duarte, USA Background and Aims There is increasing reliance on family members for informal caregiving. Caring for older adults may present challenges due to comorbidities and increased frailty. Furthermore, unexpected hospitalization can be particularly stressful for caregivers impacting their QOL. Few studies have focused on caregivers of older adults with cancer. Aims: a) To characterize caregivers of hospitalized older adults with cancer and b) to determine caregiver QOL.

MASCC-0604 Geriatric Oncology 5-FU WITH PHALLUS IMPUDICUS JUICE IN ELDERLY PATIENTS WITH ADVANCED COLORECTAL CANCER: 20 YEARS OF EXPERIENCE

S. Kuznecovs1, I. Kuznecovs1, L. Gromcakova1, K. Jegina1 1 Supportive Care, Institute of Preventive Medicine, Riga, Latvia Background and Aims The incidence of advanced colorectal cancer is high among the elderly. Zemestauki (Phallus impidicus) belongs to Traditional Baltic Medicine and is used to improve the quality of life in old people with advanced cancer . The aim of this study was to evaluate the objective tumor response rates and toxicities in elderly patients with advanced colorectal cancer treated with 5-FU.

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Methods One hundred twenty six patients were enrolled in retrospective study between 1993 and 2013 in two groups: comprehensive (5-FU 800 mg + Phallus impudicus 30 ml) (60 cases) and control group (5-FU 800 mg) (66 cases). The median survival time, relapse-metastasis rate, median time of relapses, changes of symptoms, Karnofsky (KPS) score and immune function were observed. Results The estimated median survival time in the comprehensive group was 24,7 months, longer than 8,2 months in the control group (P<0.05). The scores of function and symptom of EORTC QLQ-C30 in the comprehensive group decreased, while the overall health status increased, and the results indicated that the quality of life of the patients in the comprehensive group was improved. In the comprehensive group, the body weight, Karnofsky score and immune status after treatment was higher than in control group (P<0.05). Patients with advanced colorectal cancer treated with 5-FU alone had modestly higher rates of severe toxicity: diarrhea, stomatitis and infections. Conclusions Palliative 5-FU therapy for colorectal cancer patients in eldery may be used in combination with Phallus impudicus. Combination shows benefit for reducing relapse and metastasis rates, and prolonging survival for elderly patients.

MASCC-0333 Geriatric Oncology TREATMENT PATTERN OF ELDERLY PATIENTS WITH BREAST CANCER IN A SINGLE INSTITUTE

J. Park1, K. Kim1, J. Kim1, I. Choi1, S. Kim2, E. Ko3, K. Hwang3 1 Internal medicine, Boramae medical center, Seoul, Korea; 2Radiation oncology, Boramae medical center, Seoul, Korea; 3General surgery, Boramae medical center, Seoul, Korea Background and Aims Introduction: Although number of elderly breast cancer patients increased, elderly patients were excluded from clinical trials and standard treatment. Objective: We aimed to investigate treatment pattern of elderly breast cancer patients older than 68 years old. Methods We included 133 breast cancer cases in our study cohort at Boramae Medical Center between 2001 and 2012. Results Median age was 73 years old (69–93). Median follow up duration was 32.4 months (0.1–235.7). There were 67 patients (50.3 %) with underlying comorbidiy and median number of comorbidities was 1 (1–4). Invasive ductal carcinoma was most common subtype (116 patients, 87.2 %). At the time of diagnosis, 17 patients (12.8 %) had distant metastasis and 8 (6.0 %) refused staging work up. Only 118 patients (88.7 %) were treated immediately after diagnosis. Of curatively resected 94 cases (70.7 %), total mastectomy or modified radical mastectomy and breast conserving surgery were done in 71 patients (75.5 %) and 23 (24.5 %), respectively. There were 27 patients (28.7 %) with stage I, 49 (52.1 %) with stage II, 17 (18.1 %) with stage III. Of 94 resected cases, adjuvant chemotherapy and postoperative radiation was performed in 28 patients (29.8 %) and 19 (20.2 %), respectively. Of 73 patients (77.7 %) with hormone receptor positive breast cancer, 67 (91 %) received adjuvant hormone therapy. Recurrence occurred in 25 patients (26.6 %) and median relapse free survival was 40.3 months (CI 17.6–62.9). Conclusions Surgical resection and adjuvant hormone therapy were actively performed and tolerable in elderly breast cancer patients, although small population of patients tended to receive adjuvant chemotherapy.

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MASCC-0180 Geriatric Oncology A SYSTEMATIC REVIEW OF FACTORS INFLUENCING OLDER ADULTS’ DECISION TO ACCEPT OR DECLINE CANCER TREATMENT

M. Puts1, B. Tapscott1, M. Fitch2, M. Howell3, M. Krzyzanowska4, N. Leighl4, J. Monette5, D. Wan-Chow-Wah5, E. Springall6, S. Alibhai7 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; 2Odette Cancer Centre Patient and Family Support Program, Sunnybrook Health Sciences Centre, Toronto, Canada; 3 Oncology Nursing, University Health Network, Toronto, Canada; 4 Medical Oncology, University Health Network, Toronto, Canada; 5 Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada; 6Health Sciences Library, University of Toronto, Toronto, Canada; 7Medicine, University Health Network, Toronto, Canada Background: The majority of patients with cancer are 65 years and older. Several studies have shown that older adults decline cancer treatments more than younger adults. We conducted a systematic review to synthesize the evidence why older adults accept or decline treatment for cancer and if this differed by cancer type, stage, age and between hypothetical and actual decisions. Methods: A comprehensive search of ten databases from inception to February 2013. Study selection and data abstraction was completed by two independent reviewers. Results: Of 17343 abstracts reviewed, 56 publications reporting on 51 unique studies were included. 38 studies examined actual treatment decisions and 13 studies examined a hypothetical decision. Regarding study design, five were prospective, 20 were crosssectional, 18 were qualitative and eight were retrospective studies. However, only two studies explicitly asked older adults why they declined. The majority focused on decisions for prostate and breast cancer. The most important factors accepting treatment were trust in the physician and following the physician’s recommendation. Factors most important for refusing cancer treatments were perceived feeling discomfort of the treatments, fear of side effects and transportation difficulties. The studies examining hypothetical scenarios showed that older adults are willing to accept cancer treatments for varying levels of benefit, but in general required larger benefits than younger patients. Conclusion: The reasons why older adults accepted or refused treatment vary considerable. Further studies using large representative samples and exploring treatment decision-making incorporating health literacy and comorbidities are needed.

MASCC-0293 Geriatric Oncology THE DEVELOPMENT OF A QUESTIONNAIRE TO MEASURE REASONS WHY OLDER ADULTS ACCEPT OR DECLINE CANCER TREATMENT

M. Puts1, M. Fitch2, A. Tourangeau1, M. Krzyzanowska3, N. Leighl3, S. Alibhai4 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; 2Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; 3Medical Oncology, University Health Network, Toronto, Canada; 4Medicine, University Health Network, Toronto, Canada Background: Cancer is a significant health problem in older persons. Little is known concerning which factors influence the

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acceptance or refusal of treatment. Currently, there is no instrument available to measure reasons for accepting or refusing cancer treatment. Therefore, the aim of this study was to generate a framework which delineates the factors that are important for accepting or refusing cancer treatment by older adults undergoing chemotherapy and/or radiation therapy. In subsequent steps we will develop and test a new instrument measuring reasons for accepting or refusing cancer treatments in older adults with cancer. Methods: in the first phase of the project in-depth interviews are conducted with older adults undergoing surgery/chemotherapy and/or radiation therapy recently diagnosed with cancer to generate possible items for the instrument. Older adults were recruited at the Odette Cancer Centre and the Princess Margaret Cancer Centre in Toronto. The data are analyzed using content analysis. Results: So far 17 participants have been included, and the majority accepted treatment. Older adults find the ease of treatment, expected risks and benefits, and anticipated side-effects important in making the treatment decision. Patients interviewed to this point have perceived the guidance of their primary care physician and/or oncologist as the most crucial factor in accepting or declining treatment. Most made the initial treatment decision very quickly, the subsequent decisions were not seen as new decisions but a result of the first decision to accept the treatment. Conclusion: Most older adult choose the treatment that was recommended by their physician.

MASCC-0313 Geriatric Oncology MELANOMA IN THE ORAL CAVITY. A CLINICAL CASE

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MASCC-0275 Geriatric Oncology HEALTH-RELATED QUALITY OF LIFE OF OLDER PEOPLE WITH CANCER IN THE ADJUVANT TREATMENT

N. Sawada1, B.F. Toneti1, J.M. Paula1, A.C. Nicolussi1 1 General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil Background and Aims Cancer is one of the most deadly diseases nowadays, victimizing elderly people in most cases, who become vulnerable through the aging process. The oncologic treatment significantly affects the patients’ quality of life and is frequently related to their functional disability. The aim of this project was to identify variations in the quality of life of elderly people with cancer, characterizing social-demographic, clinical and therapeutic data, correlating them to the quality of life. Methods This is an exploratory descriptive cross-sectional study. Data were collected with instrument EORTC QLQ C 30 in a clinical oncology of Brazil. Results The results of this study concluded that health-related quality of life of elderly patients in the sample was satisfactory (mean=69.04). The correlations observed in this study indicate that the main domains of HRQOL affected were emotional function, social function, cognitive function, financial difficulties, fatigue, nausea and vomiting, dyspnea, and insomnia. Conclusions Evaluate health-related quality of life of elderly patients with cancer is important to enhance the process of rehabilitation of elderly people with cancer adjuvant treatment. According to the literature, understand the variables related to HRQOL of elderly cancer patients undergoing treatment assists in the care and interventions during treatment, which can improve health and enhance the HRQoL of these patients.

A. Rosello1, E. Jané1, J. Rosello1, R. Rodriguez1, C.J. Omaña1, J. Lopez1 1 Oral Medicine, University of Barcelona, Barcelona, Spain Background and Aims Melanoma is a malignant neoplasm, pigmented in most cases. In the 95 % of cases it is found in the skin, but it can affect the oral mucosa. The treatment is the surgical excision of the lesion with wide margins of safety, causing large defects that require a very complex rehabilitation treatment. Methods A 74 old years woman, with a diagnosis of Melanoma (Clark Level II), located on the hard palate attends to University Hospital. At the first surgical time, a partial maxillectomy was performed. In a second phase, 24 months later, 4 osteointegrated implants were placed in the upper maxilar, to stabilize the removable upper dental prosthesis with 2 micromilled bars. Results The oral Melanoma is rare malignancy, more common in women, representing 0.2 to about 8 % of all melanomas. It has a poor prognosis and it may remains asymptomatic for a long time. Generally the lesion occurs in the palate, followed by the ridge of the maxilla. The treatment of choice is a radical surgery with regional lymphadenectomy. The oral rehabilitation in this patients has a great complexity. In our case, 10 months after the placement of the implants, they are stable and radiologically osteointegrated . The patient has a high degree of satisfaction with the rehabilitation, functionally and aesthetically . Conclusions Early diagnosis of pigmented lesions in the mouth and adequate tumor resection may improve the prognosis of patients with melanoma of the oral cavity.

MASCC-0395 Geriatric Oncology BIOSIMILAR EPOETIN FOR THE MANAGEMENT OF CHEMOTHERAPY-INDUCED ANAEMIA IN ELDERLY PATIENTS: A SUBANALYSIS OF THE ORHEO STUDY

P. Soubeyran1, J.E. Kurtz2, M. Michallet3, E. Luporsi4, H. Albrand5 1 Medical Oncology, Institut Bergonié and Bordeaux Segalen University, Bordeaux, France; 2Hématologie et oncologie, Pôle d’Oncologie et d’Hématologie, Strasbourg Cedex, France; 3Hematology Department, Centre Hospitalier de Lyon Sud, Cedex, France; 4Medical Oncology, ICL, Vandoeuvre les Nancy, France; 5Médical, Hospira France SAS, Meudon La Forêt, France Background and Aims Chemotherapy-induced anaemia (CIA) requires transfusion, or epoetin administration. Elderly patients may experience severe complications from CIA, such as fatigue and cardiovascular side effects. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study explores the efficacy and tolerability of epoetin alfa biosimilar (EAB) treatment in elderly patients. Methods Patients with CIA (haemoglobin [Hb] <11.0 g/dL) due to treatment for solid tumours, lymphoma or myeloma and eligible for treatment with EAB were included. Response rate (RR) was assessed at Month 3 (M3) and Month 6 (M6). Secondary endpoints included changes in Hb level, transfusion rates and adverse events.

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Results Patients were subdivided into those aged ≥70 years (n=1009) and <70 years (n=1301). Mean baseline Hb was 9.66±0.87 g/dL and 9.57± 0.89 g/dL in elderly and younger patients, respectively. RR was 84 % at M3 and 86.8 % at M6 in the elderly cohort; 79.8 % at M3 and 86.3 % at M6 in the younger cohort. Transfusion rates were 7.9 % at M3 and 4.9 % at M6 in the elderly cohort; 10.6 % at M3 and 6.4 % at M6 in the younger cohort. Adverse events were declared in 17.6 % of elderly and 16.4 % of younger patients. Thromboembolic events were more frequent (4.5 % vs 2.7 %; p=0.011) while infections were less frequent (3.0 % vs 6.6 %; p= 0.0002) in the elderly cohort compared to the younger cohort. Conclusions EAB therapy was effective and well-tolerated in the management of CIA in elderly patients with solid tumours, lymphoma and myeloma.

MASCC-0575 Health Services BRIDGING THE GAP BETWEEN HOSPITAL AND HOME: A NEW MODEL OF CARE IN CANCER PATIENTS

C. Font1, N. Arab2, C. Calderon3, A. Carmona-Bayonas4, P. Ayora5, C. Moreno5, C. Gallego5, A. Hernando5, M. Carreño5, C. Barrera1, E. Buxo2, N. Reguart2, B. Mellado2, F. Fernandez-Avilés2, A. Tuca1 1 Supportive and Palliative Care Unit (SPCU)-Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 2 Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 3University of Barcelona, Psychology, Barcelona, Spain; 4Sociedad Española de Oncología Médica (SEOM), Continuum Cancer Care Section, Barcelona, Spain; 5Institut Clinic malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain Background and Aims Hospital admissions have a negative impact on quality of life and are a major contributor to health-care costs among cancer patients. We developed a home-based intervention program (HBIP) addressed to avoid or reduce the length of conventional hospital admission in cancer patients treated in a tertiary care institution. The aim of this present report was to describe the preliminary results of our ongoing program, the primary end-points being safety and frequency of unplanned readmissions. Methods Observational study including consecutive adult (≥ 18 years) cancer patients with an acute medical condition requiring specific interventions usually in hospital. Home-based interventions were performed by oncology-specialized nurses in coordination with the hospital medical staff. Results Table 1. Medical conditions and home interventions in 81 episodes.

Medical conditions Non neutropenic infections Febrile neutropenia Cancer pain Bowel obstruction Grade 3 intestinal toxicity Venous thromboembolism Dyspnea Grade 4 thrombocytopenia Hypocalcemia

N

%

36 18 10

44 22 12

7 4 2 2 1 1

9 5 2 2 1 1

N

%

Blood tests

61

75

Intravenous antibiotics

50

62

Intravenous hydratation

4

5

Subcutaneous medication

4

5

Nursing home interventions

Eighty-one episodes were included in the HBIP program involving 70 patients (48.6 % men; mean age 61.5, SD 12.2, range 32 to 86 years old) from October 2013 to January 2014. The most frequent cancers were: lung 26 %, breast 21 %, and colorectal 11 %. Most patients had metastatic cancer (74 %) and were receiving active anticancer therapies (72 %). Table 1 summarizes the most common medical conditions treated and home intervention. The HBIP program avoided admission in 43 (53 %) outpatients and shortened hospital stay in 38 (47 %) inpatients. The median duration of HBIP program was 5 (range 1–16) days, with no deaths reported at home. Unplanned hospital readmissions occurred in 5 (6 %) patients. Conclusions The HIBP program was safe and avoided or reduced the length of hospitalization in selected cancer patients. Strategies to reduce potentially avoidable hospital admissions can promote quality of care along the cancer-care continuum.

MASCC-0502 Health Services BRIDGING THE GAP BETWEEN HOSPITAL AND HOME: A NEW MODEL OF CARE IN CANCER PATIENTS

C. Font1, N. Arab2, C. Calderon3, P. Ayora2, C. Moreno2, C. Gallego2, A. Hernando2, M. Carreño2, C. Barrera1, E. Buxo4, N. Reguart4, B. Mellado4, F. Fernandez-Avilés5, A. Tuca1 1 Supportive and Palliative Care Unit (SPCU)-Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 2 Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 3Personality Assessment and Psychological Treatment, Barcelona University, Barcelona, Spain; 4Medical OncologyInstitut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 5Hematology-Institut Clinic Malalties HematoOncològiques (ICMHO), Hospital Clinic, Barcelona, Spain Background and Aims Hospital admissions have a negative impact on quality of life and are a major contributor to health-care costs among cancer patients. We developed a home-based intervention program (HBIP) addressed to avoid or reduce the length of conventional hospital admission in cancer patients treated in a tertiary care institution. The aim of this present report was to describe the preliminary results of our ongoing program, the primary end-points being safety and frequency of unplanned readmissions. Methods Observational study including consecutive adult (≥ 18 years) cancer patients with an acute medical condition requiring specific interventions usually in hospital. Home-based interventions were performed by oncology-specialized nurses in coordination with the hospital medical staff. Results 81 episodes were included in the HBIP program involving 70 patients (48.6 % men; mean age 61.5, SD 12.2, range 32 to 86 years old) from October 2013 to January 2014. The most frequent cancers were: lung 26 %, breast 21 %, and colorectal 11 %. Most patients had metastatic cancer (74 %) and were receiving active anticancer therapies (72 %). Table 1 summarizes the most common medical conditions treated and home intervention.

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The HBIP program avoided admission in 43 (53 %) outpatients and shortened hospital stay in 38 (47 %) inpatients. The median duration of HBIP program was 5 (range 1–16) days, with no deaths reported at home. Unplanned hospital readmissions occurred in 5 (6 %) patients. Conclusions The HIBP program was safe and avoided or reduced the length of hospitalization in selected cancer patients. Strategies to reduce potentially avoidable hospital admissions can promote quality of care along the cancer-care continuum.

MASCC-0580 Health Services A CASE OF ACUTE PROMYELOCYTIC LEUKEMIA (APL) WITH ISOCHROMOSOME (17Q) AS THE SOLE ABNORMALITY

B. Ganguly1, S. Mandal1, T.K. Dolai2, M. Bhattacharyya2, R. De2 1 Genetics, Genetics Center, Mumbai, India; 2Haematology, NRS Medical College, Kolkata, India Background and Aims Chromosome abnormalities have been recorded in 50–60 % of acute myeloid leukemia (AML). Pre-treatment cytogenetic analysis of AML is important for risk stratification and prognostication. In M3 sub-class of AML, rearrangement of RARA gene at 17(q21) is recorded predominantly with PML gene at 15(q22) and occasionally with PLZF, NPM and NUMA genes. However, isochromosome 17(q) has been reported in three APL cases. Treatment with all-trans retinoic acid did not favor prognosis in two of these cases and cases with variant rearrangements. We present a 8-year old girl reported with bleeding manifestation for 20 days, low Hb, WBC 9800 cu/cmm, atypical promyelocytes 46 %, platelet 40,000 cu/ cmm and multiple auer rods in peripheral blood smear. Methods Cytogenetic followed by FISH and RT-PCR were employed for detection of PML-RARA fusion. Results Conventional cytogenetic study has detected i(17q) as the only abnormality in 25 cells evaluated (Fig. 1). Furthermore, PML-RARA fusion was not detected in FISH and RT-PCR study. Ider(17q) indicates monosomy (17p) and trisomy 17(q). Fig. 1. The karyotype with 46,XX,ider(17q)

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MASCC-0424 Health Services INFORMATION REFERRAL PROGRAM FOR CANCER PATIENTS AT AN OUTPATIENT CANCER CENTRE

S. Lorhan1, L. Leitz2, H.M.L. Daudt3, S. Mahovlich4 1 Volunteer Services, BC Cancer Agency, Victoria, Canada; 2Library, BC Cancer Agency, Victoria, Canada; 3Clinical Research Management, BC Cancer Agency, Victoria, Canada; 4Administration, BC Cancer Agency, Victoria, Canada Background and Aims Providing patients with current and reliable information can empower patients to participate in health care decisions about their own treatment and follow-up strategies. However, many patients are not made aware of the medical library and the services it offers. The objective of the Information Referral Program is to increase awareness of the medical library and ensure patients receive accurate and tailored information. Methods A feasibility pilot was conducted in 2012. Health Care Providers (HCPs) provided patients with a filled information referral form based on the patient’s needs. Patients were asked to bring the form to the library where they would be in contact with the librarian. Information packages provided to patients were based on their information needs, preferred platform, and comprehension level. A satisfaction survey posed questions about where they previously accessed information and if they would come back to the library. A qualitative interview was conducted with a medical oncologist to understand the impact for physicians. Results Patients reported that the information referral was useful and informative. The qualitative interview indicated that the program is important for both the care of the patient and improving interactions with patients. However, in the months following the pilot, there was little uptake by HCPs. Conclusions There are barriers to the expansion of the program that have not been identified during the feasibility phase. Using the knowledge exchangedecision support model we are conducting a series of meetings with staff to collect feedback and address barriers. The program will be revised based on the assessment conducted.

MASCC-0487 Health Services UNPLANNED 30-DAY READMISSIONS AMONG ELDERLY PATIENTS WITH GASTROINTESTINAL CANCER

J.G. Manzano1, R. Luo2, L.S. Elting2, M. George1, M.E. Suarez-Almazor1 1 General Internal Medicine, UT MD Anderson Cancer Center, Houston, USA; 2Health Services Research, UT MD Anderson Cancer Center, Houston, USA

Conclusions Ider(17q) has been detected in this center among 150 APL cases studied. The pathogenesis and treatment choice for these patients with ider(17q) are not clear at this stage.

Background and Aims Thirty-day readmission is an important metric in healthcare. Policymakers have incorporated readmission rates in reimbursement decisions. It is unclear whether these metrics apply to cancer patients. More studies are needed in order to understand readmissions in the context of cancer patients. We described 30-day readmission patterns among elderly patients with gastrointestinal cancer (GI), and identified risk factors for 30-day readmission. Methods We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare data. Short stays to acute care hospitals were included. Claims data were analyzed for 2 years after cancer diagnosis.

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Multilevel analysis, with claims nested within patients, was used to identify factors associated with unplanned readmission. Results We analyzed 46,454 claims from 21,292 patients with GI cancer aged 66 and above. The unplanned readmission rate was 17.4 %, and the median time to readmission was 11 days. The most common diagnoses for readmission were volume depletion (4.3 %), congestive heart failure (4.2 %) and pneumonia (3.6 %). Increased odds for readmission were seen with age ≥80 years (OR 1.12;CI 1.04–1.21), advanced disease stage (1.61;1.49–1.74), higher comorbidity score (1.61;1.48–1.76), prior ER visit (1.38;1.27–1.49) and unplanned hospitalization (1.52;1.44–1.61). Conclusions Unplanned readmissions are common among elderly patients with GI cancer. Top reasons for readmission were potentially preventable and amenable to outpatient management. Our findings emphasize the importance of improving transitions of care processes, as well as promoting coordinated care in this patient population. Knowledge of risk factors can help identify patients who would benefit from closer follow up, and other targeted interventions to prevent readmission.

MASCC-0595 Health Services THE ECONOMIC COSTS OF SYMPTOM MANAGEMENTAND TOXICITIES IN CANCER PATIENTS TREATED IN AMBULATORY SETTING

L. Ginocchi1, A. Pasdera2, E. Vasile1, M. Lucchesi1, I.M. Brunetti1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; 2 , Studio Pasdera srl, Mirano (VE), Italy Background and Aims The economic burden of cancer is associated with costs of interventions for prevention and treatment and with the lost earnings due to inability to work. The costs for cancer care represent a high proportion of the total healthcare costs. The main item of the costs is represented by disease treatment. However an important charge is also due to management of toxicities and symptoms. The main aim of our analysis was to evaluate the economic costs of hospitalizations due to toxicities and/or symptoms management for cancer patients receiving chemotherapy in an outpatient service. Methods We evaluated all the patients receiving chemotherapy at our outpatient service during 2011 and 2012 and collected data about their hospitalizations during treatment. We have considered hospitalizations due to symptoms and/or toxicities management excluding all the others being necessary for treatment of the disease or for reasons unrelated to cancer. We counted the costs according to standard reference data taking into account the duration and the department of each hospitalization. Results A total of 413 admissions among over 2,500 patients have been considered for a total of about 3,000 days of hospitalizations. The total cost was more than 2.3 million of euros, with a medium cost for each admission of about 5,600 euros and a cost per patient of about 1,000 euro. Conclusions Symptoms and toxicities management for cancer patients may have high economic costs. However, the costs of hospitalizations for these reasons should be reduced improving the outpatient network for supportive care in cancer.

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MASCC-0594 Health Services SUPPORTIVE CARE IN CANCER PATIENTS: REPORT OF ACTIVITY

M. Lucchesi1, E. Vasile1, L. Ginocchi1, I.M. Brunetti1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy Background and Aims Recent advances in the treatment of solid tumors create a growing number of complications and relevant toxicities or symptoms that may require hospitalization of a significant number of these patients. An integrated model dedicated to symptoms management and supportive therapies, may be more effective for cancer patients’ care and reduce hospital admissions. Methods A dedicated supportive-care team receives patients without appointment, in order of the severity of cases, and gives a mobile phone consult. Results Nine hundred fifty-eight visits (March 2013–February 2014) have been performed and more than 2,000 phone calls from patients have been addressed. Patients had locally advanced (6 %) or metastatic disease (76 %) while 18 % had no evidence of disease. Seventy five percent of patients has been receiving medical therapies. Main reasons for access were: toxicities (304 patients), uncontrolled symptoms (448) and logistic problems (82); other reasons were suspected progressive disease (52) and lab test abnormalities (72). One hundred seventy-three patients received i.v. supportive therapy at the unit while 718 had a prescription for domiciliary treatment. Two hundred sixty-one blood tests cases were controlled and in 169 a radiological exam was required. In 13 cases a paracentesis or thoracentesis was performed and 197 patients were submitted to other specialist consults. For only 62 patients (6.5 %), hospitalization was required, while 896 (93.5 %) were fully managed as outpatients; 186 patients needed repeated accesses to the unit and 13 were addressed to home care. Conclusions A careful and dedicated management of supportive care for cancer patients may reduce the need for hospitalizations and optimize patients care.

MASCC-0593 Health Services SUPPORTIVE CARE ACTIVITYAND REDUCTION OF HOSPITALIZATIONS FOR CANCER PATIENTS

E. Vasile1, M. Lucchesi1, I.M. Brunetti1, L. Ginocchi1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy Background and Aims Growing problems for oncologic patients (pts) during treatments is the management of related toxicities and symptoms due to disease. Aim: to analyze the number of hospitalizations due to toxicities and/or symptoms management for outpatients receiving active oncologic treatments after the introduction of a supportive care team inside oncologic department.

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Methods We evaluated all the patients receiving chemotherapy and/or other target therapies at our day hospital across 2011 (1,275 pts and 12,482 accesses) and 2012 (1,358 pts and 14,200 accesses) and collected data about their further hospitalizations during the year of treatment. We have considered hospitalizations due to symptoms and/or toxicities management excluding all the others being necessary for treatment of the disease or for reasons unrelated to cancer. Results A total of 192 admissions in 2012 versus 221 in 2011 were observed with a total reduction of 245 days of hospitalizations (1,378 vs 1,623). The difference is also remarkable because of concomitant increased oncological activity during the 2 years. Furthermore, we have observed a different distribution of admissions with an increased surgical hospitalizations (+35 %) and a reduced emergency room direct admissions (58 vs 66 %). This phenomenon is probably due to a more accurate selection of complicated patients hospitalized after supportive care team first evaluation. Conclusions Dedicated and integrated supportive care activity may reduce hospitalizations for cancer patients undergoing active oncologic treatments. At the same time, this models of integrated cancer care should be improved through creating new links with other specialists involved in cancer patients care.

MASCC-0261 Health Services 2 REDUCTION OF HOSPITALIZATION AFTER THE IMPLEMENTATION OF THE OUT-PATIENT SUPPORTIVE CARE UNIT (SCU) IN A COMPREHENSIVE NATIONAL CANCER CENTER IN ITALY

C.I. Ripamonti1, C. Di Cristo2, G. Barone1, M.A. Pessi1, P. Molani2, G. Boscagli2, C. Desti2 1 Haematology and Pediatric Onco-Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 2 Management Control, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy Background and Aims During oncological treatments with curative or palliative intent, patients require supportive medical therapies aimed to manage toxicity/ complications of the treatments, thus ensuring greater adherence to the treatment protocols in terms of dose-intensity and interval of administration. Aim of the study is to evaluate the role of a dedicate out-patient SCU in reducing the hospitalization of the patients in the Oncological Wards. Methods Considering that SCU Unit started the activity on June 4th 2009, we collected the information regarding the Diagnostic Related Group (DRG) of the Oncological Department, the Haematological Department and the Oncological Day Hospital starting from January 2008 (1 year and half before the SCU inception) until December 2013. The same methodology was applied for the Oncological out –patient services and SCU of the INT. Results The number of the hospitalized Patients (DRG) considered from 2009 until 2013 decreased from 843 to 374. It is remarkable to point out that Oncological Patients have been treated more frequently in an ambulatorial setting. The evidence is in the increasing number of patients admitted at the out-patient setting of the SCU (see the chart).

Conclusions From a first data analysis, on the management side the presence of a dedicated Supportive Care Unit has made available direct resources such as hospital beds and staff. The outcome on the patient side is a reduction in the number of hospitalizations. Further studies should be carried out to assess whether patients’ quality of life has been maintained at the best possible level.

MASCC-0263 Health Services 2 BLOOD COMPONENT TRANSFUSIONS AT THE SUPPORTIVE CARE OUT-PATIENT UNIT (SCU) DECREASE HOSPITALIZATION IN ONCOLOGICALWARDS IN A COMPREHENSIVE NATIONAL CANCER CENTER IN ITALY

C.I. Ripamonti1, P. Molani2, G. Barone1, M.A. Pessi1, F. Ravagnani3, C. Desti2, G. Boscagli2, C. Di Cristo2 1 Supportive Care in Cancer Department of Haematology and Pediatric Onco-Haematolgy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 2Management Control, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 3Transfusion Medicine Service, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy Background and Aims Blood Component (BC) transfusions is one of the activities of the outpatient SCU ancillary for the oncological wards of the Hospital dedicated to active anti-cancer treatments with curative or palliative intent. The aim of this study was to assess the changes in the number of transfusions performed from 2009 until December 2013. Methods We compared the transfusion activity in different wards. We considered: Oncological Day Hospital, Bone Marrow Transplantation Unit, Radiotherapy Ward, Medical Oncology Unit I and II. We collected data from the Management Control department from 2009 until 2013 and compared the quantities and the costs of the global number of transfusions performed within the different structures.

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Results As shown in Chart 1, the trend is negative for every ward considered and reflects a decrease in the amount of BC transfusions performed during the hospitalization. On the contrary, the chart shows a consistent and steady growth for the Supportive Care Unit, which in less than 3 years from its inception outperformed every other ward, both in total quantities and created value for transfusions. We need to remark that for what concerns the costs (Chart 2), the expenses related to hospitalization in the oncological wards are not included.

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Background and Aims ‘Supportive care’ is the prevention and treatment of the oncological therapyrelated complications as well as the maintenance of physical, psychosocial, spiritual well being of the patients thus to improve their adherence to treatment protocols in terms of dose-intensity and interval of administration. To reach those aims, the SCU of the NCI of Milan (born on June 2009) has mainly four approaches: to collaborate with the individual specialists of NCI through integrated and ancillary activities by means of 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 care of the patient in a holistic approach; to support family members, survivors and healthcare professionals; and to promote research (pharmacological and not) and educational programs. Methods Pharmacological intravenous therapies consists of: blood component transfusions, infusion of immunoglobulins, human albumin, antibiotics, antifungals and antivirals, iron, analgesics, diuretics, steroids, octreotide, H2-antagonist, glutathione, antiemetics, antihistamines, bisphosphonates/ denosumab with prevention and treatment of ONJ, hydration for highdose chemotherapy, for acute and chronic renal failure, electrolyte supply, and/or multivitamin, protein and lipid supply in patients with compromised ability to eat and drink properly, or with toxicity due to radiotherapy or chemotherapy (i.e., diarrhea, nausea, vomiting and oropharyngeal high-grade mucositis). Results Figure 1 shows the trend of activity from June 2009 till December 2013 at the SCU.

Conclusions Supportive Care Units are necessary in each Oncological Center. Conclusions The introduction of the Supportive Care Unit has made possible the reduction of hospitalization for patients who need transfusions, so we can conclude that in terms of cost efficiency and availability of hospital beds, the effects could be underrated and should be investigated further.

MASCC-0204 Health Services 2 SUPPORTIVE CARE UNIT (SCU) AT THE NATIONAL CANCER INSTITUTE (NCI) OF MILAN

C.I. Ripamonti1, G. Barone1, M.A. Pessi1 1 Supportive Care in Cancer Department of Haematology and Pediatric Onco-Haematolgy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

MASCC-0311 Health Services 2 CORRELATES AND OUTCOMES OF LESBIAN, GAY, BISEXUAL, AND TRANSGENDER (LGBT) IDENTITY DISCLOSURE TO CANCER CARE PROVIDERS

C. Kamen1, L. Margolies2, M. Smith-Stoner3, M. Flannery1, M. Tejani1, A. Peoples1, G. Morrow1, K. Mustian1 1 Department of Surgery, University of Rochester Medical Center, Rochester, USA; 2National LGBT Cancer Network, National LGBT Cancer Network, New York City, USA; 3Nursing, California State University San Berdardino, San Bernardino, USA Background and Aims LGBT cancer patients are often invisible in United States cancer studies. Non-cancer studies indicate that LGBT patients have difficulty disclosing

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their LGBT identity to medical providers and that lack of disclosure results in poorer health outcomes. The current study explores correlates of disclosure to cancer care providers and outcomes of disclosure. Methods Three hundred eleven LGBT cancer patients (mixed cancers; 88.5 % Caucasian; 50.1 % gay, 36.3 % lesbian, 7 % bisexual, 3 % transgender) completed an online survey assessing experiences of diagnosis and treatment, including items asking about demographics, to whom patients had disclosed, how they disclosed, which provider delivered their cancer diagnosis, and about current self-reported health. Results 78.8 % reported disclosing to 1+ cancer care provider. LGBT patients were most likely to disclose identity to primary care physicians (69.8 %), least likely to disclose to clerical staff (32.5 %), and most commonly disclosed to correct heterosexual assumptions (40.8 %). Surgeons were most likely to deliver cancer diagnoses (30.9 %), though less than half of patients had disclosed to their surgeons (45 %). Bisexuals were less likely (χ2=16.49, p= 0.002), while same-ex partnered individuals were more likely (OR=2.89, p=0.01) to disclose to providers. Lesbian women who disclosed were more likely to report good or better health currently than women who did not disclose (r=0.21, p=0.018). Conclusions Disclosure of LGBT identity is a common experience in the context of cancer care and is associated with better self-reported health among certain LGBT patients. Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population.

MASCC-0415 Health Services 2 THE ROLE OF A PHYSICIAN IN PALLIATIVE CARE OF CANCER PATIENTS ADMITTED IN AWESTERN KENYA COUNTY HOSPITAL

S. Obuya1, M. Liru2, C. Kasera2, W. Aketch2, J. Oguda3, P. Were4 1 Clinical, Moi Teaching and Referral Hospital, Eldoret, Kenya; 2Clinical, Homabay District Hospital, Homabay, Kenya; 3Gynea-Oncology, Moi University, Eldoret, Kenya; 4EMBLEm Project, Moi Teaching & Referral Hospital, Eldoret, Kenya Background and Aims The physician handling a large doctor to patient ratio in Homabay County hospital feels over whelmed offering palliative care services. However, emphasis on the significance of these services has had impact on the quality of palliative care of patients admitted with cancer at Homabay County Hospital. The hospital serves a population of 963,794, is situated on the Southern shores of Lake Victoria. It has neither a trained oncologist nor palliative care specialist, hence the need to sensitize the physicians and other health care providers on the ground to offer this service. Objectives 1) To sensitize physicians and other health care providers on palliative care service. 2) To include early symptom control as part of management of cancer patients. Methods Pretest questionnaires were administered to 24 health care providers to terminally ill cancer patients on basic palliative care knowledge. This was followed by a 6 weeks twice weekly lectures and short text

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message reminders on symptom control, accessibility to drugs and other provisions used in symptom management. Post test questionnaires were administered after 6 weeks to assess the impact of the biweekly lectures and short text messages on the quality of palliative care service provision. Results The physicians felt empowered and easily provided palliative care 2) Cancer patients reported improved care Conclusions Short term discussions, lectures and even sort text messages are useful in empowering health workers in providing palliative care.

MASCC-0330 Health Services 2 IN-PATIENT SUPPORTIVE CARE UNIT IN ONCOLOGY: A THREE YEAR ASSESSMENT (2011–2013)

P. Leroy1, M. Kfoury1, S. Hans2, C. Herve3, D. Brasnu2, S. Oudard4, C. Sauvajot2, C. Aubaret1, L. Tripault2, A. Guillou2, F. Scotté4 1 Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 2Oncology Department, Georges Pompidou European Hospital, Paris, France; 3Ethics Department, Paris Descartes University, Paris, France; 4Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France Background and Aims An in-patient unit for supportive care in oncology (USSO) was created in 2011 at the Georges Pompidou European Hospital to improve patient care management during their cancer treatment. Ayearly evaluation was conducted to monitor the unit’s activity. Methods An observational prospective study was performed in the 4-bed unit from January 1 – December 31, 2013. Results A total of 244 patients were included in the study. In 2013, 67.6 % of patients came directly from home. The predominant diseases observed were head and neck cancer 37.7 % and lung cancer 24.1 %. The main reasons for hospitalization were bad performance status 30.3 %, pain 13.5 %, invasive procedures 12.7 %, and nutritional disorders 9.1 %. In USSO, an interdisciplinary approach remains the cornerstone of treatment with a daily collaboration of dieticians, psychologists, physiotherapists, and the palliative care team. Based on this policy, the patient’s average length of stay was reduced to 8.3 days. Finally, 61 % of the patients were discharged home. A total of 9 % patients were transferred to a recovery unit and 12.7 % to a palliative care unit (total 9 % deaths recorded).

Number of stays Home admissions/Discharge (%) Emergency admissions (%)

2011 158 59.4/51.8 17.7

2012 192 64/60 8.3

2013 244 67.6/61 6.5

Total 584

Conclusions With the development of an interdisciplinary strategy we greatly amended patient management. These results enabled to increase USSO capacity from 4 to 8 beds, which not only improved the supportive care organization but also the patient’s quality of life.

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MASCC-0341 Health Services 2 IS A SUPPORTIVE CARE UNIT MORE COST EFFECTIVE THAN AN ONCOLOGY UNIT?

F. Scotté1, C. Sauvajot2, P. Leroy3, M. Kfoury3, D. Brasnu2, C. Herve4, S. Oudard5, C. Aubaret3, L. Tripault2, A. Guillou2, I. Borget6 1 Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 2Oncology Department, Georges Pompidou European Hospital, Paris, France; 3Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 4Ethics Department, Paris Descartes University, Paris, France; 5Medical Oncology, Georges Pompidou European Hospital, Paris, France; 6Pharmacy Department, Gustave Roussy Cancer Campus, Villejuif, France Background and Aims A specific SCC unit (SCCU) may create a financial burden compared to standard cancer department. Costs of stays and benefits of SCCU were compared to Medical (MO) and Gastro-Intestinal (GI) Oncology departments, to estimate the cost effectiveness of both units. Methods Data were analyzed over a two year period (2011–2012). Costs of hospital stays and costs per day were calculated based on the hospital cost accounting method. Benefit for the hospital was calculated as the difference between cost and Diagnosis Related Group tariffs in the stay and was classified. Results A total of 158 and 192 patients were respectively admitted to 4 beds in the SCCU in 2011 and 2012. The performance index-median length of stay (IPDMS) was cost effective (<1.00) for the SCCU compared to MO and GI 0.79, 1.09, 1.1 respectively in 2012 (enhanced result compared to 2011). Average costs per day of stay were lower for the SCCU compared to MO and GI in 2011 and 2012. Benefit per day was also higher in favor of the SCCU permitting the unit to benefit financially compared to the two other oncology units.

Benefit per day of stay (euros)

2011 2012

SCCU 4b 492 521

MO 12 b 387 424

gouvernance, École nationale d’administration publique, Montréal, Canada; 4Département de médecine sociale et préventive Faculté de médecine et des sciences de la santé, Université Laval, Québec, Canada; 5 Centre de recherche CSSS Champlain—Charles-Le Moyne Faculté de médecine et des sciences de la santé, Université de Sherbrooke (Campus Longueuil), Longueuil, Canada Background and Aims Interdisciplinary teamwork (ITW) has been advocated in a number of forums for improving the quality of primary and specialized care. The objective of the study is to evaluate the effects of ITW on cancer patients’ perceived experience of care. Methods Data was collected in 2010–11 in 15 % of Quebec’s oncology outpatient clinics. Sites (n=9) were purposely selected on the basis of the intensity level of ITW (higher, lower). The sample included 1,379 adult cancer patients. Perceived experience of care was documented by means of a self-administered questionnaire divided into six validated sub-scales: timeliness of services (TIM), communication (COM), patient-centered care (PCC), quality of physical environment (QPE), continuity (CONT) and results of care (RES). Multiple logistic regression models were used to estimate the extent to which patients’ ratings of their care experience differed between levels of ITW. Results Patients who were treated in clinics where the ITW level is high were 3.99 times (95 % CI: 1.89–8.41) more likely to rate positively TIM and more likely to have a favorable opinion of COM (OR: 2.37; 95 % CI: 1.25– 5.45), of PCC (OR: 2.11; 95 % CI: 1.05–4.24), and of CONT (OR: 2.18; 95 % CI: 1.07–4.47). Patients’ perception of QPE and RES were not related to the level of ITW teamwork. Various patients’ characteristics and organizational attributes were associated with patients’ ratings of their care experience. Conclusions Results suggest that ITW can improve various aspects of cancer patients’ care experience. Remaining challenges to draw clear conclusions about the key elements of ITW and its benefits will be discussed.

GI

MASCC-0176 346 (9b) 394 (17b)

Conclusions The SCCU was less expensive than the other oncology units and resulted in shorter hospital stays, suggesting that its development should allow the oncology department to enhance the quality of care without occurring any additional expenses.

MASCC-0183 Health Services 2 DOES INTERDISCIPLINARY TEAMWORK IMPROVE CANCER PATIENTS’ PERCEPTIONS OF THEIR CARE EXPERIENCE? RESULTS OF A QUEBEC’S ONCOLOGY CLINICS SURVEY

D. Tremblay1, D. Roberge2, N. Touati3, E. Maunsell4, D. Berbiche5 1 École des sciences infirmières Faculté de médecine et des sciences de la santé, Université de Sherbrooke (Campus Longueuil), Longueuil, Canada; 2Département des sciences de la santé communautaire Faculté de médecine et des sciences de la santé, Université de Sherbrooke (Campus Longueuil), Longueuil, Canada; 3Centre de rechercher sur la

Health Services 2 THE PRODUCTION CONDITIONS OF THE EFFECTS OF INTERDISCIPLINARY TEAMWORK IN ONCOLOGY TEAMS: A REALIST EVALUATION PROTOCOL

D. Tremblay1, N. Touati2, D. Roberge3, J.L. Denis4, A. Turcotte1, B. Samson5 1 École des sciences infirmières Faculté de médecine et des sciences de la santé, Université de Sherbrooke (Campus Longueuil), Longueuil, Canada; 2Centre de recherche sur la gouvernance, École Nationale d’Administration Publique, Montréal, Canada; 3Département des sciences de la santé communautaire Faculté de médecine et des sciences de la santé, Université de Sherbrooke (Campus Longueuil), Longueuil, Canada; 4Chaire CRC sur la gouvernance et la transformation des organisations de santé, École Nationale d’Administration Publique, Montréal, Canada; 5Centre intégré de cancérologie de la Montérégie, CSSS Champlain-Charles Le Moyne, Brossard, Canada Background and Aims Due to the nature of the illness and its multimodal treatment, cancer patients are particularly exposed to problems of fragmentation, coordination, communication and continuity of care. Interdisciplinary team work (ITW) is considered as a key element in cancer programs, but models differ considerably, as well as the expected effects on healthcare experiences.

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The objectives of the present study are 1) identify the contextual factors and mechanisms associated with the production of effects of ITW 2) determine the synergetic or antagonistic influence of contextual factors and mechanisms of ITW on the production of effects on the patient, 3) explore the occurrence of unanticipated mechanisms and effects of ITW. Methods This retrospective multiple case study draws on realist evaluation principles which explore the context, mechanism, and outcome (CMO) associations. Qualitative data sources will be used to build a picture of CMO and to capture the patient and professional perspective about ITW. Results Results are yet to come, but we anticipate that the research project will contribute to fill the knowledge gap on professional team processes identifying the critical conditions associated to a positive patientreported care experience. Conclusions This study will mobilize realist evaluation principles to draw lessons about how combinations of contextual factors and mechanisms produce particular outcomes. The results could permit to target more specifically the actions needed for optimizing the structures and activate the mechanisms responding to the needs of cancer patients and could make an important contribution regarding developing new research methods better suited for realist evaluations of complex interventions in the healthcare sector.

MASCC-0547 Hemostasis OUTPATIENT TREATMENT FOR UNSUSPECTED PULMONARY EMBOLISM IN CANCER PATIENTS

A. Burnod1, M.N. Guilhaume2, J. Danis1, E. Renault-Tessier1, L. Copel1, C. Bouleuc1 1 Supportive and palliative care, Institute Curie, Paris, France; 2Medical Oncology, Institute Curie, Paris, France Background and Aims Unsuspected pulmonary embolism (UPE) found on routine cancer staging multi-row detector computed tomography scan is known. Practice guidelines recommend treating these patients as comparable patients with symptomatic pulmonary embolism. Is outpatient treatment for selected cancer patients with UPE safe ? Methods We conducted a retrospective study from January 2012 to December 2013. Oncology patients in whom UPE was proved by scan were included. Patient characteristics were reported and analysed. Results We included 56 patients, 57 % were women. Mean age was 63 years. 82 % of them had metastatic cancer. Breast and lung cancers accounted for 57 % of the cancers in the UPE cohort. Twenty three patients (41 %) had a WHO performance status score greather or equal to 2. Among 56 patients, 46 % had proximal UPE. A total of 44 patients (79 %) were identified by the Pulmonary Embolism Severity Index (sPESI) of 3 or more. Outpatient treatment was managed for 50 patients (88 %) with low molecular weight heparin. None of them had a complication of UPE or mortality 30day outcome. Other patients were hospitalized due to hemorrhagic risk. Conclusions The results of the current study demonstrated that outpatient treatment is safe for most of cancer patients newly diagnosed with unsuspected

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pulmonary embolism. The Pulmonary Severity Index is always High for cancer patients and does not seem appropriate for assessing risk of home treatment. Observational studies are needed to make recommendations.

MASCC-0597 Hemostasis PERFORMANCE OF PROGNOSTIC SCALES IN CANCER-RELATED PULMONARY EMBOLISM: DATA FROM 650 CONSECUTIVE PATIENTS FROM THE EPIPHANY STUDY

C. Font Puig1, A. Carmona-Bayonas2, C. Beato3, P. Jiménez-Fonseca4, L. Faez5, M.A. Vicente2, M. Biosca6, M. Antonio Rebollo7, I. de la Haba8, O. Madridano9, J. Plasencia10, D. Calvo-Temprano11, A. Domínguez12, A. Puerta13, P. Arguis14, R. Otero-Candelera15 1 Hematology and Medical Oncology, Hospital Clínic, Barcelona, Spain; 2Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; 3Hematology and Medical Oncology, Hospital Nisa Aljafarate, Sevilla, Spain; 4Hematology and Medical Oncology, Hospital Central de Asturias, Oviedo, Spain; 5 Hematology and Medical Oncology, Hospital Central de Asturias, Sevilla, Spain; 6Hematology and Medical Oncology, Hospital Vall d’Hebrón, Barcelona, Spain; 7Hematology and Medical Oncology, ICO- Duran i Reynals, Barcelona, Spain; 8Internal Medicine, ICODuran i Reynals, Barcelona, Spain; 9Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain; 10Radiology, Hospital Universitario Morales Meseguer, Murcia, Spain; 11Radiology, Hospital Central de Asturias, Murcia, Spain; 12Radiology, Hospital Virgen del Rocío, Sevilla, Spain; 13Radiology, Hospital Reína Sofía, Murcia, Spain; 14Radiology, Hospital Clinic, Barcelona, Spain; 15 Pneumology, Hospital Virgen del Rocío, Sevilla, Spain Background and Aims The simplified Pulmonary Embolism Severity Index (sPESI), Geneva Prognostic Score (GPS) and RIETE registry scale have been validated to predict short-term mortality in patients with symptomatic pulmonary embolism (PE). However, incidental PE currently represents half of cancer-related PEs. The European Cooperative Oncology Group Performance Status (ECOG-PS) scale is the single most important predictive factor in cancer. OBJECTIVE To assess the accuracy of 3 prognostic models to predict 30-days mortality in cancer-related PE. Methods EPIPHANY is an ongoing, ambispective, multicenter study to assess prognostic factors in patients with cancer-related PE, including symptomatic and incidental events. We substituted the predictor ‘history of cancer’ by ‘active cancer’ in sPESI and GPS scores. Results From January-2006 to November- 2014, 650 consecutive patients were recruited. Data were prospectively collected in 299(46 %). 319 episodes (48.8 %) were incidentally diagnosed. Table 1 shows the baseline data of our cohort. Overall 30-days mortality was 14 % (CI 95 %, 11.2–17.1 %), being cancer progression the most common cause of death (70.8 %). The AUCs were: 0.711 (95 % confidence interval [CI], 0.675–0.746) for sPESI; 0.706 (95 % CI, 0.670– 0.741) for GPS; 0.775 (95 % CI, 0.741–0.807) for RIETE and 0.780 (95 % CI, 0.748–0.813) for ECOG-PS. Pairwise comparison of ROC curves did not reveal significant differences between RIETE and ECOG-PS, and both were superior to sPESI and GPS (p<0.05) (Table 2).

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Table 1. Baseline and acute variables Category

N (%)

Age (mean ± SD)

64±12

Body weight (mean ± SD)

71±14

Male gender

361 (55.5 %)

Chronic bronchitis

82 (12.6 %)

Cardiovascular disease

35 (5.4 %)

ECOG PS ≥2

310 (47 %)

History of previous DVT

79 (12.2 %)

TNM stage IV

482 (74.3 %)

Tumor assessment Diagnosis/not yet evaluated

247 (38 %)

Tumor progression

130 (20 %)

All tumors removed

57 (8.8 %)

Chemotheraphy

360 (55.4 %)

PE-specific symptoms

331 (51.2 %)

Heart rate≥110

154 (23.7 %)

Systolic Blood pressure<100 mmHg

75 (11.5 %)

Arterial blood oxygen saturation<90 %

104 (16 %)

Table 2. Prognostic values of sPESI, GPS, RIETE, ECOG-PS to predict 30-days mortality

Background and Aims Patients (pts) with gliomas are among the most highly at-risk individuals for VTE although the true incidence of VTE remains uncertain. The aim of this study is to analyze the incidence of cancer-associated thrombosis in ambulatory pts with gliomas receiving CT or CRT. Methods We performed a retrospective review to determine the incidence of symptomatic and incidental VTE in pts attended in our service. One hundred eight consecutive pts who received CT or CRT for gliomas from January 2008 through December 2012 were identified and included in the analysis. Results VTE was identified in 14 (13.0 %) pts. Median follow-up: 26 months. Median age-year old: 59 (range 19–85). Male/female: 55.6 %/44.4 %. Type of glioma: glioblastoma multiforme 67.7 %; anaplastic astrocytoma 26.9; oligodendroglioma 6,5 %. CT-RT: 90 patients (83.3 %). CT: temozolamida 94 (87 %); bevacizumab 8 (7.4 %). Median time to diagnosis VTE: 3.5 months (range 0–36 months). VTE in first 6 months after diagnosis: 64,3 %. Type of VTE: 42.9 % pulmonary embolism (PE), 50.0 % deep vein thrombosis, 7.1 % visceral vein thrombosis (VVT). 28.6 % of the events were incidentally discovered (50 % PE, 100 % VVT). Recurrent rate: 7,1 %. 50 % of pts treated with bevacizumab developed VTE. Conclusions The high incidence of VTE observed in this study is consistent with prior reports. The incidence of bevacizumab-associated thrombosis outside clinical trials must be specifically assessed.

Parameter

sPESI (0 vs. ≥1)

GPS (<3 vs. ≥3)

RIETE (<2 vs. ≥2)

ECOG PS (<2 vs. ≥2)

Sensitivity, % (CI–95 %)

100 % (96–100)

62.6 % (51.8–72.5)

98.8 % (93.9–99.9)

89 % (80.7–94.6)

Hemostasis

Specificity, % (CI–95 %)

16.8 % (13.8–20.2)

65.5 % (61.4–69.5 %)

20.7 % (17.4–24.4)

59.1 % (54.9–63.2)

VTE-RELATED HOSPITAL COSTS FOR FRENCH PATIENTS WITH BREAST OR PROSTATE CANCER

PPV, % (CI–95 %)

16.4 % (13.4–19.7)

22.8 % (17.8–28.6)

16.7 % (13.6–20.2)

26.2 % (21.4–31.4)

NPV, % (CI–95 %)

100 % (96.1–100)

91.5 % (88.3–94)

99.1 % (95.3–99.9)

97 % (94.6–98.5)

pLR (CI–95 %)

1.20 (1.16–1.25)

1.82 (1.50–2.21)

1.25 (1.19–1.31)

2.18 (1.93–2.46)

nLR (CI–95 %)

0

0.57 (0.43–0.75)

0.05 (0.01–0.38)

0.19 (0.10–0.33)

Conclusions RIETE and ECOG-PS are equally accurate to predict short-term mortality, being more reliable than sPESI and GPS. The large influence of cancer progression on overall mortality limits the applicability of PE-specific scales in this setting.

MASCC-0504 Hemostasis INCIDENCE OF VENOUS THROMBOEMBOLISM (VTE) IN AMBULATORY PATIENTS WITH GLIOMAS RECEIVING CHEMOTHERAPY (CT) OR CHEMORADIOTHERAPY (CRT)

S. Custodio Cabello1, A. Muñoz Martín1, S. Pérez Ramírez1, A.B.. Rupérez Blanco1, M. Cavanagh Podesta1, B. Moya Ortega1, M. Lobo de Mena1, I. Echavarría Díaz-Guardamino1, G. Torres Pérez-Solero1, I. Márquez-Rodas1, M. Martín Jiménez1 1 Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

MASCC-0385

F. Scotté1, A. Vainchtock2, I. Borget3 1 Oncology, Hôpital Européen Georges Pompidou, Paris, France; 2 Medico Economy, Health Evaluation, Lyon, France; 3Health Economy, Institut Gustave Roussy, Villejuif, France Background and Aims Cancer patients are known to have an increased risk of venous thromboembolism (VTE). Our objective was to determine the number of hospital stays related to VTE in patients with breast or prostate cancer and to calculate the associated hospital costs. Methods From the French Medical Information System, we identified patients diagnosed with breast cancer (BC) or prostate cancer (PC) in 2010 and hospitalized for VTE at least once during the following 2 years. Associated hospital costs were estimated from the perspective of the third-party payer, using the French official tariffs. Results Table: Cost of hospital stays for patients with BC or PC and VTE Breast cancer Mean cost/stay Total cost

1st event €3,302 €1,789,615

Recurrence €2,916 €186,620

Total €3,261 €1,976,235

Prostate cancer Mean cost/stay Total cost

1st event €3,611 €1,278,397

Recurrence €3,363 €147,959

Total €3,584 €1,426,357

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In 2010, 62,365 patients newly diagnosed with BC and 45,551 with PC were admitted in French hospitals. Among them, 1,271 in the BC cohort (2.0 %) and 997 in the PC cohort (2.2 %) were hospitalized for VTE at least once during the 2-year follow-up. In total, 1,604 stays for BC patients and 1,210 stays for PC patients were analyzed. In BC patients, the mean cost per stay amounted to €3,302 and €2,916 for first event and recurrence, respectively, and in PC patients, to €3,611 and €3,363 for first event and recurrence, respectively. Over a 2-year period, the total cost of hospital stays induced by VTE reached €1.98 m for BC and €1.43 m for PC. Conclusions The economic burden of VTE in cancer patients is high, both in breast and prostate cancer, and could be reduced by decreasing the occurrence of thromboembolic complications in this at-risk population.

MASCC-0549 Infections COMPLICATIONS, MORTALITYAND LENGTH OF HOSPITAL STAY IN CANCER PATIENTS WITH LOW RISK FEBRILE NEUTROPENIA: PROSPECTIVE DATA FROM THE FINITE STUDY COHORT

P. Jiménez-Fonseca1, A. Carmona-Bayonas2, C. Font Puig3, M. Antonio Rebollo 4, M. Biosca 5 , J. Martínez 6, E. Martínez de Castro7 , J. Hernando8, A. Ramchandani9, J. Virizuela10, I. Ghanem11, C. Beato12, A. Blasco13, F. Casao14, Y. Bonilla15, R. Mondéjar16, J. Espinosa17, M.A. Arcusa-Lanza18, E. Gallardo19, F. Ayala de la Peña20 1 Medical Oncology, Hospital Central de Asturias, Oviedo, Spain; 2 Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; 3Medical Oncology, Hospital Clínic, Barcelona, Spain; 4Medical Oncology, ICO- Duran i Reynals, Barcelona, Spain; 5 Medical Oncology, Hospital Vall d’Hebrón, Barcelona, Spain; 6Medical Oncology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 7 Medical Oncology, Hospital Marqués de Valdecilla, Santander, Spain; 8 Medical Oncology, Hospital Miguel Servet, Zaragoza, Spain; 9Medical Oncology, Hospital de Las Palmas, Las Palmas, Spain; 10Medical Oncology, Hospital Virgen de la Macarena, Sevilla, Spain; 11Medical Oncology, Hospital Universitario La Paz, Madrid, Spain; 12Medical Oncology, Hospital Nisa Aljafarate, Sevilla, Spain; 13Medical Oncology, Hospital General Universitario Valencia, Valencia, Spain; 14Medical Oncology, Hospital de Campinas, Campinas, Brazil; 15Intensive Care Unit, Hospital Santa Lucía, Cartagena, Spain; 16Medical Oncology, Hospital de Cuenca, Cuenca, Spain; 17Medical Oncology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 18Medical Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain; 19Medical Oncology, Hospital de Pontevedra, Pontevedra, Spain; 20Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain Background and Aims Home-based care is an option for patients with low-risk febrile neutropenia (FN) but the adoption of this strategy is unknown in Spain. Clinical guidelines suggest two strategies to select patients for this approach: validated prognostic models and/or empiric sets of exclusion criteria. However, the prognostic role of specific infections/tumors remains uncertain among clinically stable outpatients. Objectives: To assess disparities on patterns of care, infection-related complications, mortality and length of hospital stay among cancer patients with apparently stable FN (ASFN). Methods FINITE is an ongoing, prospective, multicenter study to assess prognostic factors and patterns of care in patients with ASFN, defined by the absence of shock, organ dysfunctions or major infections.

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Results From Oct/12 to Dec/13, 781 patients with ASFN were prospectively recruited from 21 Spanish hospitals. Most episodes were initially classified as low-risk by either MASCC ≥21 or TalcottIV criteria (95.5 %). The rate of infection-related complications and death was 15.6 % (95 % CI, 12.9–18.6 %) and 1.7 % (95 % CI, 0.98–3 %). Concerning the site of treatment, 594 (76 %) were admitted to hospital, 169 (21.6 %) received early discharge and 18 (2.3 %) were treated at home, with long stays detected even for mild syndromes (Fig-1). Significant differences in complications and mortality were observed according to the site of infection and specific tumors (Tables 1–2). Patients with breast and lung cancer, respiratory infections, bacteremia and mucosa-associated infections represented particular sources of misclassification. Table 1. Tumor

No. (%)

% complications

% mortality

% bacteremia

Length of stay median [CI 95 %]+

Breast Lung Colorectal

261 (33.4 %) 165 (2.11 %) 43 (5.5 %)

23 (8.8 %)* 42 (25.5 %)* 7 (16.3 %)

2 (0.8 %) 5 (3 %) 2 (4.7 %)

20 (7.7 %)* 22 (13.3 %) 11 (25.6 %)*

4 [4.0, 4.0] 6[5.0, 6.0] 7 [5.0, 8.0]

Stomach Head and neck Ovarian Lymphoma

50 (6.4 %) 32 (4.1 %)

8 (16 %) 7 (21.9 %)

1 (2 %) 1 (3.1 %)

7 (14 %) 5 (15.6 %)

5 [4.0, 7.0] 7 [5.0, 8.0]

26 (3.3 %) 16 (2 %)

3 (11.5 %) 2 (12.5 %)

0 0

5 (19.2 %) 3 (18.8 %)

5 [3.6, 6.0] 6 [5.0, 8.2]

Sarcoma Prostate Other

43 (5.5) 12 (1.5 %) 99 (12.7 %)

5 (11.6 %) 3 (25 %) 17 (17.2 %)

0 1 (8.3 %) 2 (2 %)

5 (11.6 %) 2 (16.1 %) 14 (14.1 %)

5 [4.0, 6.0] 4 [2.3, 8.0] 6 [5.0, 6.7]

Pancreas/ biliary Germinal All patients

13 (1.7 %)

3 (23.1 %)

0

4 (30.8 %)

5 [4.0, 9.0]

21 (2.7 %) 781 (100 %)

3 (14.3 %) 123 (15.7 %)

0 14 (1.8 %)

4 (19 %) 102 (13.1 %)

8 [4.6, 9.7] 5 [5.0, 5.0]

* +

p<0.05 (z-test of proportions adjusted using the Bonferroni method) p<0.05 (Kruskal-Wallis test)

Table 2. Infection

No. (%)

% complications

% mortality

% bacteremia

Length of stay median [CI 95 %]+

FOD Primary bacteremia Lower respiratory Skin Cholecystitis

292 (37.4 %) 17 (2.2 %)

29 (9.9 %)* 7 (41.2 %)*

6 (2.1 %) 2 (11.8 %)*

18 (6.2 %)* 17 (100 %)

5 [4.0, 5.0] 7 [5.0, 10.9]

75 (9.6 %)

19 (25.3 %)*

1 (1.3 %)

15 (20 %)

5 [5.0, 7.0]

21 (2.7 %) 1 (0.1 %)

4 (19 %) 0

0 0

3 (14.3 %) 1 (100 %)

6 [4.0, 7.6] 11

Enteritis Esophagitis Stomatitis

89 (11.4 %) 6 (0.8 %) 57 (7.3 %)

23 (25.8 %)* 1 (16.1 %) 3 (5.3 %)*

1 (1.1 %) 0 0

14 (15.7 %) 0 5 (8.8 %)

6 [5.0, 7.0] 7 [2.7, 9.6] 6 [5.0, 7.0]

Odontogenic Catheter Perianal

11 (1.4 %) 11 (1.4 %) 4 (0.5 %)

1 (9.1 %) 3 (27.3 %) 1 (25 %)

0 0 0

1 (9.1 %) 8 (72.7 %)* 0

5 [2.8, 6.0] 10 [7.9, 13.2] 6 [5–12.2]

Cough Urinary Meningitis

87 (11.1 %) 60 (7.7 %) 1 (0.1 %)

2 (2.3 %)* 7 (11.7 %) 1 (100 %)

0 1 (1.7 %) 0

3 (3.4 %)* 8 (13.3 %) 1 (100 %)

4 [3.0, 4.1] 5 [4.0, 6.0] 16

Pneumonia Other All patients

32 (4.1 %) 17 (2.2 %) 781 (100 %)

17 (53.1 %)* 5 (29.4 %) 123 (15.7 %)

3 (9.4 %)* 0 14 (1.8 %)

6 (18.8 %) 2 (11.8 %) 102 (13.1 %)

9 [7.0, 14.0] 6 [4.0, 7.0] 5 [5.0, 5.0]

*

p<0.05 (z-test of proportions adjusted using the Bonferroni method) p<0.05 (Kruskal-Wallis test)

+

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Conclusions Septic cancer patients on the wards have better outcome if MET is activated. Most of these patients exhibit SIRS criteria which should prompt immediate MET activation. MET improves outcome in these patients through early management and ICU transfer.

MASCC-0550 Infections CANDIDA ALBICANS AND CANDIDA GUILLIERMONDII CO-INFECTION IN PEDIATRIC LEUKEMIA PATIENT

R.G. Lima-Neto1, A.M.R.C. Parahym2, P.J. Rolim-Neto3, C.M. Silva2, D.P.C. Macêdo3, S.S. Gonçalves4, V.L.L. Moraes5, R.P. Neves2 1 Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 2 Mycology, Federal University of Pernambuco, Recife, Brazil; 3 Pharmacy, Federal University of Pernambuco, Recife, Brazil; 4 Foundation of Hematology of Pernambuco, Health Secretariat of the Pernambuco state, Recife, Brazil; 5Oncology Pediatric Center, Oswald Cruz University Hospital, Recife, Brazil Conclusions This study identified additional risk factors associated to complications and mortality. The adherence to home-based strategies for FN remains low in Spain.

MASCC-0509 Infections OUTCOME OF SEPTIC CANCER PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT WITH AND WITHOUT MEDICAL EMERGENCY TEAM INTERVENTION

I. Khalid1, A.A. Saeedi1, K. Al Harbi1, M. Kadri1, I.A. Qushmaq1 1 Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia Background and Aims Cancer patients with sepsis have high mortality. However, there is limited data regarding outcome of septic ward patients who are admitted to the intensive care unit (ICU) with and without Medical Emergency Team (MET) intervention. We evaluated this question in our study. Methods We evaluated 4,852 oncology ward patients from January 2009 to July 2011. One hundred thirty-nine patients were included in analysis who were admitted to the ICU and divided into MET transfers (admitted to ICU after MET involvement) and Non-MET transfers. Primary outcome was 28-day mortality. Data was analyzed using t-test and Pearson chisquare test, as appropriate. Results Out of 139 ICU transfers, 91 were MET transfers and 48 were nonMET transfers. The MET and Non-MET patients had similar APACHE II scores (22.1 vs. 23.4; p=0.07). However, MET transfers as compared to Non-MET transfers had lower rates of intubation (47 % vs. 66 %; p=0.03), lower ICU mortality (41 % vs. 62 %; p= 0.02), and lower 28-day mortality (43 % vs. 65 %; p=0.01). Among the non-MET patients, 84 % fulfilled the Hospital MET activation and Systemic Inflammatory Response Syndrome (SIRS) criteria up to 6 h prior to ICU admission. Non-MET transfers had delayed initiation of resuscitation, transfer to ICU and normalization of lactic acid (p≤0.04).

Introduction: Candidiasis is common in children receiving cancer therapy, particularly during severe neutropenia. Among Candida species C. albicans is frequently involved in oral and life threatening infections in immunosuppressed patients and C. guilliermondii has been described as an emerging pathogen and rarely cause invasive infection in pediatric cancer patient. Objectives: Report a case of oral and systemic candidiasis due to C. albicans and C. guilliermondii, respectively. Methods: A 5-year-old child with juvenile myelocytic leukemia was admitted at the Oswaldo Cruz University Hospital, Recife, Brazil for chemotherapy. The child presented severe oral candidiasis with cream-colour deposits and high fever. Oral samples were obtained by swab from the palate and oral mucosa. Venous blood samples were collected aseptically in three consecutive days. Then, the samples were processed by standard methods for mycological diagnosis (direct examination and culture isolation) and identification was carried out by macroscopic, microscopic and physiologic characteristics, besides automated methods. Results: Diagnostic was concluded with the observation of hyaline hyphae and oval yeast cells in oral secretion and oval yeast cells in blood samples (Figure 1A, 1B). The clinical isolates were identified as C. albicans from the oral samples and C. guilliermondii from blood specimens. Physicians prescribed fluconazole (200 mg/day) with regression of the oral lesions, although the patient remained with fever and died 3 weeks after treatment beginning.

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Conclusions: Oral and systemic candidiasis are common in children with cancer and this co-infection present a poor prognosis. Furthermore, antifungal sensitivity tests are essential to establish an effective treatment and a good outcome.

MASCC-0552 Infections RESPIRATORY GEOTRICHOSIS IN NON-HODGKIN LYMPHOMA PATIENT

R.G. Lima-Neto1, A.M.R.C. Parahym2, P.J. Rolim-Neto3, C.M. Silva2, D.P.C. Macêdo3, S.S. Gonçalves4, G. Filho5, R.P. Neves2 1 Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 2 Mycology, Federal University of Pernambuco, Recife, Brazil; 3 Pharmacy, Federal University of Pernambuco, Recife, Brazil; 4 Mycology, Federal University of São Paulo, Recife, Brazil; 5Foundation of Hematology of Pernambuco, Health Secretariat of the Pernambuco state, Recife, Brazil Introduction: Geotrichosis is an uncommon infection associated with various clinical conditions. Geotrichum species are usually nonpathogenic, although few reported cases related to disseminated infection as well as brain abscesses, traumatic joint infection, and oral and cutaneous infections in immunocompromised hosts has been published, such as those with hematologic malignancies. G. candidum is ascomycetous yeast, ubiquitous in the environment and can colonize the human gastrointestinal tract. Objectives: Report a case of pulmonary geotrichosis in a lymphoma patient. Methods A 43-year-old woman with non-Hodgkin lymphoma hospitalized for 1 month in Intensive Care Unit of the Foundation of Hematology of Pernambuco/Brazil, presenting febrile neutropenia and respiratory failure. The patient had used mechanical ventilation, urinary and venous catheters. A chest X-ray was performed and a pulmonary radiological image was suggestive of fungal infection (Figure 1). Based on this result and on clinical conditions the samples of tracheal secretions were obtained in three consecutive days and subsequently processed for direct examination and culture. The identification of the isolates was performed trough of the morphophysiological characteristics. Results The diagnosis was based on the presence of hyaline yeast cells and arthrospored septate hyaline hyphae in the direct examination and isolation of G. candidum in the cultures of all samples (Figure 2A and 2B). The patient developed acute respiratory failure and pulmonary hemorrhage which worsened her clinical condition with fatal outcome after 3 days from the diagnosis.

Conclusions Early diagnosis of invasive fungal infections associated with early initiation of appropriate therapy is extremely important for a good prognosis.

MASCC-0569 Infections PENICILLIOSIS IN PATIENT WITH HEMATOLOGIC MALIGNANCY

D. Macêdo1, A.M.R.C. Parahym1, P.J. Rolim-Neto1, C.M. Silva2, R.G. Lima-Neto3, S.S. Gonçalves4, G.A.T.M. Henriques-Filho5, R.P. Neves2 1 Departament of Pharmacological Sciences, Federal University of Pernambuco, Recife, Brazil; 2Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 3Departament of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 4Special Mycology Laboratory, Federal University of São Paulo, Recife, Brazil; 5Intensive Care Unit, Foundation of Hematology of Pernambuco, Recife, Brazil Background and Aims Invasive fungal infections have become increasingly frequent and a gradual increase of uncommon species causing infections has been observed, including by Penicillium species. P. citrinum has been involved in the etiology of keratitis, urinary tract infection. The aim of this research was to describe the first case of fungemia by P. citrinum in a patient with multiple myeloma and pneumonia. Methods A 77-year-old man with multiple myeloma was hospitalized in an Intensive Care Unit of a Tertiary Brazilian hospital. The patient had used ventilation support due to a chronic lung disease, renal failure, septic shock and obstructive disease. Blood samples were collected in triplicate and manipulated for mycological diagnosis. The identification of the fungal isolate was performed by classical and molecular taxonomy. Results After 10 days of incubation were observed the growth of flat, cottony, filamentous, green and gray colored colonies (Fig. 1A). After microscopic examination the cultures exhibited septate hyaline hyphae, simple or branched conidiophores, metulae, phialides, and conidia (Fig. 1B). By the methods of classical and molecular identification the isolate was identified as P. citrinum. After diagnosis treatment was started with amphotericin B (0.5 mg/kg/day). However on the second day after therapy the patient died due to complications of the clinical conditions.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Fig.1.Colony aspects after 10 days of growth (A) and microscopy showing septate hyaline hyphae, simple or branched conidiophores, matulae, phialides, and conidia typical of Penicillium citrinum. (B).

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fungus Paracoccidioides brasiliensis. More than 90 % of patients are affected with the chronic form, which appears mainly in male and rural workers. Unlike other opportunistic mycoses, PCM is not usually related to immunosuppressive diseases. The aim of this research was to describe a case of PCM in a patient with chronic lymphoblastic leukemia (CLL). Methods A 62-year-old male patient with CLL was admitted to the Intensive Care Unit from the Foundation of Hematology of Pernambuco/Brazil, with fever, prolonged neutropenia, cough and radiological image suggestive of pulmonary fungal infection. The patient was a retired rural worker and was empirically treated with voriconazole and amphotericin B. Samples of tracheal aspirates were obtained in 3 consecutive days and processed for mycological diagnosis. Results The direct examination showed the presence of yeast cells consistent with P. brasiliensis (Figure 1).

Conclusions P. citrinum cause fungemia in immunocompromised patients and may be associated to death depending on the patient general condition, time of diagnosis and treatment response.

MASCC-0568 Infections INFECTION DUE TO PARACOCCIDIOIDES BRASILIENSIS IN CHRONIC LYMPHOBLASTIC LEUKEMIA PATIENT

D. Macêdo1, A.M.R.C. Parahym1, P.J. Rolim-Neto1, R.G. Lima-Neto2, C.M. Silva3, G.A.T.M. Henriques-Filho4, R.P. Neves3 1 Departament of Pharmacologycal Sciences, Federal University of Pernambuco, Recife, Brazil; 2Departament of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 3Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 4Intensive Care Unit, Foundation of Hematology of Pernambuco, Recife, Brazil Background and Aims Paracoccidioidomycosis (PCM) is a systemic mycosis of great interest for Latin America countries. This disease is caused by the thermo-dimorphic

Figure 1. Direct examination showing the presence of yeasts cells with double refractive rounded contour and multiple budding, consistent with Paracoccidiodes brasiliensis

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No cultures were obtained. Serology by double immuno diffusion was performed to detect antibodies, however this test was negative due to immunosuppression. He died 15 days after the diagnosis. Conclusions The occurrence of chronic diseases in immunocompromised individuals complicates the prognosis, often leading to death. Thus the rapid and accurate diagnosis is extremely important in order to initiate specific therapy avoiding the increase of lung injury fibrosis and the spread to other organs.

MASCC-0591 Infections DEVELOPMENT OF AN ALGORITHM FOR THE MANAGEMENT OF FEBRILE PEDIATRIC ONCOLOGY PATIENTS IN DAVAO CITY, PHILIPPINES

S. Mukkada1, D. Aguilar2, C.M. Castillo-Deluao2, M. Dolendo2, M. Caniza1 1 Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, USA; 2Pediatric Oncology, Southern Philippines Medical Center, Davao City, Philippines Background and Aims Evidence based guidelines used in high income countries to standardize care of febrile oncology children are underutilized in low and middleincome countries (LMIC) in part due to applicability concerns. Objective To describe the sequential steps we followed to create and implement a fever management algorithm at the pediatric cancer center (PCC) in Davao City, Philippines. Methods Information gathering. We conducted interviews with medical personnel, reviewed medical records, observed care practices, and verified pricing and availability of ancillary studies and antimicrobials. Algorithm and consensus building. We constructed an algorithm based on our findings that was formally approved by the oncology and infectious disease personnel of the PCC. Implementation. The content and flow of the algorithm were reviewed weekly at the clinical staff meeting and its use monitored by PCC infection preventionist. Results During the information gathering step, we found that interpretation of fever, urgency, and approach to management differed between resident and nursing team members. During the algorithm building and consensus step, we adapted published guidelines to local resources. Following construction, stakeholders agreed to the feasibility and utility of applying the guideline. During implementation, rotating pediatric residents and nurses were trained in algorithm use. Additionally, once a week, during the PCC clinical meeting, the use of the algorithm was reviewed. Conclusion By undertaking systematic review of practices and epidemiology, it is possible to construct site-specific algorithms that achieve local support in LMIC. Future studies will include review of adherence to the algorithm and its effect on patient outcomes.

MASCC-0555 Infections TRICHOSPORONOSIS IN A PATIENT WITH ACUTE MYELOID LEUKEMIA

R.P. Neves1, A.M.R.C. Parahym1, P.J. Rolim-Neto2, C.M. Silva1, D.P.C. Macêdo3, V.L.L. Moraes4, R.G. Lima-Neto5

Support Care Cancer (2014) 22 (Suppl 1):S1–S238 1

Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 2Departament of Pharmacy, Federal University of Pernambuco, Recife, Brazil; 3Pharmacy, Federal University of Pernambuco, Recife, Brazil; 4 Oncology Pediatric Center, Oswald Cruz University Hospital, Recife, Brazil; 5 Tropical Medicine, Federal University of Pernambuco, Recife, Brazil Introduction: Trichosporon species are yeasts that can be found in soil, water and occasionally in the normal human microbiota of the skin, nails and mucous membranes, respiratory and gastrointestinal tract. T. inkin is considered the classic agent of white piedra and may cause various clinical manifestations from superficial skin involvement to invasive infections. Trichosporonosis is an uncommon opportunistic invasive mycosis often fatal. Objectives: Describe a fatal case of invasive pulmonary infection by T. inkin in a patient with acute myeloid leukemia. Methods: A 10-year-old female with acute myeloid leukemia was hospitalized in the Pediatric Oncology Centre from Oswaldo Cruz University Hospital/Brazil, with respiratory failure and started empirical treatment with caspofungin for 12 days and amphotericin B for 8 days. Then was transferred to the Pediatric ICU of the same hospital for performance of artificial ventilation and three samples of tracheal aspirates were obtained for mycological diagnosis. Subsequently the samples were processed for direct examination and cultures. Results: At direct exam yeast cells and septate and arthrosporated hyaline mycelial filaments were visualized (Figure 1). After growth T. inkin was isolated in pure culture from all clinical specimens (Figure 2A) and microscopic characteristics are presented in Figure 2B. Two days after diagnosis, the patient died with pulmonary hemorrhage leading to worsening of the underlying disease condition.

Conclusions: The occurrence of invasive disease in immunocompromised patients complicates the course of the acute myeloid leukemia, often leading to death. Thus the rapid and accurate diagnosis is extremely important in order to initiate specific therapy.

MASCC-0556 Infections CANDIDIASIS IN CANCER PATIENT AND ANTIFUNGAL PROFILE

R. Neves1, A.M.R.C. Parahym1, P.J. Rolim-Neto2, C.M. Silva1, D.P.C. Macêdo2, V.L.L. Moraes3, M.M. Rodrigues3, R.G. Lima-Neto4 1 Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 2Departament of Pharmacy, Federal University of Pernambuco, Recife, Brazil; 3Oncology Pediatric Center, Health Secretariat of the Pernambuco state, Recife, Brazil; 4Tropical Medicine, Federal University of Pernambuco, Recife, Brazil Background and Aims Introduction: The incidence of candidiasis has been increasing, especially in immunocompromised as cancer patients. Several Candida

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species are involved in the etiology of this mycosis, leading to occurrence of superficial or systemic infections with fatal course. Objectives: Conduct the diagnosis of candidiasis in patients with cancer and evaluate the antifungal susceptibility profile of the aethiological agents. Methods The study was carried in the oncology center at the Oswaldo Cruz University Hospital. Samples of blood, urine and tracheal aspirates were collected and immediately sent to Medical Mycology Laboratory for mycological diagnosis. Microbiological identification was performed by classical taxonomy using the chromogenic method CHROMagar Candida and the automated method VITEK 2. The antifungal susceptibility tests were developed based on the method of broth microdilution according to CLSI M27-A3 protocol. Results Clinical samples of 120 patients were collected. The mycological diagnosis was based on direct examination detection of hyaline oval yeast cells and septate hyaline hyphae (Figure 1), and isolation of Candida species in pure culture. The isolated species and the association with the underlying disease of the patients are presented in Table 1. The antifungal susceptibility profile is expressed in Table 2.

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Cerqueira Macedo2, R.G.L.N. Reginaldo Gonçalves de Lima Neto4, R.P.N. Rejane Pereira Neves1 1 Mycology, Ufpe, Recife, Brazil; 2Ciências farmacêuticas, Ufpe, Recife, Brazil; 3Oncology Center, University Hospital Oswaldo Cruz, Recife, Brazil; 4Tropical Medicine, Ufpe, Recife, Brazil Background and Aims Candidiasis infections are frequent in cancer patients presenting a wide spectrum of clinical manifestations as mucocutaneous infections to systemic disease. Objectives: Diagnose cases of candidiasis in pediatric leukemia patients and evaluate the isolates ability to form biofilms. Methods The study was carried out in the oncology center at a University Hospital/ Brazil. Samples of blood, urine and tracheal aspirates were collected according to doctor request. All samples were immediately sent for laboratorial mycological diagnosis. Microbiological identification was assessed by traditional and molecular taxonomy, CHROMagar Candida and VITEK 2 system. The antifungal susceptibility tests were preceded according to CLSI M27-A3. Evaluation on biofilm formation was performed by a visual reading test based on the staining of isolates using safranin. Results Different clinical samples of 46 patients with suspicion of candidiasis were collected. The diagnosis was based on detection of hyaline oval yeast cells and septate hyaline hyphae at direct examination, and isolation of Candida species in pure culture. The identified species were C. albicans (4), C. parapsilosis (1) and C. tropicalis (1). All species were susceptible to MICA and CAS except C. parapsilosis that was resistant to ANI. Resistance to FLZ, VRZ and ANF B were detected in C. albicans and C. tropicalis isolates. Capacity of biofilm production was more expressed in C. albicans and C. tropicalis isolates. Conclusions C. albicans was the most common species involved in candidiasis cases. Acquired resistance for amphotericin B and azoles was detected in C. albicans and C. tropicalis and also the high ability to produce biofilms, with clinical relevance.

MASCC-0551 Infections MUCOCUTANEOUS ASPERGILLUS TAMARII INFECTION IN A LEUKEMIA PATIENT – FIRST CASE REPORT

Conclusions Candidiasis infections were prevalent in cancer patients, and malignant hematology was the most predisposing condition. C. albicans was the most frequently isolated species and Candida non-albicans were considered prevalent in cancer patients. The acquired resistance to fluconazole was verified in C. albicans and C. tropicalis and these data strengthens the importance of antifungal sensitivity tests before therapy management.

MASCC-0553 Infections DIAGNOSTIC OF CANDIDIASIS IN LEUKEMIA PEDIATRIC PATIENTS, ANTIFUNGAL SUSCEPTIBILITYAND EVALUATION OF BIOFILM PRODUCTION

A. Parahym1, P.J.R.N. Pedro José Rolim Neto2, C.M.S. Carolina Maria da Silva1, M.M.R. Márcia de Melo Rodrigues3, A.L.M. Adriana Lins de Morais3, V.L.L.M. Vera Lúcia Lins de Morais3, D.P.C.M. Danielle Patricia

A. Parahym1, P.J.R.N. Pedro José Rolim Neto2, C.M.S. Carolina Maria da Silva1, M.M.R. Márcia de Melo Rodrigues3, T.J.M.S. Terezinha Salles3, A.L.M. Adriana Lins de Morais3, D.P.C.M. Danielle Patricia Cerqueira Macedo2, R.G.L.N. Reginaldo Gonçalves de Lima Neto4, R.P.N. Rejane Pereira Neves1 1 Mycology, Ufpe, Recife, Brazil; 2Ciências farmacêuticas, Ufpe, Recife, Brazil; 3Oncology Center, University Hospital Oswaldo Cruz, Recife, Brazil; 4Tropical Medicine, Ufpe, Recife, Brazil Introduction: Aspergillus infections have been described in immunocompromised children and A. fumigatus and A. flavus are the most frequently involved species. However, infections due to A. tamarii are uncommon and only one case is reported in imunocompetente patient. Objective: Describe a case of mucocutaneous A. tamarii infection in a child with acute lymphoblastic leukemia (ALL). Methods: A 3-year-old boy with ALL was admitted in a Brazilian Oncology Center with low neutrophil count, high fever, and swelling in nasal and paranasal regions. Computed tomography scans showed a heterogeneous opacity in the maxillary sinus and clinical examination presented necrotic and hemorrhagic lesions with hyperemia in the

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external nose. Samples from nasal lesions were collected for mycological diagnosis. Blood samples were obtained for culture and galactomannan antigen detection. The patient died after 2 months of hospitalization and face tissue samples were biopsied. Microbiological identification involved traditional and molecular methods. Antifungal susceptibility tests for amphotericin B, caspofungin, itraconazole, posaconazole and voriconazole were performed in accordance with CLSI M38-A2. Results Results: High levels of galactomannan antigens were verified, but fungi were not found in blood samples. Direct examination of nasal swab and tissue samples showed dichotomous hyaline hyphae. Colonies were visualized after 10 days of growth and traditional and molecular taxonomy identified A. tamarii. The strains were susceptible to all drugs. Despite treatment the patient died probably due to the clinical conditions and immunosuppression. Conclusions Conclusions: A. tamarii is an emerging species and cause mucocutaneous infection in leukemia patients.

MASCC-0506 Infections DISSEMINATED ASPERGILLOSIS IN LEUKEMIA PATIENT

C. Silva1, A.M.R.C. Parahym2, P.J. Rolim-Neto2, D.P.C. Macêdo2, R.G. Lima-Neto3, S.S. Gonçalves4, G.A.T.M. Henriques-Filho5, O.B. Silva5, R.P. Neves1 1 Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 2Departament of Pharmacological Sciences, Federal University of Pernambuco, Recife, Brazil; 3Departament of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 4Special Mycology Laboratory, Federal University of São Paulo, São Paulo, Brazil; 5 Intensive Care Unit, Foundation of Hematology of Pernambuco, Recife, Brazil

Fig. 1 a Chest X-ray showing pulmonary infiltration. b Brain magnetic resonance showing abscesses. c Dichotomous septate hyphae. d Microscopic characteristics of Aspergillus flavus.

Background and Aims Invasive aspergillosis is a cause of mortality and morbidity in haematological malignancies patients. The etiologic agents are ubiquitous fungi which may cause life-threatening infections in immunossupressed. The aim is to report a fatal case of disseminated aspergillosis due to A. flavus in acute lymphoblastic leukemia (ALL) patient. Methods A 46-year-old male with ALL was admitted to Foundation of Hematology and Hemotherapy of Pernambuco/Brazil for chemotherapy. The patient presented febrile neutropenia, thrombocytopenia, respiratory insufficiency, hemoptysis and lowering of consciousness and was transferred to ICU for mechanical ventilation. At chest Xray pulmonary infiltrations were observed (Fig. 1a). Brain magnetic resonance showed abscesses in both cerebral hemispheres (Fig. 1b). According to clinical aspects invasive fungal infection was suspected and Samples of tracheal secretion and blood cultures were collected for mycological diagnosis. Identification was achieved using traditional taxonomy and sequencing fragments of the ITS region of rDNA. Results Blood cultures were negative, but in three samples of tracheal secretions dichotomous septate hyaline hyphae were observed at direct examination (Fig. 1c). Also, A. flavus was isolated in cultures. The molecular tools confirmed the species (GenBank-HQ693703). Although treated with amphotericin B followed by voriconazole therapy, the patient died after 13 days.

MASCC-0315

Conclusions Disseminated aspergillosis is usually fatal when associated with haematological malignancies, although the early diagnosis is related to clinical improvement.

Infections 2 A TWO-YEAR SINGLE-CENTER ANALYSIS OF TREATMENT AND OUTCOMES OF HOSPITALISED CANCER PATIENTS WITH FEBRILE NEUTROPENIA IN A TERTIARY CARE HOSPITAL IN MONTREAL, CANADA

M.A. Fournier1, N. Letarte1, C. Messier1, L.A. St-Jean2, S. Doucet3, N. Blais3 1 Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, Canada; 2Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, Canada; 3Hemato-oncology, Centre Hospitalierde l’Université de Montréal, Montreal, Canada Background and Aims IDSA recommends antipseudomonal monotherapy as empirical treatment for febrile neutropenia (FN) in cancer patients. Ceftazidime combined with tobramycine has been the recommended therapy for years at the Centre Hospitalier Universitaire de Montréal in Montreal, Canada. The primary objective was to evaluate empiric treatment response at 96 h defined as a composite endpoint including fever defervescence, absence of hemodynamic instability, lack of antimicrobial therapy change, and symptom improvement. Secondary objectives included characterisation of isolated bacteria, survival and use of GSCF.

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Methods A retrospective cohort analysis of all cancer patients hospitalized between April 2011 and March 2013 with FN was conducted. Results A total of 277 episodes of FN were identified in 216 patients. Solid tumour represented 49,1 % of episodes. Median age was 59 years. The empiric treatment response was 32,9 % (CI95 %27,4–38,4). Survival to these episodes was 91,3 % (CI95 %88,0–94,7). At least one microorganism was identified in 49,1 % (CI95 %43,2 %– 55,0) of episodes. No gram-negative bacterium resistant to ceftazidime, tobramycin or piperacilline-tazobactam was identified among blood cultures. Eight cases of P.aeruginosa were identified, with only two resistant to piperacilline-tazobactam and one to ceftazidime; all isolated from two patients with known risk factors. GSCF was used in 204 episodes with 54 where no ASCO guideline criteria could be identified. Conclusions The empirical regimen used seems adequate according to isolated bacteria sensitivities despite failure rate of primary objective. The low response rate could be explained in part by individualized therapy modifications. However, the double coverage against P.aeruginosa does not seem to be necessary in all patients.

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MASCC-0229 Infections 2 EVIDENCE SUPPORTING PATIENT RISK FACTORS FOR FEBRILE NEUTROPENIA IN NON-HODGKIN’S LYMPHOMA

B. Chou1, P.K. Morrow2, R. Ismail3 1 Department of Pharmacy, University of Southern California, Los Angeles, USA; 2Clinical Development, Amgen, Thousand Oaks, USA; 3 Medical Communications, Amgen, Thousand Oaks, USA

CEFEPIME AS MONOTHERAPY TREATMENT OF FEBRILE NEUTROPENIC PATIENTS WITH LUNG CANCER

Background and Aims Treatment guidelines based on broad tumor populations list several risk factors in the development of febrile neutropenia (FN) and include both chemotherapy regimen and patient-specific risk factors. However, patient risk factors have limited primary literature supporting their impact on development of FN. Aim: To provide a novel, comprehensive assessment of existing primary literature that supports patient risk factors for developing FN in patients with Non-Hodgkin’s Lymphoma (NHL). Methods Patient risk factors were compiled from US and EU Guidelines, and PubMed was searched using MeSH terms of ‘Non-Hodgkin’s Lymphoma’, ‘febrile neutropenia,’ ‘patient risk factors,’ ‘risk factors,’ ‘patientspecific risk factors,’ and the name of the specific risk factor. Results Fourteen unique patient risk factors were identified from guideline and literature searches. Supporting evidence for each patient risk factor was found to vary based on the number of total publications and those publications showing a statistically significant correlation with FN risk compared to a control group (table below). Further data about the publications (ie, included FN as endpoint, prospective studies, randomized phase III trials) and 7 additional risk factors not listed below will be presented.

P. Heras1, V. Natsis1, K. Grigoriou1, T. Sirbilantze1, V. Niarou1 1 Internal Medicine, General Hospital of Nafplion, Athens, Greece

Select Risk Factor

Publications, n

Age≥65 Bone Marrow Involvement General Comorbidities Liver Disease Previous FN Body Surface Area Previous Radiation Therapy

11 6 4 3 3 3 2

MASCC-0205 Infections 2

Background and Aims To evaluate the efficacy of cefepime as monotherapy as initial treatment in febrile neutropenic patients with lung cancer (lc) that required hospitalization. Methods We have treated 25 grade 3–4 neutropenic patients, median age 60 (44–76 years) most of the patients presented as Karnofsky index of 80–90 %, 22 patients presented fever (3 during hospitalization). All of them have received chemotherapy. Treatment consisted of cefepime: 2 g i.v./8 h. All patients received GCSF. We took peripheral blood cultures in all patients before treatment, with 2 bacteriemias (E. Coli, and K. Pneumoniae) , infection without bacteria in 10 patients(respiratory:7 patients, genitourinary:2, oropharingeal:1) and fever of unknown origin :13 patients. Results Fever disappeared at 72 h in 17 patients and persisted in 5 adding an aminiglucoside (amikasine), a glucopeptide (teicoplanine) or both. Neutrophiles were 1,000/microL of fifth day in 21 patients. Nineteen presented a good response to treatment without any adverse event. Six patients died during hospitalization. (1 sepsis, 2 persistent neutropenia and other complication not related to febrile neutropenia: 3 patients). Conclusions In our experience, cefepime as monotherapy has efficacy in the initial management of more than 75 % of our febrile neutropenic lung cancer patients. The persistence of fever and neutropenia suggests worse evolution and possible complication.

Publications with statistically significant FN risk vs control, n 7 4 4 2 1 2 1

Conclusions Current analysis supports that clinicians should utilize a tiered, evidencebased approach when assessing FN risk in NHL, and information illustrates the need for comprehensive analyses and practical guidance in assessing FN risk.

MASCC-0470 Infections 2 MAINTAINING ADHERENCE TO OPTIMAL BLOOD CULTURE PRACTICES AT A PEDIATRIC CANCER UNIT IN MANAGUA, NICARAGUA

K.M. Johnson1, R.P. Ojha2, M.M. Somarriba3, C.G. Lam4, M.A. Caniza5

S80 1 Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, USA; 2Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, USA; 3Department of Hematology/Oncology, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua; 4Department of Oncology and the International Outreach Program, St. Jude Children’s Research Hosptial, Memphis, USA; 5 Department of Infectious Diseases and the International Outreach Program, St. Jude Children’s Research Hosptial, Memphis, USA

Background and Aims Blood cultures are critical for diagnosis of bloodstream infections, but blood culture practices are often suboptimal for pediatric cancer units in low- and middle-income countries. We implemented a systematic quality improvement program in November 2012 at the pediatric cancer unit of Hospital Infantil Manuel de Jesús Rivera (Managua, Nicaragua) to provide blood culture supplies and reagents, and train oncology staff about indications for blood cultures. To assess the adherence of an intervention to promote optimal blood culture practices at a pediatric cancer unit within a national public hospital in Nicaragua. Methods We reviewed blood culture surveillance data between November 2012 and December 2013 to assess the monthly proportion of blood cultures that were drawn from those that were indicated for blood culture (i.e. adherence rate). We estimated the difference in adherence rates (RD) and corresponding 95 % confidence limits (CL) for each month compared with baseline. Results The adherence rate for the first month after intervention was 75 %. The adherence rate peaked at month 5 (100 %, RD=25 %, 95 % CL: 8.9 %, 41 %) but gradually decreased to 78 % by month 12 (RD=3.2 %, 95 % CL: −20 %, 27 %). The adherence rate modestly improved by the end of the assessment period to 88 % (RD=13 %, 95 % CL: −10 %, 35 %). Conclusions Our results suggest that optimal blood culture practices in this setting can result in adherence rates ≥75 % if a quality improvement program is maintained. Modifications to the training regimen may be required to ensure that the oncology staff remain informed about the indications for blood culture among pediatric cancer patients.

MASCC-0280 Infections 2 INTERACTION BETWEEN TUBERCULOSIS INFECTION AND LUNG CANCER

M. Kiagia1, A. Christopoulos1, A. Charpidou1, I. Gkiozos1, M. Zontanos1, S. Tsagkouli1, K. Syrigos1 1 Oncology Unit GPP, Sotiria General Hospital, Athens, Greece Background and Aims Nowadays, there is strong evidence to support that preexisting TB is an independent factor highly associated with increased risk of lung cancer. The aim of this review article is to evaluate the available literature concerning the prevalence of active tuberculosis in lung cancer patients. Methods MEDLINE, PubMed, EMBASE and Medscape databases were searched for studies with quantitative data on the interaction between TB and lung cancer, published since 1952. We used the Medical Subject Headings’ term “tuberculosis” and the text-word terms ”TB” and “Mycobacterium infection”, and also, the Medical Subject Headings’ terms “neoplasm” and “lung neoplasm” or the text-word term “lung cancer”.

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Results The prevalence of active tuberculosis among lung cancer patients varies depending on spatial and regional factors. Lung cancer patients that are more prone to developing tuberculosis are Asian and Caucasian males, with an average age of 60 years old. The prevalence of tuberculosis is higher in patients with chest X-ray evidence of old tuberculosis and/or history of tuberculosis, chronic obstructive pulmonary disease, heavy cigarette smoking, increased alcohol consumption and/or diabetes mellitus. A high mortality rate due to tuberculosis in lung cancer patients was also estimated. Conclusions Active tuberculosis complicating lung cancer is a significant clinical issue in countries with high prevalence of tuberculosis. However, as the there is a lack of reports from developed countries over the last 20 years, the significance of this interaction in countries with low tuberculosis burden remains controversial.

MASCC-0493 Infections 2 IMPROVING HOSPITAL PERFORMANCE TO FEBRILE NEUTROPENIA: A MIXED-METHOD ANALYSIS OF ROOT CAUSE PROBLEMS AND RESULTING SYSTEM SOLUTIONS

B. Meisenberg1, J. Clemons1, J. Ness2, N. Faust1, M. Clance3 1 DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, USA; 2Department of Pharmacy, Anne Arundel Medical Center, Annapolis, USA; 3Department of Epidemiology, Anne Arundel Medical Center, Annapolis, USA Background and Aims Febrile neutropenia (FN) remains a common and dangerous complication of cancer treatment. Guidelines from the Infectious Disease Society of America urge initiating antibiotics within 2 h of presentation. We reviewed our institution’s performance to identify areas of needed improvement and design performance improvement steps. Methods FN management was deconstructed into discrete tasks and experienced practitioners estimated maximal appropriate time to complete these tasks. Cycle time analysis data on a baseline cohort (Baseline group) identified common sources of delay. Based on these data, new processes were introduced. Performance monitoring continued as these changes were implemented (the Transitional group) and for 20 months thereafter (the post-Intervention group). Results Sixty-nine episodes of FN were analyzed. Delays were noted in almost every discrete step in management. System solutions included standardized order sets, releasing preliminary lab results immediately, and dispensing pre-formulated antibiotics in the ED rather than central pharmacy. Median time to antibiotics improved: 252 min, 188 min and 118 min for the Baseline, Transitional and post-Intervention groups, respectively (p=0.0002 for the Baseline vs. the post-Intervention). Variability was reduced with the interquartile range falling from 174 min (Baseline) to 65 min (postIntervention). Despite improvement, there were still episodes of prolonged delays, often due to competing priorities from other patients. Standardized order sets eliminated improper antibiotic choices. Conclusions Improvements in the management of FN can be accomplished and sustained by the focused study of performance of individual steps, streamlining processes and ongoing review of performance with feedback to clinical departments.

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MASCC-0082 Infections 2 THE ASSOCIATION BETWEEN NEUTROPENIA AND GAST ROENTERITIS AMONG PEDIATRIC CANCER PATIENTS IN LA PLATA, ARGENTINA

R.P. Ojha1, K.M. Johnson2, S. Gomez3, M.A. Caniza2 1 Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, USA; 2Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, USA; 3 Department of Hematology, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina Background and Aims Neutropenia is associated with various infectious conditions among pediatric cancer patients. Nonetheless, the association between neutropenia and gastroenteritis has not been systematically assessed, particularly in low- and middle-income countries with a high burden of pathogens that are associated with gastroenteritis. We assessed the association between neutropenia and gastroenteritis among pediatric cancer patients in La Plata, Argentina. Methods We reviewed infection surveillance data that was prospectively collected for all patients aged <20 years treated at the Pediatric Cancer Center of Hospital de Niños Sor Maria Ludovica (La Plata, Argentina) between September 2010 and June 2013. Gastroenteritis was defined as diarrhea with or without vomiting, and neutropenia was defined as an absolute neutrophil count <500. We used randomeffects Poisson regression to estimate overall and subgroup-specific risk ratios (RR) and corresponding 95 % confidence limits (CL) for the association between neutropenia and gastroenteritis after adjustment for age, sex, and treatment phase. Results Our study population comprised 151 patients. We observed 23 cases of gastroenteritis, of which 19 occurred among neutropenic patients (RR= 10, 95 % CL: 3.3, 30). The association between neutropenia and gastroenteritis was stronger among pediatric cancer patients aged <10 years (RR=14, 95 % CL: 1.7, 118) than patients aged 10–19 years (RR=7.2, 95 % CL: 1.9, 27). Conclusions Our results suggest that neutropenia is a strong risk factor for gastroenteritis among pediatric cancer patients, particularly at younger ages. Future studies should assess the distribution of pathogens associated with gastroenteritis to better inform prevention and management in similar settings.

MASCC-0022 Infections 2 FREQUENCY OF HEPATITIS B AND C AND ITS ASSOCIATED RISK FACTORS IN SURGICAL PATIENTS, CIVIL HOSPITAL KARACHI

R. Rafaqat1 1 medicine, dow medical college, Karachi, Pakistan Background and Aims Hepatitis B and C is a serious health problem worldwide. Infections with hepatitis B and C virus have been escalating in Pakistan and it has reached in endemic state. This study was carried out to determine the frequency of hepatitis B and C in surgical patients.

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Methods This cross-sectional study was conducted in Civil Hospital Karachi. Total 662 patients admitted in surgical department were approached. All patients were screened for HBsAg and antiHCV using immunochromatography ICT. The information about risk factors was also assessed. The data was analyzed on SPSS 17. Results Out of 662, 325 (49.1 %) were males and 337 (50.9 %) were females. Mean age of patients was 37.52. Hepatitis B surface antigen (HBsAg) was positive in 19 (2.9 %) and Hepatitis C (anti-HCV) in 45 (6.8 %) patients. HBsAg was positive in 12 (63.15 %) males and 7 (36.84 %) females. Whereas anti-HCV was positive in 21 (46.66 %) males and 24 (53.33 %) females. The results show that out of 19 positive patients for HBsAg, 17 (89.47 %) have history of intravenous injections and out of 45 anti-HCV, 44 (97.77 %) have the same history. The other major risk factors found were blood transfusion, blood donation, ear-nose piercing, dental procedure and barber shave. Conclusions The study suggests a moderate to high prevalence of hepatitis B and hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precaution before surgery.

MASCC-0023 Infections 2 KNOWLEDGE & SELF-PERCEIVED PRACTICE REGARDING INFECTION CONTROL AMONG NURSING STUDENTS OF CIVIL HOSPITAL KARACHI

R. Rafaqat1 1 medicine, dow medical college, Karachi, Pakistan Background and Aims Health-care associated infections cover all clinically evident infections that are not the part of patient’s original illness for which patient is admitted. Most of these infections clinically become evident after 48 h of admission. In all settings, nurses can play a dominant role in infection prevention and control by using their knowledge, skill and judgment. This reflects the importance and need of such type of study among nursing students. Methods A cross-sectional study was conducted at Civil Hospital Karachi. Nursing students practicing in Civil Hospital Karachi were approached for the study. A pre-designed interview based questionnaire was used for data collection. The collected data was analyzed using SPSS version 17. Results Total 241 students were interviewed including 41.5 % males and 58.5 % females. Of all students, 71.4 % had received guidelines about infection control from their seniors nursing staff. Hand hygiene facility was available in 78.8 % of wards. Among all students 80.9 % were aware of WHO guidlines on hand washing but only 20.3 % performed complete steps. Only 128 students (53.1 %) were aware of the term Health-care Associated Infections. Overall half of the students of this study reported lack of proper practice such as washing hand before and after procedure, using gloves and applying proper alcohol. Conclusions There is lack of proper practice among nursing students and lack of knowledge regarding health care associated infections. This study warrants the health associated education programs to fill the gap in knowledge as well as in practice.

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MASCC-0056 Infections 2 PROCALCITONIN IS THE FIRST BIOMARKER THAT SIGNIFICANTLY CORRELATED WITH THE INFECTION RELATED MORTALITY INDEPENDENT FROM C-REACTIVE PROTEIN, SEDIMENTATION RATE, PERFORMANCE SCALE, AND LEUKOCYTE COUNT

A. Sedef1, F. Kose1, O. Dogan1, H. Mertsoylu1, A. Sezer1, S. Muallaoglu1, A. Besen1, O. Ozyilkan1 1 medical oncology, baskent university, Adana, Turkey Background and Aims Infection is one of the major causes for mortality and morbidity that requires long hospitalization in cancer patients. Serum procalcitonin is highly sensitive and specific biomarker fro bacterial infection and not affected from primary malignancy as CRP, ESR did. Main aim of this study is to evaluate possible prognostic role of serum procalcitonin for infection related mortality in hospitalized cancer patients. Methods Consecutive 104 cancer patients those who were hospitalized for infection related fever (as clinician decision). Demographic characteristics and results of procalcitonin, CRP; leukocyte count, ESR, LDH, blood culture, serum albumin and calcium were recorded. All statistics were made by using SPSS 17.0 software program me. Results Most frequent primary diagnosis and type of infection were lung cancer %40.4 (n=42) and pneumonia %56.7 (n=59). Mortality rate for whole population was %17.3 (n=18). In statistical analysis, only ECOG performance score and procalcitonin value showed significant relation with mortality with p value of p<0.0001 and p: 0.001, respectively. Over the cut-off value of procalcitonin (2 ng/mL), procalcitonin showed mortality with %35 of sensitivity and %75 of specificity. Statistical analysis failed to show significant relation between CRP, ESR, leukocyte count, LDH, Calcium, albumin and positive culture result. Conclusions Infection is the most feared complication during oncologic follow-up. Infectious complication usually requires wide-spectrum antibiotics, long hospitalization stay and high costs. So, this study clearly demonstrated prognostic role of procalcitonin for cancer patients those who were hospitalized by infection. Using the procalcitonin levels as a prognostic biomarker may result decrease in hospitalization stay and wide-spectrum antibiotic costs.

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patient with hematological malignancies after empirical antifungal therapy with caspofungin. Methods A 15-years-old man with acute myeloid leukemia was admitted in a Hospital for chemotherapy. Thereafter, antifungal prophylaxis with caspofungin (50 mg/day) was conducted. After 8 days of hospitalization the patient was admitted to the ICU and a computerized tomography of the chest showed pleural effusion in the right lung and pulmonary nodules in the left lung. Blood and urine samples were collected and processed for mycological diagnosis. Microbiological identification was achieved by traditional taxonomy and sequencing of fragments from rDNA ITS region. Antifungal susceptibility test was performed in accordance with CLSI M27-A3 protocol. Results Direct examination of urine showed hyaline septate hyphae and arthroconidia (Fig. 1A), after growth in the culture of all samples were visualized dry and white to cream-colored colonies. Microscopic examination showed arthroconidia and septated hyaline hyphae (Fig. 1B).

The isolates were identified as S. capitata by traditional taxonomy and ITS sequence. The DNA sequence was submitted to GenBank (JN573270). The isolates were susceptible for amphotericin B, anidulafungin and voriconazole, but dose-dependent for fluconazole. Amphotericin B lipid complex (5 mg/kg/day) was administered intravenously for 24 days and then oral voriconazole (400 mg/day) with good response. Conclusions Invasive infection by S. capitata occurs in patient with leukemia and empirical treatment with caspofungin is not effective.

MASCC-0076 MASCC-0491

Information Technology

Infections 2 INVASIVE INFECTION DUE TO EMERGING YEAST IN A YOUNG PATIENT WITH HEMATOLOGIC MALIGNANCIES AFTER CASPOFUNGIN THERAPY

C. Silva1, A.M.R.C. Parahym2, P.J. Rolim-Neto2, D.P.C. Macêdo2, R.G. Lima-Neto3, S.S. Gonçalves4, V.L.L. Morais5, R.P. Neves1 1 Departament of Mycology, Federal University of Pernambuco, Recife, Brazil; 2Departament of Pharmacological Sciences, Federal University of Pernambuco, Recife, Brazil; 3Departament of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 4Special Mycology Laboratory, Federal University of São Paulo, São Paulo, Brazil; 5Oncology Center, Oswaldo Cruz University Hospital, Recife, Brazil Background and Aims Emerging yeast species may cause invasive infections in cancer patients, however Saprochaete capitata is uncommonly involved as aethiological agent. We report a case of invasive infection caused by S. capitata in a

DEVELOPMENT OF AN IT-BASED INTERVENTION FURTHERING RESILIENCE AND SUPPORTIVE CARE FOR PATIENTS DURING EARLY SYSTEMIC TREATMENT: RESIL-SHEET

M. Eicher1, F. Carrino2, E. Mugellini2, K. Ribi3, D. Betticher4, C. Hoeppli5, C. Dubey5 1 School of Health Science, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland; 2Technology for Human Wellbeing Institute, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland; 3Quality of Life, International Breast Cancer Study Group, Berne, Switzerland; 4Oncology and internal medicine, Hopital Fribourgeois, Frbourg, Switzerland; 5School of Health Science, University of Applied Arts and Sciences Western Switzerland, Frbourg, Switzerland Background and Aims Electronic recorded patient response with direct feed-back to professionals positively impacts psychosocial care. The concept

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of resilience is gaining increasing importance as a key component for integrated psychosocial care in cancer. However, it has been today rarely addressed in intervention studies for adult cancer patients. The aim is to present a newly developed, IT-based complex intervention furthering resilience and supportive care for patients during early systemic treatment. Methods According to the Medical Research Councils Framework for the development and evaluation of complex interventions, we followed three phases: 1) Conduction of a descriptive study to analyze the level of resilience and supportive care needs of newly diagnosed cancer patients, 2) interdisciplinary development of interventions furthering resilience and addressing unmet needs based on international guidelines for psychosocial care by the use of an electronic device providing a direct feed-back (RESIL-Sheet) to the oncologist and the nurse in charge of the patient, 3) testing the feasibility of the interventions. Results Phase 1: We found a strong association between high resilience and low unmet supportive care needs. Phase 2: The electronic RESIL-Sheet includes an individual resilience score (Connor-Davidson-Resilience Scale), prompted unmet needs (Supportive Care Needs Survey Short Form – 10 items) and tailored interventions to unmet needs. Phase 3: The interventions applied three times over 16 weeks are currently tested in a phase II trial supported by the European Oncology Nursing Society and Swiss Cancer Research. Conclusions Preliminary results of the phase II trial (interim analysis) will be shown at the meeting.

MASCC-0319

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Methods Newly diagnosed men who chose curative treatment and those who chose AS, and their partners, from 3 hospitals completed semi-structured telephone interviews. Transcribed interviews underwent inductive, cyclic, and comparative analysis with inter-rater reliability. Findings were fed into the development of an online DA. Results Twenty-one men and 14 partners participated. Prostate cancer treatment information was regularly described as contradictory, confusing, and stressful. AS was commonly misunderstood. Men and partners were sometimes encumbered by memories of treatment decision-making, ongoing conflicting information and unanswered medical questions. Radical treatment was selected when cancer progression was feared or medically indicated. The online DA presents unbiased, evidence-based information in a clear form - written, graphical and audio-visual - then lead the patient and partner through a process of weighing up the benefits and costs of whether to adopt AS or a curative treatment. The video-clips involve men, their partners, urologists and radiation oncologists presenting information and personal experiences. Conclusions Rigorously-tested, up-to-date and culturally-specific DAs for LRPC which is easily accessible is urgently needed to assist with treatment decision-making involving both men and partner.

MASCC-0267 Information Technology TABLET COMPUTER ASSESSMENT OF SYMPTOM BURDEN IN OUTPATIENT ONCOLOGY

S. Thomas1, A. Aktas1, S. Shrotriya1, D. Walsh1, B. Hullihen1, B. Estfan2 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, USA; 2Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA

Information Technology “WHAT IS THIS AS THING?”: THE DEVELOPMENT OF AN ONLINE TREATMENT DECISION-MAKING AID FOR LOW RISK PROSTATE CANCER WHEN ACTIVE SURVEILLANCE IS A TREATMENT OPTION

P. Schofield1, C. O’Callaghan1, T. Dryden1, A. Hyatt1, J. Brooker2, S. Burney2 , A. Wootten3, A. White 4 , D. Murphy 5 , S. Williams6 , M. Frydenberg7 1 Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Australia; 2Cabrini Monash Psycho-oncology Unit, Monash University, Melbourne, Australia; 3Department of Urology, Royal Melbourne Hospital, Melbourne, Australia; 4Consumer Representative, Prostate Cancer Foundation Australia, Melbourne, Australia; 5Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia; 6 Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia; 7Urology, Cabrini Medical Centre, Malvern, Australia

Background and Aims The lack of survival advantage, adverse quality of life effects and health care costs associated with curative treatments have convinced health authorities internationally to recommend Active Surveillance(AS) as a management strategy for most low risk prostate cancers(LRPC). Research shows only 15– 40 % adopt AS. Aim: To examine men with LLPC and partners’ experiences of choosing between AS and the radical treatments; and using these findings, develop an online treatment decision aid(DA).

Background and Aims Little is known about symptom burden in cancer populations at diagnosis. Utilization of tablet computers (TC) like iPads (© 2013 Apple Inc, Cupertino, California) for symptom assessment may streamline this time-consuming process. The aims of this study are: 1. Assess TC acceptability and practicality for symptom and quality of life (QOL) self-assessment 2. Capture symptom burden at first visit to Solid Tumor Oncology (STO) Outpatients Methods Participants completed a symptom assessment instrument on TC at their first visit to STO Outpatients. The questions (17 symptoms; 17 QOL) were adapted from the European Palliative Care Research CollaborativeComputerized Symptom Assessment. Responses were simultaneously wirelessly downloaded to REDCap (Research Electronic Data Capture; REDCap Software - Version 5.1.3 - © 2013 Vanderbilt University) a secure online database. Hard copy results were given to the Oncologist before the patient encounter. Results I. Survey & Screened 348; Eligible 174; Participants 107 & Completion rate 98 % (65 % self completed; 68 % completed easily) & Completion time: mean (SD) 10 (+/− 2.6) minutes - without any appointment delays

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II. Demographics & Age: median (range) 64 (23–95) yrs & Males 65 %; College education>4 yrs 17 % & Cancer: Respiratory 16 %; Genitourinary 26 %; Digestive 39 %; Metastases 51 %

III. Symptoms & Pain score≥8 20 %; clinically significant depression 20 %; &

drowsiness 28 %; moderate-severe anxiety 33 %; decreased food intake 42 %; tiredness 48 % Poor QOL 24 %

Conclusions 1. TC-based symptom assessment in newly diagnosed oncology outpatients is practical 2. Completion rate 98 %; mean completion time 10 min 3. Participants had significant symptom/QOL burden at diagnosis

MASCC-0590 Information Technology PATIENT HEALTH RECORDS (PHR) FOR MEDICINE

Background and Aims Pharmacogenomics is becoming increasingly important to ensure optimal medication use. Mobile apps are a potential resource of pharmacogenomics information. However, it is unclear whether the quality of pharmacogenomics information in mobile health apps (MHA) is current, accurate and reliable. The objective of this project is to develop a tool to assess the quality of pharmacogenomics information on chemotherapy drugs in MHA. Methods A tool assessing 4 aspects of quality (reliability, ease-of-use, privacy, content accuracy) was developed and used to evaluate a list of relevant MHA from iTunes and Google Play stores. Reference monographs comprising of pharmacogenomics-related information were developed for irinotecan and tamoxifen. Results Twenty apps were assessed, among which, 14 apps scored more than 50 % for the first 3 criteria. Davis Drug Guide and FDA Drugs obtained the highest (30/36, 83 %) and lowest composite scores (10/36, 28 %) respectively. None of the apps scored above 50 % for content accuracy – Drugs Guide and iPharmacy Direct scored the highest score of 12/26 (46.2 %), while Drugs Dictionary, Drugs Interaction, Drugs and Medications, McGraw-Hill Nurse’s Drug Handbook (NDH2011) and Top 100 Drug Interactions scored zero. Conclusions Majority of MHA fared well in the quality assessment with regards to reliability, ease-of-use and privacy, but lacked in terms of the quality of pharmacogenomics information. As more pharmacogenomics information becomes available, it is necessary to develop better MHA to provide accurate and up-to-date information to oncology practitioners and cancer patients.

N. Shklovskiy-Kordi1, B.V. Zingerman1 1 Medical Informatics, National Center fo Hematology, Moscow, Russia Background and Aims Medical records — the key question of the integrity of Medicine. Doctor has to record the results of his research and reflections — it is the fundament of the continuity and development in Medicine. No one but the patient can collect ALL the records relating to his health. Only patient has right to share his information for research. Methods System of electronic health records, constructed to be patient-driven and comfortable for doctor. Patient takes responsibility for the collection, storing, and policies of use of his personal medical records. Results Based on our experience in creating the National Standard of Russain Federation “Electron Medical Records”, developed the Internet-based System for Patient Health Records. The System accepts records in any format. Main features are: 1. Ensuring the origin and credibility of records. 2. Integral presentation of all data on a single time axes allows estimation of the real-time correlations of dynamic changes in clinical parameters. Conclusions The system of Patient Health Records facilitates development of modern medicine with respectful role of the patient and medical specialists.

MASCC-0052 Information Technology QUALITYASSESSMENT OF MOBILE HEALTH APPS FOR CHEMOTHERAPY-RELATED PHARMACOGENOMICS INFORMATION

C.J.Y. Chong1, J.Q. Chak1, P.S. Ong2, K. Yap2 1 Science Research Program, Hwa Chong Institution, Singapore, Singapore; 2Department of Pharmacy, National University of Singapore, Singapore, Singapore

MASCC-0584 Mucositis IN SEARCH OF THE SUSPICIOUS LINK: SMOKELESS TOBACCO USE AND ORAL MUCOSITIS IN HEAD AND NECK CANCER PATIENTS

S. Begum1, S. Mukhopadhyay2 1 Pharmacology, R.G.Kar Medical College & Hospital, Kolkata, India; 2 Pharmacology, Christian Medical College Ludhiana India, Ludhiana, India Background and Aims Smoking of tobacco is implicated as one of the major risk factors for development of oral mucositis (OM). Tobacco in other smokeless forms is a major form of addiction in many countries. However, the association of smokeless tobacco with oral mucositis has hardly studied. The present study aims at finding the association, if any, with different types of tobacco use with OM. Methods In this cross-sectional study, head and neck cancer patients receiving radiation, chemotherapy or concurrent chemo-radiation who developed oral mucositis over a study period of 3 months were enrolled. History of different forms of tobacco use, alcohol, oral hygene and other risk factors were noted along with other demographic variables and analysed. Results Out of total 20 enrolled patients of OM, data of 18 consenting patients were analysed. Smokeless tobacco addiction in any form was found in 59 % patients (n=10) compared to 16.7 % patients (n=3) who had no history of tobacco addiction (p=0.01). Similar numbers of smokers were detected to have OM. Poor dental hygene were noted in 72 % patients. Conclusions Smokeless tobacco, like its smoking counterpart, was found to be associated significantly with oral mucositis among the head neck cancer

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patients receiving radiation or chemotherapy. However, larger longitudinal study is recommended to find out whether it is a mere association or a significant risk factor.

MASCC-0475 Mucositis ORAL EVALUATION OF A PATIENT WITH TONGUE CANCER GIVEN POST-SURGERY RADIOTHERAPY: A CASE REPORT

E.I. Bustamante1, J. Wettlin1, L. Carmona2 1 R&D, Fundación Arturo López Pérez, Santiago, Chile; 2Radiotherapy, Fundación Arturo López Pérez, Santiago, Chile Background and Aims Introduction: Oral Mucositis (OM) is a frequent secondary complication affecting close to 96 % of patients undergoing chemo-radiotherapy for head and neck (H&N) cancer. This painful process interferes with food intake and oral hygiene causing local and systemic infections and interrupting treatment regimes. Objective: Evaluate the preventive effect of Dentoxol® in a H&N cancer patient. Methods Methods: 25 year-old male patient with diagnosed tongue cancer. Treatment was 5.000 cGy divided in 28 sessions. Dentoxol®, following a standard oral hygiene protocol, was given five times a day for 2 weeks from the beginning therapy. OM based on the WHO scale was weekly evaluated. Results Results: No lesions were present in the first 2 weeks. A small on-recover lesion on the tongue appears at 3 weeks resulting from a self-inflicted bite. In weeks 4/5 the patient presents healthy mucosa. During the sixth evaluation (last treatment week) the patient presented an erythema on the tongue that persisted for 5 days. No pain was reported, nor interference with communication and eating (Grade 1). The seventh and eighth evaluation showed a healthy mucosa. Conclusions Conclusions: The patient presented just an erythema attributable to radiotherapy, without perception of pain. Normal consumption and communication was reported and treatment was completed without interruption. Together with previous reports, our results support a controlled clinical study of Dentoxol® to determine preventive value.

MASCC-0474 Mucositis CLINICAL EVALUATION OF THE EFFECT OF DENTOXOL® IN ORAL MUCOSITIS OF CANCER PATIENTS

E.I. Bustamante1, J. Wettlin1, N. Sandoval2 1 R&D, Fundación Arturo López Pérez, Santiago, Chile; 2Chemotherapy, Fundación Arturo López Pérez, Santiago, Chile Background and Aims Introduction: Oral Mucositis (OM) is a pathological process characterized by lesion of the mucosa, which ranges from minor inflammation to deep ulceration, depending on cancer type, treatment and patient characteristics. Dentoxol® is an authorized Chilean mouthwash that combines active components with antibacterial, antiinflammatory and analgesic properties. Objective: Determine the effect of Dentoxol® in the reduction of OM. Methods Methods: Using the WHO scale, the OM of 32 patients undergoing mucotoxic cancer treatments were tracked from June 2011 to April

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2012. All patients used Dentoxol® at the fist day of the cycle. Nine patients were at their first cycle while the other 23 patients had undergone at least one previous cycle. The highest grade of OM during the evaluated cycle was compared to the highest grade on the previous cycle where the product had not been used. Data was collected through interviews in conjunction with clinical evaluation. Results Results: The first row of Table 1 show first cycle patients. Patient * was a head and neck cancer patient who received radio/chemotherapy. The following rows show the comparison between cycles. Table 1: Effect of DENTOXOL® in OM OM previous Dentoxol® 0

OM post Dentoxol® 0 1 2 8 0 1*

3 0

4 0

9

1 2 3 4 Total

10 4 1 0 23

0 0 0 0 0

0 0 0 0 0

10 7 6 0 32

0 3 4 0 7

0 0 1 0 2

Total

Conclusions Conclusion: Oral ulcers are rapidly colonized by bacteria aggravating the OM and delaying healing. While this study lacks a control, the results suggest that Dentoxol® is a safe and effective product that may reduce OM incidence. Further controlled studies are justified.

MASCC-0617 Mucositis LOW LEVEL LASER TREATMENT FOR THE MANAGEMENT OF ORAL MUCOSITIS: MECHANISMS OF ACTION, IRRADIATION PARAMETERS AND DOSE

J.D. Carroll1, A. Barasch2, J.A. Dominguez3, J.B. Epstein4, R.G. Nair5, J.E. Raber-Durlacher6, R.J. Bensadoun7 1 , THOR Photomedicine, Chesham, United Kingdom; 2, Winthrop University Hospital, Mineola NY., USA; 3, University of Barcelona, Barcelona, Spain; 4Division of Otolaryngology and Head and Neck Surgery, City of Hope National Medical Center, Duarte, USA; 5Dept of Haematology and Oncology, Gold Coast University Hospital, Gold Coast, Australia; 6 Department of Oral and Maxillofacial Surgery, University of Amsterdam, Amsterdam, Netherlands; 7Service d’Oncologie Radiothérapique, Poitiers University Hospital, CHU de Poitiers, France

Background and Aims Introduction: The role of low level laser/light therapy (LLLT) for the management of oral mucositis (OM) has been evaluated in a number of studies including randomised clinical trials (RCTs). Subsequently the MASCC/ISOO clinical practice guidelines have included LLLT as a recommended treatment option for the prevention of OM in haematopoietic stem cell transplantation recipients conditioned with high-dose chemotherapy, with or without total body irradiation, and suggested its use for the prevention of OM in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. The mechanism of action, and optimal irradiation parameters and treatment dose have been reported in other pathologies but are not well defined in OM. Objectives: To assess the mechanisms of action, optimal irradiation parameters, and treatment dose.

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Methods Methods: A systematic review was performed of in vitro and in vivo studies focusing upon mechanisms of action, and of irradiation parameters and dose used in RCTs of LLLT in OM. Results Results: We identified 12 papers addressing mechanism \and 19 RCTs. Studies provided evidence for a reduced inflammatory response (e.g., reduced COX-2 expression, reduced numbers of neutrophils), and improved wound healing (e.g., increased expression of growth factors, fibroblasts proliferation, increased angiogenesis). A dose response pattern could be established, although irradiation parameters appeared to be inconsistent. Conclusions Conclusion: There is evidence for LLLT efficacy in OM management, but reporting of irradiation parameters needs improvement. More studies are needed to provide a better understanding of LLLT mechanisms in OM management.

MASCC-0564 Mucositis A PILOT STUDY OF EFFICACY OF LACTOBACILLUS CD2 LOZENGES IN PREVENTING HIGH-DOSE CHEMOTHERAPY INDUCED ORAL MUCOSITIS IN PATIENTS UNDERGOING HEMATOPOIETIC STEM CELLTRANSPLANTATION

S. chaudhary1, A. Sharma1, T. Tilak1, S. Bakhshi1, V. Raina1, L. kumar1 1 Medical Oncology, All India Institute of Medical Science, Delhi, India Background and Aims Oral mucositis is a complication of high dose chemotherapy and blood or marrow transplantation for which little effective therapy is available. Lactobacillus brevis CD 2 has been found useful in preventing chemoradiotherapy induced oral mucositis in head and neck squamous cell carcinoma patients. Thirty one patients undergoing high dose chemotherapy and stem cell transplantation were enrolled into this single center phase II study. Primary endpoint was grade III or IV mucositis. Methods 4-6 lozenges of Lactobacillus brevis CD 2 were given to eligible patients beginning 7 days before initiation of chemotherapy and continued until resolution of mucositis or day +24. Results Median age was 29 years (range 10–64), 22 were autologous transplantation. Out of 31 patients 7 (22.6 %) did not develop any mucositis, 6 (19.4 %) developed grade I, 12 (38.79 %) developed grade II, 4 (12.9 %) developed grade III, and 2 (6.5 %) developed grade IV mucositis. Median time to onset of mucositis was 6 days (range 3–9) and median time to resolution of mucositis was 8 days (range 5–40). One patient died of sepsis. Conclusions No side effect attributed to study medication was observed. However we would like to stress the need of a randomized study to confirm finding of this phase II study.

MASCC-0488 Mucositis MANAGEMENT OF STOMATITIS ASSOCIATED WITH MTOR INHIBITORS IN HORMONE RECEPTOR–POSITIVE/HER2NEGATIVE ADVANCED BREAST CANCER: CLINICAL EXPERIENCES FROM A SINGLE CENTER

J. Divers1 1 Breast Cancer, Texas Oncology - Baylor Charles A. Sammons Cancer Center, Dallas, USA

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Background and Aims Stomatitis is a frequent adverse event that occurs with mTOR inhibitors that significantly affects patient quality of life. Knowledge of effective strategies to manage stomatitis may help improve tolerability and patient outcomes. To describe the experiences and techniques from a single center to manage mTOR-related stomatitis in patients with HR+/HER2negative advanced breast cancer. Methods Use of a prophylactic measure to prevent stomatitis is essential. A baseline oral assessment must be performed to ensure no gum irritation or mouth sores are noted before initiating treatment. Combination of mouth rinses strongly recommended, and should be used as directed. If mouth sores develop, stop medication and call the nurse immediately. Communication between nurse and patient is important, so continued reinforcement of symptom prevention and management is imperative. If there are no changes from baseline oral assessment, medication is continued. Using triamcinolone oral paste can assist in healing mouth ulcers. Results Patient will have office visits every 2 weeks with an oral assessment. If there are no changes from baseline oral assessment, medication is continued. If changes develop, patient is instructed to hold dose of medication until grade of stomatitis is determined by the clinical team. Conclusions Prevention is the key to managing stomatitis associated with mTOR inhibitors. By teaching the patient to recognize any changes in the mouth, communicate those changes to nursing staff, and be compliant with oral rinses, our center has been successful in minimizing stomatitis. Funding for abstract preparation supported by Novartis.

MASCC-0516 Mucositis HANGESHASHINTO, A KAMPO MEDICATION, INHIBIT THE DEVELOPMENT OF RADIOTHERAPY INDUCED ORAL MUCOSITIS HEAD AND NECK CANCER PATIENTS

R. Hosokawa1, T. Tamahara1, E. Ito1, N. Tanda2, W. Iijima2, M. Dodo1, T. Kato1, T. Koseki1 1 Graduate School of Dentistry, Tohoku University, Sendai, Japan; 2 University Hospital, Tohoku University, Sendai, Japan Background and Aims Oral mucositis is one of severe side effect during anti cancer therapy. Especially radiotherapy for head and neck cancer showed severe oral mucositis, which cause interruption of cancer therapy sometimes. Thus it is very important to prevent or palliate pain related to oral mucositis. Traditionally, it has been known that Hangeshashinto (HST), a Kampo medication, heals stomatitis of oral mucosa. However, it is unknown whether it works for radiotherapy induced oral mucositis. Our aim of this presentation is to evaluate the effect of HST for the prevention of oral mucositis at both clinical and experiment level. Methods We applied HST as oral rinse for eight patients who were suffering from head and neck cancer. Then we evaluate the grade of mucositis. Control was former 11 patients who did not take HST. The severity of oral mucositis was graded by using common Terminology Criteria of mucositis, CTACAE v3.0. We applied HST for cell culture medium. Cell line we used was TR146, human squamous cell carcinoma. Then we analyzed activity of cell proliferation induced by HST. Results The mean of oral mucositis grade in HST applied group (Grade 1.6) was lower than that of control group (Grade 2.8) significantly (P<0.01). The ratio of BrdU positive cells was higher in 100 ug/ml when compared with

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0 ug/ml significantly (P<0.05). The ratio was increasing slightly dosedependently (0, 1, 10, and 100 ug/ml). Conclusions Our data suggests that HST might activate cell proliferation and then inhibit oral mucositis.

MASCC-0599 Mucositis ROLE OF SALIVARY DYSFUNCTION IN HEMATOPOIETIC STEM CELLTRANSPLANT PATIENTS (HCST): ORASTEM STUDY

I. von Bultzingslowen1, P.M. Williams2, P. Samim2, P. Johansson3, K. Garming Legert4, B. Hasséus5, M.T. Brennan6 1 Oral Microbiology and Immunology, Sahlgrenska Acaemy, Gothenburg, Sweden; 2Oral Oncology/Dentistry, BC Cancer Agency, Vancouver British Columbia, Canada; 3Hospital Dentistry and Oral Medicine, Public Dental Health, Gothenburg, Sweden; 4Orofacial Medicine and Pathology, Karolinska Institute, Huddinge, Sweden; 5Oral Medicine and Pathology, Sahlgrenska Academy, Gothenburg, Sweden; 6Oral Medicine, Carolinas Medical Center, Charlotte North Carolina, USA Background and Aims HSCT patients experience oral complications which can increase risk of infection, pain, poor nutrition, increased hospitalization and decrease QoL. We evaluated the relationship of salivary dysfunction and xerostomia on mucositis, pain and pain-related QoL after HSCT. Methods Patients were seen at baseline and 3 days/week during hospitalization after HSCTas part of the OraStem study. Stimulated salivary flow was measured at baseline and was dichotomized. 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). Pain was documented by WHO pain grade (0–4), and CTC pain scale. Descriptive statistics, correlations and non-parametric comparisons between the low and high salivary groups were assessed. Results This interim analysis included 52 patients, age 54.8 years (SD=9.5), 58 % male. Common medical diagnoses were lymphoma (n=15), multiple myeloma (n=14) and acute myelogenous leukemia (n=10). Mean and worst xerostomia scores were positively correlated with mean and worst mucositis and pain measures: WHO mucositis, OMAS ulceration and erythema, WHO pain, and mean and CTC pain (range r=0.41–0.80, p= 0.02–<0.0001). Comparing low (mean=4.4, SD=3.3 ml/5 min) and high (mean=10.0, SD=8.5 ml/5 min) baseline salivary groups, there was significant differences in mean xerostomia score; 1.1 (0.6) versus 0.6 (0.6) (p=0.004), worst xerostomia score; 1.6 (0.8) versus 1.1 (0.7) (p= 0.02) and worst pain CTC; 1.8 (1.7) versus 0.9 (1.6), (p=0.04). Conclusions Xerostomia and salivary dysfunction have a relationship with mucositis, pain and QoL after HSCT. This study will continue to enroll patients for more robust analyses.

MASCC-0505 Mucositis THE INTESTINAL HORMONES GLP-1 AND GLP-2 ARE NOT IMPLICATED IN THE PATHOPHYSIOLOGY OF MUCOSITIS

H. Kissow1, J. Pedersen1, B. Hartmann1, J.J. Holst1 1 Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

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Background and Aims Glucagon-like peptide 1 (GLP-1) and glucagon-like peptide-2 (GLP-2) are hormones co-secreted from the intestinal L-cells in respond to nutrient intake, but also in response to intestinal injury such as chemotherapy induced mucositis. It has been shown that treatment with both hormones can ameliorate mucositis in rats and mice. It is therefore possible that the hormones are implicated in the pathophysiology of mucositis. We hypothesized that mice lacking the ability to secrete both hormones would be more susceptible to chemotherapy. Methods We used the diphtheria-toxin-receptor-cellular knock-out mice, TgN(GCG.DTR) which allowed us to study the effects of chemotherapy in mice with acute ablation of L- cells. In different experiments WT mice and TgN(GCG.DTR) mice were treated with 5-FU (400 mg/kg) or PBS, and euthanized 2, 4 and 6 days after this injection. Body and intestinal weight, villus height and crypth depth were measured and mucositis grade was scored histologically. GLP2 concentration in plasma was measured using an in-house radioimmuno assay. Results The TgN(GCG.DTR) mice were unable to secrete GLP-2 both 2 and 4 days after 5-FU, while the 5-FU treated WT mice had a highly significant increase in GLP-2 concentration compared to healthy WT mice. There was no difference between 5-FU treated TgN(GCG.DTR) mice and 5-FU treated WT mice in body weight loss, intestinal weight loss, morphometric parameters or grade of mucositis. Conclusions We conclude that the severity of mucositis does not depend on the functionality of L-cells and the hormones are probably not implicated in the pathophysiology of mucositis.

MASCC-0527 Mucositis NEW LOCAL ANESTHETIC LOZENGE FOR ORAL MUCOSITIS PAIN: IS THERE A RISK OF TOXIC PLASMA CONCENTRATION AND SIDE EFFECTS?

S. Mogensen 1 , K. Sveindottier 1 , C. Treldal 1 , C.A. Kristensen 2 , J. Jacobsen3, J. Petersen1, M. Kreilgaard4, O. Andersen1 1 Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; 2Oncology, Rigshospitalet, Copenhagen, Denmark; 3 Department of Pharmacy, SUND Copenhagen University, Copenhagen, Denmark; 4Department of Drug Design and Pharmacology, SUND Copenhagen University, Copenhagen, Denmark Background and Aims Oral mucositis is a common and serious complication to cancer treatment. Mucositis is caused by a damage of the mucosa in the oral cavity and pharynx which induces server pain. There is currently no sufficient pain management for patients with oral mucositis. The research group has developed a bupivacaine lozenge as new local anesthetic treatment. It is novel to administrate bupivacaine as a topical oral anesthetic lozenge. The inflammation of the mucosa could theoretical lead to toxic side effects of bupivacaine due to rapid absorption. The aim was to investigate the absorption of topical administered bupivacaine and monitor possible side effects, in healthy subject with normal mucosa and in patient with oral mucositis. Methods The bupivacaine plasma concentration was measured after administration of a 25 mg bupivacaine lozenge as single dose. Baseline

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blood sample was drawn before administration of the lozenge and followed by ongoing blood samples for 6 h on 10 healthy subjects and 3 h on 10 patients. Results No side effects were observed in both groups. The healthy subjects had a maximum concentration of 376 ng/ml bupivacaine in the plasma after administration of the lozenge. This is far below the toxic concentration which is estimated to 2,000–4,000 ng/ml. The plasma samples from the patients will be fully analysed in March 2014, but a preliminary analysis showed similar results as the healthy subjects. Conclusions The preliminary results showed that patients with oral mucositis can use the bupivacaine lozenge as pain management safely without risk of toxic side effects.

MASCC-0529 Mucositis NEW LOCAL ANESTHETIC LOZENGE FOR ORAL MUCOSITIS PAIN: IS THERE RISK OF DYSPHAGIA AND ASPIRATION IN HEAD AND NECK CANCER PATIENTS AND HEALTHY SUBJECTS?

S. Mogensen 1 , K. Sveindottier 1 , C. Treldal 1 , A. Nygaard 2 , A. Mohammad2, C.A. Kristensen3, J. Petersen4, O. Andersen4 1 Clinical Research Centre, Copenhagen University Hospital Hvidovre, Copenhagen SV, Denmark; 2Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; 3Department of Oncology, Rigshospitalet, Copenhagen, Denmark; 4Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark Background and Aims Oral mucositis induces server oral pain and is a serious complication to cancer treatment with severe negative influences the patient’s nutritional status. Many patients undergoing high-dose chemotherapy or radiation treatment for head and neck cancer develops oral mucositis. There is currently no sufficient pain management for oral mucositis pain. Therefore there is an urgent need for new treatments. Therefore a bupivacaine lozenge as a local oromucosal and pharynx anesthesia could be interesting. However, it has previously been assumed that pharyngeal anesthesia with local anaesthetics induces a risk of dysphagia and aspiration, including that it affects the self-regulating swallowing reflex. The aim of this study was to investigate the risk of aspiration after administration of a bupivacaine lozenge to healthy subjects with normal mucosa and to oral mucositis patients. Methods The risk of dysphagia and aspiration in 10 healthy subjects and 5 patients with mucositis was included in the study before and after administration of a 25 mg bupivacaine lozenge. They swallowed 20 ml barium-contrast agent and this was recorded using video radiography which were then analysed for sign of aspiration. Results None of the 10 healthy subjects and the 5 oral mucositis patient showed any signs of dysphagia or aspiration after administration of the bupivacaine lozenge. Additional five patients will be included in the study by March 2014. Conclusions The preliminary results showed that the bupivacaine lozenge is safe to use as local anesthetic for head and neck cancer patients with oral mucositis before eating and drinking.

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MASCC-0443 Mucositis STOMATITIS PREVENTION DURING EVEROLIMUS/EXEMESTANE TREATMENT FOR METAST ATIC BREAST CANCER: A PHASE 2 STUDY OF STEROID-BASED MOUTHWASH

D. Weikel1, S. Lindsay2, A.J. Ajmera2 1 Oncology and Diagnostic Sciences, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, USA; 2Cancer Center-Breast Medicine, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA Background and Aims Anecdotal clinician reports indicate that steroid-based mouthwashes can prevent and manage stomatitis in patients with advanced breast cancer treated with everolimus. However, no clinical trial data are available. The objective of this study was to evaluate an alcohol-free, steroid-based mouthwash in women with hormone receptor–positive (HR+) metastatic breast cancer prescribed everolimus plus exemestane. Methods This phase 2, single-arm study will evaluate the effectiveness of a dexamethasone oral solution in preventing stomatitis during treatment of HR+/HER2– breast cancer with everolimus 10 mg/day plus exemestane 25 mg/day. Eligible patients will receive a steroid-based mouthwash (alcohol-free 0.5 mg/5 mL dexamethasone solution) prophylactically. Patients will be instructed to perform the mouthwash regimen 4 times per day and to swish the mouthwash in the mouth for a minimum of 2 min 4 times per day. Patients will be instructed to abstain from eating or drinking for at least 1 h after using the mouthwash. The mouthwash regimen will begin on the first day of everolimus administration, after dosing. Preventive therapy will continue for 56 days, with optional continued use for an additional 56 days. Primary endpoint: incidence of stomatitis (grade ≥2) at 56 days. Results Enrollment for this in-progress study is planned for 97 patients. The definition of grade ≥2 stomatitis will be strictly defined using physical examination, the Normalcy of Diet Subscale, and patient-reported Visual Analogue Scale scores to ensure objective and consistent grading. Conclusions This study is expected to reveal specific treatment strategies to prevent everolimus-associated stomatitis or to ameliorate its severity. Supported by Novartis Pharmaceuticals Corporation.

MASCC-0148 Mucositis 2 CLONIDINE INHIBITS PRO-INFLAMMATORY CYTOKINE (PIC) LEVELS IN EX-VIVO HUMAN ORAL MUCOSA

P. Attali1, V. Rouley2, S. Boisnic3, V. Trochon-Joseph4, C. Lemarchand4, L. Zakin2 1 Medical Affairs and Strategy, BioAlliance Pharma, Paris, France; 2 Clinical development, BioAlliance Pharma, Paris, France; 3Research, GREDECO Research Association, Paris, France; 4Preclinical R&D, BioAlliance Pharma, Paris, France Background and Aims PIC are rapidly produced and released at the initiation stage of Oral Mucositis. Clonidine inhibits the expression and production of PIC, presumably through the NF-kB pathway. Evaluation of the effects of clonidine on PIC in an ex vivo model of human oral mucosa.

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Methods Five cubic millimeter biopsy samples of non-keratinized oral mucosa obtained from healthy volunteers were transferred onto permeable polycarbonate membrane transwells (12 mm diameter, 12 μm pore size). Saline (control group), Clonidine in 6 different concentrations or clonidine + saline were apically added every 2 h for 6 doses. Substance P (SP) was added simultaneously with the last clonidine dose. 24 h later, supernatants were removed and selected PIC levels were measured using ELISA (AbCys, France). Results SP increases of TNF-α, IL-6, IL-1β and IL-10 in controls. Clonidine dose-dependently reduced TNF-α levels with significant reductions at concentration of 0.9 μg/mL (p=0.01) and 3 μg/mL (p=0.006). A similar trend was noted for IL-6 and IL-1β.

p<0.001) and 30.2 % (300 μg/kg, p<0.001). In S2, % days was reduced from 35.4 % in controls to 21.9 % (100 μg/kg, p=0.003), 28.1 % (12.5 μg/kg, p=0.12) and 26 % (25 μg/kg, p=0.04). OM severity was significantly (p<0.01) reduced in the clonidine 100 and 300 μg/kg QD groups in S1, and in the clonidine 100 μg/kg QD, 12.5 and 25 μg/kg qid in S2. Conclusions Topically administered clonidine mitigated Ri-OM in hamsters in a dosedependent manner. QD administration was as effective as QID dosing.

MASCC-0072 Mucositis 2

Cytokine (pg/mg) TNF-α IL-10 IL-6 IL-1β

Untreated control 0.63±0.44 0.21±0.16 9.8±7.7 1.83±0.53

SP-treated control 1.7±1.1 0.96±0.59 38.2±34.2 5.85±4.5

Clonidine 0.9 g/mL 0.74±0.36 0.37±0.23 20±15 3.61±1.64

Clonidine 3 μg/mL 0.67±0.27 0.41±0.47 22.4±19.3 4.29±3.18

Conclusions Clonidine significantly reduced TNF-α and modulated measurable IL-6 and IL-1β (not significant). This suggests that topical application of clonidine may be active in the prevention of OM and supports further investigations in animal models.

MASCC-0150 Mucositis 2 TOPICAL CLONIDINE REDUCES THE DURATION AND SEVERITY OF RADIATION-INDUCED ORAL MUCOSITIS (RIOM) IN A TRANSLATIONAL HAMSTER MODEL

P. Attali1, L. Zakin2, G. Lyng3, V. Roulet2, V. Trochon-Joseph4, C. Lemarchand4, S. Sonis5 1 Medical Affairs and Strategy, BioAlliance Pharma, Paris, France; 2 Clinical development, BioAlliance Pharma, Paris, France; 3Research, BioModels, Watertown, USA; 4Preclinical R&D, BioAlliance Pharma, Paris, France; 5, BioModels, Watertown, USA Background and Aims NF-kappaB is an attractive interventional target for RIOM. Clonidine inhibits NF-kappaB-mediated pro-inflammatory cytokines expression and release. To assess the efficacy of a novel topical clonidine formulation on RiOM in an established animal model. Methods Male Golden Syrian hamsters were randomly assigned to equally-sized groups in 2 independent studies. Clonidine administered topically starting before radiation (D-1) and continuing until D20 was compared to saline controls. The left buccal cheek pouch of hamsters was irradiated once with 40 Gy on D0. Standardized Images of the cheek pouch mucosa obtained on alternate days (D6-D26) were blindly scored for RiOM severity. The number of days of ulcerative OM and the individual daily group scores were evaluated. In Studies 1 (S1) and 2 (S2), clonidine was administered topically QD doses of 30, 100 and 300 μg/kg (S1) and QD at 100 μg/kg and QID at 12.5 and 25 μg/kg (S2). Results In S1, clonidine dose-dependently reduced the % days of score≥3 from 46.9 % in controls to 41.7 % (30 μg/kg), p=0.35), 29.2 % (100 μg/kg,

EFFECTS OF PRE-RADIATION EXPOSURE TO SOFT LASER OF NORMAL AND MALIGNANT CELLS

A. barasch1, J.B. epstein2, J.B. Raber-Durlacher3 1 oral diagnosis, University of Alabama at Birmingham, Birmingham, USA; 2oral diagnosis, Cancer Center City of Hope CA, Duarte, USA; 3 periodontology, ACTA-University of Amsterdam, Amsterdam, Netherlands Background and Aims Low Level Laser Therapy (LLLT) efficacy for prevention of cancer treatment-induced oral mucositis (OM) has been amply described. However, potential protection of malignant cells remains a legitimate concern for clinicians. Methods We treated normal human lymphoblasts (TK6) and human leukemia cells (HL60) with LLLT prior to ionizing radiation (IR). Cells were then incubated and counted daily for 6 days to determine their survival. Growth curves were compared to calculate differences between LLLTexposed and control cells. Results Growth curves for both cell lines showed significant declines after exposure to 50 cGy IR. Pre-radiation exposure to LLLT (4.0 J/cm2) blocked this decline in TK6 but not in HL60. The latter were sensitized to the killing effects of IR in an energy dose-dependent manner . Table 1. TK6 response (50 cGy IR) CELLTREATMENT

RELATIVE CELL NUMBER (Nt/No)

Control Laser (4 J/cm2)

Day 1 2.1±0.1 1.6±0.2

Day2 4.5±0.2 3.9±0.2

Day 3 10.6±0.6 7.2±0.3

Day4 18.9±2.7 18.2±2.1*

Day5 57.0±0.9 53.0±7.5

Day6 111±1.4 100.5±1.8*

IR

1.3+0.1

3.0+0.6

5.5+0.1

9.6+1.3

28.2+0.6

52.4+1.9

* p<0.01 Table 2. HL60 response (50 cGy IR) CELLTREATMENT

RELATIVE CELL NUMBER (Nt/No) Day1 Day 2 Day 3 Day 4

Day5

Day 6

Control IR Laser 1.0 J/cm2

1.5±0.1 1.6±0.3 1.4±0.1

3.5±0.2 1.7±0.2 2.6±0.1

9.9±0.1 4.8±1.2* 6.7±0.1

16.3±2.4 6.5±1.3* 9.8±1.0

28.4±0.4 12.8±0.5* 27.9±0.9

50.0±0.8 28.8±2.3* 46.1±2.1

Laser 4.0 J/cm2 Laser 8.0 J/cm2

1.0±0.1 1.0±0.0

2.4±0.3 2.5±1.1

5.2±0.7* 5.8±0.2*

5.9±0.8* 7.4±0.2*

13.5±0.6* 12.3±0.6*

24.3±6.0* 19.1±1.3*

* p<0.05 Conclusions Pre-IR LLLT results in a differential response of normal vs. malignant cells, suggesting that LLLT does not confer IR protection to cancer cells.

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MASCC-0098 Mucositis 2 SERUM-DERIVED IMMUNOGLOBULIN SHOWS EARLY PROMISE IN THE ALLEVIATION OF IRINOTECAN-INDUCED MUCOSITIS

E. Bateman1, E. Weaver2, G. Klein2, E. Plews3, A. Wignall4, B. Wozniak4, D. Keefe4 1 Mucositis Research Group School of Medicine, University of Adelaide, Adelaide, Australia; 2Research, Entera Health Inc, Cary, USA; 3Animal Facility, Flinders University, Adelaide, Australia; 4Health and Medical Sciences, Adelaide University, Adelaide, Australia Background and Aims BACKGROUND: Gastrointestinal (GI) mucositis is associated with diarrhoea and intestinal barrier dysfunction caused by apoptosis, immune dysfunction, and microbiome alterations. Serum-derived bovine immunoglobulin (SBI) has been shown to ameliorate inflammation in colitis models, has been shown to improve HIV-induced enteropathy and nutritional status, and is being investigated in post-surgical recovery in oncology patients. We investigated in a rat model whether SBI was effective in alleviating symptoms of GI mucositis. OBJECTIVES: To determine firstly SBI tolerability, and the effect of SBI on irinotecan-induced GI mucositis. Methods METHODS: Animals were gavaged with 250 or 500 mg/kg of SBI twice daily, before intraperitoneal administration of 200 mg/kg irinotecan on day 4, and for 6 days post-irinotecan. Animals were monitored for bodyweight and diarrhoea. Tissues were collected at necropsy 6, 48, 96 and 144 h post-irinotecan. H&E-stained colon and jejunum were analysed for histological damage. Results RESULTS: The overall incidence, severity and duration of diarrhoea, and clinical symptoms of mucositis, were decreased in irinotecan-treated animals that had received SBI. Animals receiving 500 mg SBI/kg also tended to lose less bodyweight than animals treated only with irinotecan (P>0.10). Animals receiving SBI had less pronounced irinotecaninduced changes in neutrophil (P=0.04959) and lymphocyte (P= 0.0035) levels, and lower tissue damage scores than those receiving irinotecan alone (P<0.0001). Conclusions CONCLUSIONS Twice daily oral gavage of SBI was well-tolerated, and reduced the incidence, severity and duration of irinotecan-induced mucositis. SBI was associated with less pronounced changes in inflammatory cell levels and intestinal tissue damage. Ongoing experiments aim to elucidate the mechanisms of SBI-associated gastrointestinal protection.

MASCC-0124 Mucositis 2 A NEW TOPICALVASOCONSTRICTOR-BASED STRATEGY FOR PREVENTION OF ORAL MUCOSITIS

W. Fahl1, M.L. Hoover-Regan2, A. Graul-Conroy2 1 UW Carbone Cancer Center, University of Wisconsin-Madison ProCertus BioPharm, Madison, USA; 2UW Carbone Cancer Center, University of Wisconsin-Madison, Madison, USA Background and Aims Oral mucositis is a common, significant, and costly side effect in bone marrow transplant and other cancer therapy patients. We sought to determine whether transient vasoconstriction and hypoxia of oral mucosa,

secondary to orotopical application of an adrenergic agonist vasoconstrictor, would prevent or suppress oral mucositis induced by irradiation or systemic chemotherapy. Methods Topical vasoconstrictor was applied once to oral cavity; 20 min later hamsters or mice received 19–30 Gy to the oral mucosa. Oral mucositis was scored using a functional assay, gross morphology, and histology of mucosal tissue over the next 12–16 days. Results A single application of phenylephrine (14–136 mM) 20 min before irradiation conferred highly significant (P<0.001), dose-dependent suppression of weight loss, oral secretion, and histopathology of mucosa seen in mice treated with 0 mM phenylephrine+19 Gy radiation. Epinephrine, norepinephrine and phenylephrine showed up to 100 % radioprotective efficacy at concentrations that reflected their rank-ordered affinities for the a1 adrenergic receptor.

Conclusions Animal model results indicate that this strategy could provide a simple orotopical formulation to prevent or suppress oral mucositis in humans, and a Phase I/IIa proof of concept trial to determine efficacy of orotopical phenylephrine in suppressing oral mucositis in adult and pediatric cyclophosphamide + total body irradiation bone marrow transplant patients is about to be undertaken.

MASCC-0108 Mucositis 2 PATIENT’S PERCEPTIONS WITH THE USE OF CRYOTHERAPY FOR THE PREVENTION OF ORAL MUCOSITIS

M. Geuke1, A.P. Mank2, J.E. Raber-Durlacher1, M.D. Hazenberg2, J. Lange de1 1 department of oral- and maxillofacial surgery, Academic Medical Center, Amsterdam, Netherlands; 2department of hematology, Academic Medical Center, Amsterdam, Netherlands Background and Aims Objectives: Evidence supports the use of oral cryotherapy (CRYOtx) for the prevention of oral mucositis during the administration of selected chemotherapeutic anticancer agents. However, the time that patients have to hold ice chips in their mouth is considerable and this may negatively affect their compliance. This study was aimed to obtain more insight into patient’s perceptions and their ability to complete CRYOtx. Methods: 41 consecutive dentate patients diagnosed with multiple myeloma or non-Hodgkin lymphoma and scheduled for high-dose melphalan (HDM) containing conditioning regimens followed by autologous stem cell transplant were included (58,9 % male, mean age 55,9 years, range 20–69 years) after giving informed consent. Patients were instructed to keep ice chips 15 min before, during the complete HDM infusion, and 15 min after HDM infusion. Nurses assisted patients and supervised compliance. Patients filled out a 5-point Likert type questionnaire.

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Results: As depicted in the Table, most patients (89.4 %) reported not having any trouble or just a little with CRYOtx and all were able to complete this regimen. Tooth sensitivity, nausea and developing a headache (frost bite) were not a problem in most of the patients. Not at all A little

n 23

Did you have trouble using cryotherapy? Were your teeth sensitive/ 23 painful during CRYOtx? Were you nauseous? 31 Did you develop a headache? 32

Moderate Severe Complaints so severe that I had to stop CRYOtx

% 60,5

n % n 11 28,9 4

% 10,5

n 0

% 0

n 0

% 0

62,2

10 27

4

10,8

0

0

0

0

81,6 84,2

3 5

7,9 4 13,2 1

10,5 2,6

0 0

0 0

0 0

0 0

Conclusions Conclusion: All patients were able to complete 60 min of oral CRYtx. Our results indicate this was well tolerated by the majority of patients.

MASCC-0187

MASCC-0189 Mucositis 2 A RANDOMISED PHASE IIB TRIALTO ASSESS THE EFFICACY OF ICE-CREAM-FORMULATED IRONSATURATED LACTOFERRIN AND ANHYDROUS MILK FAT IN PREVENTING CHEMOTHERAPY INDUCED DIARRHEA

D. Perez1, K.J. Sharples2, R. Broom3, M. Jeffery4, J. Proctor5, V. Hinder5, S. Pollard5, J. Edwards6, A. Simpson6, R. Isaacs7, M.B. Jameson8, R. North9, J. Scott5, S. Benge5, G. Krissensen5, A. Geursen10, K. Palmano10, D. Keefe11, M. Findlay5 1 Oncology, Dunedin Hospital, Dunedin, New Zealand; 2Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; 3Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 4Medical Oncology, Christchurch Hospital, Christchurch, New Zealand; 5Cancer Trials New Zealand, University of Auckland, Auckland, New Zealand; 6Wellington Blood and Cancer Centre, Wellington Hospital, Wellington, New Zealand; 7Medical Oncology, Palmerston North Hospital, Palmerston North, New Zealand; 8Medical Oncology, Waikato Hospital, Hamilton, New Zealand; 9Medical Oncology, Tauranga Hospital, Tauranga, New Zealand; 10Research, LactoPharma NZ, Auckland, New Zealand; 11Cancer Medicine, University of Adelaide, Adelaide, Australia

Mucositis 2 HIGH POTENCY POLYMERIZED (CROSS-LINKED) SUCRALFATE MANAGES BOTH ORAL AND ALIMENTARY MUCOSITIS SIMULTANEOUSLY

R. McCullough1 1 Translational Medicine Research, Mueller Medical International LLC, Foster, USA Background and Aims Background: High potency sucralfate (HPS) is standard sucralfate polymerized by chelated calcium into cross-linked sheets. Three hours postadministration, when, HPS achieves and maintains a sucralfate surface concentration that is 800 % greater on normal lining and 2,400 % greater on ulcerated lining compared to non-polymerized sucralfate . HPS has a 7 day 80 % healing rate on esophageal erosions compared to 30 % for omeprazole. Aims: Manage oral and alimentary mucositis using HPS Methods Subjects: A 43 yo male with advanced head and neck squamous cell carcinoma (T3 N3 M0 Stage IVb) requiring 6 weeks concurrent chemoradiation (Paclitaxel and Carboplatin; radiation totaling 201 Gy) developed Grade 2 oral mucositis and Grade 2 alimentary mucositis within 1 week. A 48 yo female with Stage 4 melanoma developed chemoinduced diarrhea on ipilimumab. Intervention: 1.5 g of HPS in suspension taken three times daily for 2 days then twice daily. Outcome Measures: (1) change from baseline in (a) oropharyngeal lesions and (b) patient-reported odynophagia, nausea, vomiting and diarrhea; (2) use of opiate analgesia, tube-feeding supplementation and (3) the Naranjo Score for intervention-response association. Results Within 48 h of HPS (1) oral mucositis disappeared, as did patient-reported pain, nausea and diarrhea (alimentary mucositis). (2) Patients required no analgesia, no tube-feeding and tolerated a regular diet. (3) A modified Naranjo Questionnaire score of 10 supported HPS as cause of observed clinical effects. No adverse reactions were noted. Conclusions Polymerized cross-linked (high potency) sucralfate should be considered for use in cancer treatment patients with known or anticipated oral and alimentary mucositis.

Background and Aims Background: A medicinal food product containing iron-saturated lactoferrin and anhydrous milk fat (ReChargeTM) has been shown to reduce the effects of chemotherapy on the gut in animals. We report results of a randomized blinded placebo-controlled Phase IIb trial investigating the efficacy and safety of ReCharge formulated as ice-cream in preventing chemotherapy induced diarrhea (CID) in patients receiving chemotherapy. Objectives: To determine whether ReCharge reduces the number of days with CID and, as a key secondary measure, the incidence of diarrhea. Methods Patients (197) were randomized 1:1 to ReCharge or placebo. Patients consumed 100 ml study product for 14±4 days before starting chemotherapy and for 6 weeks after starting chemotherapy; completed daily diaries for 8 weeks and attended clinic visits until 12 weeks (2week cycles) or 14 weeks (3-week cycles). Results The mean number of days with diary-recorded CID was marginally but not statistically significantly lower on ReCharge than placebo (−2.0, 95 % confidence interval (−4.7 to 0.7)), (p=0.2). However the proportion reporting diarrhea at clinic was 30 % lower (p=0.012). Missing diary data may have contributed to the discrepancy. Conclusions We found no clear evidence of a benefit from ReCharge in reducing CID as measured by patient self-report diary. The converse finding of benefit as measured at clinic visits (secondary endpoint) and the incomplete adherence to diary completion however indicate further research is required into optimal methods for measuring CID.

MASCC-0223 Mucositis 2 COMPLETION OF THE JAPANESE TRANSLATION OF THE MASCC/ISOO MUCOSITIS GUIDELINES

Y. Soga1, T. Mori2, R. Hosokawa3, T. Yurikusa4 1 Division of Hospital Dentistry, Okayama University Hospital, Okayama, Japan; 2Division of Hematology Department of Internal Medicine, Keio

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University School of Medicine, Tokyo, Japan; 3Division of Preventive Dentistry Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai, Japan; 4Department of Dentistry and Oral Surgery, Shizuoka Cancer Center Hospital, Sunto-gun Shizuoka, Japan Background and Aims A major effort of the Mucositis Study Group of MASCC/ISOO has been comprehensive review of the literature related to mucositis and development of evidence-based clinical practice guidelines. A summary of the most recent update (2013–2014) of the MASCC/ISOO Mucositis Guidelines is now available on this website. One of the points of discussion at the Mucositis Study Group Business Meeting held in 2013 in Berlin was dissemination of the guidelines, including translation into multiple languages. The objective was translation of MASCC/ISOO Mucositis Guidelines into Japanese to facilitate dissemination of the guidelines in Japan. Methods We translated the MASCC/ISOO Mucositis Guidelines into Japanese according to the MASCC policy for translation from English to other languages, which requests another bilingual health care professionals to review the translation after a bilingual MASCC member is approached. After a Japanese MASCC/ISOO member was approached to do a careful translation, three other independent Japanese MASCC/ISOO members reviewed and edited the translation. The reviewing and editing processes were performed a total of four times. Results The Japanese translation of the MASCC/ISOO Mucositis Guidelines was completed in 2 months. With permission from the Chair of Mucositis Study Group, MASCC/ISOO, the pdf version was posted on the homepage of the university hospital of one of the editing members (http://hospitaldentistry.cc.okayama-u.ac.jp/siryoshu.html). A total of 223 page views were counted in 2 months from the day of uploading of the Japanese translation (Dec 1, 2013). Conclusions The Japanese translation of the MASCC/ISOO Mucositis Guidelines was completed and is publicly available.

MASCC-0251 Mucositis 3 ANALGESIC OPIOID THERAPY FOR ORAL MUCOSITIS (OM) ASSOCIATED PAIN DURING CURATIVE CHEMORADIOTHERAPY IN OROPHARYNGEAL CANCER (OPC) PATIENTS

P. Bossi1, R. Granata1, S. Alfieri1, C. Ripamonti2, L.D. Locati1, C. Bergamini1, M. Imbimbo1, C. Resteghini1, E. Orlandi3, C. Fallai3, L. Licitra1 1 Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 2Supportive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Background and Aims OM-related pain is one of the most distressing symptoms in head and neck cancer patients receiving chemoradiation. Its management results in better compliance to therapy and improvement in quality of life. We assessed systemic opioid therapy use in an homogeneous setting of OPC patients during curative treatment. Methods We retrospectively examined all the locally advanced OPC patients treated at our Institution between 2009 and 2013 with intensity modulated radiotherapy and concurrent cisplatin, considering analgesic systemic opioid therapy use for OM -related pain.

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Results Seventy-five patients were evaluated, 11 already receiving background opioid therapy for cancer pain. Globally, all the patients developed OM (67 % WHO grade 3–4) and received opioid treatment (80 % with strong opioids) for OM-related pain during chemoradiation (starting from the 1st to the 7th week of radiotherapy, median 4th). The highest dose of opioids was reached in a range between the 3rd and the 11th week (median 7th), consisting in a daily oral morphine equivalent dose (OMED) of 5 to 450 mg (median 90 mg). Intentional breakthrough pain during eating/ drinking due to OM was recognized in 84 % of patients and treated with strong (68 %) or weak (16 %) opioids. Opioid treatment for OM finished from 0 to 25 weeks after the end of treatment (median 6). Conclusions Opioid therapy remains the mainstay for the management of background and breakthrough pain in OPC patients receiving chemoradiation. Prospective studies are strongly necessary to evaluate: 1. patient reported outcome 2. correlation of analgesic therapy with nutritional issues as well as with compliance to oncologic treatment.

MASCC-0392 Mucositis 3 BACTERIAL PROFILING OF THE ORAL COMMUNITY OF HEAD AND NECK CANCER PATIENTS TREATED WITH RADIOTHERAPY

T. De Ryck1, F. Duprez2, M. Bracke1, T. Van de Wiele3, B. Vanhoecke3 1 Laboratory of experimental cancer research, Ghent University, Ghent, Belgium; 2Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium; 3Laboratory of Microbial Ecology and Technology, Ghent University, Ghent, Belgium Background and Aims Oral mucositis is an important side effect of radiotherapy for head and neck cancer. Preliminary data suggest a role for the oral microbiota in the onset, duration and severity of mucositis, although large clinical datasets are missing. In this prospective cohort study, the oral microbial composition and diversity of 30 patients was analysed before, during and after their radio(chemo)therapy. Methods Buccal mucosa and tongue swabs of 30 patients with squamous cell carcinoma of oral cavity, oropharynx, larynx, hypopharynx and neck metastasis of unknown primary origin were collected before, during and after radio(chemo)therapy and bacterial 16S rDNA was extracted for DGGE analysis. Cluster analysis, and Pareto Lorenz curves were generated to evaluate microbial shifts. Results Analysis of the DGGE data revealed interesting shifts of the oral microbiota, which evolved to more uneven communities at the end of treatment. At the inflammatory sites, the microbial diversity was characterised by the dominance of particular species as evidenced by higher gini coefficients. Pareto Lorenz curves and gini coefficients further indicated that, at least in the tongue swabs, there was a correlation between the initial oral composition and the mucositis grade, marking its prognostic value. Conclusions This is the first large clinical study, which shows that oral microbial shifts indeed occur during radiation therapy. Identification of species that are modified during radio(chemo)therapy is ongoing and outcomes should help us to develop new management strategies for oral mucositis.

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MASCC-0396 Mucositis 3 HOST-MICROBE CROSSTALK IN CANCER THERAPY

T. De Ryck1, E. Vanlancker2, T. Boterberg3, M. Bracke1, T. Van de Wiele2, B. Vanhoecke2 1 Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium; 2Laboratory of Microbial Ecology and Technology, Ghent University, Ghent, Belgium; 3Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium Background and Aims Crosstalk between the human host and its microbiota is reported to influence various diseases such as mucositis. Fundamental research in this area is however complicated by the timeframe restrictions during which host-microbe interactions can be studied in vitro. For this study, we developed a new model, consisting of an oral epithelium and a biofilm to study host-microbe crosstalk in vitro in noninfectious conditions up to 72 h. Methods For the model, microbiota derived from oral swabs were cultured on an agar/mucin layer and challenged with monolayers of keratinocytes. The microbiota and epithelial cells were treated with anti-cancer agents like 5FU or radiotherapy. Results The overall microbial biofilm composition in terms of species diversity remained representative for the oral microbiome, whilst the epithelial cell morphology and viability were unaffected. Applying the model to investigate wound healing revealed a reduced healing in presence of oral microbiota, which was not caused by a reduction of the proliferation index or a significantly increased number of apoptotic or necrotic cells. The use of anti-cancer treatments revealed important alterations in this microbial effect, bringing new insights in the host-microbe interactions along the treatment. Conclusions This new model should help us to understand the role of host-microbe crosstalk before and during the development of mucositis and to develop new preventive and/or therapeutic drugs.

MASCC-0235 Mucositis 3 A FORMULATION OF EMU OIL AND LYPRINOL™ REDUCES ACUTE SMALL INTESTINAL INFLAMMATION IN A RAT MODEL OF 5-FLUOROURACIL-INDUCED MUCOSITIS

L.L. Lampton1, G.L. Eden1, K.Y. Cheah2, K.A. Lymn1, S. Mashtoub3, G.S. Howarth1 1 School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia; 2Gastroenterology Department, Women’s and Children’s Hospital, North Adelaide, Australia; 3School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Australia Background and Aims Mucositis is typified by ulceration and inflammation of the alimentary tract following chemotherapy. Emu Oil (EO) and Lyprinol™ have individually demonstrated anti-inflammatory properties in gastrointestinal ailments, including intestinal mucositis. We investigated EO and Lyprinol™ in combination for their potential to further reduce the severity of chemotherapy (5-Fluorouracil; 5-FU)-induced mucositis in rats. Methods Female Dark Agouti rats (n=8/group) were oro-gastrically gavaged (1 ml) with Water, Olive Oil (OO), EO+OO, Lyprinol™+OO or EO+Lyprinol™ from days

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0–7 and injected with saline (control) or 5-FU (150 mg/kg) on day 5. Intestinal tissues were collected on day 8 for quantitative histological analysis and myeloperoxidase activity (MPO). p<0.05 was considered significant. Results 5-FU administration significantly elevated ileal MPO levels by 4.1-fold relative to saline controls (p<0.001). Amongst 5-FU-injected groups, only EO+Lyprinol™ reduced ileal MPO activity by 1.7-fold compared to 5-FU controls (p=0.012). Moreover, OO and EO+Lyprinol™ administration to 5-FU-treated rats resulted in decreased ileal MPO levels (1.2-fold and 1.4fold respectively; p<0.05) compared with EO+OO treatment. Furthermore, all oil treatments decreased histological severity scores in the jejunum and ileum, and normalised crypt depth in the mid small intestine (≥24 %), relative to 5-FU controls (p<0.05). Additionally, OO maintained ileal villus height (21 %) and crypt depth (24 %) relative to 5-FU controls (p<0.05). Conclusions Emu Oil in combination with Lyprinol™ reduced damage associated with intestinal mucositis; however, Olive Oil demonstrated similar effects. Further studies are warranted to isolate the bioactive constituents of these naturallysourced oils for their potential utility in protection against mucositis.

MASCC-0238 Mucositis 3 5-FLUOROURACIL-INDUCED MUCOSITIS LEADS TO SPINAL GFAP EXPRESSION CHANGES IN RATS

J.E. Bajic1, G.S. Howarth2, G.L. Eden2, L.L. Lampton2, S. Mashtoub3, M.R. Hutchinson1 1 School of Medical Sciences, The University of Adelaide, Adelaide, Australia; 2School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia; 3School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Australia Background and Aims 5-Fluorouracil (5-FU) is a widely utilised chemotherapy agent that induces side-effects, termed mucositis in the gastrointestinal tract (GIT) and glial dysregulation in the central nervous system (CNS). Glia, particularly astrocytes, are vital in neuronal and CNS homeostasis; increased expression of their marker, glial fibrillary-associated protein (GFAP), implies neuroinflammation, linked with neuropathic pain and memory impairment. We determined whether 5-FU-induced neuroinflammation via mucositis by immuneto-CNS signalling pathways (neuronal vs humoral) and secondly, examined if astrocyte reactivity persisted beyond the mucositis-driven GIT injury. Methods Female Dark Agouti rats (n=8) were randomly allocated to saline control or 5-FU (i.p. 150 mg/kg) groups and tissues collected at either injury peak (day 3) or recovery (day 5). Western Blot analysed hippocampal and thoracic sections for GFAP and Interleukin-1 beta (IL-1β) expression. Myeloperoxidase (MPO) assay quantified intestinal inflammation. Statistical comparisons conducted using a linear model in R studio. Results 5-FU reduced bodyweight (p<0.01) and increased MPO activity at day 3 compared to vehicle controls (p<0.01). Although hippocampal GFAP expression showed little variance (p>0.05), interestingly thoracic GFAP expression was significantly reduced by 28 % in 5-FU treated rats — compared to vehicle controls at injury peak (p<0.05) but normalised during the recovery phase (day 5; p>0.05). IL-1β expression levels remained unchanged at both time-points. Conclusions Down-regulation of thoracic GFAP expression reflects astrocyte dysregulation in rats with 5-FU-induced mucositis. This may have further implications for CNS homeostasis and neuronal signalling. Future studies should clarify the role of glial dysregulation in 5-FU-related cognitive impairment and neuropathic pain.

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MASCC-0234 Mucositis 3 ORAL NUCLEOTIDES PARTIALLYATTENUATE 5-FLUOROURACIL-INDUCED MUCOSITIS IN RATS

S. Mashtoub1, B. Feo2, A.L. Whittaker2, K.A. Lymn2, D. Martinez-Puig3, G.S. Howarth2 1 School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Australia; 2School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia; 3Bioiberica, S.A., Barcelona, Spain Background and Aims Chemotherapy-induced mucositis is characterized by inflammation and ulceration of the intestinal mucosa, compromising intestinal function. Exogenous nucleotides have been reported to repair the mucosa. The nucleotide preparation, Nucleoforce F0328 (Nucleoforce), was investigated for its potential to ameliorate intestinal mucositis in rats. Methods Female Dark Agouti rats (110–130 g; n=8/group) were oro-gastrically gavaged daily with Nucleoforce (175 mg/kg) or water from days 0 to 8 and injected (i.p.) with 5-Fluorouracil (5-FU:150 mg/kg) or saline on day 5. Sucrase activity was quantified in vivo by the sucrose breath test. Tissue sections were collected on day 8 for histological (disease severity, crypt depth and villus height measurements) and myeloperoxidase activity (indicative of acute inflammation) analyses. p Results 5-FU significantly decreased (81 %) the %cumulative dose of 13C (%CD), compared to normal controls, indicative of decreased sucrase activity (p0.05). Intestinal myeloperoxidase activity was significantly elevated by 5-FU (8.8-fold), compared to normal controls (p0.05). Conclusions Nucleoforce only partially improved parameters associated with experimentally-induced mucositis. Future studies could investigate increased concentrations, more frequent administration, or protective microencapsulation delivery methods, to increase bioavailability.

MASCC-0237 Mucositis 3 AQUEOUS RHUBARB EXTRACT IMPROVES MUCOSAL INTEGRITYAND REDUCES ACUTE INFLAMMATION IN THE ILEUM IN A RAT MODEL OF CHEMOTHERAPY-INDUCED INTESTINAL MUCOSITIS

G.L. Eden1, L.L. Lampton1, K.Y. Cheah2, K.A. Lymn1, A.J. Yool3, S. Mashtoub4, G.S. Howarth1 1 School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia; 2Gastroenterology Department, The Women’s and Children’s Hospital, North Adelaide, Australia; 3School of Medical Sciences, The University of Adelaide, Adelaide, Australia; 4School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Australia Background and Aims Mucositis, a common side-effect of chemotherapy, is characterised by acute intestinal inflammation and impaired mucosal integrity. Currently, no effective treatment has been established for this debilitating disorder. In the present study, aqueous rhubarb extract (RE) was investigated as a therapeutic modality for intestinal mucositis due to its anti-inflammatory properties and its potential to protect against mucosal damage. Methods Female dark agouti rats (n=8/group) received a daily gavage (1 mL) of water, high-dose RE (HDR; 200 mg/kg) or low-dose RE (LDR;

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20 mg/kg) for 8 days. Mucositis was induced on day five following an intraperitoneal injection of 5-Fluorouracil (5-FU; 150 mg/kg). Rats were euthanized on day eight and intestinal tissue samples were collected for quantitative assessment of myeloperoxidase (MPO) activity and histological structure. Statistical significance was assumed at P<0.05 by oneway ANOVA. Results 5-FU significantly reduced intestinal mucosal thickness (≥29 %; P<0.001) compared to healthy controls. However, LDR significantly increased ileal mucosal thickness in 5-FU treated rats (19 %; P<0.05), back towards normal values, relative to 5-FU controls. Although 5-FU significantly increased MPO levels (≥307 %; P<0.001) in all intestinal regions, compared to healthy controls, LDR in 5-FU treated rats was able to significantly decrease ileal MPO activity (45 %; P<0.05), compared to 5-FU controls; suggesting a reduction of acute inflammation in the ileum. Conclusions In conclusion, LDR improved ileal mucosal integrity and reduced inflammation manifested as a result of 5-FU cytotoxicity. RE has the potential to act as an adjunct to chemotherapy regimens by reducing inflammation and protecting against mucosal damage associated with intestinal mucositis.

MASCC-0264 Mucositis 3 PREVENTIVE EFFECT OF REBAMIPIDE ON CHEMOTHERAPY-INDUCED ORAL MUCOSITIS IN PATIENTS WITH BREAST CANCER (THE RANDOMIZED MULTI-CENTER PHASE II STUDY)

S. Nishimura1, S. Ohno2, A. Enami3, N. Matsunami4, T. Morimoto5, S. Kamigaki6, K. Higaki7, K. Shiota8, A. Hidaka9, M. Takahashi10, K. Aogi11, M. Kagawa12, T. Kadoya13, Y. Hamaguchi14, Y. Sagara15, K. Shibuta16, S. Saji17, S. Anami18, T. Yamanaka19, N. Masuda20 1 Department of Breast Oncology, National Kyushu Cancer Center, Fukuoka, Japan; 2Clinical Research Center, National Kyushu Cancer Center, Fukuoka, Japan; 3Department of nursing, NHO Osaka National Hospital, Osaka, Japan; 4Department of Breast Surgery, Osaka Rosai Hospital, Osaka, Japan; 5Department of Breast Surgery, Yao Municipal Hospital, Osaka, Japan; 6Department of Surgery, Sakai City Hospital, Osaka, Japan; 7Department of Breast Surgery, Hiroshima City Hospital, Hiroshima, Japan; 8Department of Pharmacy, NHO Kumamoto Medical Center, Kumamoto, Japan; 9Department of Nursing, Osaka Rosai Hospital, Osaka, Japan; 10Department of Breast Surgery, NHO Hokkaido Cancer Center, Hokkaido, Japan; 11Department of Breast Oncology, NHO Shikoku Cancer Center, Ehime, Japan; 12Department of Pharmacy, Yao Municipal Hospital, Osaka, Japan; 13Department of Surgical Oncology Research Institute for Radiation biology and Medicine, Hiroshima University, Hiroshima, Japan 14Department of Nursing, Sakai City Hospital, Osaka, Japan; 15Department of Surgery Breast Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan; 16Department of Breast Surgery, Ueo Breast Cancer Hospital, Oita, Japan; 17Department of Target Therapy Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 18Education and Research Center for Clinical pharmacy, Doshisha Women’s College of Liberal Arts, Kyoto, Japan; 19 Department of Biostatistics, National Cancer Center, Chiba, Japan; 20 Department of Surgery Breast Oncology, NHO Osaka National Hospital, Osaka, Japan Background and Aims Introduction: Chemotherapy-induced oral mucositis is a common adverse event. Rebamipide, a gastro protective drug, has been reported to suppress gastric mucosal inflammation.

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Objectives: The purpose of this study is to assess the efficacy and safety of rebamipide in preventing chemotherapy-induced oral mucositis in patients with breast cancer. Methods Methods Patients with early breast cancer who were scheduled to receive chemotherapy including 5-FU/epirubicine/cyclophosphamide or docetaxel/ cyclophosphamide were randomized to usual oral care with or without rebamipide. Patients in the rebamipide group had an oral administration of rebamipide 300 mg daily during three cycles of chemotherapy. The primary endpoint was incidence of oral mucositis assessed by the NCICTC v 4.0. Results Results Between August 2011 and January 2013, 163 patients were randomly assigned to either rebamipide group (n=81) or control group (n= 83). There were no significant difference in frequency of oral mucositis during 3 cycles of chemotherapy between these two groups (p=0.476). In patients with no mucositis at 1st cycle, the incidence of mucositis at 2nd and 3rd cycle was significantly lower in the rebamipide group than the control (p=0.029). The reduction of taste was significantly less frequent in the rebamipide group than the control (p=0.004 at 3rd cycle). The self-report by patients showed higher incidence of oral mucositis and reduction of taste as compared to observation by physicians. Conclusions Conclusion These results could not show the efficacy of rebamipide in preventing chemotherapy-induced oral mucositis, whereas rebamipide may be effective to protect the sensory of taste, in breast cancer patients receiving chemotherapy. (-UMIN000005712)

MASCC-0240 Mucositis 3 ORAL CARE: DISSEMINATING BEST PRACTICE

B. Quinn1, M. Thompson2, F. Campbell3, C. mc Gowan4, J. Treleaven5, S. Hoy6, J. Horn7, L. Fullman8, E. Riley9, M. Davis10, D. Houghton11, A. Beasley12, K. Mais10 1 Cancer, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom; 2Radiotherapy, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom; 3Head & Neck Cancer, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom; 4Palliative Care, St George’s NHS Trust, London, United Kingdom; 5Haematology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; 6Head & Neck Cancer, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; 7Haematology, NHS Grampian, Abberdeen, United Kingdom; 8Radiotherapy, Independent, Nottingham, United Kingdom; 9 Dentistry, Pennines NHS Trust, Manchester, United Kingdom; 10Cancer, Christie NHS Foundation Trust, Manchester, United Kingdom; 11Pharmacy, Rivers Hospital, Hertfordshire, United Kingdom; 12Cancer, Cardiff Royal Infirmary NHS Trust, Wales, United Kingdom Background and Aims Despite the advances made in understanding the pathophysiology of oral mucositis OM and the variety of treatment options available, clinical teams still struggle to address OM in a consistent manner. The United Kingdom Oral Mucositis in Cancer Care (UKOMiC), was founded 3 years ago to address the challenges of oral complications secondary to disease and treatment in the cancer and supportive care setting.

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Methods Having developed oral care guidelines, which have been widely used in the United Kingdom and other countries, the group continue to deliver educational opportunities for clinical staff. This presentation will address the content, the learning and the evaluations from 3 study days which were delivered in London, Glasgow and Manchester. The days were attended by over 230 delegates including, radiographers, nurses, oncologists, dentists, pharmacists, oral surgeons, therapists and educators. Results Using a combination of learning approaches including, lectures, case studies and interactive workshops led by experts, the content of each day covered the key principles of good oral care based on accurate assessment, good care, instigating prevention measures and correct treatment. Each interactive session focussed on an aspect of oral mucositis including, anatomy and physiology of the oral cavity, pathophysiology of OM, pharmacology, nutrition, dysphagia, pain management and the patient experience. Each day was carefully evaluated and each attendee was asked to consider how they would put the learning into practice. Conclusions The learning from each study day has not only informed further educational events but has been used to develop the work of the expert group.

MASCC-0289 Mucositis 3 REDUCTION OF ORAL MUCOSITIS AFTER ADOPTION OF CRYOTHERAPYAS A STANDARD OF CARE FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA

J.J. Toro1, D. Haile1, F. Gushiken1, C.O. Freytes1 1 Medicine, South Texas Veterans Health Care System, San Antonio, USA Background and Aims Oral mucositis (OM) is a frequent complication of high-dose melphalan (HDM - 200 mg/m2) followed by autologous hematopoietic stem cell transplantation (AHSCT) in patients with multiple myeloma (MM). In previous studies oral cryotherapy significantly decreased OM. There is limited information regarding the effectiveness of cryotherapy outside a clinical trial. Our goal was to evaluate the efficacy of a cryotherapy protocol (CP), which was adopted at our institution, based on results obtained in a randomized study. We wanted to determine if the same results could be replicated outside a clinical trial setting. Methods The CP consisted of placing ice chips in the mouth for 2 h. Patients were assessed every other day for OM, until OM resolution or hospital discharge, using the World Health Organization (WHO) mucositis scale. Thirty-nine patients who received CP were matched with the most recent 39 patients who received saline solution mouth rinses (SSR) 4 times a day, our previous standard of care. Results Thirty-four (87 %) subjects did not develop OM in the CP group. Only 5 patients (13 %) in the CP group experienced OM, compared to 29 (74 %) in the SSR group (p<0.0001). Length of hospital stay was significantly shorter in the CP group compare to the SSR group, mean duration in days 16.5 vs. 19.6 (p=0.005). Conclusions Cryotherapy was associated with a significant lower incidence of OM severity and hospital length of stay compared to SSR in MM patients who received HDM followed by AHSCT.

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Table. Patient Characteristics

Patients, n

Saline Solution

Cryotheraphy

39

39

Age, years Median (range)

61 (52–73)

62 (27–74)

Mean (SD)

61.5 (4.7)

60.5 (8.9)

Male

38 (97 %)

37 (95 %)

Female

1 (3 %)

2 (5 %)

Caucasian

19 (49 %)

22 (56 %)

African Americans

11 (28 %)

11 (28 %)

Hispanic

9 (23 %)

4 (10 %)

Native American

0 (0 %)

2 (5 %)

Stage I

9 (23 %)

10 (26 %)

Stage II

5 (13 %)

6 (15 %)

Stage III

25 (64 %)

23 (59 %)

Yes (at any given time)

27 (69 %)

30 (77 %)

No (ever)

12 (31 %)

9 (23 %)

Grade 0

10 (26 %)

34 (87 %)

Grades 1–3

29 (74 %)

5 (13 %)

Median (range)

17 (13–48)

16 (12–25)

Median (SD)

19.64 (6.77)

16.51 (2.99)

Median (range)

10 (9–13)

10 (9–12)

Mean (SD)

10.51 (0.85)

10.41 (0.64)

Gender, n (%)

Race/Ethnicity, n (%)

MM Stage, n (%)

Smoking, n (%)

Oral mucositis (WHO), n (%)

Length of hospital stay

Days to ANC engraftment

MASCC-0302 Mucositis 3 DOES TLR4/PKC SIGNALLING DRIVE CHEMOTHERAPY INDUCED BARRIER DYSFUNCTION AND MUCOSITIS?

H.R. Wardill1, R.J. Gibson1, R.M. Logan2, J.M. Bowen1 1 Medical Sciences, University of Adelaide, Adelaide, Australia; 2 Dentistry, University of Adelaide, Adelaide, Australia Background and Aims Chemotherapy-induced mucositis is a major clinical and economic burden. We have identified functional and structural alterations in TJs following chemotherapy, however the mechanisms responsible are illdefined. Protein kinase C (PKC) is able to modulate TJ proteins, with recent links established with toll-like receptor (TLR) 4, a key mediator of mucositis. TLR4/PKC signalling in the setting of chemotherapy-induced barrier dysfunction and mucositis has not been investigated. We therefore aim to determine the impact of TLR4/PKC signalling on gastrointestinal barrier integrity and mucositis development. Methods In vitro: Polarised T84 monolayers will be grown on permeable, mixed-cellulose inserts. TEM analysis will confirm differentiated epithelial phenotype and the presence of TJs. Expression knockdown of PKCtheta and/or TLR4 by shRNA transfection, followed by treatment with SN-38, will elucidate signalling dependence. Cells will also be treated with Go6976, an established PKC inhibitor.

Preclinical: TLR4−/−KO and wild-type balb/c mice will receive a single i.p. dose of irinotecan (300 mg/kg), or vehicle control, and will be killed at 6 h and 72 h post-chemotherapy. Mucositis severity will be assessed using validated clinical and histopathological markers. Barrier function will be assessed through FITC-dextran permeability, transepithelial resistance and short circuit current, measured using Ussing chambers. TJs will be assessed by immunofluorescence, western blotting and RT-PCR for key TJ components, ZO-1, claudin-1 and occludin. ELISAwill assess PKC activity. Results Please see ‘conclusions’. Conclusions Expected outcomes: 1. PKC/TLR4 inhibition/silencing will improve barrier function and TJ integrity following irinotecan. 2. Irinotecan-treated TLR4−/−KO mice will have reduced gastrointestinal mucositis severity, improved barrier integrity and decreased PKC activity compared to wild-type.

MASCC-0437 Nausea-Vomiting EFFICACY OF A TRANSDERMAL GRANISETRON PATCH IN CONTROLLING CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN HEAD AND NECK CANCER PATIENTS

D. Paul1, D. Wong2, A. Yellowlees3, F. Herr4, D. Braccia5 1 Medical Oncology, Monter Cancer Center, Lake Success, USA; 2Medical Affairs, ProStrakan, Bridgewater, USA; 3Statistics, Quantics Consulting Ltd, Edinburgh, United Kingdom; 4Scientific Communications, Aranmore Medical Communications LLC, Lawrenceville, USA; 5Medical Affairs, ProStrakan Inc, Bridgewater, USA Background and Aims Head and neck cancer patients can experience mechanical obstruction or dysphagia making adherence to oral antiemetics difficult. A granisetron transdermal system (GTS) has been shown to be as effective as oral granisetron in controlling CINVacross multiple tumor types. This posthoc analysis examined the efficacy and safety of GTS in head and neck cancer patients. The objectives were to compare the rates of complete control (CC; no vomiting, mild nausea, no resuce medication), complete response (CR; no vomiting, no rescue medication), need for rescue medication, and patient-reported assessment in head and neck cancer patients using either GTS or oral granisetron. Methods A randomized, phase 3 study has been published comparing GTS (7 day application) to oral granisetron (2 mg/day) in patients receiving either moderately or highly emetogenic chemotherapy for 3– 5 days. Data for this analysis were limited to patients with head and neck primary tumors. Results Seventy one patients (38 GTS, 33 oral granisetron) were included. The CC rate of 66 % and CR rate of 68 % in the GTS group were similar to rates in the overall population. There was no difference in CC, CR, and use of rescue medication between GTS and oral granisetron (P=0.94, 0.91, and 0.57, respectively). Patient assessment of overall response to therapy was not different between arms (P=0.26). GTS was well tolerated and treatment related adverse events were mild. Conclusions This retrospective analysis suggests GTS may be an appropriate option for prevention of CINV in head and neck cancer patients at high risk of dysphagia treated with chemotherapy.

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MASCC-0438 Nausea-Vomiting COMPARISON OF ORAL AND TRANSDERMAL GRANISETRON IN CONTROLLING CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN PATIENTS WITH LUNG CANCER (LC) GIVEN MULTI-DAY CHEMOTHERAPY

D. Wong1, R. Gralla2, F. Herr3, D. Braccia1 1 Medical Affairs, ProStrakan Inc, Bridgewater, USA; 2Medical Oncology, Albert Einstein College of Medicine Jacobi Medical Center, Bronx, USA; 3 Scientific Communications, Aranmore Medical Communications, Lawrenceville, USA Background and Aims Chemotherapy for small cell (SCLC) and non-small cell lung cancer (NSCLC) frequently requires agents likely to cause emesis. Adherence to antiemetic regimens over several days is difficult for many patients. A granisetron transdermal system (GTS) has been shown to be as effective as oral granisetron (OG) in controlling multi-day CINVacross multiple tumor types. This analysis examined the efficacy and safety of GTS specifically in LC patients. The objectives were to compare complete control rates (CC; no vomiting, mild nausea, no rescue), complete response (CR; no vomiting, no rescue), need for rescue medication and patient-reported assessment in a post-hoc analysis of LC patients randomly assigned to either GTS or OG. Methods A randomized phase 3 study (N=715, clinicaltrial.gov NCT00273468) compared GTS (7-day application) to OG (2 mg/day) in patients receiving moderately or highly emetic chemotherapy for 3–5 days. This post hoc analysis examines results only in patients with lung cancer. Results One hundred twenty-eight patients (64 GTS, 64 OG) were included. Ninety-four percent received cisplatin for≤3 days. Fifty-one patients given GTS (80 %) and 41 on OG (64 %) received chemotherapy with a Hesketh score of 5. CC & CR rates, the use of rescue medication, and patient assessment of response were not significantly different between GTS and OG. Constipation was more frequent with GTS; all treatment related adverse events were mild. Conclusions This analysis indicates that the convenient single application of GTS can be an effective option for preventing CINVin lung cancer patients treated with highly-emetic multi-day chemotherapy.

MASCC-0571 Nausea-Vomiting GINGER THERAPY FOR CHEMOTHERAPY- AND RADIATION THERAPY-INDUCED NAUSEA AND VOMITING: A SYSTEMATIC REVIEW

E. Nguyen1, P. Ciesielski2, A. Tsang1, A. Steinmetz3, K. Dennis4 1 Faculty of Medicine, University of Ottawa, Ottawa, Canada; 2Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; 3 Library Services and Learning Centre, The Ottawa Hospital, Ottawa, Canada; 4Radiation Oncology, Ottawa Hospital Research Institute The Ottawa Hospital Cancer Centre Universit, Ottawa, Canada Background and Aims We reviewed the literature describing ginger therapy for chemotherapyand radiation therapy-induced nausea and vomiting (CINVand RINV). Methods We followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A medical librarian searched the

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Ovid versions of EMBASE and EMBASE Classic, MEDLINE and PsychINFO for relevant references. Four authors independently screened and abstracted data according to pre-determined criteria. Results From 611 references we selected 10 articles for review. These described 10 randomised trials published between 2003 and 2013 that cumulatively enrolled 1,367 patients (range: 31–744) with a variety of primary tumors. All trials involved ginger prophylaxis to prevent CINV induced from either highly- or moderately-emetogenic chemotherapy. Ginger prophylaxis consisted of ginger added to ‘standard’ antiemetic regimens in 9 trials and ginger alone in 1 trial. Ginger doses ranged from 0.5 to 2.0 g. Control arms contained a variety of antiemetics, with 8 having a 5-HT3 receptor antagonist base. Endpoints varied; 10 trials studied acute CINV (definitions ranging from 1 to 4 days following chemotherapy) and 2 trials also studied delayed CINV (defined as up to 5 or 10 days following chemotherapy). Heterogeneity of chemotherapy agents, trial designs and quality precluded formal modelling analyses. A significant benefit from ginger was reported in 7 of 10 trials. Conclusions More trials with methodologic rigor involving homogeneous patient populations are required to determine the efficacy of ginger prophylaxis for the prevention of CINVand RINV. Research into RINV is underrepresented.

MASCC-0567 Nausea-Vomiting A PROSPECTIVE PILOT STUDY OF RADIATION THERAPY-INDUCED NAUSEA AND VOMITING AMONG PATIENTS RECEIVING NEOADJUVANT LONG COURSE RADIATION THERAPYAND CONCURRENT 5-FU-BASED CHEMOTHERAPY FOR RECTAL ADENOCARCINOMA

K. Dennis1, M. Poon2, J. Stinson3, G. Cramarossa2, L. Zeng2, C. De Angelis3, H. Chung2, N. Coburn4, C.S. Wong2, E. Chow2 1 Radiation Oncology, University of Ottawa & Ottawa Hospital Research Institute, Ottawa, Canada; 2Radiation Oncology, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 3Pharmacy, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 4General Surgery, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Antiemetic guidelines estimate pelvic radiation therapy (RT) carries a 30– 60 % risk of inducing vomiting and suggest 5-HT3 receptor antagonist (5HT3RA) prophylaxis as an approach to prevent RT-induced nausea and vomiting (RINV). However, 5-HT3RA-induced constipation increases the risk of obstruction among patients with rectal adenocarcinoma. As the cumulative incidence of RINV among these patients is unknown, whether 5-HT3RA prophylaxis is warranted for them is unclear. We studied the incidence of RINVamong patients with rectal adenocarcinoma receiving neoadjuvant long-course pelvic RT with concurrent 5FU-based chemotherapy (CT). Methods Patients recorded symptoms and antiemetic use until 7 days following RT completion. Staff verified data daily. Antiemetic therapy was not pre-specified. Results Patients enrolled: 34. Patients evaluable: 33 [male(64 %), female(36 %)]. None received prophylactic antiemetics. RT median duration: 41 days(range: 32–51). RT median dose: 50.4 Gy (range: 40–50.4). Mean planning target volume: 1,393 cc(SD:444). Small bowel dose level volumes [mean(SD)]: V15Gy[169 cc(143)], V45Gy[36 cc(52)], V50Gy[19 cc(28)]. CT received: capecitabine(94 %), infusional 5FU(3 %), none(3 %). Days of evaluable symptom data: 1407(89 % of 1575 potential days). Patients reporting vomiting: 7(21 %); for them,

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median days with vomiting: 2(range:1–9), median days until vomiting: 20(range: 2–43). Cumulative days with vomiting for cohort: 22(1.6 % of 1,407 evaluable days). Patients reporting nausea: 21(63 %); for them, median days with nausea: 4(range: 1–36), median days until nausea: 4(range: 1–36). Cumulative days with nausea for cohort: 210(15 % of 1,407 evaluable days). Patients receiving rescue antiemetics: 11(33 %). Conclusions The reported incidence of vomiting was considerably lower than guideline estimates. Confirmation studies are planned. 5-HT3RA prophylaxis may not be warranted in this setting.

MASCC-0459 Nausea-Vomiting CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN CHILDREN RECEIVING HIGH DOSE METHOTREXATE WITH OR WITHOUT VINCRISTINE

J. Flank1, H. Vol1, S. Lavoratore1, T. Taylor1, E. Zelunka1, P. Nathan2, A.M. Maloney2, L.L. Dupuis1 1 Pharmacy, The Hospital for Sick Children, Toronto, Canada; 2 Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada Background and Aims Chemotherapy-induced nausea and vomiting (CINV) negatively influences the quality of life of children receiving chemotherapy. Little is known about the severity of CINVexperienced by children receiving IV methotrexate≥1 g/m2/dose (HD-MTX). Objective: To describe the prevalence of acute and delayed phase CINVin children receiving HD-MTX±vincristine. Methods Children aged 4–18 years about to receive HD-MTX were eligible to participate in this prospective, observational study. Nausea severity, time of emetic episodes, and administration of antiemetics were recorded in a diary beginning immediately before HD-MTX administration, for 24 h after achievement of the protocol-specific threshold MTX concentration (acute phase), and for an additional 7 days (delayed phase). Complete CINV control was defined as: no vomiting, no retching and a maximum nausea assessment score of 1 (out of 4). Results Data are available for 29 patients (mean age: 11.7±4.0 years; 19 boys). Nineteen patients received HD-MTX plus vincristine while 10 received HD-MTX alone. The mean MTX dose was 6.4 g/m2 (range: 3.6–12.5 g/ m2). Antiemetic prophylaxis consisted of either ondansetron (20) or granisetron (9) with (12) or without (17) dexamethasone. Two (7 %) and 10 (34 %) patients experienced complete CINV control during the acute and delayed phases, respectively. More patients experienced complete vomiting control during the acute (55 %) and delayed (59 %) phases than experienced complete nausea control (7 % vs 34 %). Conclusions Acute and delayed phase CINV control, and more specifically nausea control, following HD-MTX administration is sub-optimal. The emetogenicity ranking of HD-MTX should be reconsidered in light of these findings.

MASCC-0394 Nausea-Vomiting RESOURCE UTILIZATION AND COSTS ASSOCIATED WITH NAUSEA IN PATIENTS EXPERIENCING CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

C. Faria1, X. Li1, R. Knoth1, A. Powers1 1 Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake, USA

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Background and Aims Chemotherapy induced nausea and vomiting (CINV) is a recognized burden for oncology patients. Studies have demonstrated the overall impact of CINV, but little information exists on the effects of nausea in the absence of vomiting. The purpose of this study was to evaluate the implications of nausea alone on resource utilization and costs. Methods Retrospective database utilizing claims from 2005 to 2011 from a commercial (96 %) and Medicaid (4 %) population. Patients with a diagnosis of cancer receiving a single-day chemotherapy regimen and a 5-HT3-RA were eligible. Medical claims from chemotherapy days 2–5 were evaluated for an ICD-9 code of nausea with vomiting (n+v, 78701), nausea only (78702), or vomiting only (78703). Costs were compared among cohorts. Results Twenty six thousand nine hundred seventy-four patients met inclusion criteria, and 1,514 experienced CINV (70.3 % n+v, 23.8 % nausea only, 1.8 % vomiting only, 4.1 % with multiple diagnoses). For overall costs, nausea only patients had the highest mean per patient cost at $1,672, but due to the skewed data had the lowest median cost ($596) compared to n+v and vomiting only ($804 and $674, respectively). Median emergency room (ER) costs were highest for nausea only ($1,021; n=11) compared to n+v or vomiting alone ($864; n=25 and $758; n=12, respectively). Inpatient costs were highest for n+v ($1290; n=76), followed by nausea only and vomiting only ($923; n=10, and $674; n=5). Similar trends occurred for rescue medications: median $204 for n+v (n = 659), $193 for nausea only (n = 201), and $65 for vomiting only (n=4). Conclusions Nausea alone has economic implications for patients receiving chemotherapy.

MASCC-0356 Nausea-Vomiting PATIENT SATISFACTION DURING TREATMENT WITH SANC USO FOR CINV

R. Musch1, D. Maessen2 1 Office for Oncology, Krebsheilkunde Lichtenberg, Berlin, Germany; 2 Medical Affairs, ProStrakan Pharma GmbH, Düsseldorf, Germany Background and Aims Sancuso transdermal Granisetron has demonstrated efficacy for prevention of CINV in patients receiving multi-day moderately to highly emetogenic chemotherapy. The objective of this study is to examine patient satisfaction with Sancuso in clinical practice. Methods The study is being conducted in 19 oncology units in Germany. All patients scheduled to receive Sancuso at the prescribing physician’s discretion for prevention of CINV in moderately or highly emetogenic multi-day chemotherapy are observed. Patients are asked to record on a visual analogue scale (VAS [0–100]) their ‘general satisfaction’ with Sancuso treatment, for each cycle of chemotherapy where Sancuso was used. Basic demographic and clinical information is also collected about each patient. Results Overall, the study is planned to recruit 250 patients. Of the first 34 patients observed, 18 (53 %) were male. The average age of patients to date was 67. The maximum number of cycles of chemotherapy for an individual patient was five (one patient only). Nineteen patients contributed one cycle each. In all, information was collected on 63 cycles. The most common cancers were

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colorectal/anal (19 patients) and urological (6 patients). FOLFOX and FOLFIRI were the most common regimens; 83 % of cycles were moderately emetogenic. Additional anti-emetics were coadministered in 76 % of cycles. Complete control was achieved in 92 % of cycles and complete response in a further 5 %. Average general satisfaction with Sancuso was 93 (VAS). Updated results will be presented. Conclusions Overall, general patient satisfaction with Sancuso was high.

Olanzapine treated patients had better control of delayed emesis (incidence 3.3 % versus 27 % in control group, p=0.02) and overall emesis. (Fig 1)

MASCC-0403 Nausea-Vomiting OLANZAPINE, CONCURRENT CHEMO-RADIATION PATIENTS AND CHEMOTHERAPY INDUCED NAUSEA AND VOMITING: THE SURPRISE CONTINUES

S. Mukhopadhyay1, G. Kwatra1, D. Badyal1, P. Kingsley2 1 Pharmacology, Christian Medical College Ludhiana, Ludhiana, India; 2 Radiotherapy, Christian Medical College Ludhiana, Ludhiana, India Background and Aims Concurrent chemo-radiation patients suffer from high incidence of nausea and vomiting. Olanzapine, though found efficacious in breakthrough emesis and improved outcome of chemotherapy induced nausea and vomiting (CINV), was hardly ever tested on chemoradiation patients receiving platinum chemotherapy. The present study evaluates olanzapine as an add-on in control of CINV in concurrent chemo-radiation patients. Methods Sixty chemotherapy patients on concurrent radiation were randomized to test (n=30) and control (n=30) group. The control group received palonosetron and dexamethasone prophylaxis as standard. The test group received additional olanzapine 10 mg once a day for 5 days from the 1st day of chemotherapy. CINV was monitored using vomiting diary and ‘MASCC anti-emesis tool’ for 5 days and analysed. Results Distribution of patients in different groups were similar.(Table 1)

Nausea was also significantly less severe in olanzapine treated patients. However, acute emesis was equally controlled in both groups. (Fig 2)

Conclusions Olanzapine significantly improves the control of emesis when used as an add-on in prophylaxis of CINV in chemo-radiation patients.

Table 1: Distribution of patients

MASCC-0398 Nausea-Vomiting Gender (M/F) Alcoholism Smoking Type of Cancer HNCa Ca Cervix Ca Esophagus Regimen Cisplatin Carboplatin Oxaliplatin

Figure in number (percent). M: Male, F: Female HNCa: head & neck cancer Ca: Carcinoma

Control (n=30) 19/11(63.3/36.7) 9 (30) 11 (39.3)

Test (n=30) 15/15 (50/50) 9 (30) 13 (44.8)

18 (60) 8 (26.7)

19 (63.3) 7 (23.3)

4 (13.3)

4 (13.3)

29 (96.7) 0 1 (3.3)

29 (96.7) 1 (3.3) 0

PHASE 1 POSITRON EMISSION TOMOGRAPHY (PET) STUDY OF THE RECEPTOR OCCUPANCY OF ROLAPITANT, A NOVEL NK-1 RECEPTOR ANTAGONIST

A. Poma1, J. Christensen1, J. Davis1, V. Kansra2, R. Martell3 1 Medical, Tesaro, Waltham, USA; 2Clinical Pharmacology, Tesaro, Waltham, USA; 3Oncology, Division of Hematology Oncology Tufts Medical Center, Boston, USA Background and Aims Rolapitant is highly selective, competitive and long-acting NK-1 receptor antagonist in development for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic chemotherapy. NK-1 receptor occupancy (RO) is a critical predictor of delayed efficacy in CINV. This PET study determined the levels and duration of RO achieved by rolapitant. Methods Fourteen healthy subjects were enrolled into this open-label, single-dose, pharmacodynamic, dose-escalation phase 1 study. Baseline PET scans

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with 11C-GR205171, a radiolabeled tracer NK-1 ligand, alone followed by repeat PET scans 120 h post administration of rolapitant were performed. Blood samples were collected up to 120 h following rolapitant administration to determine rolapitant plasma concentration. The Patlak method was used to assess the baseline (uptake of 11C-GR205171) for the regions of interest. Regional occupancies (%) for each individual subject were then calculated as ((Ki’baseline – Ki’blocked)/Ki’baseline) * 100. Results Oral rolapitant was rapidly absorbed. Exposure, both Cmaxand AUC, increased dose proportionally. NK-1 RO in the cortex was directly related to rolapitant dose and plasma concentration. A PK/PD model based on the sigmoid Emax model demonstrated that rolapitant concentrations >348 ng/mL, achieved at 120 h with 200 mg dose level, corresponded to >90 % NK-1 RO. No adverse event (AE) were reported. Conclusions Greater than 90 % NK-1 RO was maintained up to 5 days following rolapitant administration. This indicates that a single oral 200 mg dose of rolapitant administered prior to chemotherapy may protect a patient for the entire 5-day period during which the patient is at risk of developing CINV. Rolapitant was safe and well tolerated in this study.

MASCC-0391 Nausea-Vomiting SAFETY OF ROLAPITANT, A NOVEL NK-1 RECEPTORANTAGONIST, FOR PREVENTION OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN SUBJECTS RECEIVING MODERATELY OR HIGHLY EMETOGENIC CHEMOTHERAPY (MEC OR HEC)

L. Urban1, A. Poma2, M. Dardeno2, R. Martell3 1 Oncology, Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary; 2Medical, Tesaro, Waltham, USA; 3Oncology, Division of Hematology Oncology Tufts Medical Center, Boston, USA Background and Aims Rolapitant is a selective competitive-long acting NK-1 receptorantagonist that successfully achieved the primary endpoint of complete response (no emesis and no rescue medication) in the delayed phase of CINV in two phase 3 studies in subjects receiving MEC or HEC. These studies further evaluated the safety and tolerability of rolapitant in these subjects. Methods Two separate phase 3 double-blind active-control studies were conducted. One thousand three hundred sixty-nine subjects scheduled to receive MEC and 555 subjects scheduled to receive HEC (≥60 mg/m2 cisplatin) were randomized 1:1 to either (1) rolapitant 200 mg + granisetron + dexamethasone or (2) placebo + granisetron + dexamethasone. Adverse events (AE) and serious adverse events (SAE) were collected for all subjects. Results AE rates in cycle 1 were similar across rolapitant and control groups for both MEC and HEC studies (63.9 % vs 66.0 %; 64.7 % vs 60.2 %, respectively). The most frequent AEs observed across both rolapitant and control groups, respectively, for the MEC study were fatigue (16.3 % vs 15.4 %), constipation (10.3 % vs 14.1 %) and alopecia (11.3 % vs 12.3 %); and for HEC study were constipation (7.4 % vs 10.9 %), asthenia (6.6 % vs 11.3 %) and neutropenia (9.9 % vs 6.9 %). SAEs rates in cycle 1 were also similar across rolapitant and control groups for both MEC and HEC studies (6.6 % vs 7.1 %; 12.5 % vs 14.2 %, respectively). No serious, related and unexpected AEs were reported for either study. Conclusions Rolapitant 200 mg in combination with a 5-HT3 receptor antagonist and dexamethasone was demonstrated to be safe and well tolerated in two global phase 3 studies in subjects receiving HEC or MEC.

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MASCC-0387 Nausea-Vomiting PHASE 3 TRIAL RESULTS FOR ROLAPITANT, A NOVEL NK-1 RECEPTOR ANTAGONIST, IN THE PREVENTION OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN SUBJECTS RECEIVING HIGHLY EMETOGENIC CHEMOTHERAPY (HEC)

B. Rapoport1, A. Poma2, M.L. Hedley3, R. Martell4, R. Navari5 1 Oncology, The Medical Oncology Center of Rosebank, Johannesburg, South Africa; 2Medical, Tesaro, Waltham, USA; 3President, Tesaro, Waltham, USA; 4Oncology, Division of Hematology Oncology Tufts Medical Center, Boston, USA; 5Oncology, Indiana University School of Medicine South Bend Center, South Bend, USA Background and Aims Rolapitant is a highly selective competitive long-acting NK-1 receptorantagonist that demonstrated efficacy and safety in a large randomized P2 dose-finding study. This study evaluated the 200 mg dose for efficacy and safety in the prevention of CINV in subjects receiving HEC. Methods Randomized phase 3 double-blind active-control study. 555 cisplatinnaïve subjects treated with HEC (≥60 mg/m2 cisplatin) were randomized 1:1 to receive either (1) rolapitant + granisetron + dexamethasone or (2) placebo + granisetron + dexamethasone. The primary endpoint was complete response (CR = no emesis and no rescue medication) in the delayed phase (>24–120 h) post-chemotherapy. Secondary endpoints included CR during the acute (0–24 h) and overall (0–120 h) phases. Treatment comparisons were performed using a Mantel-Haenszel chisquare test. Subjects recorded episodes of emesis, nausea and rescue medication using a subject diary during 0–120 h post-chemotherapy. Results Five hundred forty-four evaluable subjects. Subjects in the rolapitant group had a significantly higher CR rate for the primary study endpoint during the delayed phase (70.1 % vs 61.9 %, p=0.043) compared to control. CR rates were also higher in rolapitant group for acute and overall phases (83.4 % vs 79.5 %, p=0.233; 67.5 % vs 60.4 %, p=0.084, respectively). The rolapitant group achieved higher rates of no nausea (maximum VAS<5 mm, 0–100 mm) in both the delayed and overall phases compared to control (58.3 % vs 46.9 %, p=0.007; 55.0 % vs 44.0 %, p=0.009, respectively). AE rates were similar across both groups. Conclusions Rolapitant in combination with a 5-HT3 receptor antagonist and dexamethasone was well-tolerated and demonstrated superior efficacy over control in the primary endpoint of the prevention of delayed CINV in subjects receiving HEC in a global phase 3 study.

MASCC-0384 Nausea-Vomiting PHASE 3 TRIAL RESULTS FOR ROLAPITANT, A NOVEL NK-1 RECEPTOR ANTAGONIST, IN THE PREVENTION OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN SUBJECTS RECEIVING MODERATELY EMETOGENIC CHEMOTHERAPY (MEC)

I. Schnadig1, M. Modiano2, A. Poma3, M.L. Hedley4, R. Martell5, L. Schwartzberg6 1 Oncology, Compass Oncology and The US Oncology Network, Portland, USA; 2Oncology, Arizona Clinical Research Center, Tucson, USA; 3Medical, Tesaro, Waltham, USA; 4President, Tesaro, Waltham, USA; 5Oncology, Division of Hematology Oncology Tufts Medical Center, Boston, USA; 6 Oncology, University of Tennessee Health Sciences Center, Memphis, USA

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Background and Aims Rolapitant is a selective competitive long-acting NK-1 receptorantagonist that demonstrated efficacy in a large randomized phase 2 study. This study evaluated the 200 mg dose for efficacy and safety in the prevention of CINV in subjects receiving MEC. Methods Randomized P3 double-blind active-control study. One thousand three hundred sixty-nine chemo-naïve subjects treated with MEC (cyclophosphamide, doxorubicin, epirubicin, carboplatin, irinotecan, daunorubicin or cytarabine) were randomized 1:1 to either (1) rolapitant + granisetron + dexamethasone or (2) placebo + granisetron + dexamethasone. The primary endpoint was complete response (CR = no emesis and no rescue medication) in delayed phase (>24–120 h). Secondary endpoints included CR in acute (0–24 h) and overall (0–120 h) phases. Treatment comparisons were performed using Mantel-Haenszel chi-square test. Subjects recorded episodes of emesis, nausea and rescue medication using a diary during 0–120 h post-chemo. Results One thousand three hundred forty-four evaluable subjects (>50 % received anthracycline-cyclophosphamide therapy). Subjects in rolapitant group had a significantly higher CR rate for the primary study endpoint during delayed phase compared to control (71.3 % vs 61.6 %, p<0.001, respectively). CR rates were also higher in rolapitant group for acute and overall phases (83.5 % vs 80.3 %, p=0.143; 68.6 % vs 57.8 %, p<0.001, respectively). The rolapitant group achieved higher rates of complete protection (no emesis, no rescue medication and maximum nausea VAS <25 mm) in delayed and overall phases compared to control (64.3 % vs 56.9 %, p=0.006; 62.0 % vs 53.2 %, p=0.001, respectively). AE rates were similar across groups. Conclusions Rolapitant in combination a with 5-HT3 receptor-antagonist and dexamethasone was well-tolerated and demonstrated superior efficacy over control in the primary endpoint of the prevention of delayed CINV in subjects receiving MEC in a global phase 3 study.

MASCC-0448 Nausea-Vomiting PALONOSETRON IN CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: ARE STATISTICALLY SIGNIFICANT DIFFERENCES ALWAYS CLINICALLY IMPORTANT?

M. Popovic1, D.G. Warr2, C. DeAngelis3, M. Tsao1, K.K.W. Chan4, M. Poon1, C. Yip1, N. Pulenzas1, H. Lam1, L. Zhang1, M. Milakovic1, E. Chow1 1 Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Medical Oncology, Princess Margaret Cancer Centre University of Toronto, Toronto, Canada; 3Department of Pharmacy, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 4Department of Medical Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims MASCC and ASCO recommend palonosetron as the preferred 5-HT3 receptor antagonist (5-HT3RA) antiemetic for moderately emetogenic chemotherapy (MEC). Although previous palonosetron meta-analyses have focused on statistical significance, MASCC has suggested that an absolute difference of 10 % between therapies is sufficient to warrant a change in practice. We performed a meta-analysis of randomized controlled trials (RCTs) examining the efficacy and safety of palonosetron versus other 5-HT3RAs to determine whether the absolute differences between arms met the MASCC criterion.

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Methods A literature search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL was conducted. Primary endpoints were complete response, no emesis and no nausea in the overall phase. Secondary endpoints spanned the acute and delayed phases. Review Manager was used for metaanalysis. Results Sixteen RCTs were identified, with 2,896 patients randomized to palonosetron and 3,187 patients randomized to other 5-HT3RAs. Palonosetron was statistically superior in all outcomes. As judged by MASCC guidelines, clinical superiority of palonosetron in primary endpoints were 10 % for complete response, 10 % for no emesis, and 9 % for no nausea. Absolute differences were substantially greater in the delayed than the acute phase. Conclusions Palonosetron is statistically superior to other 5-HT3RAs irrespective of endpoint. Certain point estimates of absolute differences met the MASCC criterion for clinical significance; some but not all of the superiority may be explained by the longer half-life of palonosetron versus its comparators. It is unknown what differences would be observed had the comparator arms contained a neurokinin-1 RA or a corticosteroid beyond day 1.

MASCC-0358 Nausea-Vomiting HOW OFFICE BASED GYNECO-ONCOLOGISTS IN GERMANYAPPLYANTIEMETIC GUIDELINES IN PATIENTS RECEIVING AC-CONTAINING (NEO) ADJUVANT CHEMOTHERAPY

J. Schilling1, H.J. Hindenburg1 1 BNGO e.V., BNGO e.V., Neuenhagen b. Berlin, Germany Background and Aims Supportive care guidelines are an important instrument to maintain quality of treatment and quality of life in cancer patients (pts). However, there are limitations in the adherence to guidelines and application of guideline changes. To evaluate the awareness of modern antiemetic guidelines (GL) and their practical use in pts receiving anthracycline plus cyclophosphamide (AC)containing chemotherapy among German practice-based gynecooncologists. ASCO recommends prophylaxis with 5-HT 3 receptorantagonist (RA), Neurokinin1-RA and dexamethasone. Methods Forty-nine practices used the ODM Quasi® GYN system for the online documentation of data on institutions, patients, knowledge and application of antiemetic GL. Antiemetic treatment was documented in 250 breast cancer pts who received cycle 1 and 3 of AC chemotherapy (80 % adjuvant, 20 % neoadjuvant). Results Awareness of antiemetic GL: AGO* 76 %, ASCO 82 %, NCCN 31 %, MASCC 22 %; application of GL: AGO 57 %, ASCO 53 %, MASCC 12 %, NCCN 8 %, none (2 %). 94 % were aware of the change of the emetic group of AC in the ASCO GL. Active use of triple drug antiemesis: 84 %, planned use: 12 %, no use: 4 %. Antiemetic treatment documentation in 246 pts: Cycle 1: 82 (33 %) received the triple drug schedule according to GL, 113 (46 %) a combination of 5HT3-RA and DEX. Cycle 3: triple: 35 %, 5HT3-RA + Dex: 44 %. Four pts were lost to follow up. * AGO - German Working Group of Gynecologic Oncology Conclusions Although current antiemesis GL were well known only 33 % of pts received the triple combination according to GL in the first cycle of AC, 35 % in the third cycle.

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MASCC-0317 Nausea-Vomiting 3 SYMPTOM CLUSTERS USING THE FUNCTIONAL LIVING INDEX – EMESIS INSTRUMENT IN PATIENTS WITH GASTROINTESTINAL CANCER RECEIVING RADIOTHERAPY TREATMENTS

P.M. Cheon1, M. Poon1, L. Zhang1, C. Deangelis1, K. Dennis2 , H. Chung1, J. Stinson1, G. Bedard1, M. Popovic1, S. Wong1, E. Chow1 1 Odette Cancer Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; 2Division of Radiation Oncology University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada Background and Aims The Functional Living Index–Emesis (FLIE) instrument is a validated nausea and vomiting specific tool. The primary objective of the present study was to determine symptom clusters within the FLIE on a weekly basis for the entirety of gastrointestinal cancer patients’ radiotherapy treatments. Methods Quality of life (QOL) was assessed weekly using the 18-item FLIE questionnaire for 86 patients’ radiotherapy treatments. A principal component analysis (PCA) with varimax rotation was performed on the 18 FLIE items at baseline and weekly visit. Inversed scores were applied for Q3/Q6/Q11/Q15/Q18 to get the same direction as other items. The internal consistency and reliability of the derived clusters was assessed with Cronbach’s alpha. Robust relationship and correlation among symptoms was displayed with biplot graphics. Results Two symptom clusters were consistently identified except in week 5 where only one was identified. Cluster 1 contained the items “Q1–Q9” which included all nausea items. Cluster 2 included all vomiting items from “Q10–Q18”. All the variables are well accounted for by 2 components for most weeks with excellent internal consistency (Cronbach’s alpha>0.96 for two clusters). Biplots indicate evidence of two symptom clusters at each week, except for week 1. Conclusions Assessment of patients with gastrointestinal cancers using the FLIE-18 questionnaire revealed two symptom clusters that respectively address nausea and vomiting. However, further investigation into the cause of RINVand their effects on QOL should be warranted in considering the FLIE-18 as a QOL assessment tool.

MASCC-0349 Nausea-Vomiting 3 A TARGETED VERSUS EMPIRIC APPROACH TO ANTIEMETIC USE IN ADVANCED CANCER

J. Hardy1, P. Yates2, J. Philip3, P. Martin4, P. Glare5, D. Currow6 1 Palliative and Supportive Care, Mater Research Institute-The University of Queensland, Brisbane, Australia; 2School of Nursing, Queensland University of Technology, Brisbane, Australia; 3Centre for Palliative Care Education and Research, St Vincent’s Hospital and University of Melbourne, Melbourne, Australia; 4Palliative care, Barwon Health, Geelong, Australia; 5Pain and Palliative Care, Memorial Sloan Kettering Cancer Centre, New York, USA; 6Palliative and Supportive Services, Flinders University, Adelaide, Australia Background and Aims The ‘mechanistic’ approach to nausea management, uses specific antiemetic drugs according to the aetiology of the nausea, and draws on knowledge of emetogenic pathways, matching supposed emetogenic

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stimulus to the drug most likely to block that stimulus. The ‘empirical’ approach uses antiemetics acting on multiple receptors without regard to the underlying cause of nausea. Both approaches have been shown to be effective in uncontrolled studies but have never been formally compared. We aimed to determine whether guideline driven aetiology based antiemetic therapy (mechanistic approach) is superior to single agent therapy with haloperidol (empirical approach) in patients with cancer and nausea not related to anticancer therapy. Methods Antiemetic guidelines were developed according to the presumed cause of nausea by an expert consensus group using licensed antiemetics in a 3 step dose escalation schedule. Consenting participants with a nausea score ≥3/10 were randomized to guideline driven antiemetic therapy, or single agent therapy with haloperidol (1 mg/ 24 h to 3 mg/24 h) given orally or parenterally. Response was defined as a 2 point improvement on an 11 point nausea NRS for average nausea and end score <3/10. The primary endpoint was average nausea score for the previous 24 h at 72 h. Results This trial is nearing completion. Preliminary analysis of the raw unblinded data shows a high response rate (approximately 65 %) with no difference between arms. Conclusions A targeted approach to antiemetic therapy does not appear superior to single agent therapy when given regularly for nausea not related to anticancer therapy.

MASCC-0163 Nausea-Vomiting 3 A RANDOMIZED PHASE III TRIAL OF PALONOSETRON IN COMBINATION WITH 1-DAY VERSUS 3-DAY DEXAMETHASONE FOR PREVENTION OF NAUSEA AND VOMITING INDUCED BY NON-AC MEC: HOPE-01

H. Isobe1, S. Yuki2, T. Furuhata3, T. Sagawa4, H. Masuko5, K. Hatanaka6, T. Miyagishima7, K. Sasaki8, M. Nakamura9, T. Sasaki10, J. Nakajima11, M. Tateyama12, R. Yokoyama13, S. Minami14, K. Eto15, I. Iwanaga16, H. Shibuya17, M. Kudo18, K. Oba19, Y. Komatsu20 1 Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan; 2 Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan; 3Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan; 4Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan; 5Surgery, Sapporo-Kosei General Hospital, Sapporo, Japan; 6Gastroenterology, Hakodate Municipal Hospital, Hakodate, Japan; 7Internal Medicine, Kushiro Rosai Hospital, Kushiro, Japan; 8 Surgery, Otaru Ekisaikai Hospital, Otaru, Japan; 9 Gastroenterology, Sapporo City General Hospital, Sapporo, Japan; 10 Respiratory Center, Asahikawa Medical University, Asahikawa, Japan; 11 3rd Internal Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan; 12Internal Medicine, Tomakomai Nisshou Hospital, Tomakomai, Japan; 13Surgery, Iwamizawa Municipal General Hospital, Iwamizawa, Japan; 14Gastroenterology, Oji General Hospital, Tomakomai, Japan; 15 Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan; 16 Gastroenterology, Japanese Red Cross Kitami Hospital, Kitami, Japan; 17 Surgery, Muroran City General Hospital, Muroran, Japan; 18 Gastroenterology, Sapporo Hokuyu Hospital, Sapporo, Japan; 19 Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan; 20Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan Background and Aims 5HT3 receptor antagonist plus dexamethasone (DEX) is recommended for the prevention of CINV at the time of the MEC.

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However, administration schedule of DEX has been established based on the data obtained with the first-generation 5-HT3 receptor antagonists. The purpose of this study was to compare the efficacy of DEX day1 single administration against DEX days1–3 administration in combination with palonosetron (PALO), the 2nd-generation 5HT3 receptor antagonist, for CINV in non-AC MEC. Methods This phase III trial was conducted as a multi-center, randomized, non-inferiority design. Patients who received non-AC MEC as an initial chemotherapy were randomly assigned to either a group which was administered PALO (0.75 mg, IV) and DEX (9.9 mg, IV) prior to chemotherapy (armB), or a group which was administered additional administration of DEX (8 mg, IVor PO) on days 2– 3 (armA). Primary endpoint was Complete Response (CR) rate. CR rate difference was estimated by logistic regression with stratification factors as covariates. Non-inferiority margin was set at −15 % (armB-armA). Results From April 2011 to March 2013, 305 patients who received non-AC MEC were randomly assigned. Overall CR rate was 66.2 % in armB (n= 151) and 63.6 % in armA (n=154). PALO+DEX day1 was non-inferior to PALO+DEX days1–3 (difference, 2.5 %; 95 % Cl, −7.8 % to 12.8 %; p for non-inferiority test=0.0004). There were no differences between two arms on complete control rate (64.9 % vs 61.7 %) and total control rate (49.7 % vs 47.4 %). Conclusions The administration of DEX on days 2–3 can be eliminated when used with PALO for the prevention of CINV in patients receiving non-AC MEC.

MASCC-0286 Nausea-Vomiting 3 APREPITANT FOR PREVENTING CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN CHILDREN

H. Kang1, S. Loftus2, A. Taylor3, C. DiCristina2, C.M. Zwaan4, S. Green5 1 Pediatrics, Cancer Research Institute Seoul National University College of Medicine, Seoul, Korea; 2Clinical Development Executive Organization, Merck & Co. Inc., Whitehouse Station NJ, USA; 3Biostatistics, Merck & Co. Inc., Whitehouse Station NJ, USA; 4Pediatric Oncology, Erasmus MC/Sophia Children’s Hospital, Rotterdam, Netherlands; 5Vice President Clinical Research, Merck & Co. Inc., Whitehouse Station NJ, USA Background and Aims Aprepitant with a 5HT3-antagonist and corticosteroid is indicated for prevention of CINV due to highly/moderately emetogenic chemotherapy (EC) in adults. To evaluate aprepitant for CINV prevention in children, a global, phase III, randomized, double-blind, active-comparator study was conducted in patients 6 months to 17 years (NCT01362530). Objectives: Primary – compare an aprepitant vs control regimen in eliciting complete response (CR: no vomiting/retching/rescue medication) 25–120 h after chemotherapy initiation (delayed phase) in Cycle 1. Secondary – CR in acute (0–24 h) and overall phases (0–120 h), no vomiting (NV) in overall phase, safety. Methods Patients 12–17 years undergoing EC received aprepitant capsule 125 mg/ ondansetron before chemotherapy (Day 1) + aprepitant capsule 80 mg (Days 2–3) OR placebo (Days 1–3) + ondansetron (Day 1). Patients <12 years received aprepitant powder-for-suspension (PFS) 3 mg/kg (to 125 mg)/ondansetron (Day 1) + aprepitant PFS 2 mg/kg (to 80 mg) (Days

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2–3) OR placebo (Days 1–3) + ondansetron (Day 1). Dexamethasone was added at investigator discretion. Results Efficacy and safety were evaluated in 152 aprepitant and 150 control patients. The proportion of patients achieving CR in the delayed phase was significantly higher for aprepitant than controls (50.7 % vs 26.0 %, P<0.01). Significantly more aprepitant patients showed CR during acute (66.4 % vs 52.0 %, P<0.05) and overall (40.1 % vs 20.0 %, P<0.01) phases, and NV in the overall phase (46.7 % vs 21.3 %, P<0.01). Aprepitant was well tolerated; adverse events were similar between regimens and consistent with those in patients undergoing chemotherapy. Conclusions In pediatric cancer patients 6 months to 17 years treated with EC, the 3day regimen containing aprepitant was well tolerated and significantly more effective than a control regimen for CINV prevention.

MASCC-0283 Nausea-Vomiting 3 SINGLE-DOSE PALONOSETRON AND DEXAMETHASONE FOR PREVENTION OF CINV IN PATIENTS WITH SMALL CELL LUNG CARCINOMA RECEIVING MULTIPLE-DAYAND MULTIPLE-CYCLE CHEMOTHERAPY: A RETROSPECTIVE STUDY

M. Kiagia1, M. Panagiotarakou1, D. Vassos1, E. Dalakou1, A. Marioli1, E. Kainis1, K. Syrigos1 1 Oncology Unit GPP, Sotiria General Hospital, Athens, Greece Background and Aims Optimal prevention of chemotherapy-induced nausea and vomiting (CINV) in the setting of multiple-day chemotherapy remains a challenging task. The aim of this retrospective study was to further investigate the safety and efficacy of single-dose palonosetron and dexamethasone for CINV prevention in patients with small-cell lung cancer (SCLC) receiving multiple-day chemotherapy. Methods Retrospective analysis of medical records of 417 patients with SCLC receiving multiple cycles of 3-day platinum-based chemotherapy was performed. Chemotherapy regimens administered included either 3-day carboplatin-based or cisplatin-based combinations. The primary objectives were the assessment of the complete response rate (CR: no vomiting, no rescue) and of the complete control rate (CC: no vomiting, no nausea, no rescue) across the overall period of treatment . All patients received antiemetic prophylaxis with a single pretreatment dose of palonosetron (0.25 mg, i.v.) and dexamethasone (8 mg, i.v.). Results Carboplatin- and cisplatin-based chemotherapies were received by 93.3 % and 6.7 % of patients, respectively. The highest CR/CC rates (91.8 %/76.6 %) were observed in the carboplatin subgroup, while the CR/CC rates in the cisplatin subgroup and the overall study population were 60.7 %/46.4 % and 89.7 %/74.6 %, respectively. No serious adverse events related to the antiemetic treatment were recorded. Logistic regression analysis showed that younger age, female gender, extensive disease stage and cisplatinbased chemotherapy had an independent negative effect on the CC rate. Conclusions Single-dose palonosetron and dexamethasone achieved complete control of CINV throughout the entire period of consecutive platinum-based chemotherapy cycles in the majority of SCLC patients.

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MASCC-0228 Nausea-Vomiting 3 COMPARING THE INCIDENCE OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING FOLLOWING 5HT3RA AND NK1 ANTIEMETIC PROPHYLAXIS

R. Knoth1, C. Faria1, E. Chang2, M. Broder2, A. Powers1 1 Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake NJ, USA; 2Partnership for Health Analytic Research, LLC, Beverly Hills CA, USA Background and Aims Chemotherapy-induced nausea and vomiting (CINV) is a significant adverse effect of cancer treatment. The 5-hydroxytryptamine-3 receptor antagonists (5HT3RAs) are recommended for the prevention of CINV. This study compared the incidence of CINV in patients undergoing chemotherapy and treated prophylactically with either I.V. palonosetron alone or another 5HT3RA (ondansetron, dolasetron, granisetron) in combination with an I.V. or oral neurokinin1 receptor antagonist (NK1). Methods A retrospective cohort analysis was conducted using the Optum LabRx database. Adult patients, treated with moderately (MEC) or highly emetogenic chemotherapy (HEC), who received a 5HT3RA from 4/1/ 08 to 3/31/09, were identified. Once identified, patients were grouped by cohort (palonosetron alone vs. other 5HT3RA+NK1). CINV was defined by medical claims with a primary diagnosis of nausea, vomiting, fluid depletion or replacement, or the use of a rescue antiemetic, and measured from initiation of chemotherapy to end of the first cycle. Results A total of 5,912 patients (age=56.1, 77 % female) were identified, 25.7 % treated with HEC and 74.3 % with MEC, and 19.9 % experienced CINV. For palonosetron-treated patients (n=4,243), 833 (19.6 %) received palonosetron alone and 3,140 (80.4 %) received it in combination with another antiemetic. For the other 5HT3RA -treated group (n=1,667), 414 (24.8 %) received it alone, 1,022 (61.3 %) with an oral antiemetic, and 231 (13.9 %) with an NK1. Patients treated with palonosetron alone demonstrated significantly less CINV than those treated with the combination other 5HT3RA+NK1 (19.3 % vs. 34.6 %, respectively), OR=1.8, p=0.007. Conclusions Significant reductions in CINV were observed in patients treated with palonosetron alone vs. treated with another 5HT3RA+NK1 in combination.

MASCC-0227 Nausea-Vomiting 3 COMPARING THE COSTS OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING FOLLOWING 5HT3RA AND NK1 ANTIEMETIC PROPHYLAXIS

C. Faria1, R. Knoth1, E. Chang2, M. Broder2, A. Powers1 1 Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake NJ, USA; 2Partnership for Health Analytic Research, LLC, Beverly Hills CA, USA Background and Aims Chemotherapy-induced nausea and vomiting (CINV) is a significant adverse effect of cancer treatment. The 5-hydroxytryptamine3 receptor antagonists (5HT3RA) are recommended for the prevention of CINV. This study compared the costs to prevent CINV in patients undergoing chemotherapy and treated prophylactically with either I.V. palonosetron alone vs. with another 5HT3RA (ondansetron, dolasetron, or granisetron) in combination with an I.V. or oral neurokinin1 receptor antagonist (NK1).

Methods A retrospective cohort analysis was conducted using the Optum LabRx database. Adult patients, treated with moderately (MEC) or highly emetogenic chemotherapy (HEC), who received a 5HT3RA from 4/1/ 08 to 3/31/09, were identified and grouped into cohorts (palonosetron alone vs. other 5HT3RA+NK1). CINV-related costs were calculated using claims with a primary diagnosis of nausea, vomiting, fluid depletion/ replacement, or rescue antiemetic, and measured from chemotherapy initiation to end of first cycle. Results A total of 5,912 patients (mean age=56.1, 77 % female) were identified. Of these, 833 (14.1 %) were treated with palonosetron alone, 414 (7.0 %) received the other 5HT3RA alone, and 231 (3.9 %) received the other 5HT3RA+NK1 combination. Significant differences (p<0.05) were found by cohort (palonosetron alone vs. other 5HT3RA+NK1) for mean cost of antiemetic medications, $188 vs. $620, respectively, cost of nonchemotherapy related medications, $446 vs. $1082, and total CINVrelated costs, $281 vs. $876. Conclusions Patients treated with I.V. palonosetron alone experienced significantly less CINV-related treatment costs compared to those treated with a 5HT3RA+ NK1 combination. These results suggest that prophylactic use of palonosetron in patients undergoing MEC and HEC chemotherapy could result in significant savings to payers.

MASCC-0343 Nausea-Vomiting 3 GAPS BETWEEN CLINICIANS’ AWARENESS ABOUT CINV AND PATIENT EXPERIENCE

J. Lee1, S. Rha2, Y. Park1, S. Song3, C. Lee3 1 College of Nursing, Eulji University, Daejeon, Korea; 2College of Medicine, Yonsei University, Seoul, Korea; 3Yonsei Cancer Hospital, Severance Hospital, Seoul, Korea Background and Aims Corresponding clinicians’ understanding about symptom experience with that of patients’ would contribute advancing symptom management. The study aimed to evaluate clinicians’ awareness about CINVand compare it with patients’ symptom experience. Methods A descriptive study was conducted at two university hospitals including clinicians and cancer patients receiving the first adjuvant HEC or MEC. The MAT items were utilized to generate survey questions and symptom diary. Descriptive statistics were used to analyze the data. Results A total of 73 clinicians with mean oncology care experience of 6 yrs. and 194 cancer patients receiving HEC or MEC completed study participation. Clinicians estimated acute vomiting to occur twice after HEC and once after MEC, and delayed vomiting as three times after HEC and twice after MEC. However, patients’ average vomiting frequency was less than once in both acute and delayed phase, either HEC or MEC. Intense acute and delayed nausea was expected by clinicians after HEC (6 out of 10), whereas patients experienced less intense acute nausea (2 out of 10) and delayed nausea (3 out of 10). After MEC, moderate acute and delayed nausea was estimated (4 out of 10), whereas delayed nausea on day 3 and day 4 only reached the intensity. Conclusions This study demonstrated gaps between clinicians’ awareness and patients’ symptom experience of CINV. In general, clinicians overestimated CINVexperience. Nausea is a still a significant symptom with room for further improvement. Further data collection and analyses regarding patients’ CINVexperience will be ensued.

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MASCC-0307 Nausea-Vomiting 3 FOSAPREPITANT AS SALVAGE TREATMENT OF CHEMOTHERAPY-INDUCED VOMITING (CIV) IN BREAST AND GYNECOLOGICAL CANCER

A. Covens1, B. Higgins2, S. Verma3, P. Bessette4, J. Bin5, L. Gilbert6, P. Hoskins7, D. Provencher8, P. Ghatage9, D. Warr10, M. Majdan11, J.F. Pouliot11 1 Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; 2 Oncology, Credit Valley Hospital, Mississauga, Canada; 3Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada; 4Oncology, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada; 5 Oncology, Toronto East General Hospital, Toronto, Canada; 6Oncology, McGill University Health Centre, Montreal, Canada; 7Oncology, Vancouver Cancer Centre, Vancouver, Canada; 8Oncology, Centre hospitalier universitaire de Montreal, Montreal, Canada; 9Oncology, Tom Baker Cancer Centre, Calgary, Canada; 10Oncology, Princess Margaret Cancer Centre, Toronto, Canada; 11Medical Affairs, Merck Canada, Kirkland, Canada Background and Aims Despite the addition of NK1 receptor antagonists to several antiemetic guidelines in oncology, inconsistent adherence to these guidelines undermines optimal emesis prevention in a significant proportion of patients. Objective: To demonstrate that fosaprepitant significantly improves CIV control in subjects who experienced vomiting or retching in the first cycle of chemotherapy. Methods This study enrolled one hundred and six patients with either breast (FEC and AC chemotherapy) or gynecological cancer (Carbo-Taxol chemotherapy), who experienced vomiting or retching during the first 5 days of treatment cycle 1. The primary objective was the proportion of subjects responding to fosaprepitant (no vomiting, no retching 0–120 h) when combined with standard anti-emetic therapy. Nausea, rescue medication, and Complete Response were also assessed. Results Median age was 45 and 55 years for breast and gynecological cancer patients, respectively. The overall control rate was 58 %, with 63 % in breast cancer and 50 % in gynecological cancer. Vomiting episodes occurred early in breast cancer, while a delayed pattern was observed in gynecological cancers (Figure 1).

Similar observations were made for the timing of nausea and use of rescue medications. Most common side effects, irrespective of causality, were: fatigue (26 %), headache (19 %) and constipation (18 %). Conclusions Fosaprepitant can successfully rescue majority of patients who experienced CIV during the first cycle of chemotherapy, suggesting that most vomiting episodes can be prevented when fosaprepitant is used in conjunction with conventional anti-emetics.

MASCC-0347 Nausea-Vomiting 3 CAN APREPITANT IMPROVE DOSE INTENSITY OF ANTH RACYCLINE AND SURVIVAL IN BREAST CANCER PATIENTS?

T. Nakayama1, S. Tokunaga2, K. Yoshidome3, M. Ishitobi1, M. Morimoto4, M. Yamaguchi5, M. Baba6, M. Okishiro7, T. Ito8, T. Yanagisawa9, M. Tsubota10, M. Iwamoto11, J. Tsurutani12, M. Nomura13, K. Oshima14, S. Morita15, N. Masuda16 1 Breast Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; 2Medical Oncology, Osaka City General Hospital, Osaka, Japan; 3Breast Surgery, Osaka Police Hospital, Osaka, Japan; 4Breast Surgery, Yao City Hospital, Osaka, Japan; 5Breast Surgery, Matsushita Memorial Hospital, Osaka, Japan; 6Breast Surgery, Itami City Hospital, Osaka, Japan; 7Breast Surgery, Kansai Rousai Hospital, Osaka, Japan; 8Breast Surgery, Rinku General Medical Center, Osaka, Japan; 9Breast Surgery, Suita City Hospital, Osaka, Japan; 10 Breast Surgery, Kansai Medical Uiversity, Osaka, Japan; 11Breast and Endocrine Surgery, Osaka Medical College, Osaka, Japan; 12Medical Oncology, Kinki University, Osaka, Japan; 13Breast Surgery, Osaka General Medical Center, Osaka, Japan; 14Breast and Endocrine Surgery, Toyonaka Municipal Hospital, Osaka, Japan; 15Biomedical Statistics and Bioinformatics, Kyoto University, Kyoto, Japan; 16Breast Surgery, Osaka National Hospital, Osaka, Japan Background and Aims Chemotherapy induced nausea and vomiting (CINV) are the most distressing side effects. Aprepitant can reduce CINV severity and it is also expected to improve relative dose intensity (RDI) and survival. To

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investigate whether adding aprepitant can improve RDI of anthracycline (A) and survival of the breast cancer patients treated with A. Methods According to the predefined study design, data on patients who were planned to be treated with A at least three cycles was collected prospectively and retrospectively. Aprepitant, corticosteroid and 5HT3 antagonist were given to AP group (N=205) and only corticosteroid and 5HT3 antagonist to nAP group (N=299). Ratio of pts who achieved more than 85 % of RDI, RDI, frequency and grade of CIVN and survival (DFS and OS) at 1 year and 5 years after treatment was assessed. In comparison of two groups, propensity score matching methods was used to adjust confounder bias in this study. Results Ratio of pts who achieved more than 85 % of RDI was 86.1 % in AP and 88.2 % in nAP, respectively (p=0.554). Mean RDI was 93.4 % in AP and 94.7 % in nAP, respectively (p=0.106). Incidence of vomiting (>=Grade 1) was significantly reduced in AP (AP: 23.8 % vs nAP: 37.0 %, p=0.006). In terms of survival benefit, DFS at 1 year was 98.4 % in AP and 97.7 % in nAP, respectively (p=0.412), which was not significant. Conclusions In this study, we could not show the benefit of aprepitant in improving RDI and survival. But it significantly reduced incidence of vomiting, which leads to maintain patients’ QOL during chemotherapy.

MASCC-0177 Nausea-Vomiting 3 A PROSPECTIVE STUDY OF GASTROINTESTINAL RADIATION THERAPY-INDUCED NAUSEA AND VOMITING

M. Poon1, K. Dennis2, C. DeAngelis1, H. Chung1, J. Stinson1, L. Zhang1, G. Bedard1, M. Popovic1, N. Lao1, N. Pulenzas1, S. Wong1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada; 2Department of Radiation Oncology, Ottawa Hospital Research Institute, Ottawa, Canada

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Fig. 1 a Percentage of patients with no nausea, any nausea, occasional nausea or frequent nausea over time. D = day. b Percentage of patients with no emesis, any nemesis, occasional emesis or frequent emesis over time. D = day. c Percentage of patients who experienced nausea while receiving concurrent chemotheraphy with RTor RTwithout chemotheraphy over time. D = day. d. Percentage of patients who experienced emesis while receiving concurrent chemotherapy with RT or without RT chemotherapy over time. D = day. e Percentage of patients who experienced nausea with and without antiemetics over time. D = day. f Percentage of patients who experienced emesis with and without antiemetics over time. D = day Conclusions RINV worsened QOL and was experienced even after treatment was completed; physicians should therefore be cognizant and monitor patients in the week following radiotherapy. Concomitant chemoradiotherapy should potentially be included in the moderate emetogenic risk category.

MASCC-0171 Background and Aims Nausea and vomiting are side effects from radiotherapy that can interfere with gastrointestinal (GI) cancer patients’ quality of life (QOL). A prospective study among patients with GI cancers was conducted to document the timing, incidence, and risk factors of radiation therapyinduced nausea and vomiting (RINV). Methods Forty-eight patients planned to receive abdominal and/or pelvic radiotherapy alone or with concomitant chemoradiotherapy were followed prospectively. All episodes of nausea, vomiting, retching and antiemetic use were recorded daily for the treatment period and the week following completion of therapy. QOL was assessed weekly using the Functional Living Index – Emesis Quality of Life Tool and the EORTC QLQ-C30 questionnaire. Results Nausea occurred in 83 % of patients and emesis in 54 %. Pancreatic cancer patients had significantly higher proportions of nausea and emesis (p=0.002 and p=0.0003). There were no significant differences between concomitant chemoradiotherapy and radiotherapy only patients for RINV. Patients had significantly greater proportions of RINV during the first, second, and fifth weeks of treatment and during the first week following treatment. Vomiting was found to impair patients’ usual recreation or leisure activities and enjoyment of their meals. Worse physical, role and social functioning, and greater fatigue and appetite loss over the course of treatment correlated directly with the timing of RINV symptoms.

Nausea-Vomiting 3 CLINICAL IMPACTS OF GRANISETRON TRANSDERMAL SYSTEM:SUSTAINED ANTI-EMETIC EFFICACYAND QUALITY OF LIFE IN CONTROL OF NAUSEA AND VOMITING INDUCED BY HIGHLY EMETOGENIC CHEMOTHERAPY

D.S. SUN1, Y.H. Ko1, J.Y. Jin2, I.S. Woo3, Y.S. Park4, J.H. Kang5, H.K. Kim6 1 Internal Medicine, Uijeongbu St Mary’s hospital Catholic University Medical College, Uijeongbu-si Gyeonggi-do, Korea; 2Internal Medicine, Bucheon St Mary’s hospital Catholic University Medical College, Bucheon-si Gyeonggi-do, Korea; 3Internal Medicine, Yeouido St Mary’s hospital Catholic University Medical College, Seoul City, Korea; 4 Internal Medicine, Daejeon St Mary’s hospital Catholic University Medical College, Daejeon City, Korea; 5Internal Medicine, Seoul St Mary’s hospital Catholic University Medical College, Seoul City, Korea; 6 Internal Medicine, St Vincent’s hospital Catholic University Medical College, Suwon City, Korea Background and Aims The efficacy and safety of granisetron transdermal system(GTS, Sancuso®) was investigated for the prevention of chemotherapyinduced nausea and vomiting(CINV) in the patients receiving highly emetogenic chemotherapy (HEC).

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Methods In this multicenter, randomized, open-label, parallel-group, activecontrolled study, patients receiving HEC were randomized to GTS or ondansetron. The GTS was applied onto the skin at least 24 h before chemotherapy and maintained for 5 days after start of chemotherapy; ondansetron was administered intravenously on chemotherapy Day 1 and orally on Day 2–5. Primary endpoint was the percentage of patients achieving Complete Response(CR) without rescue medication from the first administration to 24 h after start of the last chemotherapy. Quality of life(QoL) was assessed using the Functional Living Index-Emesis(FLI-E). Statistical analyses were performed in per-protocol set. Results A total of 389 patients, 199 were in GTS group and 190 in ondansetron group. Baseline characteristics were similar between two groups. The percentage of CR during the primary endpoint evaluation period was 86.84 % in GTS and 90.36 % in ondansetron, demonstrating noninferiority of GTS (95 % CI: [−10.52 %, 3.48 %], Margin:−15 %). During the study, CR and complete control(CC) rates were gradually decreased in the ondansetron, those in the GTS were sustained. Moreover, CC rate at Day 5 was significantly higher with GTS than ondansetron (92.76 % vs 84.94 %, p=0.0278). The total score of the FLI-E was significantly higher with GTS than ondansetron(mean 1,547.38±306.00 and 1,494.07± 312.05, p=0.0449). Adverse events between two groups were similar each other. Conclusions Compared with ondansetron, the GTS showed sustained anti-emetic efficacy and improvement in QoL in the patients receiving multi-day HEC.

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ECCO,2009) where a cycle 1 no emesis rate of 84 % was seen in a similar carboplatin subset (N=102). This compared with a no emesis rate of 70 % for the 2-agent control group (N=90). This incremental benefit in response (~10–14 %) for NEPA/APR is similar to the difference seen with NK1RA cisplatin trials. Conclusions This NEPA dataset is the largest prospective report evaluating the contribution of an NK1RA in preventing emesis in patients receiving carboplatin. Given the consistent evidence seen in >250 total patients treated with NEPA+DEX or the aprepitant triplet, guideline groups should strongly consider the addition of an NK1RA in patients receiving carboplatin.

MASCC-0161 Nausea-Vomiting 3 DO NK1 RECEPTOR ANTAGONISTS (RA) CONTRIBUTE TO NAUSEA CONTROL? EVALUATION OF THE NOVEL NEPA FIXED-DOSE COMBINATION OF NK1 RA+5-HT3 RA FROM PIVOTALTRIALS

L. Schwartzberg1, M. Aapro2, P.J. Hesketh3, G. Rossi4, G. Rizzi5, M. Palmas4, R. Gralla6 1 Division of Hematology & Oncology, West Clinic, Memphis, USA; 2 Department of Medical Oncology, Clinique de Genolier, Genolier, Switzerland; 3Department of Hematology & Oncology, Lahey Hospital & Medical Center, Burlington, USA; 4Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 5Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland; 6Department of Oncology, Albert Einstein College of Medicine, Bronx, USA

Nausea-Vomiting 3 IS THE ADDITION OF AN NK1 RECEPTOR ANTAGONIST BENEFICIAL IN PATIENTS RECEIVING CARBOPLATIN? SUPPLEMENTARY DATAWITH NEPA, A FIXED-DOSE COMBINATION OF NETUPITANT AND PALONOSETRON

K. Jordan1, R. Gralla2, G. Rossi3, M.E. Borroni3, G. Rizzi4 1 Department of Oncology/Hematology, University of Halle, Halle, Germany; 2Department of Oncology, Albert Einstein College of Medicine, Bronx, USA; 3 Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 4Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland Background and Aims A triplet regimen of an NK1 receptor antagonist (RA)+5-HT3RA+dexamethasone (DEX) is unanimously recommended by Antiemetic Guideline Committees for patients receiving cisplatin-based chemotherapy. However, there is limited data supporting an NK1 RA recommendation with other platinum agents. NEPA, a fixed-dose combination of the NK1RA, netupitant (NETU), and palonosetron (PALO) was at least as effective as the aprepitant (APR) triplet in patients receiving cisplatin. We performed a post-hoc analysis from a prospective phase 3 trial to assess NEPA’s effectiveness in a subset of patients receiving carboplatin. Methods One hundred forty-nine chemotherapy-naïve patients from a randomized, multinational study were included. They received a single oral dose of NEPA (NETU 300 mg+PALO 0.50 mg)+DEX on day 1 of repeated carboplatin cycles. Results The overall (0–120 h) complete response rates (no emesis/rescue) for NEPA (80 %, 91 %, 92 %, and 94 % for cycles 1–4, respectively) were consistent with the historical aprepitant triplet data (Gralla ESMO-

Background and Aims Despite progress in more effective CINV prevention, nausea control remains suboptimal. Debate exists whether NK1 receptor antagonists (RAs) enhance nausea control. NEPA, a fixed-dose oral combination of the NK1RA, netupitant plus palonosetron (PALO) has shown superior prevention of emesis compared with PALO. We evaluated whether the addition of netupitant to PALO offers better nausea control than singleagent PALO. Methods Patients from two randomized, multinational studies received a single dose of NEPA (netupitant 300 mg+PALO 0.50 mg) or PALO on Day 1+ dexamethasone prior to cisplatin or anthracycline+cyclosphosphamide (AC). The proportion of patients with no significant nausea (NSN:max <25 mm of 100 mm VAS) with odds ratios and mean VAS scores were calculated. Results The NEPA groups had more patients with NSN and lower VAS scores; patients given only PALO were at greater risk of nausea. This was most apparent in the delayed phase and cisplatin-treated patients, but improvement was also seen in AC. Study 1 (HEC) % Pts NSN (Odds Ratios) NEPA PALO N=135 N=136 Acute Delayed Overall

99 % (4.74)* 90 % (2.25)* 90 % (2.28)*

Study 2 (AC MEC) Mean VAS NEPA N=135

PALO N=136

93 %

3.0

6.5

81 %

7.5*

15.2

79 %

8.0*

16.9

*p≤0.05 vs PALO

% Pts NSN (Odds Ratios) NEPA PALO N=724 N=725

Mean VAS

87 % (0.95) 77 % (1.35)* 75 % (1.32)*

88 %

8.7

9.2

71 %

15.2*

19.4

69 %

16.7

21.0

NEPA N=724

PALO N=725

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Conclusions The addition of the NK1RA, netupitant to PALO (NEPA) significantly improves prevention of nausea over PALO alone in patients receiving cisplatin or AC.

MASCC-0160 Nausea-Vomiting 3 MULTIPLE CYCLE CINV CONTROL AND SAFETY OF NEPA, A CAPSULE CONTAINING NETUPITANT AND PALONOSETRON ADMINISTERED ONCE PER CYCLE OF MODERATELY EMETOGENIC CHEMOTHERAPY (MEC)

M. Aapro1, M. Karthaus2, L. Schwartzberg3, G. Rossi4, G. Rizzi5, M.E. Borroni4, M. Palmas4, H. Rugo6 1 Department of Oncology, Clinique de Genolier, Genolier, Switzerland; 2 Department of Hematology Oncology and Palliative Medicine, Hematology & Oncology Staedt. Klinikum Neuperlach and Harlaching, Munich, Germany; 3Division of Hematology & Oncology, West Clinic, Memphis, USA; 4Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 5Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland; 6Breast Oncology and Clinical Trials Education, University of California San Francisco Comprehensive Cancer Center, San Francisco, USA Background and Aims Antiemetic guidelines recommend co-administration of targeted prophylactic medications aimed at inhibiting several molecular pathways involved in emesis. NEPA is a fixed-dose combination of a new NK1 receptor antagonist (RA), netupitant (NETU 300 mg), and palonosetron (PALO 0.50 mg), a pharmacologically distinct 5-HT3 RA, administered orally in one capsule once per cycle. NEPAwas previously shown to be superior to PALO after a single chemotherapy cycle. The aim was to evaluate the maintenance of efficacy/safety over continuing cycles. Methods This was a randomized, double-blind Phase 3 study assessing the efficacy/safety of a single dose of NEPA versus PALO in chemotherapynaïve patients receiving multiple cycles of anthracyclinecyclophosphamide. Patients received oral dexamethasone on Day 1 only. Efficacy endpoints: complete response (CR: no emesis/no rescue) and no significant nausea (max<25 mm on 100 mm VAS) during the overall (0– 120 h) interval. Results One thousand two hundred eighty-six patients participated in the multiple cycle extension for 5969 chemotherapy cycles; 76 % completed at least 4 cycles. The superiority of NEPA over PALO during Cycle 1 for both complete response and no significant nausea was maintained over multiple cycles.

MASCC-0054 Nausea-Vomiting2 META-ANALYSIS OF COADJUVANT NON-NK1 ANTAGONIST MEDICATIONS FOR CONTROL OF ACUTE AND DELAYED NAUSEA AND VOMITING INDUCED BY MODERATE AND HIGHLY EMETOGENIC CHEMOTHERAPY

T.A.S. Thaiana Aragão Santana1, D.C.T. Damila Christina Trufelli1, L.L.M. Leandro Luongo de Matos2, F.M.C. Felipe Melo Cruz1, A.D.G. Auro Del Giglio1 1 Oncology, ABC Foundation School of Medicine, Santo André, Brazil; 2 Head and Neck Surgery, ABC Foundation School of Medicine, Santo André, Brazil Background and Aims Chemotherapy Induced Nausea and Vomiting (CINV) is a very distressing chemotherapy induced symptom that may adversely impact cancer patients’ quality of life. Methods We conducted a systematic search in Pubmed, Bireme and Cochrane databases for randomized clinical trials, published in English, that evaluated the efficacy of combination of coadjuvant non-Neurokinin 1 (NK1) antagonists drugs (ie neuroleptics, anti-convulsivants and benzodiazepines) with 5Hydroxitriptamine 3 (5-HT3) antagonists for adult cancer patients recruited to recieve moderate or highly emetogenic chemotherapy. We employed Review Manager (RevMan) Computer program Version 5.2 for statistical calculations. Results We included 15 studies with 1,793 patients. We observed a significant higher complete protection for acute CINV with coadjuvant medications (OR=0.43; 95 % CI: 0.26–0.72; p=0.001; I2 44 %) but not for the delayed period (OR=0.80; 95 % CI: 0.58–1.09, p=0.16, I2 7 %). We observed coadjuvant medications significantly increased complete control of nausea (OR=0.31; 95 % CI 0.24–0.40; p<0.00001, I2 73 %) and vomiting (OR=0.37; 95 % CI: 0.30–0.47; p<0.00001; I2 49 %). We could not find in subgroup analysis evidence of superiority of any one of the groups of coadjuvant medications over another. Conclusions We conclude that coadjuvant non-NK1antagonists medications may be useful for CINV control. Prospective randomized studies incorporating these low cost medications to new regimens combining 5-HT3 and NK1 antagonists may be warranted.

MASCC-0039 Nausea-Vomiting2 TRAJECTORYAND RISK FACTORS FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN ASIAN HEAD AND NECK CANCER PATIENTS

Cycle N=NEPA/PALO Complete Response NEPA PALO Cycle 1 N=724/725 74 %* 67 % Cycle 2 N=635/651 80 %* 67 %

No Significant Nausea NEPA PALO 75 %* 69 % 77 %* 72 %

A. Chan1, M. Shwe1, Y.X. Gan2, X.H. Low1, K. Yap1, D. Lim3 1 Pharmacy, National University of Singapore, Singapore, Singapore; 2 Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; 3 Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

Cycle 3 N=598/606 Cycle 4 N=551/560

78 %* 80 %*

Background and Aims Head and neck cancers are highly prevalent in Asia. However, data regarding chemotherapy-induced nausea and vomiting in the head and neck cancer population are lacking. This study was designed to analyze the trajectory of and risk factors for chemotherapy-induced nausea and vomiting in Asian head and neck cancer patients. Methods This was a single-center, prospective, observational study conducted between September 2008 and May 2013. Adult head and neck cancer

84 %* 84 %*

70 % 75 %

73 % 75 %

*P≤0.05 vs PALO The type/incidence of adverse events was similar for NEPA and PALO. Conclusions NEPA, a novel, convenient fixed-dose combination targeting dual antiemetic pathways, is highly effective and safe over multiple cycles of MEC.

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patients scheduled to receive cisplatin-based chemotherapy were recruited for the study. Clinical events were collated from standardized diaries. Primary endpoints included overall significant nausea, overall vomiting, and complete response to antiemetics. Results Two hundred thirty-five patients were included in the analyses. The majority (75.7 %) was male and Chinese (81.7 %), manifested nasopharyngeal cancer (83.4 %), and the overall median age was 49.5 (19–81) years; 62.1 % received aprepitant with their chemotherapy. The overall incidence of significant nausea and vomiting was 73.7 % and 24.7 %, respectively, with single-day cisplatin regimens and 48.9 % and 28.9 %, respectively, with the multiple-day cisplatin regimen. The complete response to antiemetics was 63.2 % with the single-day chemotherapy regimens and 68.9 % with the multiple-day regimen. Patients using complementary alternative medicine were less likely than others to achieve a complete response to antiemetics, and patients who were more educated and those with a poor performance status were more likely than others to complain of post-chemotherapy nausea or vomiting. Conclusions Whereas post-chemotherapy vomiting is relatively well controlled in Asian head and neck cancer patients, post-chemotherapy nausea remains problematic in this population.

MASCC-0149 Nausea-Vomiting2 SEROTONIN 5-HT3 RECEPTOR-MEDIATED VOMITING OCCURS VIA A ACTIVATION OF CA2+/CAMKII-DEPENDENT ERK1/2 SIGNALING

N. Darmani1, W. Zhong1, T.E. Hutchinson1, S. Chebolu1 1 Basic Medical Sciences, COMP/WUHS, Pomona, USA Background and Aims 5-hydroxytryptamine 3 receptors (5-HT3Rs) have high permeability to extracellular Ca2+ and upon stimulation allow increased Ca2+ influx. Stimulation of 5-HT3Rs by 2-methyl serotonin (2-Me-5-HT) induces vomiting, however its downstream signaling pathways remain unknown. This study demonstrates the involvement Ca2+ sensor calmodulin and Ca2+/calmodulin-dependent protein kinase IIα (Ca2+/CaMKIIα) in 2-Me-5-HT-induced emesis. Methods Ca2+ imaging, immunoprecipitation, immunoblot, immunostaining and behavioral emesis studies in the least shrew. Results Using fluo-4 AM dye, we found that the emetogen 2-Me-5-HT (1 μM) augments intracellular Ca2+ concentration in least shrew brainstem slices, which was abolished in the presence of the selective 5-HT3R antagonist palonosetron (1 μM). Systemic 2-Me-5-HT administration (5 mg/kg, i.p.) significantly: i) enhanced the 5-HT3R-calmodulin interaction in the least shrew brainstem as revealed by immunoprecipitation, and their colocalization in the area postrema of brainstem and small intestine by immunohistochemistry; and ii) activated CaMKIIα in brainstem and enterochromaffin cells isolated from the small intestine by immunoblot and immunocytochemistry. These effects were also suppressed by pretreatment with palonosetron (5 mg/kg, s.c.). Moreover, the following pretreatments, i) amlodipine, an L-type Ca2+ channel (LTCC) blocker; ii) dantrolene, an inhibitor of ryanodine receptors (RyRs) Ca2+-release channels on the endoplasmic reticulum (ER); or iii) a combination of their less-effective doses; but not 2-APB, the blocker of ER inositol 1, 4, 5-triphosphate receptors, dose-dependently suppress the 2-Me-5-HT-caused emesis. Conclusions During 5-HT3R-mediated emesis Ca2+ mobilization occurs via extracellular Ca2+ influx through 5-HT3Rs/LTCCs and Ca2+ release via intracellular RyRs, which initiate activation of Ca2+-dependent CaMKIIα and ERK1/2 signaling to invoke vomiting.

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MASCC-0127 Nausea-Vomiting2 META–ANALYSIS OF APREPITANT COMBINATION REGIMENS FOR PREVENTION OF CHEMOTHERAPY– INDUCED NAUSEA AND VOMITING (CINV) IN ADULTS

N. Gupta1, H. Hatoum2, O. Al Ustwani2, P. Danchaivijitr2, K. Wang3, R. Pili4 1 Palliative Care, State University of New York at Buffalo, Buffalo, USA; 2 Medical Oncology, Roswell Park Cancer Institute, Buffalo, USA; 3 Biostatistics, Roswell Park Cancer Institute, Buffalo, USA; 4 Genitourinary Oncology, Roswell Park Cancer Institute, Buffalo, USA Background and Aims Various randomized controlled trials (RCTs) have shown improved outcomes with addition of aprepitant to standard antiemetic treatment (SAT) for CINV prevention. We conducted a meta-analysis to compare the overall effectiveness and toxicities of aprepitant combination regimens (ACR) versus SAT in CINV. Methods We searched MEDLINE databases and meetings abstracts for RCTs that compared ACR to SAT for CINV prevention in adult cancer patients. Major study end points were complete response to treatment (CR; defined as no emesis and no use of rescue medications) in overall phase (OP; 0– 120 h of chemotherapy), acute phase (AP; 0–24 h) and delayed phase (DP; 24–120 h). Additionally, we assessed nausea control and toxicity profile (TP). Stouffer’s Z-score method was used to calculate overall effect. Results Sixteen RCTs (n=5,547 patients) were included. 3,314 patients received highly emetogenic chemotherapy (HEC) and 2,233 patients received moderately emetogenic chemotherapy (MEC). ACR increased CR in OP from 47 to 63 %(OR=0.52, CI=0.46 to 0.58; p<0.001), in AP from 73 to 81 %(p<0.01), and in DP from 51 to 66 %(p<0.001). Significant increase in nausea control was seen in DP (p=0.03) but not in OP or AP. Slightly higher rate of fatigue (p=0.02), hiccups (p<0.001), and lower rate of neutropenia (p=0.02) was seen in ACR group. Conclusions ACR is effective in CINV due to both HEC and MEC in adult cancer patients. ACR improves the control of emesis in all phases, and nausea in delayed phase only. With the exception of causing more fatigue & hiccups, and lesser neutropenia, overall TP of ACR is similar to SAT.

MASCC-0008 Nausea-Vomiting2 RANDOMIZED STUDY OF THE EFFICACYAND SAFETY OF TRANSDERMAL GRANISTERON COMPARED WITH INTRAVENOUS AND ORAL GRANISETRON WITH MODERATELY EMETOGENIC CHEMOTHERAPY

J. Kim1, Y.S. Hong1, J.L. Lee1, K.P. Kim1, S.J. Park1, Y.O.O.N. S1, S.J. Sym2, D.B. Shin2, J.Y. Lee3, Y.S. Park3, J.S. Ahn3, T.W. Kim1 1 Department of Oncology, Asan Medical Center, Seoul, Korea; 2Division of Hematology and Medical Oncology Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea; 3Division of Hematology/Oncology Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea Background and Aims Granisetron transdermal system (GTS) showed non-inferior efficacy to oral granisetron in chemotherapy-induced nausea and vomiting (CINV) with multi-day chemotherapy. We compared the efficacy and safety of GTS with intravenous (iv) and oral (po) granisetron in Korean patient (pts) receiving moderately emetogenic chemotherapy (MEC).

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Methods A total of 276 pts were randomized to GTS (n=139, one patch, Day 1 to 4) or control group (n=137, iv granisetron 3 mg on D1 and po 2 mg/day on D2-4). The primary endpoint was the percentage of pts achieving complete response (CR: no vomiting and/or retching, no rescue medication) from chemotherapy initiation until 24 h after final administration (non-inferiority margin, 15 %). Results Out of 234 pts (112 in GTS and 122 in control group) included in the per protocol analysis, 0.229 pts had gastrointestinal origin cancer and 180 pts received 3-day chemotherapy. The GTS showed non-inferior efficacy achieving CR in 75.0 % of pts; 74.6 % in control group. (95 % confidence interval: −10.73 % to 11.55 %).CR was not different with subgroup analyses by sex, age, and chemotherapy naivety and analysis per day (D1, 2, 3, 4) and overall days (D1-4). CR in GTS group showed a tendency to maintain through D1 to D4 compared to control group. Patients’ satisfaction using functional living index-emesis (FLI-E), showed no difference. Both treatments were well tolerated and safe with low incidence of severe adverse events. Conclusions GTS showed non-inferior and sustained efficacy with comparable tolerability and FLI-E score in pts receiving MEC. It offers a convenient alternative option for relieving CINV in this setting.

MASCC-0090 Nausea-Vomiting2 SAFETYAND EFFICACY OF APREPITANT, RAMOSETRON, AND DEXAMETHASONE FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN PATIENTS WITH OVARIAN CANCER TREATED WITH PACLITAXEL/CARBOPLATIN

M. Kim1, C. Choi2, L. Lee2, B. Kim2, D. Bae2 1 Obstetrics and Gynecology, Samsung Changwon Hospital Sungkyunkwan University of Medicine, Changwon-si, Korea; 2Obstetrics and Gynecology, Samsung Medical Center Sungkyunkwan University of Medicine, Seoul, Korea Background and Aims Women with ovarian carcinoma that are treated with paclitaxel/ carboplatin are particularly susceptible to chemotherapy-induced nausea and vomiting (CINV). The current study evaluated the new combination (aprepitant/ramosetron/dexamethasone, 20 mg) in ovarian cancer patients receiving multiple cycles of paclitaxel/carboplatin. Methods This is a prospective non-randomized single site study. Patients received the following regimen for the prevention of CINV: Day 1: 125 mg aprepitant, 0.6 mg ramosetron, and 20 mg dexamethasone before chemotherapy; and Days 2–3: 80 mg aprepitant each day. The primary end point was the proportion of patients with complete response (CR) during the 120 h following the first chemotherapy cycle. Toxicity assessments were conducted using the NCI-CTC investigator guide (Version 3.0). Results Of the 89 patients enrolled, 85 patients were evaluable for efficacy and toxicity, and 68 (80 %) completed all 6 cycles. In cycle 1, the percentage of patients who achieved CR in the acute, delayed, and overall phases was 98.8 %, 89.4 %, and 89.4 %, respectively. Of the 460 cycles, adverse events, drug-related adverse events, and serious adverse events occurred in 179 cycles (38.9 %), 35 cycles (7.6 %), and 10 cycles (2.2 %), respectively. The most common adverse event was constipation (12.4 %) and headache (11.1 %). None of the patients discontinued the study because of adverse events. Conclusions The combination of aprepitant, ramosetron, and high-dose dexamethasone demonstrated efficacy for CINV prevention in ovarian cancer patients receiving paclitaxel and carboplatin.

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MASCC-0110 Nausea-Vomiting2 NAUSEA PROFILE ACCORDING TO CONDITIONING REGIMENS IN CANCER PATIENTS UNDERWENT HIGH DOSE CHEMOTHERAPYAND STEM CELLTRANSPLANTATION

S. Komurcu1, M. Ozturk2, N. Karadurmus2, S. Ozaydin2, G. Erdem2, R. Ogur3, F. Arpaci2, M. Beyzadeoglu4, S. Demirbas5 1 Medical Oncology, Memorial Ankara Hospital, Ankara, Turkey; 2 Medical Oncology, Gulhane Medical Academy, Ankara, Turkey; 3Public Health, Gulhane Medical Academy, Ankara, Turkey; 4Radiation Oncology, Gulhane Medical Academy, Ankara, Turkey; 5Internal Medicine, Gulhane Medical Academy, Ankara, Turkey Background and Aims Patients underwent high dose chemotherapy(HDC) and autologous or allogeneic stem cell infusion (SCI) experience nausea frequently. This study was done to evaluate the severity of nausea in the first 10 days after HDC and SCI. Methods Patients underwent HDC and SCI were asked to score nausea severity they have experienced daily in the first 10 days after SCI. Scoring was performed according to a five-grade scale. Total nausea score (TNS) was defined as the addition of the scores of symptom severity in 10 days after SCI. 127 patients, 89 (70 %) of them men, were included into the study. BCNU, Etoposide, Cytarabine, and Melphalan regimen (BEAM) (38,6 %,n=49), Ifosfamide, Carboplatin, and Etoposide regimen (ICE) (23,6 %,n=30), Melphelan regimen (M200)(12,6 %,n=16) or total body irradiation + Cyclophosphamide regimen (TBI+C) (22 %, n=28) were used as conditioning regimens. Results All of the patients experienced nausea at any grade. Mean TNS in the first 5 days according to gender was higher in women when compared to the men (1,34±0,14 vs 0,87±0,09) (p<0.05). No difference was found according to the transplantation type (allogeneic or autologous). The highest mean TNS was achieved at the fourth day after SCI (1,34± 0,10). Mean TNS in 10 days in BEAM,ICE,M200 and TBI + C groups were 0,92±0,10; 0,88±0,15; 1,6±0,24; 1,01±0,18 respectively. TNS in patients who received M200 was the highest when compared with the other regimens (p<0.05). Conclusions All patients that underwent HDC faced nausea at any grade. TNS was higher in women and in the fourth day after HDC and SCI.

MASCC-0037 Nausea-Vomiting2 GINGER - MECHANISM OF ACTION IN CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: A REVIEW

W. Marx1, E. Isenring1, K. Reid2, A. Sali2, L. Vitetta3, D. McKavanagh4, A. McCarthy5 1 Health Sciences and Medicine, Bond University, Gold Coast, Australia; 2 Research Department, National Institute of Integrative Medicine, Melbourne, Australia; 3Research Department, Medlab, Sydney, Australia; 4 Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia; 5School of Nursing, Queensland University of Technology, Brisbane, Australia Background and Aims Despite advances in anti-emetic therapy, chemotherapy-induced nausea and vomiting (CINV) still poses a significant burden to

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patients undergoing chemotherapy. Nausea, in particular, is still highly prevalent in this population. Ginger has been traditionally used as a folk remedy for gastrointestinal complaints and has been suggested as a viable adjuvant treatment for nausea and vomiting in the cancer context. While there is a large body of research that has investigated the potential mechanisms of action of gingers anti-nausea effect, this is the first review to systematically evaluate the evidence-base for these proposed mechanisms. Methods A systematic literature review was conducted which included clinical, in vitro and animal studies both within the chemotherapy context and in other relevant fields. Results Substantial research has revealed ginger to possess properties that could exert multiple beneficial effects on chemotherapy patients who experience nausea and vomiting. Bioactive compounds within the rhizome of ginger, particularly the gingerol and shogaol class of compounds, interact with several pathways that are directly implicated in CINV in addition to pathways that could play secondary roles by exacerbating symptoms. These properties include 5-HT3, substance P and acetylcholine receptor antagonism; anti-inflammatory properties; and modulation of cellular redox signalling, vasopressin release, gastrointestinal motility, and gastric emptying rate. Conclusions The evidence presented in this review indicates that ginger possesses multiple properties that could be beneficial in reducing chemotherapyinduced nausea and vomiting. However, due to existing limitations within the literature, further studies are required before firm recommendations regarding its usage in the oncology setting can be made.

MASCC-0083 Nausea-Vomiting2 APREPITANT VERSUS METOCLOPRAMIDE, BOTH COMBINED WITH DEXAMETHASONE, FOR PREVENTING CISPLATIN-INDUCED DELAYED EMESIS: A RANDOMIZED, DOUBLE-BLIND STUDY

F. Roila1, E. Ballatori2, B. Ruggeri3, S. Fatigoni4, A. Mirabile5, B. Frau6, L. Cavanna7, S. Fava8, I. Colantonio9, L. Angelelli10, L. Ciuffreda11, S.E. Lutrino12, F. Zerilli13 1 Medical Oncology, S.Maria Hospital, Terni, Italy; 2University of L’Aquila, Medical Statistics Institute, L’Aquila, Italy; 3ASUR Marche, Clinical Government, Ascoli Piceno, Italy; 4S.Maria Hospital, Medical Oncology, Terni, Italy; 5Istituto Nazionale Tumori, Fondazione IRCCS, Milano, Italy; 6Monserrato, Medical Oncology Division II, Cagliari, Italy; 7Piacenza Hospital, Medical Oncology, Piacenza, Italy; 8Legnano Hospital, Oncology Unit, Legnano, Italy; 9Azienda Ospedaliera S.Croce e Carle, Medical Oncology, Confreria (CN), Italy; 10Mazzoni Hospital, Medical Oncology, Ascoli Piceno, Italy; 11Molinette Hospital, Medical Oncology Unit, Torino, Italy; 12Azienda Ospedaliera Universitaria, Medical Oncology, Udine, Italy; 13San Antonio Abate Hospital, Medical Oncology, Trapani, Italy Background and Aims A combination of aprepitant, a 5-HT3 receptor antagonist, and dexamethasone is recommended for the prophylaxis of cisplatininduced nausea and vomiting in acute phase, and aprepitant+dexamethasone (A+D) in delayed phase. Aim of this study was to verify if A+D is superior to metoclopramide plus dexamethasone (M+D) in preventing delayed emesis in cancer patients receiving the same prophylaxis for acute emesis.

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Methods A randomized double-blind study comparing A+D versus M+D was completed in previously untreated cancer patients. Before chemotherapy, all patients were treated with intravenous palonosetron 0.25 mg, dexamethasone 8 mg, and oral aprepitant 125 mg. On day 2–4 patients randomly received oral dexamethasone 8 mg qd plus aprepitant 80 mg qd (days 2–3) or metoclopramide 20 mg qid plus dexamethasone 8 mg bid. Primary endpoint was rate of complete response (no vomiting, no rescue treatment) in day 2–5 after chemotherapy. Results Of 303 enrolled patients 288 were evaluable, 147 receiving A+D, 137 M+ D. Day 1 results were similar in both arms. On day 2–5, complete response rate was not significantly different (80.3 % with A+D versus 82.5 % with M+D, p<0.38, respectively), and all secondary endpoints were also similar (complete protection, total control, no vomiting, no nausea, score of Functional Living Index-Emesis; p<0.24). Adverse events incidence was not significantly different between the two treatments. Conclusions In cancer patients submitted to cisplatin-based chemotherapy, receiving the same antiemetic prophylaxis for acute emesis, A+D is not superior to M+D in preventing delayed emesis, and both treatments present similar toxicity.

MASCC-0130 Nausea-Vomiting2 RELATIONSHIP BETWEEN ALCOHOL METABOLISM & CHEMOTHERAPY INDUCED EMESIS

T. Uomori1, J. Matsuoka2, N. Yonemoto2, M. Saito1 1 Breast oncology, Juntendo University Faculty of Medicine, Tokyo, Japan; 2Clinical research center, Juntendo University Faculty of Medicine, Tokyo, Japan Background and Aims Chemotherapy induced nausea & vomiting (CINV) is a common occurrence. Emetic risk is reportedly low in habitual alcoholdrinking patients. Therefore, we hypothesized that CINV is influenced by alcohol metabolism, which might be related to the metabolic pathways of chemotherapeutic drugs or neurotransmitters. We thus aimed to develop a personalized antiemetic therapy based on genetic information. Methods Seventy-three women between 20 and 75 years of age, diagnosed with primary breast cancer stage?-? and undergoing highly emetogenic chemotherapy, were enrolled after providing informed consent. We investigated the relationship between ALDH2 gene typing with an ALDH2 typing kit® and CINV, especially in CR (complete response defined as the absence of vomiting without for rescue) cases, as assessed by patient diaries and MAT scores. Results 40/73 were ALDH2 wild type; 21 CR and 19 non-CR. 31/73 were ALDH2 hetero type; 17 CR and 14 non-CR. 2/73 were ALDH2 mutant type; 1 CR and 1 non-CR. Sixteen of 73 patients drank alcohol more than 3 times/week. Among 12 ALDH2 wild type, there were 10 CR and 2 non-CR cases. However, among 4 ALDH2 hetero type, there were 2 CR and 2 non-CR cases. Conclusions A relationship between alcohol habit and CINV was found in ALDH2 wild type which is common among western countries where most of evidences were obtained. This is the first report investigating the relationships with ALDH2 hetero types. Even though alcohol metabolism in some populations influences the mechanism underlying CINV, other

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pathways or mechanisms may also be involved. Further investigations are necessary to identify these mechanisms.

MASCC-0159 Nausea-Vomiting2 NEPA, A FIXED-DOSE ANTIEMETIC COMBINATION OF NETUPITANT AND PALONOSETRON: RESULTS OF EFFECTIVENESS IN 407 PATIENTS RECEIVING CISPLATIN PLUS CHEMOTHERAPY OF VARIOUS EMETIC RISK

MASCC-0158 Nausea-Vomiting2 SAFETY OF NEPA, AN ORAL FIXED-DOSE COMBINATION OF NETUPITANT AND PALONOSETRON: POOLED DATA FROM THE PHASE 2/3 CLINICAL PROGRAM

M. Aapro1, P.J. Hesketh2, K. Jordan3, R. Gralla4, G. Rossi5, G. Rizzi6, M. Palmas5 1 Department of Medical Oncology, Clinique de Genolier, Genolier, Switzerland; 2Department of Hematology & Oncology, Lahey Hospital & Medical Center, Burlington, USA; 3Department of Oncology/ Hematology, University of Halle, Halle, Germany; 4Department of Oncology, Albert Einstein College of Medicine, Bronx, USA; 5Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 6 Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland Background and Aims NEPA is a convenient dual-pathway antiemetic capsule offering guideline-based prophylaxis as a fixed-dose combination of the new NK1 receptor antagonist (RA), netupitant (NETU), and the pharmacologically distinct 5-HT3 RA, palonosetron (PALO). In Phase 2/3 clinical trials NEPAwas shown to be superior to PALO in preventing CINV with highly (HEC) and moderately emetogenic (MEC) chemotherapy. We evaluated the safety profile of NEPA from the 4 pivotal trials in the Phase 2/3 clinical program. Methods Pooled adverse event (AE) data were evaluated for 3280 patients (7,930 cycles) who participated in 4 randomized, double-blind, multinational clinical trials. NEPA (NETU 300 mg+PALO 0.50 mg) was administered with dexamethasone (DEX) prior to HEC/MEC on Day 1; either PALO 0.50 mg+DEX or aprepitant+5-HT3RA+DEX were comparators. Results The AE profile for NEPAwas as expected, with the majority of AEs being related to the chemotherapy. Headache and constipation were the most commonly reported treatment-related AEs. Serious AEs occurred infrequently. The AE profile was similar over multiple cycles. Cycle 1

NEPA N=1,442

PALO N=1,600

APR N=238

Any AE Treatment-related* AE Headache Constipation Any serious AE Treatment-related* serious AE

955 (65.5 %) 138 (9.6 %) 32 (2.2 %) 27 (1.9 %) 33 (2.3 %) 2 (0.1 %)

945 (59.1 %) 105 (6.6 %) 32 (2.0 %) 29 (1.8 %) 87 (5.4 %) 2 (0.1 %)

135 (56.7 %) 29 (12.2 %) 4 (1.7 %) 2 (0.8 %) 4 (1.7 %) 0

*Investigator assessed as possibly, probably, or definitely related to study drug Conclusions NEPAwas safe and well-tolerated in the Phase 2/3 clinical program during single and multiple cycles of chemotherapy.

P.J. Hesketh1, R.J. Gralla2, G. Rossi3, M. Palmas3, G. Rizzi4 1 Department of Hematology & Oncology, Lahey Hospital & Medical Center, Burlington, USA; 2Department of Oncology, Albert Einstein College of Medicine, Bronx, USA; 3Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 4Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland Background and Aims Prior antiemetic trials have indicated that the emetogenicity of chemotherapy added to cisplatin can affect antiemetic control. Results of the 3-agent aprepitant+ondansetron+dexamethasone regimen showed less efficacy when anthracyclines and/or cyclophosphamide were added to cisplatin. Recent large trials have indicated high efficacy with the 3-agent NEPA+dexamethasone regimen. We analyzed results of a completed, double-blind, 3-agent NEPA study to determine if emetic prevention differed by the chemotherapy added to cisplatin. Methods This analysis evaluated combined NEPA groups from a pivotal trial with 407 chemotherapy-naïve patients receiving 100 mg, 200 mg or 300 mg netupitant+0.50 mg palonosetron on Day 1+dexamethasone during the initial cycle of cisplatin. Results were then analyzed by: Group 1 (additional chemotherapy: none, minimal or low risk) or Group 2 (additional chemotherapy: moderate or high risk). Results Median cisplatin dose: 75 mg/m2; most common additional chemotherapy: cyclophosphamide, fluorouracil, etoposide, doxorubicin. Response category

GROUP 1 (Cisplatin + Lower Risk) N=265

Complete Response Acute 96 % Delayed 91 % Overall 88 % No Significant Nausea* Acute 96 % Delayed 87 % Overall 86 %

GROUP 2 (Cisplatin + Higher Risk) N=142 94 % 91 % 87 % 94 % 87 % 85 %

*CR: no emesis/rescue; No Significant Nausea: max VAS<25 of 100 mm

Conclusions In these patients receiving cisplatin-based chemotherapy, NEPA+ dexamethasone resulted in good control in all risk categories; control was similar no matter which type of additional chemotherapy was given. Interestingly these results differ from prior reports using older NK1 and 5HT3 receptor antagonists in which poorer control occurred with cyclophosphamide and/or anthracyclines added to cisplatin.

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MASCC-0062 Nausea-Vomiting2 OUTCOME OF SUPPORTIVE MANAGEMENT IN THE PREVENTION OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

P. Gachigi Kamau1, J. Rotich1, P. Bartilol1 1 Hemancology, Ampath, Eldoret, Kenya

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Methods Spectra obtained from online sound libraries were analyzed to obtain the ‘fingerprint’ region which isolates vomiting sounds from other associated sounds/noise. Principal component (PC) and principal variable analyses was performed to distinguish vomiting from running tap water (RTW) and coughing. Results Fingerprint region of vomiting soundwave spectra generally comprised of short intense peaks at the beginning, in contrast to coughing spectra, which had longer intense peaks. The RTW spectra were of uniform intensity with no obvious peaks. Amplitudes of coughing spectra were higher than those of vomiting and RTW. Vomiting and coughing could be distinguished from RTW within the first 6 PCs, accounting for 52 % of the variance. Vomiting could be differentiated from coughing within the first 3 PCs (43 % variance). Individual spectra of vomiting, RTW and coughing sounds could be explained within the first 5 (82 %), 6 (82 %) and 7 (84 %) PCs respectively.

Background and Aims PURPOSE: To asses the efficiency of using a 5-HT3 Receptor antagonist, Ondansetron and corticosteroid Dexamethasone and hydration. In the prevention of chemotherapy induced nausea and vomiting in patients with different malignancies receiving moderately ematogenic regime of Doxorubicin and cyclophosphamide and those on high ematogenic single regime Cisplatin. Methods A total of 1,000 patients were recruited in the study between 2010 and 2013. These were patients with confirmed malignancy scheduled to receive moderate ematogenic agent and high ematogenic agent. Both male and females were included. A5-HT3 receptor antagonist ondansetron 8 mgs intravenous bolus and a corticosteroid dexamethasone 12 mgs infusion both 30 to 60 min before chemotherapy. Then intravenous fluids 1 l before chemotherapy and 1 l after chemotherapy. Oral ondansetron and Dexamethasone twice dailyfor 5 days and plenty of oral fluids. Patients telephone numbers were taken for follow up to report on any nausea or vomiting. Results Arm 1 both male and females proportionally 108(15 %) patients experienced nausea during and chemotherapy, while 14(2 %) patients had vomiting. Arm 2 patients receiving high amatogenic single regime Cisplatin females 280,11(4 %) experienced nausea while 3(1.1 %) experienced vomiting during chemotherapy and no delayed nor breakthrough nausea and vomiting reported. Conclusions Administration of Ondansetron, Dexamethasone and good hydration before and after chemotherapy is very affective in preventing nausea and vomiting due to chemotherapy. Supportive care makes excellent cancer care possible.

Conclusions Vomiting soundwave spectra can be used to discriminate patients with CINV from associated background sounds/noise due to the high explanatory power. A clinical pathway based on CINV sound mapping can ultimately be proposed for effective therapeutic management of cancer patients.

MASCC-0051

MASCC-0115

Nausea-Vomiting2

Nutrition

MAPPING OF ‘FINGERPRINT’ SOUNDWAVE SPECTRA AS A MEANS OF DISTINGUISHING CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING

UNDER-DIAGNOSIS OF MALNUTRITION IN PALLIATIVE MEDICINE

K.Y. Yap1, S.W.O. Tan2 1 Department of Pharmacy, National University of Singapore, Singapore, Singapore; 2 Science Research Program, Anglo -Chinese School (Independent), Singapore, Singapore Background and Aims Most risk factors that have been used as clinical predictors of chemotherapy-induced nausea and vomiting (CINV) are subjective. Utilizing vomiting sounds in conjunction with these risk factors presents a more intuitive and objective approach to CINV prediction. This research explores the feasibility of distinguishing vomiting sounds from associated background sounds/noise based on recorded soundwave spectra.

A. Aktas1, D. Walsh1, M. Fischer1, L. Rybicki1 1 The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland, USA Background and Aims Malnutrition is common but likely under-diagnosed. Our objectives were to determine 1) prevalence and severity of malnutrition in cancer patients who received a nutrition therapy assessment (NTA) 2) if the registered dietitian (RD) and physician (MD) agree on malnutrition prevalence 3) if malnutrition is associated with survival. Methods N=182 consecutive NTA by a single RD. ≥2 of the 6 criteria were diagnostic of malnutrition: 1) any unintentional weight loss (WL) 2)

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BMI 3) visual muscle wasting 4) nutrient intake 5) wounds 6) laboratory values (pre-albumin, albumin, transferrin). McNemar’s test determined congruence between RD and MD. Cox analysis assessed the association between malnutrition and survival. Results Median age 61 years (range 28–96); 51 % female. The commonest primary cancer sites: lung (21 %), GI (16 %), GU (15 %). NTA done by RD in 145 patients and malnutrition present in 70 % (9 % mild, 31 % moderate, 30 % severe). The commonest RD malnutrition criteria were: 1) unintentional WL (47 %) 2) low oral intake (39 %) 3) low serum albumin (29 %). N=91 (50 %) nutritional status recorded by MD; malnutrition was noted in 77 % (24 % mild, 22 % moderate, 22 % severe, 9 % unspecified). N=77 had both MD and RD assessment; there was high congruence between RD (77 %) and MD (75 %; P=0.78). Malnutrition was an indicator for poor prognosis (hazard ratio 1.88, 95 % confidence interval 1.26–2.81, P=0.002). Conclusions Malnutrition was highly prevalent. Any WL, oral intake, and albumin were the commonest criteria used by RD to detect malnutrition. Physicians under-recorded nutritional status. Physician and RD agreed on the prevalence of malnutrition. Malnutrition was an indicator of poor prognosis in cancer.

MASCC-0104 Nutrition THE EFFECT OF GINGER (ZINGIBER OFFICINALE ROSCOE) IN PATIENTS WITH THE ANOREXIA CACHEXIA SYNDROME (ACS)

M. Chasen1, R. Bhargava1 1 Palliative Care, Bruyere Research Institute, Ottawa, Canada Background and Aims Our aim is (1) To determine effect of oral Ginger administration on Gastric Myoelectrical activity (GMA) in patients with ACS (2) To evaluate symptoms in patients with ACS as measured by Edmonton symptom assessment scale (ESAS), patient generated subjective global assessment (PGSGA) and dyspepsia symptom severity index (DSSI). (3) To correlate level of inflammatory markers and Ghrelin in patients with ACS and impaired GMA. Methods Patients with ACS are recruited to document a baseline and post water load Electrogastrography (EGG) after oral ingestion of Ginger capsule (1,650 mg) once daily, for 14 days . DSSI, ESAS and PG-SGA are filled and Blood test to measure Ghrelin, albumin and CRP are done pre and post intervention. Descriptive statistics of EGG findings will be presented reflecting the categories of dysfunction. Results This study is active. To-date 8 patients (M2;F6; median age 57 years) were enrolled and all completed the 14 day trial. EGG Diagnosis before the intervention: 4 Tachygastria, 3 Bradygastria, 1 Mixed Dysrythmia; after the 14 day trial with Ginger-All 8 patients had Mixed Dysrythmianonspecific type. All reported improvement in GI symptoms as measured by the DSSI, ESAS and PG-SGA. Results will be analyzed in May 2014. Conclusions This study is primarily exploratory as there is no data on pattern of GMA in response to Ginger in patients with ACS. Preliminary findings suggest that Ginger probably enhances gastric motility as measured by EGG. By increasing gastric emptying, ginger may improve a range of GI symptoms that can affect oral intake and quality of life.

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MASCC-0427 Nutrition A STUDY OF DIETARY INTAKE AND THE RELATIONSHIP TO NEUTROPHIL ENGRAFTMENT AMONG OUTPATIENT HEMATOPOIETIC STEM CELLTRANSPLANT PATIENTS WITH MULTIPLE MYELOMA

J. Heimgartner1, F.K. Buadi2, J. Vruwink1, W.J. Hogan2, S. Hashmi2 1 Clinical Nutrition, Mayo Clinic, Rochester, USA; 2Hematology/BMT, Mayo Clinic, Rochester, USA Background and Aims At Mayo Clinic (MN) autologous hematopoietic stem cell transplants (HSCT) for Multiple Myeloma (MM) are performed in an outpatient basis and patients consume only an oral ad libitum diet. Current literature suggests that calorie/protein needs following HSCT exceed basal requirements, despite lack of evidence that this improves outcomes. Objectives: To describe the calorie and protein intake of MM patients receiving outpatient autologous HSCT, and explore relationships between intake and neutrophil engraftment. Methods Intake information from patient food records were reviewed retrospectively for adult MM patients who received auto-HSCT 2010–2012. Descriptive statistics were used to describe demographic/clinical characteristics. Pearson’s correlations were utilized to explore relationships between calorie/protein intake and engraftment. Results The study population (n=230) was predominantly male (56.1 %) with mean age of 60.6 years (range 35–75 years). At time of transplant, 77.8 % had a BMI classified as either overweight or obese. The mean calorie intake of the sample was 1530.4±452.1 per day (18.8±6.3 kcal/kg/day) and mean protein intake of 52.7±20.0 g per day (0.65±0.26 g/kg/day). Mean time to neutrophil engraftment was 15.1 ± 2.5 days (range 10–23 days). There were statistically significant weak positive correlations between calorie (r=+0.187, p=0.004) and protein intake (r=+0.199, p=0.002) and engraftment, but not clinically meaningful given many other variables affecting engraftment.

Calorie & Protein Intake and Timing of Neutrophil Engraftment Mean ± SD Mean daily calorie intake (kcal) Total 1,530.4±452.1 Kcal/kg 18.8±6.3 Mean daily protein intake (grams) Total 52.7±20.0 g/kg 0.65±0.26 Time to neutrophil 15.1±2.5 engraftment (days)

Median

Range

1,516.0 18.5

253.0–2,697.0 3.2–38.5

50.7 0.63 15.0

4.5–109.4 0.06–1.48 10–23

Conclusions Compared to the general population, study subjects had higher prevalence of overweight or obesity. A majority of patients did not meet estimated basal energy or protein requirements; however there was no correlation between calorie or protein intake and engraftment timing that could be considered clinically relevant.

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MASCC-0390 Nutrition PREVALENCE OF LONG TERM CRITICALWEIGHT LOSS AND ITS EFFECT ON TREATMENT OUTCOMES IN PATIENTS WITH HEAD AND NECK CANCERS TREATED WITH CONCURRENT CHEMORADIOTHERAPY

J. Kim1, S. Park1, D. Yoon1, S. Kim1 1 Medical Oncology, Asan Medical Center, Seoul, Korea Background and Aims The incidence of long-term severe weight loss (LT-SWL) with its related clinical factors and its effect on treatment outcomes were investigated in patients with locally advanced head and neck cancers (LAHNC) treated with concurrent chemoradiotherapy (CCRT). Methods LT-SWL was defined as more than 10 % weight loss compared with pretreatment body weight at 6 months after completion of CCRT. Between January 2008 and December 2009, a total of 116 patients with LAHNCs treated with CCRT in Asan Medical Center was identified LTSWL. Results Fifteen patients (12.9 %) had BMI of less than 20, initially. After completion of CCRT, absolute and proportional weight loss was 9.0 kg (SD 4.59) and 13.4 % (SD 6.25), respectively. Sixty three patients (54.3 %) had LT-SWL and 19 patients (16.4 %) experienced more than 20 % weight loss at 6 months after completion of CCRT. The patients who required gastrostomy during CCRT showed increased risk of LT-SWL [Hazard ratio (HR) 5.59 95 % CI 1.5–20.8; p=0.010]. LT-SWL patients showed shorter disease-free survival (DFS) (median DFS, 44 months vs not reached p=0.010). The patients with prophylactic gastrostomy and those without need for gastrostomy showed longer DFS than those who required gastrostomy during CCRT, respectively (median DFS, not reached in both groups vs 10.0 months, p=0.013). On multivariate analysis, LTSWL was the independent prognostic factor associated with DFS (HR 3.01, 95 % CI 1.39–6.51; p=0.005). Conclusions Significant proportion of patients treated with CCRT has experienced LTSWL, and LT-SWL was associated with worse treatment outcomes. Early nutritional intervention via gastrostomy might be of help to ameliorate incidence of LT-SWL in patients with LAHNC receiving CCRT.

MASCC-0624 Nutrition PREVALENCE OF LONG TERM CRITICALWEIGHT LOSS AND ITS EFFECT ON TREATMENT OUTCOMES IN PATIENTS WITH HEAD AND NECK CANCERS TREATED WITH CONCURRENT CHEMORADIOTHERAPY

J. Kim1, S. Park1, D. Yoon1, S. Kim1 1 Medical Oncology, Asan Medical Center, Seoul, Korea Background and Aims The incidence of long-term severe weight loss (LT-SWL) and its effect on treatment outcomes were investigated in patients with locally advanced head and neck cancers (LAHNC) treated with concurrent chemoradiotherapy (CCRT). Methods We identified 116 patients with LAHNCs treated with CCRT in Asan Medical Center from January 2008 to December 2009. LT-SWL was

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defined as more than 10 % weight loss compared with pretreatment body weight at 6 months after the completion of CCRT. Results Fifteen patients (12.9 %) had BMI of less than 20, initially. After completion of CCRT, absolute and proportional weight loss was 9.0 kg (SD 4.59) and 13.4 % (SD 6.25), respectively. Sixty three patients (54.3 %) had LT-SWL and 19 patients (16.4 %) experienced more than 20 % weight loss at 6 months after completion of CCRT. The patients who required gastrostomy during CCRT showed increased risk of LT-SWL [Hazard ratio (HR) 5.59 95 % CI 1.5–20.8; p =0.010]. LT-SWL patients showed shorter disease-free survival (DFS) (median DFS, 44 months vs not reached p =0.010). The patients with prophylactic gastrostomy and those without need for gastrostomy showed longer DFS than those who required gastrostomy during CCRT, respectively (median DFS, not reached in both groups vs 10.0 months, p=0.013). On multivariate analysis, LT-SWL was the independent prognostic factor associated with DFS (HR 3.01, 95 % CI 1.39–6.51; p=0.005). Conclusions Significant proportion of patients treated with CCRT has experienced LT-SWL, and LT-SWL was associated with worse treatment outcomes. Early nutritional intervention via gastrostomy might be of help to ameliorate incidence of LT-SWL in patients with LAHNC receiving CCRT.

MASCC-0087 Nutrition PATIENT SATISFACTION WITH AN INTENSIVE NUTRITION INTERVENTION COMPARED TO USUAL CARE IN LUNG CANCER PATIENTS RECEIVING (CHEMO)RADIOTHERAPY

N. Kiss1, M. Krishnasamy1, K. Gough1, G. Wheeler2, A. Wirth2, B. Campbell2, E. Isenring3 1 Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; 2Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia; 3Faculty of Health Sciences and Medicine, Bond University, Melbourne, Australia Background and Aims Patient satisfaction with health care services is a key indicator of quality of care and an important measure of the acceptability of a new model of care. Objectives: To determine patient satisfaction with an intensive nutrition intervention compared to usual care in lung cancer patients receiving (chemo)radiotherapy. Methods A phase II nutrition intervention study included 24 lung cancer patients randomised to the intervention (n=12) or usual care (n= 12). The intervention employed a care pathway to guide intensive, individualised nutritional management up to 6 weeks postradiotherapy. Patient satisfaction was assessed at 6 weeks postradiotherapy using a valid satisfaction with nutrition services questionnaire. A priori difference of 0.3 is clinically important. Groups were compared using independent t-tests. Results Twenty-four patients consented to participate in the study (50 % male, mean age 63.4±12.2 years), 19 completed the study to the end of the intervention period and 14 patients completed the questionnaire (n=7 usual care; n=7 intervention; 74 % response rate). Overall satisfaction was rated higher in intervention participants, which was clinically but not statistically significant (4.67±0.82 vs 4.00±0.58, p=0.11). Although not

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statistically significant, patient-perceived health benefit was rated higher in the intervention arm (4.37±0.64 vs 4.04±0.44, p=0.28). Dietitian interpersonal skills were rated equally across groups (3.54±0.44 vs 3.54±0.80, p=1.00).

Dimension

Overall satisfaction Perceived benefit Interpersonal skills

Usual care n=7 Mean (SD) 4.00 (0.58)

Intervention n=7 Mean (SD) 4.67 (0.82)

Mean difference (95 %CI)

p

−0.67 (−1.5, 0.19)

0.11

4.04 (0.44)

4.37 (0.64)

−0.33 (−0.97, 0.31) 0.28

3.54 (0.44)

3.54 (0.80)

0.00 (−0.75, 0.75)

wellbeing had improved relative to baseline in both groups and between-groups differences were trivial to small. Time point/ variable

End of radiotheraphy Weight (kg)

1.00

Conclusions Patient satisfaction was high in both study arms but higher overall satisfaction was observed in the intervention arm, indicating acceptability of an intensive nutrition intervention in lung cancer patients receiving (chemo) radiotherapy.

Maximum likelihood estimates of within-groups change relative to baseline Usual care Intervention arm Difference Difference (95 %CI) (95 %CI)

Between-groups comparison Difference (95 %CI)

Effect size

−0.88 (−3.47, 1.71)

2.15 (−0.64, 4.93)

3.0 (−0.8, 6.8)

0.70

Fat-free mass (kg) Physical well-being Functional well-being 3 months post radiotherapy Weight (kg) Fat-free mass(kg)

−0.03 (−1.87, 1.81) −2.72 (−5.68, 0.24)

0.56 (−1.44, 2.56) −0.63 (−3.85, 2.59)

0.6 (−2.1, 3.3) 2.1 (−2.3, 6.5)

0.19 0.42

−5.62 (−8.01, −3.22)

−0.53 (−3.07, 2.01)

5.1 (1.6, 8.6)

1.29

0.34 (−4.37, 5.05) −0.25 (−1.62, 1.13)

5.82 (0.87, 10.77) 1.24 (−0.24, 2.71)

5.5 (−1.4, 12.3) 1.48 (−0.5, 3.5)

0.71 0.67

Physical well-being Functional well-being

2.96 (−0.32, 6.22) 0.27 (−3.08, 0.56)

2.25 (−1.11, 5.61) −1.19 (−4.29, 1.92)

−0.7 (−5.39, 4.0) −1.4 (−5.8, 2.9)

0.13 0.31

Conclusions In this pilot study dietary counselling improved weight, fat-free mass, fatigue and functional outcomes in lung cancer patients receiving (chemo)radiotherapy.

MASCC-0086 Nutrition EARLYAND INTENSIVE DIETARY COUNSELLING IN LUNG CANCER PATIENTS RECEIVING (CHEMO)RADIOTHERAPY – A PILOT RANDOMISED CONTROLLED TRIAL

MASCC-0278

N. Kiss1, E. Isenring2, K. Gough1, G. Wheeler3, A. Wirth3, B. Campbell3, M. Krishnasamy1 1 Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; 2Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; 3Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia

EVALUATION OF NUTRITIONAL ASSESSMENT BY RADIOLOGICALLY INSERTED GASTROSTOMY IN HEAD AND NECK CANCER PATIENTS

Background and Aims Despite a high prevalence of malnutrition, intensive dietary counselling has not been evaluated in lung cancer patients during (chemo)radiation. Objectives: To evaluate the impact of intensive dietary counselling on nutritional, functional and fatigue outcomes. Methods A phase II nutritional intervention study included 24 lung cancer patients randomised to the intervention or usual care. The intervention employed a care pathway to guide intensive, individualised nutritional management up to 6 weeks post-radiotherapy. Nutritional (patient-generated subjective global assessment, weight, fat-free mass) and QOL (FACT-L functional and physical wellbeing) outcomes were assessed before randomisation, start and end of radiotherapy, at one and 3 months post-radiotherapy. Outcomes were analysed with linear mixed models. Results Twenty-four participants were recruited (50 % male, mean age 63.4± 12.2 years). Relative to baseline, intervention patients (n=12) showed clinically important benefits at the end of radiotherapy compared to usual care patients (n=12): weight (3.0 kg; 95 %CI −0.8, 6.8, p=0.11) and fatfree mass (0.6 kg; 95 %CI −2.1, 3.3, p=0.66) improved, and physical (2.1; 95 %CI −2.3, 6.5, p=0.33) and functional wellbeing (5.1; 95 %CI 1.6, 8.6, p=0.01) deteriorated less. Between-groups difference for functional wellbeing was large and statistically significant (p=0.01). Three months post-radiotherapy, intervention benefits for weight (5.5 kg; 95 %CI −1.4, 12.3, p=0.71) and fat-free mass (1.48 kg; 95 %CI −0.5, 3.5, p=0.14) were sustained. At this time, physical and functional

Nutrition

G. Gobert1, E. Tresch2, D. Chevalier3, L. Ceugnart4, C. Calcoen5, F. Ghestem1, G. Lefebvre1 1 Head and Neck Oncology, Oscar Lambret Center, Lille, France; 2 Methodology and Biostatistics Unit, Oscar Lambret Center, Lille, France; 3Head and Neck Surgery Department, University Hospital C.Huriez, Lille, France; 4Radiology Department, Oscar Lambret Center, Lille, France; 5 Supportive Care Department, Oscar Lambret Center, Lille, France Background and Aims Enteral nutrition using radiologically inserted gastrostomy (RIG) is currently a widespread technique in oncology. The real efficiency in weight gain in addition to the life expectancy according to the performance status (PS) of the patient is controversial, and the incidence of the undesirable effects is unknown. Methods This retrospective study focus on patients hospitalised in 2011 and 2012 for RIG. We collected data at inclusion and after 1 month and 3 months. Results One hundred twenty-nine patients were included in the study. The most frequent indication for RIG was malnutrition (n=79, 62 %). The median PS at inclusion was 2 [0–4] (43 % patients included). The median time for hospitalization was 4 days [1–14]. A failure of insertion of the gastrostomy device occurred for 22 % of the patients (n=28), the most common reason was anatomic causes (n=20, 16 %). Digestive tolerance was good (n=87, 96 %). Moderate complications occurred in 53 % (n= 53), most common cause was accidental removal of the tube (n=26, 26 %). The average gap between the original weight and the normal weight was −11.1 kg (SD=6.8), with a more significant loss in the group of PS≥3 versus PS <3 (p=0.031). The variation in weight after 1 month compared to the normal weight was also significantly more important in the group of PS≥3 versus PS<3 (p=0.033).

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Conclusions In our study, the PS at the moment of the insertion was predictive to the weight change after 1 month compared to the normal weight, with a more significant loss in patients with PS≥3. RIG was well tolerated.

MASCC-0373 Nutrition ASSOCIATION OF NUTRITIONAL STATUS WITH CHEMOTHERAPY RELATED ADVERSE EVENTS IN CURA TIVE OPERATED GASTRIC CANCER PATIENTS

S.H. Seo1, Y.K. Kang2, B.Y. Ryoo2, M.H. Ryu2, J.H. Jeong2, S.S. Kang1, J.E. Lee3, M.K. Sung3 1 Dietetics and Nutrition Services Team, Asan Medical Cencer, Seoul, Korea; 2Oncology, Asan Medical Cencer University of Ulsan College of Medicine, Seoul, Korea; 3Food and Nutrition, Sookmyung Women’s University, Seoul, Korea Background and Aims Gastric cancer patients who underwent gastrectomy often experience the increased susceptibility to chemotherapy-related side effects as well as the decreased treatment responses. It is critical to perceive the rate of malnutrition in gastrectomized patients receiving chemotherapy and to identify indices of malnutrition predicting the susceptibility to chemotherapy-related adverse events. Tthe objective of this study was to determine malnutrition indices closely related to the side-effects in patients receiving chemotherapy. Methods The medical records of 234 cancer patients who had received adjuvant S-1 chemotherapy following curative gastrectomy with D2 lymph node dissection were used in the analyses. Nutritional status were assessed using PG-SGA (Patient-Generated Subjective Global Assessment), body weight, body mass index (BMI), serum albumin concentration and nutrition risk index (NRI). Chemotherapy-originated adverse events were determined during the entire treatment period. Results The mean age of the patients was 55 years-old (25 to 78 years-old) and 59 % of the patients were malnourished based on and 27.8 % of the patients revealed the PG-SGA score of ≥9, an indicator of serious malnutrition. Multivariate analysis using binary logistic regression showed that female, lower BMI, and hypoalbuminemia were independent risk factors for grade 3/4 hematologic adverse events and that the old age was a risk factor for grade 3/4 nonhematologic adverse events. Neutropenia was the most frequently occurring hematological adverse event and associated risk factors were female, total gastrectomy and hypoalbuminemia. Conclusions Proper nutrition intervention to retain body mass index and hypoabluminemia before starting chemotherapy may increase the success rate of chemotherapy in gastrectomized cancer patients.

MASCC-0241 Oncology Nursing A LONGITUDINAL STUDY OF THE EFFECTS OF HOME-BASED RELAXATION TRAINING PROGRAM ON ANXIETYAND DEPRESSION FOR PATIENTS WITH BREAST AND COLORECTAL CANCER

K. Cheng1, N. Chan2, C. Chan3, N.K.E. Ang4 1 Nursing, National University of Singapore, Singapore, Singapore; 2 Medicine, National University Cancer Institute, Singapore, Singapore; 3 Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 4Nursing, National University Cancer Institute, Singapore, Singapore

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Background and Aims Cancer diagnosis and the morbidities associated with cancer therapy can give rise to psychological distress and depressive symptoms in patients with breast or colorectal cancer. The study aims to determine the effects of relaxation training program on anxiety and depression. Methods Subjects who had a diagnosis of breast or colorectal cancer and treated with adjuvant cancer therapy were recruited and randomized either to an experimental (homebased relaxation training program including progressive muscle relaxation, distraction and guided imagery) or a control group. Hospital and Depression Scale (HADS) was completed at baseline (time 1), at 6 weeks from time 1 (time 2), at 12 weeks from time 1 (time 3), and at 24 weeks from time 1 (time 4). Results One hundred forty-three subjects (mean age 54 years; 75 % with breast cancer) were accrued and randomized into experimental (n=72) or control (n=71) group. Subject characteristics and HADS scores were equivalent at baseline. The mean HADS-A and HADS-D scores of both groups varied significantly across the study points (p<0.01). In general, the patterns of HADS-A and HADS-D scores were similar in the two groups, which peaked on time 2 and 3. Comparison between the groups showed that subjects in the experimental group reported lower mean HADS-A and HADS-D scores than the control group at time 2–3, but the differences were not significant (p>0.05). There was statistically significant difference in the mean HADS-A and HADS-D scores between the groups at time 4 (p<0.05). Conclusions The finding suggests that relaxation training program may reduce the levels of anxiety and depression at 24 weeks.

MASCC-0350 Oncology Nursing PARENTAL DECISION MAKING AND QUALITY OF LIFE IN CHILDREN WITH CANCER

M. Chen1, H.S. Yang2, L.H. Hung3, W.Y. Wu3, Y.L. Lee3, K.G. Yao4, Y.C. Chang5 1 Nursing, Tzu Chi College of Technology, Hualien, Taiwan; 2medical college, Tzu Chi university, Hualien, Taiwan; 3Nursing, National Taiwan University, Taipei, Taiwan; 4Psychology, National Taiwan University, Taipei, Taiwan; 5Mathematics, Tamkang University, Taipei, Taiwan Background and Aims To understand how the cancer treatment decisions, and how the cultural context of eastern Taiwan affect the quality of life of parents when their children are hospitalized. It is important of these integrations into the daily lives, as well as to serve as a reference for medical care. Methods There are a total of ten parents participating in this quantitative research. By In-depth interviews and focus group discussions. Results There are four terms of the quality of life: (1) Physiologically: Their sleep is disturbed due to the treatments of the children; They are more prone to feeling tired or catching a cold. (2) Psychologically: They are concerned about (a) the side effects of the treatments on the children, and (b) the children’s emotional changes under the invasive treatments; Feeling guilty when the other children in the family are being neglected; Feeling difficult reconciling the demands of work and caring for the sick children. (3) The changes in everyday lives: the diets are mainly composed of self-grown food; Timely isolations in the home environments; Living in one’s tribe. (4) Using the support system: the mutual support among couples, siblings, and paramedical staff.

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Conclusions They hope that the health of their children can be improved given that (1) the treatments are done in nearby hospitals; (2) they can spend more time with their children; and (3) there are changes in the way of living. It is recommended that the family members and paramedical staff be the positive force supporting the healing of the children.

MASCC-0375 Oncology Nursing THE EFFECT OF MINDFULNESS-BASED STRESS REDUCTION PROGRAM ON PHYSICAL, PSYCHOLOGICAL STATUS AND QUALITY OF LIFE FOR PATIENTS WITH METASTATIC BREAST CANCER

L. Chung Eun1, L. Soohyeon2, K. Sang Hee3, K. Sue3, J. Hye Myung4 1 Medical oncology outpatient clinic, Yonsei cancer center Yonsei Univertiy Health System, Seoul, Korea; 2Yonsei University College of Medicine, Division of Oncology Department of Internal Medicine, Seoul, Korea; 3Yonsei University College of Nursing, Department of Clinical Nursing, Seoul, Korea; 4Instructor, Mindfulness Institute, Seoul, Korea Background and Aims This study is to intervene metastatic breast cancer (MBC) patients under the palliative treatment. The nonequivalent control group pre-posttest design was utilized to explore the effectiveness of Mindfulness-Based Stress Reduction Program (MBSR) for improving physical and psychological status with MBC patients. Methods The MBSR program was conducted once a week, 2 h each, for 8 weeks at Yonsei Cancer center outpatient clinic in Korea from May 14th to August 21th in 2013. Total 18 patients were assigned to both MBSR group and control arm. We assessed pain (Brief Pain Inventory, BPI), autonomic nervous function (Heart rate variability), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), distress (distress thermometer), and quality of life (Functional Assessment of Cancer Therapy–Breast, FACT-B) This data was assessed by of using nonparametric statistics because of insufficient number. Results Average pain score slightly decreased (p=0.080), general activity, sleep, and enjoyment of life were improved (p=0.049, p=0.042, p=0.045 respectively) between groups. Within MBSR-group, the mean of SDNN showed improved tendency from 24.84 to 59.95 (p=0.051), DT was significantly improved from 4.89 to 3.56 (p=0.042), and functional well-being was increased (p=0.037). This study did not showed improvement in anxiety, depression and quality of life. Conclusions The MBSR program had some mild effect to improve physical status and alleviate distress. All of them were satisfied with the MBSR program, felt improved sleep quality and wanted to maintain the peer group activities though the interview. Therefore, there should be the supportive intervention to help the MBC patients.

MASCC-0314 Oncology Nursing STUDY ON THE HELPFULNESS OF SUPPORT GROUPS FOR THE FAMILIES OF OUTPATIENTS UNDERGOING CHEMOTHERAPY FOR CANCER

N. Hira1, F. Karatsu1, I. Tanaka2, H. Narui3 1 Nursing and Social Services, Health Sciences University of Hokkaido, Tobetsu, Japan; 2Nursing, Teine Keijinkai Hospital, Sapporo, Japan; 3 Nursing, Aomori University of Health and Welfare, Aomori, Japan

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Background and Aims This study aims at examining the helpfulness of a support group program for the families of outpatients undergoing chemotherapy for cancer. Methods The program consists of three sessions according to its three goals: 1) Enhancing coping skills, 2) Promoting the physical and psychosocial stability of each participant and 3) Developing a positive attitude toward life with a family member who is undergoing chemotherapy. Each of the sessions includes communication among families, the sharing of information and knowledge, and relaxation. Four nurses, a physical therapist and a dietitian worked together in conducting a pretest of the program. Results Family members of four outpatients with cancer participated the program. Regarding the participants, the T-score for vigor in the Profile of Mood States (POMS), which was 38.3 before they participated in the program, increased to 45.7 after the program. Also on Ozeki’s Coping Scale, the scores for emotionfocused coping and avoidance coping decreased from 5.66 to 3.66 and from 6.33 to 3, respectively. The participants were asked how they were caring for their own health. After the program, the number of participants who answered ‘It would be better if I didn’t express my own mental distress’ and ‘I’m not supporting the patient sufficiently’ decreased, and the number of participants who answered ‘The more I’m informed, the better I can cope’ increased. Conclusions The pretest result suggests the helpfulness of the support group program as well as the situations that make it difficult for family members to take part in this kind of program.

MASCC-0355 Oncology Nursing NURSES’ RECOGNITION OF TEAM MEDICAL CARE THAT SUPPORTS OUTPATIENTS UNDERGOING CHEMOTHERAPY FOR CANCER

H. narui1, N. hira2, T. honma1, A. denpoya1, G. urita1 1 Department of Nursing Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan; 2School of Nursing and Social Services, Health Sciences University of Hokkaido, Tobetsucho, Japan Background and Aims The research investigates how nurses recognize team medical care that provides support to outpatients undergoing chemotherapy for cancer. Methods Research participants were 10 nurses taking care of outpatients undergoing chemotherapy for cancer. Data was collected in an interview survey, with the data being analyzed qualitatively and inductively. The ethics boards of the university and the hospital approved of the study. Results The views were summarized in eight items, among which were the following: 1) comprehensive support provided by health care professionals from multiple fields who make a holistic assessment of each patient should be ensured, 2) problems that patients may have should be promptly identified and resolved, 3) patients and medical care teams should have discussions on equal terms, 4) nurses should be allowed to serve as coordinators who help the health care professionals from diverse fields on medical care teams and 5) nurses need to make efforts to gain the trust of health care professionals by improving the nurses’ skills and knowledge regarding care for outpatients undergoing chemotherapy. Conclusions The nurses hold the view that medical care teams for supporting outpatients undergoing chemotherapy for cancer should be interdisciplinary ones that place a high value on the process of reaching a mutual understanding among team members, who work on equal terms. The nurses also consider it necessary that nurses be allowed to serve as coordinators who help the health care professionals from diverse fields on medical care teams.

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MASCC-0511 Oncology Nursing SUPPORTIVE CARE NEEDS IN PATIENTS WITH LUNG CANCER

K. Suwannapong1, S. Thanasilp1 1 Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand Background and Aims The supportive care needs of patients with lung cancer will change in severity and complexity along the disease trajectory. It is important to identify those needs as effectively as possible so that nurses can be provided the appropriate resources for help. The purpose of this study was to identify component of the supportive care needs for Thai patients with lung cancer. Methods A total of 193 lung cancer patients who aged 20–59 year, attended at outpatient oncology units of tertiary hospitals in Bangkok, Thailand participated in this study by completing a Supportive Care Needs Survey Short Form 34 (SCNS-SF34) questionnaire (Thai version). Principal factor analysis was used to identify component of the supportive care needs. Results The results found that supportive care needs in Thai patients with lung cancer comprise of five components with 81.84 % of variance explained. Physical and daily living needs (5 items), Psychological needs (9 items), Health information needs (9 items), Caring (Self-care & treatment) needs (7 items), and Health system needs (4 items). Conclusions Oncology nurses should emphasize in terms of these naturally components of supportive care needs when conducting intervention. Future researches are offered to find the factors effecting on supportive care needs and the intervention for improving patients‘ needs of lung cancer patients.

MASCC-0524 Oncology Nursing DOING ONE’S UTTERMOST: NURSES EXPERIENCES ON CARING FOR DYING PATIENTS IN MAINLAND CHINA

R.Z. Zheng1, Q.G. Guo2, F.D. Dong3, G.O. Owens4 1 Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; 2College of Nursing, University of Massachusetts Amherst, Amherst, USA; 3Department of Hepatobiliary, Tianjin Medical University Cancer Hospital, Tianjin, China; 4School of Psychology, University of Auckland, Auckland, New Zealand

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loss and sadness when caring for the dying. They were inexperienced in psychological care and how to communicate with the dying, but tried their best at promoting comfort and maintaining dignity for patients and family members. Conclusions Nurses suffered but also benefited from their experiences. The more years that nurses have been working with dying patients, the more positive the experience becomes. End-of-life care trainings are needed by Chinese oncology nurses, especially for younger and less experienced ones.

MASCC-0019 Oncology Nursing 2 ASSESSING SYMPTOM USING AWEB-BASED SURVEY PLATFORM AMONG CHINESE ONCOLOGY PATIENTS

C. Chan1, K. Kwong2, W. So1, K.M. Chow1, J. Sit1 1 Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 2Nursing, National University of Singaporre, Singapore, Singapore Background and Aims This paper aimed to report a pilot study of using an electronic self-report symptom assessment tool among Chinese oncology patients undergoing cancer therapy. Methods A web-based survey platform, the Electronic Self Report Assessment – Cancer (ESRA-C), developed by The University of Washington, Distributed Health Assessment and Intervention Research (DHAIR) group, was translated and adapted into Chinese and tested in a cancer resource centre in Hong Kong. The assessment of the severity and impacts of the symptoms was undertaken using four measures: quality of life (EORTC QLQ-30 v.3), symptom distress (Symptom Distress Scale (SDS)), pain (The Pain-Intensity Numerical Scale (PINS)) and psychological distress (Patient Health Questionnaire-depression module (PHQ-9)). Results A convenience sample of 30 (11 male and 19 female) oncology patients was assessed. Participants had very low scores on pain, symptoms, and depression and their overall QOL was good [EORTC Global Health Status/Quality of Life=60 (SD: 20.94), PINS=1.69 (SD: 2.09), SDS= 22.57 (SD: 7.34), PHQ-9-overall depression scale=5.46 (SD: 5.8). Conclusions The study suggested that electronic assessment can offer a feasible means of implementing regular and comprehensive symptom assessment, which can lead to better symptom management in cancer patients.

MASCC-0239 Oncology Nursing 2

Background and Aims Caring for dying patients may be very stressful for nurses. However, little is known about Chinese oncology nurses’ experience of caring for dying cancer patients. This study aims to elucidate the views of Chinese nurses’ experiences in caring for dying cancer patients who are on their final days. Methods A phenomenological study using a qualitative approach with semistructured interviews was utilized to explore views of convenient sample of 23 nurses who have taken care of terminally ill patients in a cancer hospital in Tianjin, mainland China. Thematic analysis was used to analyze the data. Results Subjects expressed negative experiences and feelings when caring for dying cancer patients. Nurses, especially the younger and inexperienced ones reported feelings of fear, stress, and helplessness along with sense of

A LONGITUDINAL STUDY OF THE SYMPTOM AND QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH CANCER

K. Cheng1, C. Chan2, L.T.M. Tan3 1 Nursing, National University of Singapore, Singapore, Singapore; 2 Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 3Viva University Children Cancer Centre, National University Hospital, Singapore, Singapore Background and Aims To characterize the symptoms reported by cancer patients who were between 10 and 18 years of age, and to explore the relationship between symptom and quality of life (QoL) scores.

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Methods Thirty-one children (mean age, 14 years; 65 % was boys) diagnosed with hematological malignancy (71 %) and solid tumor (29 %) were enrolled for analysis. Data were collected before commencement of chemotherapy (time 1), at 2 months from time 1 (T2), at 4 months from time 1 (T3), and at 6 months from time 1 (T4). Measuring instruments included Memorial Symptom Assessment Scale Pediatric 10–18 (MSAS) and Pediatric Cancer QoL Inventory. Results The prevalence of symptoms ranged from 71 % for lack of energy to 3 % for diarrhea at T1. The most common reporting symptoms (>45 %) were lack of energy, weight loss, lack of appetite, pain, dry mouth, nausea and feeling of sadness, and they decreased to 36 %, 23 %, 26 %, 13 %, 7 %, 26 % and 13 %, respectively, at T4. The median score for the MSAS Physical (PHY) was the highest at T1 (0.85). All of the MSAS subscale and total scores decreased significantly over time (p<0.01). The median score for the Physical QoL was the lowest at baseline (66.6), and it decreased significantly at T2 and T3 (p<0.05). Significant strong correlations were noted between MSAS PSYCH and GDI scores, and Emotional and Psychosocial Health across study points (r>0.55; p<0.01). Conclusions Symptoms are highly prevalent but are in a descending pattern over time. The data also support the correlations between psychological symptoms and the emotional sphere of QoL.

MASCC-0089 Oncology Nursing 2 LUNG CANCER SCREENING: IS IT ALL SMOKE?

A. Devigne1, S.K. Keaveney1, N.R. Rizk1 1 Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York City, USA Background and Aims Lung cancer is the number one cause of cancer deaths in the US and worldwide. Cigarette smoking is the principal risk factor associated with the development of lung cancer. The majority of lung cancers are detected when patients are symptomatic. Recently, the National Lung Screening Trial (NLST) demonstrated the efficacy of a low dose CT scan as a screening method. Findings from the study resulted in a 20 % reduction in lung cancer mortality. At this NCI designated cancer center, our objective was to create a screening program based on the results of the NLST using low dose CT scans for at risk patients. Methods A pilot program was conducted from June to August 2013 enrolling former and current 30 pack year smokers aged 55 to 74. Each participant met a nurse practitioner (NP) prior to their scan. Scans were read by a thoracic radiologist. The NP reviewed the results with a thoracic surgeon and relayed the results to the participant. Results To date, approximately 45 participants were screened. Although no lung cancers were detected, approximately 20 % of the scans demonstrated an abnormality requiring further evaluation. Conclusions Screening with a low dose CTscan can prevent lung cancer deaths among this high risk population. Based on our pilot, we have established an ongoing NP screening program. We propose to expand the program beyond its current scope by: lowering the cost, offering flexible hours for participants, hiring a full time NP and increasing the funding for marketing.

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MASCC-0203 Oncology Nursing 2 THE TENOVUS ALLWALES NURSE-LED CANCER CALLBACK SERVICE

P. Gill1, R. Skilton1, R. Iredale1 1 Cancer Support Team, Tenovus, Cardiff, United Kingdom Background and Aims Early diagnoses and treatments have resulted in increased demands on existing cancer services. There are particular concerns about how effective and sustainable aspects of current UK hospital-based follow-up services are. Emerging evidence indicates that a dedicated telephone follow-up service may be helpful, although its use in an oncology setting is limited. This paper provides an overview of the innovative Tenovus, nurse-led cancer callback project. Methods Seven hundred eleven cancer patients were purposively recruited into the project via referrals from relevant health professionals and other Tenovus support services. Participants received dedicated phone calls from oncology nurses at 1 week, 1 month and 6 months after registration. Patients were provided with information, advice and support regarding their condition, treatment and other relevant issues. Following each call, patients were sent a questionnaire, which explored their views of the callback service. Quantitative and qualitative data were respectively analysed descriptively and thematically. Results Two hundred sixty (37 %) completed survey one questionnaires were returned. Most participants (>70 %) were female and the most common cancer reported was breast cancer. Initial survey data highlight that the callback project was well evaluated by patients, across virtually all aspects of the service. Most participants reported that the duration and timing of calls were appropriate and subsequently rated the service as good or excellent. Participants also found the service to be informative, reassuring and supportive. Conclusions The project ends in summer 2014, evaluation is therefore ongoing. Early indications are that the callback service offers considerable potential for supporting cancer patients and existing cancer services.

MASCC-0009 Oncology Nursing 2 DEPRESSION, PAIN, SOCIAL SUPPORT, GENERAL INFORMATION IN PATIENTS WITH NON-SMALL CELL LUNG CANCER

L.L. Hou1, F. Gu1 1 Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, China Background and Aims Background: Lung cancer is a disease with poor prognosis and psychological impact. Lung cancer causes both physical and psychological burden on patients, and financial burden on families and society. Objective: The aim of this study was to investigate the main factors associated with depression among patients with lung cancer. Methods Methods: Quantitative study was used in this study. The data was obtained from Shanghai Pulmonary Hospital in China. There were 104 in-patients with non-small cell lung cancer surveyed. Self-rating depression scale (SDS), social support with the social support revalued scale (SSRS) and body pain with the visual analog scale (VAS) were used in this paper.

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Results Results: Among the 104 patients, 16 (15.8 %) were diagnosed with depression. Pain, age, marital status, education and the times of chemotherapy received as well as subjective supports were significantly associated with depression. Conclusions Conclusions: Social supports have impact on depression among patients with lung cancer. Effective social supports could decrease the incidence of depression and pain. Health care providers should give focused social supports to help patients to have positive attitude and increase compliance. Nurses should provide focused intervention care according to pain, chemotherapy, age, education and marital status as well as subjective supports.

MASCC-0137 Oncology Nursing 2 NURSE PRESCRIBING: THE EXPERIENCE OFA PALLIATIVE CARE CLINICAL NURSE SPECIALIST IN A UK CANCER CENTRE

S. Hall1 1 Supportive & Palliative Care, Royal Surrey County Hospital/St Luke’s Cancer Centre, Guildford, United Kingdom Background and Aims In the UK, nurses have the authority to prescribe after completion of a recognised accredited prescribing course through a UK university. Nevertheless, only a minority of nurses train as prescribers, and the data suggests that many of these nurses do not use the skill on a regular basis. The aim of this service evaluation was to determine the extent of prescribing undertaken by a newly qualified Independent Nurse Prescriber (INP)/Clinical Nurse Specialist (CNS) in Palliative Care during the first year of practice in a UK cancer centre. Methods The CNS prospectively recorded all inpatient/outpatient consultations and whether or not a prescription was written: if a prescription was written, then the drugs were recorded; if a prescription was not written, then the reason was recorded. Results In the first year, the CNS undertook 256 inpatient consultations, and prescribed on 121 occasions; the reasons for not prescribing were: 1) no indication for prescription - 99 2) CNS reluctant to prescribe relevant drug (advice given) - 10; 3) CNS sought second opinion from consultant - 5; 4) issues with acceptance of INP by primary medical team - 19; 5) issues with acceptance of INP by patient/family - 2. The most commonly prescribed drugs were opioids, anti-emetics, anti-secretory agents, antipsychotic agents, and oral care products (data to be presented). Conclusions The ability to prescribe supportive care drugs significantly enhances the role of the CNS in Palliative Care, and can lead to more timely/ appropriate management of pain and other symptoms.

MASCC-0010 Oncology Nursing 2 EFFECTS OF ELECTRIC STIMULATION TO ACUPOINTS ON GASTROINTESTINAL HORMONES AND MOTILITYAMONG OLD POSTOPERATIVE PATIENTS WITH GAST ROINTESTINALTUMORS

L. Hou1, F. Gu1 1 Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, China

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Background and Aims Background: Recently, early movement on bed was encouraged to promote gastrointestinal function recovery. However, due to old ages and weak physical strength, the effects remain limited. Objective: To evaluate the effects of electric stimulation to acupoints on gastrointestinal hormones and motility among old postoperative patients with gastrointestinal tumors and explore an efficient and noninvasive method for postoperative recovery of bowl functions. Design: Randomized control and intervention study. Methods Participants: We selected 40 old patients with gastrointestinal tumors receiving surgeries between January 2009 and December 2010. Methods: The patient evenly randomly assigned them into regular nursing care group (RNC) and acupoint electric stimulation group(AES) group each with 20 cases. Patients in the RNC group received regular nursing care and patients in the AES group received regular nursing care plus electric stimulation on acupoints. We evaluated the serum concentration of gastrin(GAS), motilin(MOT), cholecystokinin(CCK) and electrogastrogram(EGG) on the first, third and fifth day after surgery. We also recorded the anal exhaust time and the number of cases with such gastrointestinal function disorders as abdominal pain, abdominal distention and diarrhea. Results Results: Comparison between two groups in GAS, MOT, EGG, the anal exhaust time, abdominal pain, abdominal distention and diarrhea showed significant statistical difference (P<0.05). Conclusions Conclusion: Electric stimulation on acupoints could increase postoperative GAS, MOT levels, promote recovery of gastrointestinal functions and decrease complications among senile patients with gastrointestinal tumors.

MASCC-0106 Oncology Nursing 2 COMMUNICATION OF BAD NEWS: EXPERIENCE OF MOTHERS OF CHILDREN AND ADOLESCENTS WITH CANCER

T.B. Mello1, L.C. Nascimento1, G. Dupas2, R.A.G. Lima1 1 Maternal-Infant and Public Health, School of Nursing University of São Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil; 2Enfermagem, Universidade Federal de São Carlos, São Carlos, Brazil Background and Aims In oncology, the transmission of difficult news is a frequent event and complaints by patients and family members who received bad news about their health in an inappropriate manner are not uncommon. Objective: Describe the experience of mothers of children and adolescents with cancer facing the communication of bad news. Methods This descriptive and exploratory study was conducted using qualitative data analysis. The participants were mothers of children and adolescents with cancer undergoing treatment at a Brazilian teaching hospital. Data collection was performed using eight focus groups. The development of the groups was based on the following questions: what did they consider as difficult news; examples of difficult news and who communicated them. Thematic content analysis of the empirical material was carried out. Results Organized considering three themes: Communication of bad news, described based on the disclosure of the cancer diagnosis, how it was communicated, and how the news was understood; Revealing the news to children and adolescents, comprising the communication with children and adolescents, those involved in disclosing the diagnosis, as well as selfcare and decision-making; Communication of palliative care, refers to communication the change from curative care to palliative care. Bad news

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related to the diagnosis of relapse, mutilating surgeries, the toxicity of chemotherapy and radiotherapy, and palliative care were also considered. Conclusions The study can contribute to understand the experience of these mothers with a view to producing healthcare that meets the real needs of children and adolescents with cancer and their parents facing the communication of bad news.

MASCC-0154 Oncology Nursing 2 DIFFERENCES IN SYMPTOM OCCURRENCE RATES BETWEEN PATIENTS WITH GASTROINTESTINAL CANCER WHO ARE AND ARE NOT RECEIVING TARGETED THERAPIES

I. Tantoy1, K. Kober1, L. Dunn2, S. Paul1, B. Cooper1, B. Aouizerat1, C. Miaskowski1 1 School of Nursing, University of California San Francisco, San Francisco, USA; 2School of Medicine, University of California San Francisco, San Francisco, USA Background and Aims Gastrointestinal cancers account for about 20 % of new cancer cases in the US. Depending on the patient’s stage of disease and previous responses to treatment, a targeted therapy may be added to the patients’ chemotherapy (CTX) regimen. No studies were identified that compared symptom occurrence rates in patients’ who received CTX with or without a targeted therapy using a comprehensive symptom inventory. Study purposes were to evaluate for differences in the total number of symptoms and symptom occurrence rates for patients who did and did not received a targeted therapy as part of their CTX regimen. Methods Patients (n=157) were enrolled prior to their next cycle of CTX. Patients completed self-report questionnaires including the Memorial Symptom Assessment Scale (with 38 symptoms). Between group differences in total number of symptoms and symptom occurrence rates were evaluated using independent student’s t-tests and Chi square analyses, respectively. Results Compared to patients who did not receive a targeted therapy (69.2 %), patients on a targeted therapy (30.8 %) were significantly younger and had a higher number of metastatic sites. No between group differences were found in the total number of symptoms (i.e., 12.9±6.7) or in the occurrence rates for any of the MSAS symptoms. Conclusions Whether or not a patient receives a targeted therapy for gastrointestinal cancer, they experience a high symptom burden at the initiation of CTX. For the total sample, the five most common symptoms were: lack of energy, pain, difficulty sleeping, numbness and tingling in the hands and feet, and nausea.

MASCC-0224 Oncology Nursing 2 ILLNESS-RELATED UNCERTAINTY IN COLON CANCER PATIENTS – PRELIMINARY RESULTS OF A CROSS-SECTIONAL DESCRIPTIVE STUDY

M. Wallner1, H. Mayer1 1 Department of Nursing Science, University of Vienna, Vienna, Austria Background and Aims Uncertainty is a prevailing experience in cancer patients. While colon cancer is among the most prevalent types of cancer worldwide, little is known about illness-related uncertainty in these patients. This study aims

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to examine the extent to which colon cancer patients experience illnessrelated uncertainty and, thereby, generate baseline data for the conceptualization of tailored uncertainty management interventions. Methods A cross-sectional descriptive study was conducted in a convenience sample of colon cancer patients (n=54) currently undergoing chemotherapeutic treatment. Uncertainty was measured using the adult form of the Mishel Uncertainty in Illness Scale (MUIS-A). Data collection included a variety of sociodemographic variables as well as illness- and treatment-related variables. Results The MUIS-Awas completed by 26 male and 20 female patients. Preliminary analysis revealed moderate levels of uncertainty in the overall sample (n=46), with slightly greater uncertainty perceived by women, compared to men. Female patients scored considerably higher in the complexity and unpredictability subscales of the MUIS-A. Higher levels of education equated to lower levels of uncertainty. Patients 45 years of age and below experienced lower levels of uncertainty than patients aged 66 and above. Patients who had undergone surgery prior to chemotherapy appeared to perceive higher levels of uncertainty, as did patients with a colostomy. Conclusions Preliminary results appear to be in line with previous research findings and show socio-demographic and treatment-specific differences in the uncertainty experience of colon cancer patients. The results highlight the importance of tailored uncertainty management interventions to meet the individual needs of the patients.

MASCC-0084 Oncology Nursing 2 NURSE-LED MANAGEMENT OF HYPERSENSITIVITY REACTIONS IN LUNG CANCER PATIENTS WHO RECEIVING CHEMOTHERAPY IN TAXANE GROUPS

K. Wangnum1, P. Piyabandidgool1, W. Damrongrajasak1, B. Panmeesub1, O. Wongsa1, K. Suppasun1 1 Chemotherapy Unit, Rajavithi Hospital, Bangkok, Thailand Background and Aims Adverse event in patients with lung cancer during chemotherapy in taxane group had hypersensitivity reactions symptoms were recorded in the incidence report during 2011–2013. There were dyspnea, difficult breathing and facial flushing from 37 events. Clinical tracer to the process of care with gap analysis, found that the risk for HSRs of lung cancer patients including; severe malnutrition, sleep disturbance or insomnia due to the symptoms of disease, and fasting in the morning for early chemotherapy administration. In addition the surveillance of care is not good enough. We would like to develop management processes for effective care and to reduce adverse event of hypersensitivity and there is no anaphylactic shock of 2 years (2013–2014). Methods Review the incidental report 37 events since 2011–2013. Clinical tracer to process of care, root cause analysis, gaps analysis and learned from the experience to detect the risk factors with adjust nursing practice guideline by evidence based practices. Results The most of HSRs by paclitaxel 30 events from total 1,110 of paclitaxel administrations (2.70 %), followed by docetaxel 7 events from total 785 docetaxel administrations (0.89 %). Risk factors for anaphylactic shock are metastatic disease and weight loss 10 kg within 3 months. There was one patient with anaphylactic shock and died in 2011 and one anaphylactic shock with moved to ICU and recovery one person in 2012. There was no anaphylactic shock in 2013. Conclusions Hypersensitivity reactions induced by taxane groups were decreased after management of risk with development of nursing care processes.

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MASCC-0186 Other THE NEW SELECTIVE GLP-2 RECEPTOR AGONIST, ELSIGLUTIDE, IMPROVES IRINOTECAN-INDUCED DIARRHOEA AND MUCOSITIS IN THE RAT

B. Mayo1, E. Bateman2, A. Stringer1, E. Plews2, A. Wignall2, B. Wozniak2, I. White3, C. Pietra4, S. Cantoreggi4, D. Keefe2 1 School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia; 2Discipline of Medicine, University of Adelaide, Adelaide, Australia; 3School of Medical Sciences, University of Adelaide, Adelaide, Australia; 4Research and Development, Helsinn Healthcare SA, Lugano, Switzerland Background and Aims Elsiglutide has been shown to decrease diarrhoea and gastrointestinal (GI) damage caused by irinotecan administration. Previous results showed that 0.9 mg/kg/day sc (5 days) was more effective than 1.8 mg/kg sc of elsiglutide, suggesting a bell-shape response. Aim: To test whether a lower dose of elsiglutide further improves the GI toxicity of irinotecan in a rat model of irinotecan-induced mucositis. Methods A Dark Agouti rat model of irinotecan-induced mucositis was used to characterise effects of lower dose elsiglutide on irinotecan-induced diarrhoea and GI damage. Animals received 200 mg/kg intraperitoneal irinotecan, and daily sc dosing of 0.45 mg/kg elsiglutide for 5 days, then were killed at 6, 72 or 120 h post-chemotherapy (n=6). Jejunum and ileum were taken for histology and microdissection. Results Elsiglutide reduced duration of severe diarrhoea. Small intestinal wet weight increased significantly (p<0.05) following elsiglutide with irinotecan (3.75± 0.12 g at 72 h, 7.64±0.33 g at 120 h) compared with irinotecan alone (3.21± 0.07 g at 72 h, 6.39±0.39 g at 120 h). Villous blunting, crypt ablation and enterocyte disruption improved, and inflammation decreased following elsiglutide and irinotecan compared with irinotecan alone. Villous area significantly increased (mm2, p<0.05) at 72 h following elsiglutide with irinotecan (Jejunum 0.061±0.004; Ileum 0.042±0.003) when compared with irinotecan alone (Jejunum 0.042±0.005; Ileum 0.03±0.004). Conclusions Elsiglutide 0.45 mg/kg/day following irinotecan administration may protect against and reduce damage to the small intestine. This preliminary data suggests the overall effect of 0.45 mg/kg/day may be lower than that in previous experiments using 0.9 mg/kg/day, but is still significant. Additional studies are required to explain the variations and to explore a range of effective doses.

MASCC-0188 Other APOPTOSIS, PROLIFERATION AND INFLAMMATION ARE IMPROVED AFTER TREATMENT WITH THE NEW SELECTIVE GLP-2 RECEPTOR AGONIST, ELSIGLUTIDE, IN A RAT MODEL OF IRINOTECAN-INDUCED MUCOSITIS

B. Mayo1, A. Stringer1, E. Bateman2, J. Bowen3, C. Pietra4, S. Cantoreggi4, D. Keefe2 1 School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia; 2Discipline of Medicine, University of Adelaide, Adelaide, Australia; 3School of Medical Sciences, University of Adelaide, Adelaide, Australia; 4Research and Development, Helsinn Healthcare SA, Lugano, Switzerland Background and Aims Apoptosis, inflammation and decreased proliferation are associated with irinotecan-induced gastrointestinal mucositis (GIM). Elsiglutide, a

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selective GLP-2 receptor agonist, is considered a potential treatment to improve these gastrointestinal cellular effects. Aim: To determine if elsiglutide reduces apoptosis and inflammation, and increases proliferation in the small intestinal crypts of the rat, following irinotecan administration. Methods Dark Agouti rats were given irinotecan once (200 mg/kg, 0 h) and elsiglutide (0.9 mg/kg or 1.8 mg/kg per day, sc) for 5 days, and killed at 6, 72 or 120 h (n=6). Markers for apoptosis (Caspase-3), proliferation (Ki67) and inflammation (myeloperoxidase, MPO) were analysed using immunohistochemistry in the jejunum and ileum. Positive stained cells were counted per crypt or field of view. Results Apoptosis was significantly reduced following 0.9 mg/kg/day elsiglutide and irinotecan (p<0.05) at 6 h (Jejunum 10.15±1.00; Ileum 13.85±1.44 cells/crypt) compared with irinotecan control (Jejunum 14.84±1.15; Ileum 22.49±1.08 cells/crypt). Proliferation was significantly increased at 72 h (peak damage) in this group (Jejunum 31.45±2.78; Ileum 28.47±2.64) compared with irinotecan alone (Jejunum 18.98±2.13; Ileum 18.64±1.62). Preliminary results also indicate that 0.9 mg/kg/day elsiglutide reduces the number of MPO positive inflammatory cells in the small intestine following irinotecan administration. Conclusions Elsiglutide (0.9 mg/kg/day) decreases apoptosis and inflammation, which may be contributors to irinotecan-induced GIM. In addition, elsiglutide improves proliferation of crypt cells, which may shorten the duration of GIM. These results provide a basis for future studies with elsiglutide to determine the exact mechanisms for this phenomenon.

MASCC-0463 Pain RELATIONSHIP BETWEEN EFFECTIVE DOSES OF FENTAN YL SUBLINGUAL SPRAYAND AROUND-THE-CLOCK TRAN SDERMAL FENTANYL IN PATIENTS WITH BREAKTHROUGH CANCER PAIN

D. Alberts1, D. Von Hoff2, N. Forman3, L. Dillaha3, R. Rauck4 1 Medicine, University of Arizona Cancer Center, Tucson, USA; 2N/A, Translational Genomics Research Institute, Phoenix, USA; 3N/A, INSYS Therapeutics, Phoenix, USA; 4N/A, The Center for Clinical Research, Winston-Salem, USA Background and Aims Fentanyl sublingual spray is used for the treatment of breakthrough cancer pain (BTCP) in opioid-tolerant patients who receive around-theclock (ATC) opioids. This exploratory analysis determined the relationship between the dose of ATC transdermal fentanyl and the effective dose of fentanyl sublingual spray during the open-label titration phase of a previously published phase 3, randomized, placebo-controlled trial. Methods Opioid-tolerant adults receiving ATC opioids for baseline pain were enrolled in a 26-day open-label titration phase (N=130). This retrospective analysis focuses on the 32 patients who received ATC transdermal fentanyl during the titration phase of the trial. Pearson correlation analyses were conducted for the final and average transdermal fentanyl dose during the titration phase. Results At the end of the titration phase, fentanyl sublingual spray showed a low level of correlation with transdermal fentanyl in each analysis (Pearson correlation coefficient r=0.360, n=32, P=0.0433 for final dose; r=0.390, n=32, P=0.0275 for average dose). Specifically, final transdermal fentanyl doses at the end of titration and mean effective fentanyl sublingual spray dose during double-blind treatment were, respectively: <50 mcg/h, 550 mcg (n=8); 50 to <100 mcg/h, 1,000 mcg (n=11); 100 to <150 mcg/h, 933 mcg (n=9); 150 to <200 mcg/h, 800 mcg (n=1); 200 to <250 mcg/h, 1,400 mcg (n=2); and ≥250 mcg/h, 1,200 mcg (n=1).

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Conclusions The results of these exploratory analyses showed no clinically meaningful correlation between the average or final doses of transdermal fentanyl and fentanyl sublingual spray. This is consistent with previous analyses of other transmucosal immediate-release fentanyl products.

MASCC-0153 Pain SOURCES OF PAIN IN A PATIENT WITH METASTATIC PROSTATE CANCER TO BONE AND MULTIPLE CO-MORBIDITIES

E. Bain1, N. Pulenzas1, M. Popovic1, B. Lechner1, G. Bedard1, P. Sheehan1, L. Holden1, E. Wong1, R. McDonald1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Bone pain is common in metastatic prostate cancer patients and can significantly reduce a patient’s quality of life. When patients have multiple co-morbidities, sources of pain are often difficult to differentiate, and therefore may be difficult to treat. The objective of this report is to explore possible sources of pain in a patient with metastatic prostate cancer and multiple co-morbidities. Methods The current report documents the case of an 82-year old male who presented with lower back and leg pain that was exacerbated with movement. The patient suffered from metastatic castrate resistant prostate cancer with multiple bone lesions, but had no pain symptoms attributable to his cancer. In addition, the patient had end-stage renal disease, and had been on hemodialysis since 2007. Results Investigations of the patient revealed a subacute burst fracture at L1, however clinical examinations revealed that this was degenerative in nature, and was not the source of the patient’s pain. Radiological imaging determined that there were no bone metastases in the lumbar region. Furthermore, neuropathic pain and side effects of his leuprolide treatment were not congruent with the patient’s description of his pain. Conclusions Ultimately, this patient’s pain matched typical descriptions of muscle cramps, which are very prevalent in hemodialysis patients. However, it is important to regularly monitor the patient for bone metastases, as they could become a future source of pain. Overall, it is critical that all possible sources of pain are explored in order to properly diagnose and treat similar patients with prostate cancer and multiple co-morbidities.

MASCC-0107 Pain IS IT MANDATORY TO START WHO STEP 1 DRUGS IN ALL CANCER PAIN? OUR REGIONAL CANCER CENTER EXPERIENCE

L. Boregowda1, V. Vimalathithan1, S. Prabha1 1 Palliative Medicine, Kidwai Memorial Institute of Oncology, Bangalore, India Background and Aims In India, pain is still one of the most feared entities in cancer and about 75 % require opioids for severe pain. This study aims to discuss reasons for under-treatment and also the current status of WHO analgesic ladder.

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Methods We retrospectively analyzed 100 patients. We followed WHO analgesic ladder. We analyzed the benefits of step I, II & III by Visual analogue score and also analyzed the reasons for under-treatment. Results As per VAS score, 80 % of patients are having moderate to severe pain (VAS >5), 20 % are having mild pain (VAS <5). Patients (n=80) with moderate to severe pain, 30 % are having bone pain, 20 % are having neuropathic pain & 20 % are having treatment related pain. Only 12 of these patients (15 %) had adequate pain control, 68 patients (85 %) had no adequate pain relief. The mean duration of patients came with pain after starting step 1 is between 5 and 15 days. Once we started step 2 for these patients, patients having VAS score >6 to 9 it came under <5 almost in 80 % of our patients, still 20 % are not responding due to various reasons. Conclusions Our study questioned the justification for a need of overstaying in step 1 for a patient with severe pain and feared inadequate pain relief. We may directly start step 2 drugs as primary treatment thus bypassing step 1. Our study any how is not intended to advise against use of original ladder. However modifications are necessary to ensure its continued use for knowledge transfer in pain management.

MASCC-0508 Pain ODYNOPHAGIA IN HEAD AND NECK CANCER (HNC) PATIENTS UNDERGOING (CHEMO) RADIOTHERAPY: IS IT AN ORPHAN CONDITION?

M. Romero1, P. Bossi2, C. Ripamonti3 1 Pharmacoepidemiology Unit Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro (CH), Italy; 2Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Supportive Care in Cancer Unit Department of Haematology and Pediatric Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Background and Aims Odynophagia is a detrimental condition in HNC patients receiving (chemo)radiotherapy causing inability to eat and drink and secondary malnutrition and dehydration. Actually, no standard treatment is recommended and a considerable variability in the real practice is observed. Objective of this work is to evaluate both the available evidences and the ongoing clinical research on odynophagia management. Methods Pubmed database and website clinicaltrial.gov were checked to identify either published studies or ongoing trials. Pubmed (1996–present) was queried combining MESH terms “Head and neck cancer” or “Pain/drug therapy” or “Pain/Therapy” AND free words odynophagia, therapy, deglutition, clinical trials. Clinical trial.gov (1997–present) was tested to resemble the Pubmed search strategy as closely as possible. No limits were used. Results From Pubmed 16 studies were identified. However, reading the full papers, no one had odynophagia as subject in itself. Pain due to swallowing was considered in trials having as main topics oral mucositis or surgery. Some studies have analyzed the needs of HNC patients, and although odynophagia was considered a harmful condition, no trial evaluated specifically its management. About clinicaltrial.gov, 19 ongoing trials were identified. Among these, 16 are randomized clinical trials (RCTs) and 3 observational studies on genomic or QOL. RCTs concern pain overall or mucositis or post-surgerical pain. The study treatments range from various drugs to medical devices and surgical techniques. No study aimed to evaluate specifically management of odynophagia. Conclusions No evidence is available on odynophagia treatment. Clinical studies on this condition are urgently needed.

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MASCC-0421 Pain PAIN AND ITS MANAGEMENT IN INPATIENTS WITH ACUTE LEUKEMIA

V. Caraiscos1, G. Rodin1, A. Mischitelle1, D. Yuen1, S. Khan1, M. Minden2, A. Schimmer2, L. Gagliese1, A. Rydall1, C. Zimmermann1 1 Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada; 2Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada Background and Aims Acute leukemia (AL) is a hematopoietic stem cell disorder that is associated with significant morbidity and mortality. However, the burden of pain in AL patients is not well understood. We examined pain and its treatment in inpatients with AL. Methods In patients with newly-diagnosed or recently-relapsed AL completed the Memorial Symptom Assessment Scale (MSAS); two questions were added: “Is the symptom being treated?” and “Are you satisfied with the relief?” We reviewed the charts of a subset of randomly selected patients who reported moderate to very severe pain, perceived as not treated or treated without satisfactory relief, in the week prior to and including the day of MSAS completion. Results Of 280 inpatients recruited, 112 reported moderate to very severe pain; of these, pain was reported as treated in 71, untreated in 17 and treated unsatisfactorily in 23 (1 missing response). Chart reviews of 20 patients who reported moderate to very severe pain that was untreated or treated without satisfactory relief revealed that pain was documented for all 20 (pain sites listed in the Table). Pain medication was given to 18/20 patients, of whom 14 received opioids; opioid treatment was added or increased for 6/16 patients with persistent pain (≥2 days). Adjuvant medication was prescribed for 1 patient; 9 refused analgesia once or more. Table. Pain sites in inpatients with AL Pain site Musculoskeletal Arm Back/Coccyx Bone Buttock/Knee/Leg/Pelvis Flank Neck Rib Cheek/Gum/Lip/Mouth/Oral mucosa/Orophyrynx/Palate/Throat/Tongue Epigastrium/Esophagus/Heartburn/Stomach Central venous catheter/Peripheral intravenous Headache/Migraine Abdomen Jaw/Mandible/Tooth Chest Ear Eye Hemorrhoid Lumbar puncture site Skin

Number of patients 16 2 5 1 4 1 2 1 13 9 8 8 7 5 2 1 1 1 1 1

Conclusions Pain is frequent in inpatients with AL and may be related to the disease and/or its treatment. Further study is necessary to understand the pain experienced and patient expectations.

MASCC-0060 Pain AN OBSERVATIONAL STUDY OF PARACETAMOL (ACETAMINOPHEN) DISCONTINUATION IN PATIENTS WITH CANCER PAIN RECEIVING OPIOIDS FOR MODERATE-TO-SEVERE PAIN

A. Davies1, J. Vriens2, A. Buchanan1, M. Waghorn1 1 Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s Cancer Centre, Guildford, United Kingdom; 2Palliative Care, Princess Alice Hospice, Esher, United Kingdom Background and Aims The objective of the study was to investigate the utility of paracetamol in cancer patients receiving opioids for moderate-to-severe pain. Methods Patients with well controlled cancer pain (average pain intensity≤4/10), who were receiving regular paracetamol and an opioid for moderate-tosevere pain, completed the Brief Pain Inventory – Short Form at baseline and at 7 days post discontinuation of the paracetamol (or sooner if restarting the paracetamol). The study employed a Simon optimal two stage design with the aim of reducing the number of subjects exposed to a “futile” intervention. Results Forty-four patients were enrolled, and 40 patients completed the study. Eighteen (45 %) patients restarted the paracetamol, although another four patients reported a worsening of pain control and/or an increase in the use of rescue medication. The only factor associated with restarting paracetamol was the pathophysiology of the pain, with patients with mixed pain more likely to restart paracetamol than patients with nociceptive pain (P=0.013). Conclusions On the basis of these results we would recommend a trial of discontinuing paracetamol in all patients receiving opioids for moderate-to-severe pain, who are deemed to be adequately pain controlled. Patients can be reassured that there is approximately a one-in-two chance of not needing to restart the paracetamol, and that if they do need to start the paracetamol that pain control can be re-gained within a very short period of time.

MASCC-0129 Pain THE INFLUENCE OF LOW SALIVARY FLOW RATES ON THE ABSORPTION OF A SUBLINGUAL FENTANYL CITRATE FORMULATION FOR BREAKTHROUGH CANCER PAIN

A. Davies1, J. Vriens2, K. Webber3, M. Waghorn1, A. Buchanan1 1 Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s Cancer Centre, Guildford, United Kingdom; 2Palliative Care, Princess Alice Hopsice, Esher, United Kingdom; 3Palliative Care, Kings College Hospital, London, United Kingdom Background and Aims There is no data on the pharmacokinetics of oral transmucosal opioids in patients with salivary gland hypofunction (SGH; ‘dry mouth’), despite the fact that SGH may significantly amend absorption through the oral mucosa.

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Methods Nine cancer patients with pain and SGH (unstimulated whole salivary flow rate<0.1 ml/min) completed a series of pharmacokinetic studies involving a sublingual fentanyl orally disintegrating tablet (Abstral®): on the first assessment, plasma fentanyl levels were measured after no intervention for the SGH; on the second assessment, plasma fentanyl levels were measured after moistening the mouth with water; on the third assessment, plasma fentanyl levels were measured after a 5 mg dose of pilocarpine (i.e. salivary stimulant). Results

background (persistent) pain. The presence of BTcP was associated with disease status (i.e. metastatic disease more than local disease; Fisher’s exact test p<0.001), and performance status (i.e. poor performance status more than good performance status; Fisher’s exact test p<0.001). Conclusions BTcP can occur at any stage of the cancer journey, but is more common in patients with metastatic/advanced disease.

MASCC-0032 Pain ADDITION OF ADJUVANTS TO OPIOID FOR CANCER PAIN MANAGEMENT IN AN INPATIENT PALLIATIVE UNIT. DOES THIS IMPROVE PAIN CONTROL AND REDUCE OPIOID REQUIREMENTS?

M. Davis1, S. Shinde2, P. Gordon1, S. Prashant1, L. Rybicki1 1 Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; 2Tauaaig Cancer Institute, Cleveland Clinic, Cleveland, USA

The Cmax, Tmax, and AUC were lowest during the first assessment phase (i.e. no intervention for SGH). The Cmax, Tmax, and AUC were similar during the second and third assessment phases. Figure 1 shows the plasma concentration – time profiles. Conclusions The results of this study suggest that moistening the mouth is an effective intervention for improving the pharmacokinetic profile of the sublingual fentanyl orally disintegrating tablet (Abstral®) in patients with SGH. However, these results cannot be extrapolated to other oral transmucosal opioids.

MASCC-0068 Pain PREVALENCE OF BREAKTHROUGH CANCER PAIN IN THE GENERAL CANCER POPULATION

A. Davies1, A. Buchanan1, M. Waghorn1 1 Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s Cancer Centre, Guildford, United Kingdom Background and Aims The aim of this project was to determine the prevalence of breakthrough cancer pain (BTcP) in the general cancer population (as opposed to the advanced cancer population). Methods Any/all oncology patients attending St. Luke’s Cancer Centre in the United Kingdom (i.e. inpatient unit, outpatient department, chemotherapy unit, radiotherapy department) were eligible to take part in the project. The project involved a single assessment involving collection of demographic/oncological information, and completion of a diagnostic algorithm for BTcP [Davies et al., 2009]. In addition, patients with BTcP were requested to complete the Breakthrough pain Assessment Tool (‘BAT’) [Webber et al., 2013]. Results One thousand patients were enrolled in the project. In total, 382 patients reported pain, although only 244 had background (persistent) pain. In total, 90 patients reported BTcP, which represents 9 % of the total population, 24 % of patients with pain, and 37 % of patients with

Background and Aims Background: Despite introduction of the WHO Cancer pain ladder, few studies have reported prevalence of adjuvant medications on inpatient Palliative Medicine units. We evaluated adjuvant use in patients admitted to an inpatient palliative unit, pain scores or opioids doses. Methods Methods: In this retrospective observational study, patients admitted to the palliative care unit over a 2 month period with cancer on opioids were reviewed. Demographics, diagnosis, oral morphine dose equivalents on discharge, adjuvant analgesics, NSAIDs and pain scores were collected. Results Results: Of 77 patients eligible, 65 (84 %) were on adjuvant medications. The most common adjuvant was gabapentin (70 %), 57 % were on than one adjuvant. More women received adjuvants (57 % v17%, P=0.010). Those without adjuvants compared with those on adjuvants had similar pain scores on discharge gauged by physicians (0.8±0.8 v 1.0±0.7 p= 0.58) and nurses (2.0±2.7 v 2.1±2.6 p=0.86). There was no difference in discharge morphine equivalents (180±160 v 459±833 p=0.19). Seventyfive percent on adjuvants and 80 % on opioids alone responded determined by a 2 point reduction in NRS. Conclusions Discussion: Adjuvants are commonly used for cancer pain, half are on 2 adjuvants or an adjuvant plus NSAID plus opioid. We did not demonstrate a benefit in terms of improved pain or opioid doses with adjuvants but this may reflect confounding variables, small numbers and physician choice. Prospective studies are needed to define improved pain or opioid sparing effects of adjuvants. Conclusion: Adjuvants are used in 80 % of inpatients. Adjuvants were not associated with reduced pain or opioid sparing.

MASCC-0558 Pain CONTROLLING PAIN IN THE AMBULATORY SETTING USING A STANDARD OPIOID PROTOCOL

N. Wells1, M. Dietrich2, B. Murphy3 1 Nursing Administration, Vanderbilt University Medical Center, Nashville, USA; 2Research, Vanderbilt University School of Nursing, Nashville, USA; 3 Internal Medicine, Vanderbilt Ingram Cancer Center, Nashville, USA Background and Aims Pain is poorly controlled for patients with cancer. Developing strategies to improve pain control are imperative.

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Aim: To examine the effect of standing opioid titration orders on pain outcomes compared to standard care. Methods Randomization: Arm 1 - pain managed by clinic nurses using an opioid titration protocol; Arm 2 - standard care. Eligibility: current use of opioids and pain≥4. Measures: daily pain diary and weekly phone contact to assess pain control and side effects using validated instruments. Primary outcomes: average and worst pain on a 0–10 scale. Data collected on dose of analgesics prescribed and number of opioid titrations made and analyzed using Generalized Linear Modeling. Results Of 99 patients enrolled from 9 ambulatory clinics, 47 completed a minimum of 5 weeks of data and were included in the analyses. At study entry all patients had a fixed dose opioid and the majority (≥73 %) had a p.r.n. opioid prescribed. Patients in Arm 1 (n=25) had more opioid titrations than patients in Arm 2 (n=22; p<0.05) and had higher opioid consumption (p<0.05). Despite this, mean scores for average and worst pain did not differ by treatment or time. For both groups, worst pain remained moderate while average pain shifted from moderate to mild. There were no severe adverse events. Conclusions This trial confirmed the safety and feasibility of the protocol. Lack of impact on pain outcomes suggests further examination of pain report as a primary outcome. Supported by NCI RO1 CA095413 and the Department of Veterans Affairs

MASCC-0447 Pain RE-IRRADIATION FOR PAINFUL BONE METASTASES – A SYSTEMATIC REVIEW

E. Wong1, P. Hoskin2, G. Bedard1, M. Poon1, L. Zeng1, H. Lam1, H. Vulpe1, M. Tsao1, N. Pulenzas1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Clinical Oncology, Mount Vernon Hospital Cancer Centre, Middlesex, United Kingdom Background and Aims Radiotherapy is a widely accepted and effective way to palliate pain caused by bone metastases. However there are instances when patients require further radiation to the same site for secondary palliation of pain. The purpose of this review was to determine the efficacy of re-irradiation in patients with bone metastases. Methods A literature search was conducted in Ovid Medline, OldMedline, Embase, Embase Classic, and the Cochrane Central Register of Controlled Trials using keywords such as bone metastases, radiotherapy and palliative care. Articles with palliative external beam radiation retreatment response rates were included. Results The literature search produced 2,164 references and 15 articles were included in the final selection. Complete, partial and overall response rates were calculated to be 20 %, 50 % and 68 % respectively. Information on retreatment toxicities was scarce with only 7 of the 15 articles including such information. Most studies reported none or low grade toxicities, with the most common toxicity being nausea and vomiting. Only one study reported a 2.2 % rate of pathological fracture and spinal cord compression. Current evidence also suggests initial non-responders may respond to re-irradiation. Conclusions The efficacy of re-irradiation is comparable to initial radiation treatment. Therefore, re-irradiation should be recommended for patients

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experiencing ongoing pain from bone metastases regardless of the response to initial irradiation. However, aspects of re-irradiation treatment including dose fractionation, related adverse events and toxicities require further corroboration.

MASCC-0541 Pain MINIMAL CLINICALLY IMPORTANT DIFFERENCES IN THE BRIEF PAIN INVENTORY IN PATIENTS WITH BONE METASTASES

K. Wong1, L. Zeng1, L. Zhang1, G. Bedard1, E. Wong1, M. Tsao1, E. Barnes1, C. Danjoux1, A. Sahgal1, L. Holden1, N. Lauzon1, E. Chow1 1 Rapid Response Radiotherapy Program, Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Brief pain inventory (BPI) may be used to assess pain and functional interference in cancer patients. However, statistically significant changes in BPI due to large sample sizes may not necessarily be clinically relevant. The objective was to determine the minimal clinically important differences (MCID) of the BPI in patients with pain due to bone metastases. Keywords: MCID, BPI, pain and functional interference Methods BPI pain and functional interference scores were collected from patients with painful bone metastases who visited the Rapid Response Radiotherapy Program, Sunnybrook Health Sciences Centre, for palliative radiotherapy. Follow-up data was available for 256 patients, who were categorized into ‘complete or partial response,’ ‘pain progression,’ and ‘indeterminate response’ groups based on pain scores. Anchor-based determination of MCIDs of functional interference scores was calculated utilizing the difference between mean follow-up and baseline scores. Distributionbased estimates were obtained utilizing 0.2, 0.3, and 0.5 standard deviation (SD) effect sizes and the standard error of measurement. Results Statistically significant MCIDs were determined for all BPI functional interference items for patients with ‘complete or partial response’. Some functional interference items had statistically significant MCIDs for patients with ‘indeterminate response’. An effect size of 0.5 SD was the closest estimate for determining the MCID for patients with ‘indeterminate’ or ‘complete or partial’ response. Conclusions Statistically significant MCIDs ranged from 1.8 to 4.1 units for pain improvement, but could not be detected for pain deterioration. Knowledge of MCIDs for the BPI may improve ability to assess treatment and to determine sample size in future clinical trials.

MASCC-0587 Pain THE EVIDENCES OF ACUPUNCTURE IN THE MANAGEMENT OF CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY

A.P. Zandonai1, N.O. Sawada1 1 Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil Background and Aims Chemotherapy Induced Peripheral Neuropathy (CIPN) is the most frequent and distressing side effect of the cancer treatment. An estimated 30– 40 % of the patients receiving neurotoxic chemotherapy (vinca alkaloids,

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taxanes, platinum analogs, thalidomide and bortezomib) develop CIPN. Acupuncture is considered a popular and safety treatment intervention used to manage various conditions including peripheral neuropathy. The objectives were search and synthesize the evidences about the benefits of acupuncture to CIPN. Methods An integrative review, which consists in a methodological strategy to perform the evidence-based practice, was used in this study to search and synthesize the available evidence in the scientific literature. The databases LILACS, MEDLINE, CINAHL, SCielo and COCHRANE Library were consulted and eight relevant studies were selected. Results Were identified studies of low evidence, three studies classified as evidence level 6, three studies with evidence level 4, one pilot randomized controlled trial with evidence level 2 and one systematic review with evidence level 1. The acupuncture points most used were Ba feng, Ba xie, LI4 and LV3 to CIPN management. None randomized controlled trial was found. Conclusions Although studies had low evidence, these demonstrated that acupuncture relieves the symptoms of CIPN, decreased pain and consequently reduced analgesic consumption, increased quality of life related to health and improved the velocity and amplitude in nerve conduction. No adverse effects were reported. It is suggested a rigorous randomized controlled trial with a large sample to verify the safety and efficacy of acupuncture in patients with CIPN.

MASCC-0147 Pain 2 SOURCES OF PAIN IN A PATIENT WITH METASTATIC PROSTATE CANCER, PAGET’S DISEASE AND RENAL FAILURE

A. Furfari1, G. Bedard1, E. Wong1, R. McDonald1, M. Popovic1, E. Chow1 1 Department of Radiation Oncology, Rapid Response Radiotherapy Program, Toronto, Canada Background and Aims Introduction Prostate cancer is the most common cancer to affect men. In advanced prostate cancer, up to 80 % of patients can develop bone metastases, which can cause pain. Co-morbidities such as end-stage renal disease (ESRD) and Paget’s disease can also have the potential to cause pain in regions of the body similar to bone metastases. Objectives This report discusses the case of a patient with prostate cancer, ESRD and Paget’s disease, and furthermore highlights the importance of finding sources of pain in order for the patient to be successfully treated. Methods An 80-year-old male with prostate cancer and accompanying bone metastases presented to the Rapid Response Radiotherapy Clinic at the Sunnybrook Health Sciences Centre with severe pain in the lumbar spine. Results Previous imaging of the patient’s lumbar spine was unclear as to whether pain was caused by bone metastases, renal failure, or Paget’s disease. Further x-rays of the patient’s lumbar spine were taken from which it was determined that there were no definite bone metastases in that area. The x-ray did also reveal osteophytes and extensive pagetic changes. In the absence of bone metastases, it was concluded that this patient’s pain in the lumbar spine was caused by either renal failure, or more likely Paget’s disease. Conclusions This case illustrates the challenge faced by physicians who treat patients with multiple co-morbidities. In these cases, close examination of the patient’s pain is essential to successful treatment.

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MASCC-0605 Pain 2 ORAL SEAWEED CALCIUM SUPPORT IS WELLTOLERATED AND EFFECTIVE IN PAIN RELIEF IN ELDERLY PATIENTS WITH MULTIPLE MYELOMA

G. Giordano1, F. D’Amico1, B. Carabellese2, G. Berardi3 1 Oncology, John Paul II Foundation, campobasso, Italy; 2Radiology, Cardarelli Hospital, campobasso, Italy; 3Territorial Medicine, Family Medicine, campobasso, Italy Background and Aims Introduction Bone pain is frequent in elderly with multiple myeloma. Objectives Aim of this study is to verify if calcium supplementation reduces pain and analgesic drugs intake in elderly patients with multiple myeloma. Methods Methods In this study were enrolled 12 patients. Median age was75 years (R6983).M/F:3/2. All patients presented a symptomatic multiple myeloma treated with MPV regimen for a total of 9 cycles and Zoledronic acid. Four patients received seaweed (lithotamnion) calcium 400 mg p.o. t.i.d, 4patients received 500 mg of calcium lactate-gluconate and carbonate p.o. t.i.d. and 4patients were not supported by calcium p.o. Calcium was administered the first 7 days of every month of therapy. Pain was evaluated by Visual Analogical Scale (VAS) support after 3 months of therapy. Median follow-up was 2 years (R6-24 months). Results Results Patients not receiving calcium support showed a pain with a VAS of8 (R69), patients receiving seaweed calcium support showed a pain with a VAS of4(R4-6), patients receiving calcium lactate-gluconate and carbonate support showed a pain with a VAS of7(R6-8). Patients not receiving calcium support took analgesic therapy two times a day (R 1time/day2time/week), patients receiving seaweed calcium support took analgesic therapy two times a week (R1time/15 day-3time/week), patients receiving calcium lactate gluconate and carbonate support took analgesic therapy five times a week (R1time/day-3time/week). Conclusions Conclusion Calcium support seems to be effective in reducing pain and analgesic drug intake.

MASCC-0346 Pain 2 OPTIMISING THE USE OF FENTANYL FOR PAIN MANAGEMENT IN CANCER PATIENTS

J. Hardy1, S.R. Bista2, A. Tapuni1, P. Good1, R. Norris2, A. Haywood2 1 Palliative and Supportive Care, Mater Research Institute-The University of Queensland, Brisbane, Australia; 2School of Pharmacy, Griffith University, Brisbane, Australia Background and Aims As with other opioids, transdermal fentanyl has a narrow therapeutic window between analgesia and toxicity with great inter-patient variation in the dose required to achieve pain relief. Relatively little is known about the influence of factors such as age, gender, dose, genetic variation, organ function, plasma protein binding (PPB) and efficiency of patch adhesion, on the pharmacokinetics (PK) and pharmacodynamics (PD) of the drug.

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We aimed to investigate the influence of demographic and clinical factors that have the potential to influence the PK of transdermal fentanyl and to describe any relationship between saliva and plasma concentrations, patient pain and degree of patch adhesion. Methods Paired saliva and plasma samples are collected from cancer patients receiving fentanyl via a transdermal patch. The degree of adhesion of the fentanyl patch, pain scores and demographic data are recorded at the time of sampling. NONMEM will be used to obtain estimates of PK parameters and associated intra- and inter-individual variability. Results One hundred eleven paired plasma and saliva samples from 41 patients have been assayed via HPLC-MS/MS. Plasma protein binding was 89 % (predominantly to serum albumin rather than α-1 acid glycoprotein). Patch adhesion was good (FDA score 0–1) in most cases. No meaningful correlation (r=0.335) has been demonstrated between plasma and salivary concentrations on the naive pooled data to date, with little correlation between pain scores and plasma or salivary concentration. Conclusions A better understanding of the factors that influence the PK and pharmacodynamics of fentanyl will improve the way we manage cancer pain.

MASCC-0348 Pain 2 VALIDATION OF A FENTANYL PATCH ADHESION SCORING TOOL FOR USE IN CLINICAL PRACTICE

J. Hardy1, S.R. Bista2, J. Fu3, K. Gibbons3, P. Good1, A. Haywood2 1 Palliative and Supportive Care, Mater Research Institute-The University of Queensland, Brisbane, Australia; 2School of Pharmacy, Griffith University, Brisbane, Australia; 3Mater Research Office, Mater Research Institute-The University of Queensland, Brisbane, Australia Background and Aims The therapeutic efficacy of a transdermal system is directly related to the adhesion of the patch. Partial adhesion is likely to result in a lower plasma concentration. A validated scoring system assessing adhesion at the time of sampling for pharmacokinetic (PK) studies is required. We aimed to test the US Food and Drug Administration (FDA) 5-point patch adhesion scoring tool (0 – >90 % adherence) that has never been validated for clinical use in cancer patients. Methods A library of images was created from photographs of fentanyl patches/ placebo on the limbs/chest of patients/volunteers. Thirty photographs, reflecting varying degrees of adhesion, were selected for each of series A and B, with 10 photographs common to both series. Each series was shown to 30 health professionals asked to score the photographs using the FDA scoring system. Validity was assessed using Spearman’s Rank Correlation and reliability by Cohen’s Kappa (k). Photo editing software (Adobe Photoshop C6 Extended) was utilised to assign control scores to each photograph. Results Validity was high for both series (≥0.954). Inter-reliability ranged from 0.327 to 0.858 (combined k =0.547) and 0.433–0.910 (0.620) in series A and B respectively, with lower k’s being associated with FDA scores 1 and 2. The combined agreement across both series was 0.585. Intra-rater agreement of the 10 common images was k 0.605 (SE 0.028). Conclusions The FDA scoring system is an adequate tool for assessing fentanyl patch adhesion in clinical practice. Scoring partial adhesion remains a challenge.

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MASCC-0405 Pain 2 THE DEVELOPMENT OFAN EDUCATIONAL INTERVENTION FOR MANAGING END OF LIFE PAIN MEDICATION: CANCER CARERS MEDICINES MANAGEMENT

J. Hopkinson1, E. Lowson2, A. Richardson2, S. Duke2, S. Anstey1, J. Hughes1, C. May2, P. Smith3, M. Bennett4, S. Latter2 1 School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom; 2Health Sciences, University of Southampton, Southampton, United Kingdom; 3Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom; 4Institute of Health Sciences, University of Leeds, Leeds, United Kingdom

Background and Aims In the UK, 1 in 4 deaths is a cancer death and most of these people will experience pain at the end of life. In the home, family carers can play an important role in managing pain medication. Our scoping exercise of international literature found evidence of unmet need for support in this role. The aim of this paper is to report the development phase of a complex intervention (MRC 2008)1: an educational intervention called Cancer Carer Medicines Management (CCMM). Methods A staged multi-method approach was used. It included: & a systematic review of interventions for carer management of end of life pain medicines & a review examining the practice and theoretical context of pain medicines management & patient, carer and healthcare professional interviews (n=21) & User Involvement Group consultations (n=29) & observations of usual care & participatory action research workshops (n=2 with 16 nurses) to develop the intervention & a carer and healthcare professional User Consultation review (n=16) Results This multi-method, collaborative approach has been successful in enabling the development of a theoretically informed, evidencebased intervention with robust grounding in carer experience and clinical practice. Conclusions A Phase II study is now in progress to test the feasibility, acceptability & efficacy of CCMM to improve carers’ knowledge, beliefs, skills & self-efficacy for pain medicines management and decrease carer strain. This project is funded by the Dimbleby Marie Curie Cancer Care Research Fund, grant number DCMD-RF-12-05 1. Craig et al. (2008) Developing and evaluating complex interventions. Medical Research Council, London, UK.

MASCC-0435 Pain 2 PROPHYLACTIC DEXAMETHASONE FOR PAIN FLARE (PF) FOLLOWING SPINE STEREOTACTIC BODY RADIOTHERAPY (SBRT)

L. Khan1, A. Chiang1, L. Zhang1, F. Lochray1, I. Thibault1, G. Bedard1, E. Wong1, A. Loblaw1, H. Soliman1, E. Chow1, A. Sahgal1 1 Radiation Oncology, Odette Cancer Center, Toronto, Canada

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Background and Aims To determine the incidence of PF in spine SBRT patients prophylacticly treated with either 4 mg or 8 mg of dexamethasone (DEX), in a sequential prospective observational cohort study. Methods Forty-seven patients were accrued. Twenty-four patients treated with 4 mg of DEX, next 23 patients treated with 8 mg of DEX. Patients completed the BPI during and for 10 days post SBRT. PF was defined as a two point increase in ‘worst pain ’score compared to baseline with no decrease in analgesic intake, or 25 % increase in analgesic intake as compared to baseline with no decrease in worst pain score. The incidence of PF was recorded in each group and compared to our previously published steroid naïve cohort (n=41). Subgroup analyses between the 4 mg and 8 mg cohorts were also performed. Results For the entire cohort, the incidence of PF was 19 % (9/47) Within the subgroups, PF was observed in 25 % (6/24) in the 4 mg group, and 13 % (3/23) in the 8 mg group (p=0.46). When comparing functional interference scores between the 4 mg and 8 mg DEX cohorts, we observed a better profile for the 4 mg subgroup with respect to walking ability(p<0.0466) and relationship to others (p <0.0354). A significant reduction in the incidence of PF was observed when comparing the current cohort to our previously published steroid naïve cohort (68 % vs. 19 %, p<0.0001, respectively). Conclusions No significant differences between 4 mg and 8 mg dosing were observed however 8 mg, was associated with increased functional interference in selected domains.

MASCC-0520 Pain 2 THE COMBINATION OF THE KAMPO MEDICINE AND PREGABALIN FOR TREATING PERIPHERAL NEUROPATHY IN BREAST CANCER PATIENTS

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MASCC-0353 Pain 2 PAIN MANAGEMENT IN PATIENTS WITH MALIGNANT DISEASE IN CROATIA

B. Svetec1, D. Kust1 1 Oncology and Nuclear Medicine, Univesity Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia Background and Aims About half of all patients with malignant tumors are experiencing pain at some point during their disease, and moderate or severe pain is present in one third of them (especially in advanced stage tumors). The quality and intensity of pain depends on tumor site, stage of the disease, and patient’s individual characteristics. This study was undertaken to assess the quality of analgesic support in patients suffering from malignant disease in Croatia, with special emphasis on the extent of transdermal analgesic patches usage. Methods The study involved patients treated at universal hospital centers in Zagreb and Osijek, as well as several general hospitals and general community centers. Trial was carried out in the form of a questionnaire. In total, during the period from April 2013 to the end of September 2013, 153 patients were included. All patients had confirmed diagnosis of malignant disease and gave their consent to participate in the study. Results Only one third of patients talked about their pain with health care professional right away at the moment when the pain begun, while 29.2 % did it only when it became severe or unbearable. The disturbing fact is that in 14 % of patients after the first talk analgesic therapy was not introduced. Conclusions Severe pain can diminish quality of life significantly. Opioids are the basis of chronic malignant pain treatment, so we need to continue our efforts to eliminate the fear of side effects, opioid addiction, analgesic tolerance and security concerns in long-term use.

Y. Kikuchi1 1 medicine, Tokyo university, Tokyo, Japan Background and Aims Symptoms such as joint pains caused by hormone therapy and peripheral neuropathy due to chemotherapy appeared in breast cancer patients. However, there are no effective strategies to treat the pain. The Kampo, herbal medicine in Japan, are already blended, packed, and need not be compound every time, each patients, thus it is often used in Japan. Effectiveness of peripheral neuropathy pain due to pregabalin is reported in recent years, but by side effects such as fatigue and drowsiness, it sometimes be forced to stop or reduce the medicine. So, we examined effectiveness about selecting Kampo medicines, or pregabalin, depending on the condition of the patient, or combination therapy. Methods We picked up patients who were receiving hormone therapy or chemotherapy in breast cancer, and also receiving prescription of Kampo medicines, or pregabalin or each medicine. And we asked them whether pains were reduced or not by taking these medicine. Results We checked six patients of taking medicine. One patient received pregabalin only (A), two were Kampo medicines only (B), and three patients were received both (C), who were received chemotherapy and hormone therapy after operation. One patient in (C) was reduced pregabalin because of the side effect, and started taking Kampo medicines. Conclusions Kampo medicines has been suggested since the effect appears to relatively mild, when side effects are strong by taking pregabalin, and may be taken into account in the prescription of the Kampo.

MASCC-0327 Pain 2 THE INCIDENCE OF NEUROPATHIC PAIN IN BONE METAST ASES PATIENTS REFERRED FOR PALLIATIVE RADIOTHERAPY IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM

B. Lechner1, N. Pulenzas1, R. McDonald1, E. Wong1, G. Bedard1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Bone metastases can result from various primary cancer sites and can commonly lead to pain. For some patients, this pain can be neuropathic due to compression or injury of neural structures. The purpose of this study was to examine the incidence of neuropathic pain in patients with bone metastases referred for palliative radiotherapy. Methods A prospective study was conducted from January to April 2013. Patients referred to the Rapid Response Radiotherapy Program at the Sunnybrook Health Sciences Centre for symptomatic bone metastases were eligible. Patients completed the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS).

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Results Twenty-four patients agreed to participate; 13 (54.2 %) females and 11 (45.8 %) males. The median age was 71. The most common primary cancer sites were breast (29.2 %), prostate (29.2 %), and lung (25.0 %). Nineteen of the 24 patients (79.2 %) were treated with radiotherapy. The most common dose schedules were 8 Gy in 1 fraction prescribed to 12 patients (50.0 %) and 20 Gy in 5 fractions for 5 patients (20.8 %). Of the 23 patients that fully completed the S-LANSS, 7 (30.4 %) had scores suggestive of neuropathic pain. The median total score on the S-LANSS was 10 out of 24. The median pain score was 8 out of 10. Conclusions This incidence of neuropathic pain was found to be higher compared to previous studies in similar patient populations. Several patients, despite having neuropathic pain, were not receiving targeted treatments. Neuropathic pain can be a significant concern for patients with bone metastases referred for palliative radiotherapy.

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Results Among 1,505 enrolled patients, 58.8 % had moderate to severe pain (VAS≥4). Patients with NCP (DN4≥4) showed higher BPI-SF pain severity score than patients without NCP (4.94±1.65 vs 4.58±1.68; p= 0.001). BPI-SF pain severity score had clear negative correlation with QOL measured by EQ-5D (r=−0.301, p

MASCC-0401 Pain 2 KOREAN SURVEY OF CURRENT PRACTICE IN THE DIAGNOSIS AND MANAGEMENT OF NEUROPATHIC CANCER PAIN AND ITS IMPACT ON QUALITY OF LIFE

S. Oh1, S.W. Shin2, S.B. Bae3, K.H. Lee4, S.J. Koh5, N.R. Lee6, J.S. Jang7, H.J. Yun8, H.S. Han9, J.H. Kim10, D.R. Choi11, H.J. Kim12, B.Y. Shim13, S.Y. Yoon14, J.L. Lee15, H.J. Kim16, J.H. Sim17 1 Internal medicine, Seoul Medical Center, Seoul, Korea; 2Internal medicine, Korea University College of Medicine, Seoul, Korea; 3 Internal medicine, Soonchunhyang University College of Medicine, Cheonan, Korea; 4Internal medicine, Yeoungnam University College of Medicine, Daegu, Korea; 5Internal medicine, Ulsan University College of Medicine, Ulsan, Korea; 6Internal medicine, Chonbuk National University College of Medicine, Chonbuk, Korea; 7Internal medicine, Chung-Ang University College of Medicine, Seoul, Korea; 8Internal medicine, Chungnam National University College of Medicine, Chungnam, Korea; 9Internal medicine, Chungbuk National University College of Medicine, Chungbuk, Korea; 10 Internal medicine, Hallym University Kangnam Medical Center, Seoul, Korea; 11 Internal medicine, Hallym University Chuncheon Medical Center, Chuncheon, Korea; 12 Internal medicine, Hallym University Medical Center, Seoul, Korea; 13Internal medicine, St. Vincent Hospital the Catholic University College of Medicine, Suwon, Korea; 14Internal medicine, Konkuk University Medical Center Konkuk University School of Medicine, Seoul, Korea; 15Internal medicine, Fatima Hospital, Daegu, Korea; 16Health and Value, Pfizer Pharmaceutical Korea Ltd., Seoul, Korea; 17Outcomes Research, Primecore consulting, Seoul, Korea Background and Aims Diagnosis and management of neuropathic cancer pain (NCP) is difficult and complicating issue. Korean Cancer Study Group Neuropathic Cancer Pain Survey (KCSG-NCPS) investigated current practice in the diagnosis and management of NCP and its impact on quality of life (QOL). Methods Patients with cancer pain of visual analogue scales (VAS) ≥1 from 28 hospitals of Korea were enrolled in this cross-sectional observational study. If the patient was scored ≥4 by neuropathic pain diagnostic questionnaire (DN4), he/she was diagnosed with NCP. The clinical characteristics, pain severity by Brief Pain InventoryShort Form (BPI-SF), and the QOL by EuroQOL EQ-5D Health Questionnaire were evaluated.

Conclusions This large-scaled survey shows that NCP has deteriorative effect on QOL by increasing pain intensity and management of NCP and QOL is not satisfactory in South Korea. Innovative approach for proper diagnosis and management of NCP is required to improve QOL of patients with cancer.

MASCC-0270 Pain 2 EQUIANALGESIC CONVERSION RATIO (ECR) OF HYDROCODONE (HDC) TO STRONG OPIOIDS

A. Reddy1, S. Yennurajalingam1, H. Desai1, J. Wu1, D. Liu1, S. Reddy1, M. de la Cruz1, E. Bruera1 1 Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Ninety percent of cancer patients experience pain. Patients are initially treated with HDC and escalated to stronger opioids as per the cancer pain ladder. However, there are no studies in cancer patients on the ECR of HDC to strong opioids which may result in uncontrolled pain or overdosing. OBJECTIVES: To determine the morphine equivalent daily dose(MEDD) for HDC. Methods Outpatient supportive care visits in 2011–2012 were reviewed for opioid rotation(OR) from HDC to a stronger opioid. Data regarding demographics, Edmonton Symptom Assessment Scale(ESAS), and MEDD was collected in patients who followed-up within 6 weeks. Linear regression analysis was used to estimate the ECR between HDC and MEDD. Successful OR was defined as 2 point or 30 % reduction in pain score and continuation of the new opioid at follow-up.

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Results

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Conclusions There was no significant difference in pain relief after palliative radiotherapy with 1 or 10 fractions for painful bone metastasis. The overall response rate was 71%and younger patients responded better.

MASCC-0538 Palliative Care PREVALENCE OF EVIDENCE-BASED PROGNOSTIC INDICATORS FOR INPATIENT PALLIATIVE CARE CONSULT NOTES AT A SINGLE ACADEMIC MEDICAL CENTER

One hundred seventy patients underwent OR(partial/complete) from HDC to stronger opioids. One hundred twenty patients had a complete OR. 81 % had advanced cancer. Median time between OR and follow-up was 21 days. Pain −2(P<0.0001), fatigue −1(P=0.006), insomnia −2(P=0.008), and symptom distress score −7(P =0.0002) improved with successful OR(53 %). In 100 patients with complete OR to HDC and no worsening of pain at follow-up, the median ECR (Q1–Q3) from HDC to MEDD was 1.5(0.9−2) and was significantly correlated r=0.52(P<0.0001). ECR was significantly lower in patients receiving >40 mg/day of HDC. Conclusions The estimated ECR from HDC to MEDD was 1.5. Due to large interpersonal variation in ratio, personalized titration and frequent monitoring is recommended.

MASCC-0499 Pain 2 SINGLE VERSUS MULTIPLE FRACTIONS OF PALLIATIVE RADIOTHERAPY FOR PAINFUL BONE METASTASES: 30 GY IN 10 FRACTIONS COMPARED WITH 8 GY IN SINGLE FRACTION

S. Roy1, A. Shankar2, R. Bhandari2, K. Kishor2 1 Paediatrics, Safdarjung Hospital, New Delhi, India; 2Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India Background and Aims Despite high-level evidence in the literature, the use of single-fraction radiotherapy (RT) for management of painful bone metastases is not widely practiced in the world. Fractionation of palliative RT for bone metastases is very variable. Thus, we decided to perform a study comparing 30 Gy in 10 fractions with 8 Gy in single fraction. Methods Adult patients with multiple painful bone metastases were randomized to 8Gy in a single fraction or 30 Gy in 10 fractions. Pain was graded by patients on a scale of 1 to 4 just before and again 1 month after the end of RT. Results We randomized 100 patients (52 patients in single fraction and 48 in multiple fractions) in this trial (63 % women; mean age: 51.6 years). Patients graded their pain before RT in a range from 1.8 to 4.0 (mean: 3.2). At that time, pain was graded in a range from 1.0 to 4.0 (mean: 2.0). The reduction in pain grade ranged from −0.8 to 2.6 (mean: 1.1). Among the response, 14 % showed complete responses, 57 % partial responses, and 29 % no responses, for an overall response rate of 71 %. Mean age of patients with a complete response (38.7 years) was significantly lower than that of patients with a partial response or no response (53.7 years, p=0.017). The only factor with a significant effect was age (p=0.002).

A. Bruggeman1, J.D. Ma2, S.F. Heavey3, E.J. Roeland4 1 Medicine, University of California San Diego, San Diego, USA; 2Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, USA; 3Clinical Trials Office, UC San Diego Moores Cancer Center, San Diego, USA; 4Hematology/Oncology and Palliative Medicine, UC San Diego Moores Cancer Center, San Diego, USA Background and Aims Prognostication plays a key role in palliative care. It is critical for advance care planning, communication, and for determining hospice eligibility. In contrast to subjective assessment of prognostication, evidence-based prognostic indicators (EBPIs) utilize existing data to quantify prognosis. However, the extent to which palliative care providers utilize and document EBPIs remains unknown. The aim of this study was to analyze the current documentation of EBPIs in palliative care inpatient consult notes at a single academic medical center. Methods This was a retrospective chart review of all oncology patients who received an inpatient palliative care consultation at a single, academic hospital (2012–2013). Results There were 412 inpatient palliative care consultations for oncology patients (2012–2013). Reasons for consultations included: goals of care (GOC) (n=108), symptom management (n=181), or both (n= 123). Total prognostic documentation was present in 36 % (n=148) of all consultations [GOC (n=57), symptom (n=32), both (n=59)]. For consultations with prognostic documentation, specific EBPIs were present in 9.7 % (40/412) [GOC (n =9), symptom (n=15), and both (n=16)]. There was no difference between cohorts regarding the presence of an EBPI (p=0.34). When present, EBPI documentation was greater for physician (n=33) than nurse practitioner (n=7).

Total prognostic documentation—no. (%) EBPI—no. (%) EBPI documenter credentials • Physician • Nurse Practitioner

Symptom management (n=181) 32 (17.7)

Goals of care (n=108)

Both (n=123)

57 (52.8)

59 (48.0)

p<0.001

15 (8.3)

9 (8.3)

16 (13.0)

p=0.34

14 1

8 1

11 5

(33/40) (7/40)

Table 1. Total prognostic documentation and use of EBPIs

Conclusions This retrospective analysis suggests that palliative care providers are poor documenters of EBPIs. This data requires prospective validation and may suggest educational opportunities surrounding EBPIs for palliative medicine providers.

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MASCC-0598 Palliative Care DEVELOPING MOBILE PALLIATIVE CARE SERVICE FOR INCURABLE PATIENTS IN THE CAPITAL OF MOLDOVA: HOW BIG IT CAN BE?

N. Carafizi1 Hospice “Angelus”, Charity Foundation for Public Health “AngelusMoldova”, Chisinau, Moldova 1

Background and Aims Background: Palliative care is a new field that was successfully implemented in many countries of the world, but in some states it still remains neglected by the national healthcare systems. In Moldova palliative care has been growing gradually since 2000. Aims: To assess the activity of the Charity Foundation for Public Health ‘Angelus-Moldova’ in regards of the provided home-based services for incurable patients. Methods Methods: Review of the annual reports of the Charity Foundation for Public Health ‘Angelus-Moldova’ about its activity for different categories of incurable patients. Results Results: Charity Foundation for Public Health ‘Angelus-Moldova’ is a leading provider of domiciliary palliative care services for incurable patients in the capital of the country. It was started in November 2001 with the mobile palliative care service for incurable cancer and noncancer adult patients. In November 2008 the home based paediatric palliative care service for incurable cancer children was initiated, and later, in October 2011 the domiciliary palliative care service for incurable non-cancer children was launched. In December 2013 home-based palliative care service for incurable HIV/AIDS patients was established. There are also two additional palliative care services at home for women, who underwent surgical interventions due to the breast cancer and ostomy patients, when they become incurable. Conclusions Conclusions: Despite the fact that the National Program in Palliative Care is not developed, the Charity Foundation for Public Health ‘Angelus-Moldova’ still remains the only provider of qualitative domiciliary palliative care services for different categories of incurable patients in the country.

MASCC-0613 Palliative Care FEASIBILITYAND EFFECT OF SCREENING ON REFERRALS FOR PALLIATIVE CARE SERVICES

K.A. Donovan1, S. Thirlwell1, S. Winn1, S.M. Apte2, D.G. Portman1 1 Supportive Care Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA; 2Gynecologic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA Background and Aims The National Comprehensive Cancer Network (NCCN) palliative care (PC) guidelines recommend all oncology patients be screened for PC needs and provide criteria for PC referral. Data regarding validity of these criteria are limited. Few studies have examined the feasibility and effect of screening on PC referral rates. We piloted a newly developed PC screening tool to examine the feasibility of screening and assess the potential effect of screening on referrals. Methods All patients (N=151) attending the gynecologic oncology (GO) outpatient clinic during 1 week in December 2013 were screened using a pilot version of a 10-item PC screening tool based on NCCN criteria for PC

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referral. Patients were classified as appropriate for referral based on extent of disease, prognosis and PC needs. Results Forty-one percent of patients had metastatic or locally advanced disease; only 2 % had poor performance status. Twenty-two percent had a lifelimiting complication and/or serious comorbidities and 36 % evidenced difficult symptom control or psychosocial distress. Among patients with advanced disease, potential PC cases numbered 36 (24 %) when appropriateness for PC referral was broadly defined and 11 (7 %) when appropriateness was narrowly defined. Conclusions Between 7 and 24 % of GO patients with metastatic or locally advanced disease were potential PC cases. Routine screening of GO patients would facilitate appropriate referrals and enhance patient care without overwhelming the PC service. Although screening was time and labor intensive, findings suggest it is feasible and worthwhile. Future research should assess the clinical utility of the 10-item PC screening tool.

MASCC-0526 Palliative Care CHALLENGES IN CARE OF TERMINALLY ILL PALLIATIVE CARE PATIENT IN THE MIDDLE EAST, MANAGING OF PATIENT SUFFERING BEYOND MEDICATION, EXPERIENCE WITH PATIENT HAVING BOWEL OBSTRUCTION

S. Emara1, M. Soror1, G. Abudari1 1 Oncology/Palliative Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia Introduction Proper management of patient’s suffering needs multifactorial approach (Watson et al. 2009). Inadequacies in support at home contribute to the fact that terminal patients die in hospitals (Worth et al. 2006). The impact of cancer on carers can be greater than on patients (Watson et al. 2009). Case Mrs M, a 52 years old female patient with advanced ovarian carcinoma. Patient admitted because pain, vomiting, and constipation. After adjusting her medications she was able to remove nasogastric tube and swallow. After verifying family concerns; patient was discharged home under home health care service. Discussion After proper support; patient was able to remove nasogastric tube and to swallow then was able to go home. Exploring patients and her family concerns allowed us to assist her at home. There are always many concerns; it is needed to give hope but not promises that could not be achieved (Watson et al. 2009). Conclusions Future plain. We need to extend our social support and to improve communication with local hospitals.

MASCC-0518 Palliative Care PALLIATIVE SEDATION FOR TERMINALLY ILL CANCER PATIENTS IN A TERTIARY CANCER CENTER IN SHANGHAI, CHINA

D.R. Gu1, D.R. Cheng1, D.R. Chen1, D.R. Liu1, D.R. Zhang1 1 Department of Palliative Care, Fudan University Shanghai Cancer Center Department, Shanghai, China Background and Aims Palliative sedation is the lowering of patients’ consciousness using medications for the purpose of limiting patients’ awareness of

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suffering that is refractory. It is frequently used in end-of-life care for terminally ill cancer patients. The aim of this study is to describe the characteristics of patients who were sedated for refractory symptoms in Palliative Care Department from the day of admission until the day of death. Methods We collected information of 244 died terminally ill cancer patients who were enrolled in Palliative Care Department, Fudan University since March 2007 to September 2011. The medical records of patients were reviewed to determine whether the drugs were used for the purpose of palliation of refractory symptoms. Demographic variables and details of sedatives for these patients were recorded and analyzed. Results Of all 244 included patients, 82 patients (33.61 %) received palliative sedation. Sedation were performed, on average, 24.65(±1.78) hours before death. 91.46 % (N = 75) of the patients received sedation intermittently. The medication commonly used was diazepam in 39 patients, haloperidol in 35 patients. Delirium and dyspnea were the most frequent indication for sedation. There was no significant difference in survival time since admission between sedated and nonsedated patients (p>0.05). Conclusions Palliative sedation is an optional choice for terminally ill cancer patients with refractory symptoms.

Summary of Enrolled Patients Subjects

Status

Sex

Age

Race/ Ethnicity

1

Alive

F

33

Non-White

2

Alive

F

51

White

3

Alive

M

58

Non-White

Yes

Yes

TBD

4

Alive

F

58

White

Yes

No

TBD

MASCC-0486

5

Alive

M

64

White

Yes

Yes

TBD

Palliative Care

6

Alive

F

31

White

Yes

Yes

TBD

7

Alive

M

61

White

Yes

Yes

TBD

8

Alive

M

28

White

Yes

Yes

TBD

9

Alive

M

52

White

Yes

No

TBD

10

Alive

F

50

White

Yes

Yes

TBD

SINGLE CENTER, PILOT STUDY TO EVALUATE A NOVEL ADVANCE CARE PLANNING TOOLTO IDENTIFY INFORMED HEALTH CARE PROXIES IN AN ONCOLOGY PALLIATIVE CARE CLINIC 1

1

1

1

1

1

S.F. Heavey , M. Benn , C. Revta , R.S. Atayee , J.D. Ma , E.J. Roeland 1 Doris A. Howell Palliative Care Service, University of California San Diego Moores Cancer Center, San Diego, USA

Background and Aims Unfortunately, most advanced cancer patients will die. To increase the probability that cancer patients receive care consistent with their endof-life (EoL) wishes, medical providers require simple and effective tools to initiate meaningful advance care planning (ACP) discussions, which are ideally communicated to a health care proxy (HCP) and summarized in an advance directive (AD). The primary aim of this study is to determine the proportion of advanced cancer patients who identify an informed HCP implementing a novel ACP tool vs. a historical standard of 20 %. Secondary objectives include: documentation of AD, number of deaths, and determination if EoL wishes were honored. Methods In an ACS sponsored pilot study, advanced cancer patients were evaluated in an academic oncology palliative care clinic (n=34). Subjects engaged in a 1-h ACP discussion initiated utilizing a novel ACP tool developed by the investigators (Figure 1). Details of this ACP conversation were documented with the goal of completing an AD. After subject’s death, HCPs were contacted to determine if EoL wishes were honored. Results To date, 94 % (32/34) of subjects have designated an informed HCP, 50 % (17/34) have completed an AD, and 47 % (16/34) have died. Of the patients that died, 81 % (13/16) died in a setting consistent with their EoL wishes. Consistency of EoL care could not be assessed in 13 % (2/16) of subjects.

HCP Identified in EMR

End-of-life wishes honored?

Yes

Presence of AD in EMR after Intervention No

Yes

No

TBD

TBD

11

Alive

M

73

White

Yes

No

TBD

12

Alive

M

41

White

Yes

Yes

TBD

13

Alive

F

62

White

Yes

Yes

TBD

14

Alive

F

90

White

Yes

No

TBD

15

Alive

M

36

White

Yes

No

TBD

16

Alive

M

56

White

Yes

No

TBD

17

Alive

M

65

White

Yes

Yes

TBD

18

Deceased

F

63

White

Yes

No

Yes

19

Deceased

F

70

Non-White

Yes

Yes

Yes

20

Deceased

F

43

Non-White

Yes

No

Yes

21

Deceased

M

56

Non-White

Yes

Yes

Yes

22

Deceased

F

53

White

Yes

Yes

Yes

23

Deceased

M

58

White

Yes

Yes

Yes

24

Deceased

F

67

White

Yes

Yes

Yes

25

Deceased

F

45

White

Yes

No

Unknown†

26

Deceased

M

57

White

Yes

Yes

No

27

Deceased

M

54

White

Yes

Yes

Yes

28

Deceased

M

77

Non-White

No

No

Unknown‡

29

Deceased

F

72

Non-White

Yes

No

Yes

30

Deceased

F

75

White

Yes

Yes

Yes

31

Deceased

F

63

White

Yes

No

Yes

32

Deceased

F

75

Non-White

Yes

No

Yes

33

Deceased

M

73

White

Yes

No

Yes

34

Withdrew†

F

45

White

n/a

n/a

n/a

Summary

Alive: 50 % (17/34)

Male: 47 % (16)

Mean Average: 57.5±14

White: 76 % (26/34)

AD: 50 % (17/34)

Yes: 81 % (13/16)

Deceased: 47 % (16/34)

Female: 53 % (18/ 34)

HCP Identified: 94 % (32/34) No HCP Identified: 6% (2/34)

No AD: 50 % (17/34)

No: 6 % (1/16)

Withdrew: 3% (1/34)

Non-White: 24 % (8/34)

Unknown: 13 % (2/16)

Abbreviations: AD = Advance Directive; EMR = Electronic Medical Record; HCP = Health Care Proxy †Patient withdrew due to discomfort discussing advance care planning ‡Patients transitioned to hospice prior to goals of care discussion

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Preliminary results suggest that this novel ACP tool may facilitate meaningful ACP, as demonstrated by designation of an informed HCP, AD completion rate, and death consistent with EoL wishes. Results require further prospective validation.>

MASCC-0611 Palliative Care APREPITANT FOR REFRACTORY MALIGNAN CY-ASSOCIATED PRURITUS

J. Sheu1, M. Tawa2, N. LeBoeuf3 1 Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA; 2Dermatology, DanaFarber Cancer Institute, Boston, USA; 3Dermatology Brigham & Women’s Hospital/HMS, Dana-Farber Cancer Institute, Boston, USA Background and Aims Aprepitant, a recently approved medication for chemotherapy-induced nausea and vomiting, blocks the binding of substance P to neurokinin-1. Substance P is implicated in the itch pathway and recent studies have demonstrated that aprepitant can be extremely useful in treating malignancy-associated pruritus and chronic pruritus refractory to conventional treatments. Methods We describe a series of oncology patients with pruritus refractory to conventional treatments, which improved dramatically with aprepitant treatment. Results We report a series of cases of malignancy-associated pruritus responsive to aprepitant treatment after failure of symptom relief on conventional treatments. Most notably, a 73-year-old man with a 12-year history of a locally metastatic microcystic adnexal carcinoma and 2.5 months of intractable full body pruritus, not improved with conventional treatments had rapid cessation of pruritus within 5 h of aprepitant treatment. The remaining patients carried a diagnosis of cutaneous lymphoma and also experienced marked pruritus reduction with aprepitant treatment. Conclusions Aprepitant has been shown to be efficacious for treatment of pruritus associated with malignancy and in cases of chronic pruritus. Aprepitant does not change the clinical efficacy of certain chemotherapeutic medications and clinical trials for its use in preventing nausea and vomiting have validated its safety. These cases suggest that aprepitant can be highly effective in malignancy-associated pruritus and should be considered as a therapeutic option.

MASCC-0446 Palliative Care KARNOFSKY PERFORMANCE STATUS AND CHANGE IN OVERALL SURVIVAL OVER FIVE YEARS

R. McDonald1, L. Zhang1, G. Bedard1, E. Wong1, M. Popovic1, L. Holden1, M. Tsao1, E. Barnes1, C. Danjoux1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims The Karnofsky Performance Status (KPS) scale is used to assess patients based on functional impairment. KPS has been shown in many studies to be one of the most crucial and relevant predictive factors in the survival of cancer patients. The purpose of this study was to determine whether survival corresponding to the same KPS range has increased from 2007 to 2012.

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Methods All patients who were seen at an outpatient palliative radiotherapy clinic from 2007 to 2012 were included. Overall survival (OS) was calculated from the date of consultation until date of death or censored at last followup date. Kaplan-Meier survival curves and univariate Cox proportional hazard model were conducted for all patients, within subgroups with KPS of 10–40, 50–70, and 80–100. A p-value <0.05 was considered statistically significant. Results From a total of 2,690 patients, 2257 (84 %) were deceased. The median OS time was 2.9 months (95 % CI: 2.7–3.1). All patients seen from 2007 to 2008 (p<0.0001) and 2009–2010 (p=0.03) had shorter survival when compared to those seen from 2011 to 2012. Significant difference also occurred for patients with KPS of 50–70 seen in 2007–2008 (p=0.007) and 2009–2010 (p =0.0496) compared to 2011–2012. Median OS for these patients were 2.73, 2.96, and 3.02 months, respectively. For patients with KPS 80–100 seen in 2007–2008 and 2011–2012, median survival nearly doubled from 6.6 to 12.1 months (p=0.0052). Conclusions Survival has increased for patients within the same KPS categories from 2007 to 2012. Improvements in systemic therapies are likely responsible for this increase.

MASCC-0608 Palliative Care ORAL MORBIDITY IN PATIENTS RECEIVING PALLIATIVE CARE

S.ar. PS1, M.P. Mohan1 1 Oral Medicine, Mar Baselios Dental College, Cochin, India

Background and Aims This study aims to assess oral problems in patients receiving palliative care for cancers including the head and neck region. Methods One hundred forty patients were recruited to the study following the inclusion and exclusion criteria. All patients went through a face-to-face interview, covering 10 frequent cancer-related symptoms, and an oral examination including a mouth swab to test for Candida carriage. All patients had undergone an oral examination according to standard clinical practice with a systemic registration of oral finding including mucosa, teeth, dental plaque, gingival bleeding and mirror function test, Examination of the oral mucosa focussed on the clinical expression of a fungal infection, based on the WHO classification of the oral candidiasis; registration of teeth include number of teeth remaining, decayed, missing, DMFT index score, a functional dentition is defined as 20 or more remaining teeth. Results Examined patients had mean age of 66 years (range 38–82). Clinical presence of oral candidiasis 51 %, dry mouth 82 %, mouth pain 13 %, trismus 12 % and oral mucositis 25 % significantly affected the patients and oral hygiene measures were adequate. The information concerning oral problems was least available. Conclusions Oral care for patients in palliative care units are important and need better mouth care. Setting up of oral care strategy is mandatory at a grass root level in health care systems. Increased information to the caregivers, patients and staff about the presence and severity of oral problems is necessary. Information about oral problems is important in all stages of cancer treatment.

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MASCC-0606 Palliative Care FACTORS INFLUENCING PATIENT SATISFACTION WITH CARE AMONG OLDER LATINOS WITH ADVANCED CANCER

I. Torres-Vigil1, A. de la Rosa2, E. Pena3, A. Abdias3, E. Bruera4 1 Graduate College of Social Work and Department of Palliative Care, University of Houston and The University of Texas MD Anderson Cancer Center, Houston, USA; 2Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; 3Graduate College of Social Work and Department of Palliative Care, University of Houston, Houston, USA; 4Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Identifying the factors that influence patients’ satisfaction with care is crucial for informing quality improvement efforts for vulnerable populations. The aim of this study is to identify the demographic, psychosocial and clinical factors associated with satisfaction among a cohort of older Latinos with advanced-cancer. Methods Patients were interviewed to assess their satisfaction with care using a 12items version of the EORTC IN-PATSAT32. Independent variables measured demographics (age, gender, income, education); psychosocial (acculturation, medical-mistrust, racism, fatalism, social support); quality-oflife and symptom-burden (EQ-5D, FACT-G, ESAS, EGOG). Chi-square tests were conducted to identify associations between satisfaction-levels and independent variables. Results From 68 baseline-interviews, 67 % of satisfaction scores were excellentgood, and 33 % were fair-poor. Males (P=0.013) and patients under age 70 (P=0.023) had greater satisfaction than females and those over 70. Acculturated or bicultural patients reported greater satisfaction than nonacculturated patients (P=0.036). High levels of mistrust (P=0.039) and fatalism (P=0.013) were associated with reduced satisfaction scores. Patients with higher quality-of-life scores (P=0.001) and those reporting no problems with mobility, self-care, usual activities, pain, anxiety/ depression had improved satisfaction (P≤0.05). Low functional-status and moderate-severe pain, fatigue, depression/anxiety, drowsiness, dyspnea, poor-appetite and overall-wellbeing rated their satisfaction lower than those with reduced symptom-burden (P≤0.05). Conclusions Patient satisfaction with care varies significantly by sub-groups of older Latinos with advanced cancer. Consistent and significant associations between satisfaction and important quality-of-life and symptom-burden measures suggest that increased utilization of palliative care services may improve satisfaction with care. Culturally-competent, age and gender appropriate interventions are needed to improve satisfaction among this vulnerable population.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims Lipegfilgrastim is a long-acting, fixed-dose, glycopegylated recombinant granulocyte colony-stimulating factor developed to reduce the duration of severe neutropenia and the incidence of febrile neutropenia (FN) in adults receiving myelosuppressive chemotherapy with a ≥20 % risk of FN. This analysis evaluated the effects of age, weight, and treatment type (adjuvant vs metastatic disease) on the efficacy of lipegfilgrastim vs pegfilgrastim using data from 2 studies (1 phase II, 1 phase III) in breast cancer patients receiving chemotherapy. Methods Both studies randomized patients to subcutaneous lipegfilgrastim (3, 4.5, or 6 mg, phase II; 6 mg, phase III) or pegfilgrastim (6 mg)≈24 h after chemotherapy (60 mg/m2 doxorubicin/75 mg/m2 docetaxel) for 4 21day cycles. Blood samples for absolute neutrophil counts (ANC) were obtained 24 h before chemotherapy (cycle 1), daily until day 15, and during cycles 2, 3, and 4. This post hoc analysis, pooled data from the lipegfilgrastim and pegfilgrastim 6-mg groups from both studies. Study endpoints included duration of severe neutropenia; time to ANC recovery; depth of ANC nadir; and incidence of grade 4 neutropenia stratified by age, weight, and type of treatment. Results Data for stratified efficacy endpoints are summarized in the Table. Table 1. Efficacy End Point Stratified by Age, Weight, and Type of Treatment

Parameter

Pegfilgrastim 6 mg

Lipegfilgrastim 6 mg

n

n

Cycle 1

Cycle 1

Duration of severe neutropenia, mean ± SD, daysa All patients

155

0.9±0.9

151

0.7±1.0

<65 y

144

0.9±0.9

139

0.7±1.0

≥65 y

11

0.7±0.9

12

0.9±1.4

<60 kg

26

0.7±0.7

29

0.8±1.1

60–80 kg

91

1.0±1.0

77

0.8±1.0

>80 kg

38

0.8±0.9

45

0.5±1.0

Adjuvant

117

0.8±0.9

116

0.8±1.0

Metastatic

38

1.1±1.0

35

0.5±1.0

Time to ANC recovery, mean ± SD, daysb All patients

155

7.4±3.4

151

5.8±3.5

<65 y

144

7.4±3.4

139

5.8±3.6

≥65 y

11

7.4±3.8

12

5.7±3.5

<60 kg

26

6.7±3.3

29

6.0±3.5

60–80 kg

91

7.8±3.0

77

6.2±3.5

>80 kg

38

7.0±4.2

45

5.1±3.6

Adjuvant

117

7.4±3.5

116

5.9±3.7

Metastatic

38

7.6±3.0

35

5.7±3.1

Depth of ANC nadir, mean ± SD, × 109/Lc All patients

155

0.9±1.3

151

1.3±1.6

<65 y

144

0.9±1.2

139

1.3±1.5

≥65 y

11

1.3±1.5

12

1.7±2.0

MASCC-0544

<60 kg

26

1.0±1.4

29

1.3±1.5

Palliative Care

60–80 kg

91

1.8±1.1

77

1.2±1.5

>80 kg

38

1.3±1.5

45

1.6±1.7

Adjuvant

117

1.0±1.3

116

1.4±1.7

Metastatic

38

0.8±1.2

35

1.0±1.2

EFFICACY OF LIPEGFILGRASTIM VERSUS PEGFILGRAS TIM IN PATIENTS WITH BREAST CANCER: SUBGROUP ANALYSIS BASED ON AGE, WEIGHT, AND TYPE OF TREATMENT

C. Volovat1, A. Buchner2, P. Bias2, U. Mueller3 1 Medical Oncology, Centrul de Oncologie Medicala, Iasi, Romania; 2 Clinical, Teva Ratiopharm, Ulm, Germany; 3Clinical, Teva Pharmaceuticals Inc, Ulm, Germany

a

Days with grade 4 neutropenia (ANC <0.5×109/L). First day after start of chemotherapy with ANC ≥2.0×109/L after any day with ANC <2.0×109/L. c Lowest ANC value after start of chemotherapy in each cycle. ANC absolute neutrophil count; SD standard deviation. b

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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Table 2. Incidence of Grade 4 Neutropenia

MASCC-0468 Palliative Care

Pegfilgrastim 6 mg Cycle Incidence of Grade 4 1 2 3 4 Neutropenia, % of Patientsa All patients 52.3 26.1 15.9 17.2 <65 y 52.8 25.9 14.2 16.3 ≥65 y 45.5 30.0 40.0 30.0 <60 kg 46.2 11.5 7.7 15.4 60–80 kg 56.0 32.6 18.2 15.9 >80 kg 47.4 21.1 16.2 21.6 Adjuvant 50.4 24.1 14.7 14.7 Metastatic 57.9 32.4 20.0 25.7

Lipegfilgrastim 6 mg Cycle 1 2 3 4

41.7 41.7 41.7 48.3 49.4 24.4 44.8 31.4

12.8 12.3 18.2 10.7 9.1 20.5 13.0 11.8

9.5 9.5 9.1 14.3 6.5 11.6 8.8 11.8

11.0 11.9 0 11.1 10.7 11.6 10.7 12.1

a ANC <0.5×109/L. ANC, absolute neutrophil count.

Conclusions Treatment with lipegfilgrastim limits the extent of neutropenia regardless of patient age, weight, or type of treatment. This post hoc analysis demonstrates a trend for a lower rate of grade 4 neutropenia with lipegfilgrastim treatment that is consistent across all subgroups evaluated.

MASCC-0618 Palliative Care PHYSICIAN PERCEPTION OF CLINICAL BURDEN/STRESS AT A TERTIARY LEVEL PALLIATIVE CARE PROGRAM

P. Walker1, N. Schuren1, E. Bruera1 1 Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, USA Background and Aims Little is known about the areas of difficulty or burden of clinical work for Palliative Care physicians. This study was conducted to determine which components of a Palliative Care program cause the most difficulty for Palliative Care physicians. Methods The medical faculty in the department of Palliative Care in a large tertiary level cancer hospital annonymously answered surveys. These surveys pertained to the difficulty/burden/stress they experienced. An initial survey asked the physicians to rate the difficulty/burden of working on the Palliative Care Unit (PCU), Mobile Consult Teams, and the Out-Patient Center on a scale: 0=No Burden, 10=Worst Burden. A follow-up survey asked physicians to rate stress caused by various areas of work on the PCU, 0=No stress, 10=Most stress. Results Eleven full time Palliative Care physicians at MD Anderson Cancer Center (100 % of faculty with full clinical responsibility) responded to the initial survey. The PCU was rated the area of highest difficulty/burden (mean 7.4 +/− 1.4 S.D.). The Out-Patient Center was rated the second highest for difficulty (mean 6.5 +/− 2.1 S.D.). Responses on the second survey (n=10) rated stress on the PCU. Dealing with Families and Caregivers rated most stressful (mean 6.2 +/− 2.4 S.D.), followed by Rounding on Patients (mean 5.3 +/− 2.0 S.D.), Family Meetings (mean 5.3 +/− 2.2 S.D.) and interaction with the Case Manager (mean 5.1 +/− 3.1 S.D.) Conclusions Further research is required to determine if these findings are generalizable to other Palliative Care programs.

SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH BRAIN METASTASES RECEIVING WHOLE BRAIN RADIATION THERAPY

E. Wong1, M. Tsao1, L. Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1, E. Barnes1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Patients with multiple brain metastases are often treated with whole brain radiation therapy (WBRT). For these patients, symptom palliation as well as improvement of quality of life (QOL) and performance status, are of upmost importance. The objective of this study is to determine the overall QOL and symptoms experienced by patients with brain metastases before WBRT, the changes seen following WBRT, and the correlation between symptoms experienced and overall QOL. Methods Patients receiving WBRT, who completed 14 symptom scores and overall QOL assessment for up to 3 months, were included. Wilcoxon signed rank test was applied to determine significant symptoms and QOL changes. Spearman correlation was applied to determine the relationship between symptoms scores and QOL. Results Two hundred and seventeen patients were included. Appetite loss, weakness and nausea significantly increased from baseline, while balance, headache and anxiety significantly decreased. At baseline, all symptoms other than coordination were significantly correlated with QOL. At month 1 follow-up (FU), changes in concentration, weakness, coordination and balance were significantly associated with QOL changes. At month 2 FU, changes in pain, insomnia, concentration, balance and depression were significantly associated with QOL changes. At month 3 FU, only change in nausea was significantly associated with QOL changes. Conclusions Clinicians should be aware of the symptom changes following WBRTand follow-up with patients as necessary. Certain symptoms may influence overall QOL to a greater extent than others and these symptoms should be palliated with other medications to improve QOL in patients with brain metastases treated with WBRT.

MASCC-0085 Palliative Care 2 METRONOMIC ORAL COMBINATION CHEMOTHERAPY WITH CAPECITABINE AND CYCLOPHOSPHAMIDE IN PATIENTS WITH ANTHRACYCLINE-,TAXANE-AND PLATINUM PRETREATED METASTATIC TRIPLE NEGATIVE BREAST CANCER

G. Ajay1, R. Vinod1 1 Medical Oncology, All India Institute of Medical Science, Delhi, India Background and Aims Triple negative breast cancer (TNBC) constitute 25 % of all breast cancer and have short progression free survival (PFS) and overall survival (OS), is major concern in our country. The purpose of this study was to evaluate the efficacy and safety of an all-oral combination of metronomic cyclophosphamide plus capecitabine for women with anthracycline, taxane, and platinum pretreated triple negative MBC.

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Methods A retrospective single centre analysis of 60 patients with advanced triple negative breast cancer. This analysis was carried out with the aim to determine efficacy in terms of response rate, control of tumor-related symptoms, outcome, and toxicity. All patients had chemotherapy resistant metastatic disease and had previously received three lines of chemotherapy included anthracycline, taxane, and platinum . All patients received oral capcitabine 500 mg twice in a day and oral cyclophosphamide at 50 mg/day without interruption until re-evaluation or progressive disease. Results Between January 2008 and December 2013, 60 patients were enrolled and 45 were included in the efficacy analysis. The median follow-up was 12 months. ORR was 40 % and stable disease was achieved in 15 %, resulting in a 55 % clinical benefit response rate. Symptoms controlled was achieved in 58 % of cases. Median PFS was 6 months and overall survival was 9 months. The 1- and 2-year OS rates were 51 and 21 %, respectively. Toxicity was very mild and easily manageable Grade 3 adverse events comprised leukopenia (20 %), neutropenia (18 %) and transaminitis in 10 % of cases. Conclusions The all-oral combination of metronomic CTX plus capecitabine is an effective and convenient and well-tolerated regimen for MBC.

MASCC-0055 Palliative Care 2 ENDOBRONCHIAL PALLIATIVE PHOTODYNAMIC THERAPY FOR INOPERABLE CENTRAL LUNG CANCER

A. Akopov1, A. Rusanov1, N. Kazakov1, A. Gerasin1 1 Res Institute of Pulmonology, First State Pavlov Medical University, St. Petersburg, Russia Background and Aims Malignant airway stenosis often causes severe life threatening symptoms, primarily respiratory failure. Effectiveness of current treatment options cannot be considered satisfactory. We analyze the possibility to extend indications for photodynamic therapy (PDT) as a component of multidisciplinary treatment for locally advanced and metastatic non-small cell lung cancer (NSCLC). Methods Two hundred seventy-three patients with inoperable stage III-IV NSCLC underwent endobronchial PDT in combination with chemoand targeted therapy (249), argon-plasma coagulation (59), stenting (47), YAG laser (23), brachytherapy (7). Indications for PDT were obstructing central disease as well as local recurrence after surgical treatment (41) and critical airway obstruction (24). PDT involved intravenous administration of chlorine E6 (Radachlorin) in the dose of 1 mg.kg-1 followed by irradiation with 662 nm laser light up to a total dose of 100 J/cm2. Results Number of PDT sessions for the patient – from 1 to 13. The average duration of PDT session was 11,5 min (range from 9 to 18). No patients had major PDT complications. Of the 273 patients 14 % achieved complete endobronchial response, 70 % - partial response, 16 % - no response. 97 % of patients had symptoms improvement. The 1 year survival rate for patients with stage III was 71 %, stage IV – 56 %, median survival was 19 months. The best results were noted in patients with local relapse after previous resection. Conclusions PDT is safe and effective option for advanced obstructing endobronchial lesions. PDT appears to fit in well with the current multidisciplinary approach to lung cancer.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0134 Palliative Care 2 SUPPORTING A PRISONER AT THE END OF LIFE

L. Boregowda1, L. Boregowda1 1 Palliative Medicine, Kidwai Memorial Institute of Oncology, Bangalore, India Background and Aims Providing appropriate palliative care support for a prisoner with advanced, progressive disease in a high security environment presents practical, legal and ethical challenges for health care staff. The team in our Department took interest in treating him both as an outpatient and inpatient for providing palliative care. Methods Mr.X Sex: Male Age: 56 Yrs Bio-hazardous (HIV + ve) Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2nd December 2013 Currently on: Oral Morphine 70 mg 4th hrly, with adjuvants. Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Bio-hazardous (HIV + ve)Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013 Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Age: 56 Yrs Bio-hazardous (HIV + ve) Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Sex: Male Age: 56 Yrs Bio-hazardous (HIV + ve) Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013 Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. Results I will provide an overview of the palliative care services provided to him as both outpatient and inpatient at our hospital. I will present the challenges in providing good palliative care to maintain dignity and ensure comfort for a prisoner at the end of life. Conclusions This will illustrate the fascinating and satisfying aspect of my role as a Palliative care consultant in providing good Palliative care to a prisoner.

MASCC-0132 Palliative Care 2 MUSCULAR METASTASES ARISING FROM SQUAMOUS CELL CARCINOMA OF THE LUNG

N. Chiu1, L. Chiu1, G. Bedard1, M. Poon1, M. Popovic1, E. Wong1, H. Lam1, E. Chow1 1 Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Lung cancer is the leading cause of cancer-associated death in the world and is the second most commonly observed subcategory of cancer among

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

both men and women. Nonetheless, skeletal muscle metastases from lung cancer are a rare occurrence. Due to the rare incidence of muscle metastases arising from lung cancer, documentation of these types of cases in the literature may be of use to health-care professionals in understanding disease progression and consequent treatment recommendations. Methods The current case report documents the case of a 66-year old woman with lung cancer who suffered from associated metastases, including a metastatic tumor to the right rectus femoris. Results Investigations of the patient revealed extensive metastatic squamous cell carcinoma originating from the lung and involving the bones, liver, left adrenal gland, and the right rectus femoris muscle. The patient was treated with palliative radiation for her painful bone metastasis. Specifically, she received a single 8 Gy to the thoracic and lumbar spine, the pubic symphysis, and the right pelvic bone. Conclusions We recommend that further studies of metastatic growth in skeletal muscles be done in order to in identify optimal treatment procedures for patients of various stages of disease progression. As more studies of relevant cases are documented, comparisons in treatment procedures should be made to identify more effective, individualized therapies.

MASCC-0018 Palliative Care 2 GUARANA (PAULLINIA CUPANA) IMPROVES ANOREXIA IN PATIENTS WITH ADVANCED CANCER

C.G.L. Palma1, F. Cruz1, A.T. Lera2, T. Lerner3, M.M. Oliveira3, T.M. Borta3, R.P. Barbosa3, G.M. Brito3, C.A. Guazzelli3, A. del Giglio4 1 Clinical Oncologist, ABC Foundation School of Medicine, Santo André, Brazil; 2Resident in Clinical Medicine, ABC Foundation School of Medicine, Santo André, Brazil; 3Academic, ABC Foundation School of Medicine, Santo André, Brazil; 4Chairman of the Department of Hematology and Oncology, ABC Foundation School of Medicine, Santo André, Brazil Background and Aims Anorexia is prevalent in cancer patients with advanced disease. In this pilot phase II, open label, non-randomized trial, we evaluated the efficacy and safety of guarana (Paullinia cupana) in patients with cancer and weight loss. Methods We included advanced cancer patients with decreased appetite and weight loss of more than 5 % from their baseline. All of the patients received 50 mg of the crude dry extract of guarana twice a day for 4 weeks. The trial was designed in 2 phases (Simon model). We considered a positive response in the first phase to be at least 5 % weight gain or a 3-point improvement in the appetite scale in at least 3 of the first 18 evaluable patients. Results Of the 34 eligible patients, 30 were included and 18 completed the protocol. Only 1 patient abandoned the protocol due to toxicity (grade II arthralgia). There were no grade 3 or 4 toxicities. There were no significant differences in nausea, weight loss and quality of life (FACT-G). Only 2 of the 18 patients who completed the study had weight gain above 5 % from their baseline, whereas 6 patients had at least a 3-point improvement in the visual appetite scale. The M.D. Anderson Symptom Inventory (MDASI) was used to evaluate several symptoms, and we observed a significant decrease in lack of appetite (p=0.02) and in somnolence (p=0.0142).

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Conclusions We concluded that the weight stabilization and increased appetite we observed in this study justify further studies of guarana in this patient population.

MASCC-0061 Palliative Care 2 PHASE II CLINICALTRIAL OF UNCARIA TOMENTOSA (CAT’S CLAW) IN PATIENTS WITH ADVANCED SOLID TUMORS

L. de Paula1, F. Fonseca1, F. Perazzo1, F. Melo Cruz1, D. Cubero1, D. Trufelli1, S. Martins1, P. Santi1, E. Araújo da Silva1, A. Del Giglio1 1 Clinical Oncology, ABC Foundation School of Medicine, Santo André, Brazil Background and Aims Cat’s claw (Uncaria tomentosa) is a native amazonic plant that exhibits anti-inflammatory and antitumor properties. Methods Prospective phase II study assessing the effects of dry extract of U. tomentosa on individuals with advanced solid tumors, with no further therapeutic options and with at least 2 months life expectancy. We used EORTC QLQ C30 and FACIT-F questionnaires to assess participants’ quality of life, HADS questionnaire to assess their anxiety and depression and Pittsburgh index (PSQI) to assess sleep quality. In addition, several biochemical and inflammatory parameters were analyzed. Results We recruited 51 volunteers; their median age was 64 (33–85) years old, and 47 % were females. Their scores on the Karnofsky scale were equal to or less than 80 % for more than 65 % of the volunteers. Treatment caused an improvement in patients’ overall quality of life (p = 0.0411) and social functioning (p = 0.0341), as assessed by EORTC QLQ C-30, and a reduction of fatigue (p = 0.0496) by Chalder Fatigue Questionnarie (figure 1). None of the biochemical or inflammatory parameters assessed exhibited significant changes. No tumor response was detected according to RECIST criteria; however, disease stabilized for more than eight months in four participants. Medication was well tolerated by most patients.

Conclusions We conclude that use of cat’s claw might be beneficial for patients with advanced cancer because it could improve their quality of life and reduce fatigue. The mechanism of this action does not seem to be related to the anti-inflammatory properties of this plant.

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MASCC-0111 Palliative Care 2 FACTORS AFFECTING COMMUNICATION PATTERNS BETWEEN ONCOLOGY STAFFAND BEREAVED FAMILIES: A CROSS-SECTIONAL STUDY

T. Granot1, S. Perry2, N. Gordon3, S. Rizel1, S.M. Stemmer4 1 Breast Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; 2 Psycho-Oncology, Davidoff Cancer Institute, Petah-Tikva, Israel; 3 Research, Davidoff Cancer Institute, Petah-Tikva, Israel; 4Deputy of Oncology Institute, Davidoff Cancer Institute, Petah-Tikva, Israel Background and Aims Perceptions surrounding the role of the oncology staff in supporting families of deceased patients have evolved with the transition to an interdisciplinary cancer-care approach. The goal of this study was to investigate the interactions between oncology professionals and bereaved families. Methods In a cross-sectional study, all staff members, at one Cancer Center, were given a 5-point Likert scale questionnaire, including 39 statements relating to communications with bereaved families. Results One hundred seven (69 %) filled questionnaires (α=0.821). Respondents included (38 %) physicians, (50 %) nurses (8 %) social workers, and (4 %) psychologists. Median age was 45.1 yrs, 90 % were Jewish, and 63 % had ≥10 yrs of oncology experience. 73 % thought it was important to contact bereaved families, that such interaction provided closure to staff (79 %), and that it was professionally appropriate (82 %). 51 % indicated that they contact >50 % of the families of their deceased patients. Contacting bereaved families was considered to be within physicians (88 %), nurses (81 %), or social workers (87 %) responsibility. Barriers for contacting families were emotional overload (68 %) and lack of time (63 %). 60 % indicated a need for additional communication tools, to aid them in bereavement activities. In a multivariate analysis, profession (physician vs. nurse), primary workplace (inpatient vs. outpatient setting) and ethnicity (Jewish vs. Muslim) were significant variables regarding the importance of contacting bereaved families so actually contacting them. Other factors (age, gender, experience, number of dying patients) were mostly nonsignificant. Conclusions Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and ethnicities. Additional guidance/education regarding bereavement actions is warranted.

MASCC-0128 Palliative Care 2 PREDICTIONS FOR SHORT AND LONG TERM SURVIVAL AFTER ICU ADMISSION IN ADVANCED CANCER PATIENTS

S.J. Heo1, K.S. Chung1, J.H. Sohn1, S.H. Lee1 1 Department of Internal Medicine, Yonsei University College of medicine, Seoul, Korea Background and Aims Intensive care unit (ICU) admission in advanced cancer patients remains debated because of the poor short-term prognosis. Therefore, ICU admission of these patients should be assessed on the possibility to administer specific anticancer treatment, tumor characteristics and the long-term outcome.

Methods We analyzed in 116 advanced cancer patients admitted to the ICU between Jan 2010 and Dec 2012. We analyzed demographic, clinical and survival data and identified prognostic and predictive factors that could be compared with short- and long-term survival. Results Of the 116 patients, the median age at ICU admission was 64 years (59.5 % males, 40.5 % females). As the main cause of ICU admission was acute respiratory failure (73 %), 102(87.9 %) patients were managed in mechanical ventilation, 99(85.3 %) patients in vasopressor and 31(26.7 %) patients in continuous renal replacement therapy (CRRT). The ICU, hospital and 6-month survival rates were 51.7 %, 31.0 %, and 15.5 %, respectively. APACHE II score (HR: 2.86, 95 % CI: 1.00–8.15, P <0.050) and the need for CRRT (HR:2.14, 95 % CI 1.24–3.70, P <0.007) were associated with ICU mortality However, Eastern Cooperative Oncology Group (ECOG) performance status (HR 1.64, 95 % CI 1.03–2.62, P <0.010) is associated poor prognosis and controlled disease status (HR 0.372, 95 % CI 0.21–0.67, P <0.001) is good prognostic factor for 6month survival after ICU admission. Conclusions To determine short-term survival, clinical factors presenting acute illness at ICU admission were higher associated ICU mortality than factors related to the malignancy itself. We have to assess the comprehensive approach considering cancer biology, disease control status in terms of long-term survival.

MASCC-0047 Palliative Care 2 AN EXPLORATORY STUDY OF THE ATTITUDES OF PALLIATIVE CARE PRACTITIONERS TO THE USE OF PALLIATIVE CARE ASSESSMENT TOOLS IN KENYA

J. Weru1 1 Medicine, Aga Khan University Hospital Nairobi, Nairobi, Kenya Background and Aims According to WHO (2008) quality palliative care is possible if there is early identification and impeccable assessment and treatment of pain and other problems. From this definition, assessment of symptoms is an important component of quality palliative care. Objectives & Assess how attitudes of practitioners affect the use of assessment tools & Assess practitioners’ attitude on utilization of assessment tools & Identify barriers to use of tools and determine methods which could increase their use. Methods 1:1 interviews were conducted using a guideline, 10 participants who met the inclusion criteria, from 3 palliative care settings located in different parts of the country. Interviews at the practitioners’ places of work during duty time. Data recorded and transcribed with issues isolated and grouped together into themes. Results Themes: practice, communication, practical concerns, resources and training, Culture, spirituality, patient and family wellbeing, symptoms management, tools applicability and availability. Conclusions There is a need for better scientific evidence of palliative care assessment tools clinical utility locally. Evidence need to be adduced showing that the use of tools enhance practice. Review of curricula for nurses, doctors and palliative care practitioners. Development of national palliative care tools

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which are culture and language appropriate. Filling out assessment tools bit by bit for completion with multiple visits. Assessments need to be carried out at the key moments of a patient’s illness trajectory. Use of mobile telephony in assessment.

MASCC-0133 Palliative Care 2 SUSPECTED MALIGNANT SPINAL CORD COMPRESSION: CLINICAL SUSPICION IS VALID

J. MacKintosh1, A. Brady1, S. Carr1, D. MacKintosh1 1 Palliative Care, Central Coast Local Health District, Long Jetty, Australia Background and Aims Malignant spinal cord compression (MSCC) is a genuine medical emergency and untreated can result in paralysis and bowel and bladder dysfunction. Assessment, imaging and treatment needs to be initiated on suspicion and before neurological deficits are apparent. Delay in diagnosis and treatment increases the risk of those complications which may have devastating consequences for affected patients. Not all clinicians are aware of the need to start the assessment process on the basis of clinical suspicion in the absence of identifiable neurological deficits. To review outcomes for patients seen in the community with clinical suspicion of MSCC (a known cancer diagnosis PLUS development of a new back pain or an increase in an existing back pain). To develop a protocol for emergency management of suspected MSCC in the community. Methods A retrospective audit of 399 medical records identified 27 patients with a suspected MSCC. Results MSCC was confirmed by MRI in 60 % of patients with clinical suspicion of MSCC. Conclusions Clinical suspicion of MSCC using the identified criteria is valid and supports the use of a protocol enabling community based Palliative Care Specialist Nurses to administer emergency treatment of dexamethasone 16 mg prior to transfer to the emergency department for imaging and further assessment. Patients are instructed to continue dexamethasone 16 mg/day until the diagnosis has been either confirmed or refuted to minimise the risks of delayed diagnosis in the absence of neurological signs.

MASCC-0117 Palliative Care 2 PATHOLOGICAL FRACTURE FROM METASTATIC BONE DISEASE OF AN UNKNOWN PRIMARY CANCER

C. Yip1, M. Popovic1, N. Lao1, N. Pulenzas1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Cancer of an unknown primary (CUP) is a common malignancy that accounts for approximately 3–5 % of all cancer diagnoses. When patients with low performance status suffer from pathological fractures secondary to bone metastases, surgery is usually not indicated due to poor prognosis. Instead, pain management may become the primary concern. The purpose of this present case report is to discuss the treatment of pathological fractures in patients with low performance statuses from a CUP.

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Methods A 65 year-old male with a CUP was referred to the Sunnybrook Health Sciences Centre in July 2013 with widespread bone metastases causing a fracture of the lesser trochanter of the left hip. As a result, the patient experienced extreme pain and was unable to walk. Results Due to the patient’s weak condition, orthopaedics felt that surgery was not a suitable option; rather, radiotherapy for pain management was recommended. The dose of radiotherapy the patient was to receive was initially 30 Gy in ten fractions, but was reduced to 20 Gy in five fractions in order to minimize the pain and suffering associated with trips by ambulance. Conclusions The poor prognosis of CUP patients in certain risk categories makes surgery an unfavorable option, especially in the treatment of patients with poor performance status. Management of pathological fractures secondary to bone metastases through radiotherapy requires a balance in assessing the goals of treatment, as well as the needs and conditions of the patient.

MASCC-0116 Palliative Care 2 PALLIATIVE RADIOTHERAPY FOR BRAIN AND BONE METASTASES FROM A PAPILLARY THYROID CARCINOMA

C. Yip1, N. Lao1, M. Popovic1, N. Pulenzas1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada

Background and Aims Common sites of metastases from a primary papillary thyroid carcinoma (PTC) are the lung and bone; conversely, metastases to the brain are extremely rare. Complications can arise from bone metastases, including pathological fractures. Pathological fractures can be treated aggressively with surgery or conservatively with radiotherapy. Surgical indication is greatly affected by the patient’s life expectancy, which is greatly reduced with presence of brain metastases. This case report discusses the optimal therapeutic approach for patients with bone and brain metastases from a primary PTC. Methods A 78 year-old male was referred to the Sunnybrook Health Sciences Centre. The patient was diagnosed with PTC, with accompanying brain, liver, and bone metastases. The patient suffered from headaches and a pathological fracture of the right humerus secondary to a bone metastasis. Results It was decided that surgical management would put the patient at a high risk of bleeding. Recovery from surgery would also be difficult, as he was wheelchair dependent and required almost 24-h care. The patient started radiation treatment of 20 Gy in five fractions to both the right humerus fracture and the whole brain. After treatment, the patient was reported to have felt relief from pain. Conclusions This case demonstrates the potential difficulty of deciding a treatment option for a patient with a poor prognosis due to potential complications. Further studies done on this patient population would help clarify and improve treatment options available to such patients.

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MASCC-0121 Palliative Care 2 PALLIATIVE RADIOTHERAPY FOR BRAIN AND BONE METASTASES FROM A PAPILLARY THYROID CARCINOMA

C. Yip1, N. Lao1, M. Popovic1, N. Pulenzas1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Common sites of metastases from a primary papillary thyroid carcinoma (PTC) are the lung and bone; conversely, metastases to the brain are extremely rare. Complications can arise from bone metastases, including pathological fractures. Pathological fractures can be treated aggressively with surgery or conservatively with radiotherapy. Surgical indication is greatly affected by the patient’s life expectancy, which is greatly reduced with presence of brain metastases. This case report discusses the optimal therapeutic approach for patients with bone and brain metastases from a primary PTC. Methods A 78 year-old male was referred to the Sunnybrook Health Sciences Centre. The patient was diagnosed with PTC, with accompanying brain, liver, and bone metastases. The patient suffered from headaches and a pathological fracture of the right humerus secondary to a bone metastasis. Results It was decided that surgical management would put the patient at a high risk of bleeding. Recovery from surgery would also be difficult, as he was wheelchair dependent and required almost 24-h care. The patient started radiation treatment of 20 Gy in five fractions to both the right humerus fracture and the whole brain. After treatment, the patient was reported to have felt relief from pain. Conclusions This case demonstrates the potential difficulty of deciding a treatment option for a patient with a poor prognosis due to potential complications. Further studies done on this patient population would help clarify and improve treatment options available to such patients.

MASCC-0243 Palliative Care 3 THE PROMOTION OF END-OF-LIFE SUPPORTIVE CARE TO THE GENERAL PUBLIC

C. Chan1, C.K. Pang2 1 Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 2Nursing, Princess Margaret Hospital, Hong Kong, Hong Kong China Background and Aims The goal of this health promotion project was to promote public awareness and appreciation of the benefits of end-of-life supportive care. Methods Phase one of the project included 8 road-shows to disseminate the philosophy and the services available regarding end-of-life care to the community in Hong Kong. Five of the road-shows were organized in hospital lobbies and three in shopping malls. Participants were given sets of the promotional materials (pamphlet and VCD) and completed a brief survey. Phase two of the project involved a 2-day training workshop for 58 home care nurses and doctors on advance care planning and advance directives. Results The brief survey of 2,700 participants during the road-shows indicated that 87 % of participants did not know what an advanced care planning/ advance directive was, and 60 % of participants were interested in knowing more about the end-of-life supportive service.

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Most participants in phase two agreed that the workshop enabled them to understand more about advance care planning and they could apply the knowledge in their professional practice. Conclusions The project has increased the community’s awareness of, and interest in, the available services when a person is facing a life-limiting disease and encourage more openness in preparing for a good death. The project also provided updated training to nurses and doctors to improve delivery of end-of-life care.

MASCC-0155 Palliative Care 3 PALLIATIVE RADIOTHERAPY FOR BONE METASTASES FROM LUNG CANCER: EVIDENCE-BASED MEDICINE?

A.M. Fairchild1 1 Radiation Oncology, Cross Cancer Institute, Edmonton, Canada Background and Aims Palliative radiotherapy (PRT) remains the gold standard for treatment of painful bone metastases (BM) from lung cancer (LC). The objectives were to review evidence-based recommendations for PRT for BM secondary to LC and to analyze published surveys of global practice for congruence. Methods English publications related to best practice PRT for BM from LC were obtained via literature search (2003–2013). Additional consensus and clinical practice guidelines were obtained from the Standards and Guidelines Evidence Directory. Eligible surveys contained hypothetical case scenarios requiring participants to declare whether they would administer PRT and if so, to what dose. Results There is no convincing evidence of differential outcomes based on histology or for spine versus non-spine uncomplicated BM. For uncomplicated metastases, 8 Gray in one fraction (8Gy/1) is current best practice, and either 8Gy/1 or 20Gy/5 could be delivered for BM-related neuropathic pain. A multifraction schedule is recommended for impending pathologic fracture or spinal cord compression (complicated BM). Twelve cases of LC and BM have been investigated in surveys with response rates from 15.7 to 63.3 % (1998–2012). 8Gy/1 would be used by 13.7 % of respondents treating a shoulder, and up to 39.6 % to treat the spine. Fewer than 15 % would use 8Gy/1 for neuropathic pain and 54 % would use 20Gy/5 or 30Gy/10 for a complicated BM presentation. Conclusions While PRT should be appropriately customized to patients, dose should have a robust evidence base. Surveys regarding management of BM secondary to LC continue to show a large discrepancy between evidence and patterns of practice.

MASCC-0253 Palliative Care 3 KNOWLEDGE, ATTITUDES AND PRACTICES OF ONCOLOGY NURSES TOWARDS COMPLEMENTARYAND ALTERNATIVE MEDICINE FOR CANCER CARE IN QATAR

A. Hassan1, A. Allam1, S. Al Kindi2, G. Abu Zeinah3, S.A.A.D. Eziada1, A. Bashir1 1 Oncology, Hamad General Hospital, Doha, Qatar; 2Internal Medicine, University Hospital Cleaveland, Ohio, USA; 3Internal Medicine, New York Presbyterian Hospital, New York, USA

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Background and Aims Nurses play a vital role in the integration of CAM into cancer care. knowledge of applications and interactions with the ability to offer advice on CAM is essential for nurses. To investigate the attitudes, practices and knowledge of the use of CAM in cancer care among oncology nurses at the National Center for Cancer Care & Research (NCCCR), Qatar. Methods A cross-sectional cohort survey of nurses at NCCCR in the form of questionnaire exploring attitudes, practices, knowledge and interest in CAM use in cancer care. Results One hundred fifty-six nurses participated in the study. Most of the nurses were female 86 %. The majority of the nurses came from India, Pakistan, and Nepal 64 %, followed by Philippines 20 %. Most nurses were influenced by Christianity 57 % and by Asian culture 71 % followed by Arabic culture 29 % reflecting the countries of origin. Eighty-nine percent of the nurses heard about CAM, 82 % of them recommended CAM to patients. The majority believes that CAM helps the patient’s condition 94 %. About 96 % of nurses expressed interest in knowing more about CAM. The most CAM modalities nurses knew about were herbal medicine 12 %, followed by yoga and music therapy 10 % each. Most nurses (44 %) believe that CAM helps to improve the psychosocial and emotional wellbeing of patients. Conclusions The knowledge of applications and interactions with the ability to offer advice on CAM is essential in the nurses’ role in cancer care. CAM education and training will provide nurses with the knowledge to support and advocate its use for their patients.

MASCC-0245

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MASCC-0165 Palliative Care 3 PHASE ANGLE FOR PROGNOSTICATION OF SURVIVAL IN PATIENTS WITH ADVANCED CANCER

D. Hui1, S. Bansal1, M. Morgado1, R. Dev1, G. Chisholm2, E. Bruera1 1 Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA; 2Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Accurate survival prediction is essential for decision-making in cancer therapies and care planning. Objective physiologic measures may improve the accuracy of prognostication. In this prospective study, we determined the association of phase angle, hand grip strength (HGS), and maximal inspiratory pressure (MIP) with overall survival in patients with advanced cancer. Methods We enrolled hospitalized patients with advanced cancer who were seen by palliative care for consultation. We assessed the phase angle, HGS, MIP, Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI), serum albumin and body composition. We conducted univariate/ multivariate survival analysis, and examined the correlation between phase angle and other prognostic variables. Results Two hundred twenty-two patients were enrolled: average age 55, female 59 %, gastrointestinal cancers 33 %, mean Karnofsky Performance Status 55 %, and median overall survival 106 days. The median survival for patients with phase angle 2–2.9°, 3–3.9°, 4–4.9°, 5–5.9° and>=6° was 35, 54, 112, 134 and 220 days, respectively (P=0.001). PaP (P

Palliative Care 3

Table. Multivariate Survival Analysis PATTERN IN PLACE OF CANCER DEATHS IN STATE OF QATAR: A POPULATION-BASED STUDY

A. Hassan1, A. Allam1, H. Mohsen2, P. Haddad2 1 Oncology, Hamad General Hospital, Doha, Qatar; 2N/A, Weill Cornell Medical College, Doha, Qatar Background and Aims The consensus from International studies of patient preferences is that, given adequate support, most people would prefer to die at home; however, hospitals remain the most common place of death. The purpose of this study was to assess place of death of cancer patients and to evaluate the associated factors regarding that place of death. Methods The study analyzed all cancer deaths in Qatar registered by national Death Registry during the period from 2006 to 2012 including a retrospective chart review of all patients. Results A total of 1,224 cancer deaths occured during the period from 2006 to 2012. The mean age was 58 yrs. Males constituted 55 % while 45 % were females. The most common cancer dignosis were GI tract 31 % followed by hematologic malignancies 14 %, breast and lung cancer 13 % each. Majority of the patients died in ICU 28 %, followed by Oncology ward 26 %; and acute palliative unit for 24 %. Those who died at home made up only 0.4 %. The majority of patients who died in ICU spent 0–2 days accounting for 34 %. The most common malignancy in ICU deaths were hematologic with 26 % followed by hepatobiliary 15 % and GI tract 14 %. Conclusions An alarmingly high percentage of cancer deaths in Qatar occur in hospital with majority of patients dying within 2 days in ICU. As home was the preferred place of death for most cancer patients, effective home care and hospice program are needed to enable patients to remain home in accordance with their preference.

Variables Phase angle (/degree)

Hazard ratio (95 % CI) 0.86 (0.74–0.99)

P-value 0.04

PaP Score (/point) Albumin (/g/dL) Fat free mass (/kg)

1.07 (1.02–1.13) 0.67 (0.50–0.91) 0.98 (0.96–0.99)

0.008 0.009 0.02

Conclusions Phase angle was a novel and independent predictor of survival in the advanced cancer setting. This objective and non-invasive tool may be useful for bedside prognostication.

MASCC-0164 Palliative Care 3 OUTPATIENT PALLIATIVE CARE AND ITS IMPACT ON QUALITY OF END-OF-LIFE CARE IN PATIENTS WITH ADVANCED CANCER

D. Hui1, S.H. Kim1, J. Roquemore2, R. Dev1, G. Chisholm3, E. Bruera1 1 Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA; 2Clinical Operations Informatics, University of Texas MD Anderson Cancer Center, Houston, USA; 3 Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Limited data is available on how the setting of palliative care (PC) referral can affect end-of-life care. We compared the quality of end-of-life care between patients referred to outpatient and inpatient PC.

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Methods All adult patients who died of advanced cancer between 9/1/2009 and 2/28/2010 and had a PC consultation were included. We retrieved data on PC referral and quality of end-of-life care indicators. We analyzed the data using Chi-square tests, Mann–Whitney tests, and multivariate logistic regression. Results Among 366 decedents, 169 (46 %) had their first PC consultation in the outpatient setting and 197 (54 %) in the inpatient setting. Outpatient PC referral was associated with a significant decrease in emergency room visits (48 % vs. 68 %, P < 0.001), hospital admissions (52 % vs. 86 %, P<0.001), prolonged hospital stays (10 % vs. 24 %, P=0.002), hospital death (18 % vs. 34 %, P= 0.001) and intensive care unit admissions (4 % vs. 14 %, P=0.001) in the last 30 days of life. The outpatient cohort had a lower aggressive end-of-life care score (median 0 vs. 1 for inpatient referrals, P<0.001, where 0 =best and 6 =worst). In multivariate analysis, outpatient PC was independently associated with less aggressive end-of-life care (Table).

Odds ratio (95 % CI) 1.63 (1.06–2.50) 2.57 (1.18–5.59) 0.42 (0.28–0.66)

MASCC-0151 Palliative Care 3 PATIENT OUTCOMES OF A PHARMACIST-PHYSICIAN COLLABORATION IN A PALLIATIVE CARE OUTPATIENT PRACTICE

Table. Factors Associated with Aggressive End-of-Life Care

Male Hematologic malignancies Palliative care outpatient referral

Cox-regression analysis. However, ECOG performance status (HR 1.64, 95 % CI 1.03–2.62, P <0.010) is associated poor prognosis and controlled disease status (HR 0.372, 95 % CI 0.21–0.67, P <0.001) is good prognostic factor for 6-month survival after ICU admission. Conclusions To determine short term survival, clinical factors presenting acute illness at ICU admission, such as APACHE II score, the need of CRRT, were higher associated ICU mortality than factors related to the malignancy itself. However, we have to assess the comprehensive approach considering cancer biology, disease control status in terms of long term survival.

P-value 0.027 0.018 <0.001

Conclusions Patients referred to outpatient PC had improved end-of-life care compared to inpatient referral. Our findings support the need to increase the availability of PC clinics and to streamline the process of early referral.

MASCC-0143 Palliative Care 3 PREDICTIONS FOR SHORT AND LONG TERM SURVIVAL AFTER ICU ADMISSION IN ADVANCED CANCER PATIENTS

S. Lee1, S.J. Heo1, K.S. Chung1 1 Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Background and Aims Intensive care unit (ICU) admission in advanced cancer patients remains debated because of the poor short-term prognosis. However, we should also assess on the specific anticancer treatment, tumor characteristics and the long-term outcome. Methods We analyzed in 116 advanced cancer patients admitted to the ICU at single institution between Jan 2010 and Dec 2012. We excluded palliative care only patients. We analyzed demographic, clinical and survival data of patients admitted at ICU and identify prognostic and predictive factors presented at ICU admission that could be compared with short- and longterm survival. Results The median age at ICU admission was 64 years. Eighty seven (75 %) patients underwent active anticancer treatment in recent 30 days. 102(87.9 %) patients were managed in mechanical ventilation, 99(85.3 %) patients in vasopressor and 31(26.7 %) patients in CRRT. The ICU and 6-month survival rates were 51.7 %, 15.5 %, respectively. APACHE II score (HR: 2.86, 95 % CI: 1.00–8.15, P <0.050) and the need for CRRT (HR:2.14, 95 % CI 1.24–3.70, P <0.007) were associated with ICU mortality by

J.D. Ma1, E.J. Roeland1, W.M. Mitchell1, R.S. Atayee1 1 Doris A. Howell Service, University of California San Diego Moores Cancer Center, San Diego, USA Background and Aims We have previously reported the development and initial success of a unique outpatient palliative care practice under pharmacistphysician collaboration. The study objective was to evaluate patient outcomes of a pharmacist-physician palliative care collaborative practice. Methods New and follow up patient consultations were referred by an oncologist or hematologist to a palliative care clinic at an academic, comprehensive cancer center. Patients were evaluated by a pharmacist, in accordance with California code 4052 and under the supervision of a physician as detailed in a collaborative practice protocol. Pharmacists had independent prescriptive authority, with DEA licensure and NPI status, to start, adjust, or stop pharmacologic therapies, including Schedule II controlled substances for treatment of pain and other physical symptoms. Pain scores, presence of constipation, nausea/vomiting, and other physical symptoms were assessed. Results A cohort of 84 new (45 women and 39 men) and 272 follow up consultations was seen between March 2011 to March 2012. The most common cancer type was gastrointestinal (n=21). Pain score Patients with Patients without Presence of constipation a 30 % (Mean ± SD) a 30 % decrease in decrease in pain score pain score 1 (baseline) 84 7±2.7 N/A N/A 22 Visit

N

2

60 5.3±2.5*

29

31

3

45 4.8±2.4*

25

20

12

4

37 4.1±2.5*

24

13

3

5

30 3.5±2.5*

22

8

4

12

* p≤0.05 compared to baseline visit Conclusions A pharmacist-physician collaboration in a palliative care outpatient practice improved symptoms of pain and constipation.

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MASCC-0193 Palliative Care 3 DANGEROUS ROTATIONS - SWITCHING FROM HIGH DOSE OXYCODONE TO MORPHINE

D. MacKintosh1, A. Brady1, S. Carr1 1 Palliative Medicine, Central Coast Palliative Care Service, Berkeley Vale, Australia Background and Aims Opioid switching in the management of cancer related pain continues to rely heavily on the use of published equianalgesic ratios despite widely acknowledged difficulties which includes serious toxicity. Although opinions differ, some degree of agreement has been reached on a suitable conversion ratio for oral oxycodone to oral morphine of 1:1.5 (O:M). We report 3 cases where unthinking adherence to this ratio may have been problematic for patient safety. To assess the safety of switching from high dose oral oxycodone (480 mg/ day–960 mg/day) to morphine using an equianalgesic ratio of 1:1.5 (O:M). Methods Retrospective case review. Results Switching from high dose oral oxycodone to oral morphine was successfully achieved with between 8 and 17 % of the predicted oral morphine dose, equivalent to conversion ratios of 1:0.125 and 1:0.25 (O:M). Conclusions The actual required conversion ratios were well below those predicted by agreed standards and blind adherence to a published dose equivalence ratio of 1:1.5 may have placed the patients at significant risk of serious toxicity. Where, as in these cases, there has been dose escalation without sustained improvement in analgesia, we recommend an initial ‘test dose’ of immediate release morphine of no greater than 10 % of the predicted morphine dose. An alternative is gradual reduction of the oxycodone while titrating morphine upwards; this approach, however while safe, is time consuming and does not address the need for urgent pain relief.

MASCC-0213 Palliative Care 3 HANDOVER OF PALLIATIVE PATIENTS TO OUT OF HOURS PRIMARY CARE

F. Murray-Brown1 1 Palliative Care, Derriford Hospital, Plymouth, United Kingdom Background and Aims Cancer patients spend 90 % of their last year of life at home. Two thirds of the week is out of hours (OOH). Britain’s Gold Standards Framework aims to provide consistent care for palliative patients, coordinated across all community settings and delivered by practitioners aware of the person’s medical condition and care plan. Methods This audit aimed to establish how many patients known to the Specialist Palliative Care Team (SPCT) at St Lukes Hospice, Plymouth, England, were also known to Devon’s General Practice (GP) OOH coordinator, DDocs, through the Electronic Palliative Care Coordination System (EPaCCS). It also established, via a written questionnaire, GP attitudes to referring palliative patients to OOH. Results Of 382 SPCT patients, 90 % had cancer and 10 % had MND or chronic diseases. Seventy-six percent were on EPaCCs. Information included Diagnosis (72 %), Resuscitation Status (54 %) and Advance Care Plans

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(9 %). Most patients are referred by SPCTs. Two hundred thirty-five patients (62 %) had contacted DDocs in the last 6 months, almost all with palliative symptoms. Fifty-four percent of GP questionnaires were returned completed. Fifty percent felt OOH handover should be undertaken by themselves or SPCTs, suggesting joint working. Seventy-five percent felt patients should be referred when deteriorating, although GPs underestimated those not referred, stating reasons of patient stability. Four months following data collection, 57 % of patients had died, with 41 (19 %) dying with no handover at all. Conclusions Most palliative patients were flagged to GP OOH, an improvement on previous years. GPs and SPCTs are however encouraged to anticipate sudden deterioration in currently stable patients, to prevent OOH crises.

MASCC-0168 Palliative Care 3 INDICATIONS FOR INTEGRATED SUPPORTIVE CARE AMONG INDIVIDUALS WITH CERVICAL CANCER: AVIEW FROM A DEVELOPING COUNTRY

A.T. Olagunju1, O.F. Aina1, F.O. Sarimiye2, T.O. Olagunju3 1 Department of Neuropsychiatry (psychooncology), Lagos University Teaching Hospital/College of Medicine University of Lagos, Lagos, Nigeria; 2Department of Radiotherapy and Oncology, University College Hospital Ibadan Nigeria, Ibadan, Nigeria; 3Department of Infectious Diseases and related cancers, Health Service Commission Lagos Nigeria, Lagos, Nigeria Background and Aims Cervical cancer is not only a leading gynecologic cancer in the developing countries but disproportionately accounts for disease burden due to cancers. However, little is known about the experience of the affected populations beyond their ‘primary’ cancer treatment. This study aims to investigate the pattern and distribution of symptoms in subjects with cervical cancer. Methods This cross sectional study was carried out among 122 consenting participants with cervical cancer using a designed questionnaire to elicit socio-demographic, clinical profile and symptoms burden. Subsequently, Centre for Epidemiological Studies Depression Scale Revised (CESD-R) was used to ascertain depressive symptoms in participants. Results Majority of the subjects, 50(41.0 %) and 68(55.7 %) were in their fifth decade of life and unmarried respectively. Six (4.9 %) participants presented with early stage cancer, while close to two-thirds of the participants made up of 76(62.3 %) subjects had advanced stage cancer. The largest proportion, consisting of about 7 in every 10 participants had pain, 70(57.4 %) participants reported sexual dysfunction, and common sexual problems that were reported include loss of libido, dyspareunia and an organism among others. In addition, physical complications like ulcer, weight loss and multiple complaints were seen in 56(45.9 %) participants. Significant depressive symptoms based on CESD-R cut-off score of 16 and above was elicited among close to half of the participants, 58(47.5 %). Conclusions Late presentation and significant burden of diverse symptoms were prevalent among individuals with cervical cancer. Health education, proactive health interventions to promote early presentation and supportive care to ensure qualitative care with best outcome are implied.

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MASCC-0236 Palliative Care 3 FREQUENCYAND OUTCOME OF NEUROLEPTIC ROTATION IN THE MANAGEMENT OF DELIRIUM IN PATIENTS WITH ADVANCED CANCER

S. Shin1, D. Hui2, G.B. Chisholm3, J.L. Williams2, J.H. Kang4, I. Park1, E. Bruera2 1 Department of Internal Medicine College of Medicine, Kosin University, Busan, Korea; 2Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA; 4Department of Internal Medicine College of Medicine, Gyeongsang National University, Jinju, Korea Background and Aims The response rate to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. To determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to second neuroleptic. Methods We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January, 2012 and March, 2013. Inclusion criteria were a diagnosis of delirium and firstline treatment with haloperidol. Results Among 167 patients with delirium, 128 (77 %) received only haloperidol and 39 (23 %) needed a second neuroleptic. Ninety-one (71 %) patients who did not require neuroleptic rotation improved and were discharged alive. Median initial haloperidol dose was 5 mg (IQR 3-7) and median duration was 5 days (IQR 3-7). Median final haloperidol dose was 6 mg (IQR 5-7). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87 %). Significant factors associated with neuroleptic rotation were inpatient mortality (59 % vs. 29 %, P=0.001), and white race (87 % vs. 62 %, P=0.014). Chlorpromazine was given to 37 (95 %) patients who failed haloperidol. Median initial chlorpromazine dose was 150 mg (IQR 100-150) and median duration was 3 days (IQR 2-6). Thirteen (33 %) patients had reduced symptoms after the second neuroleptic. Conclusions Neuroleptic rotation from haloperidol was required in only 23 % of patients with delirium and was associated with inpatient mortality and white race.

MASCC-0218 Palliative Care 3 TRANSFERRING SPIRITUAL AND PALLIATIVE CARE COMPETENCY THROUGH WORKPLACE LEARNING - A HOSPICE TEACHING TEAM’S EXPERIENCE

K.A. Tornoe1, L.J. Danbolt2, K.J. Kvigne3, V.M. Sørlie4 1 Nursing, Lovisenberg Deaconal University College and Center for the Psychology of Religion, Oslo and Ottestad, Norway; 2Innlandet Hospital Trust, Center for the Psychology of Religion, Ottestad, Norway; 3Nursing and Mental Health, Hedmark University College, Elverum, Norway; 4 Nursing, Lovisenberg Deaconal University College, Oslo, Norway Background and Aims Unskilled care workers in nursing homes and home care increasingly deal with palliative care challenges, due to the international trend towards downsizing specialized health care units. Registered nurses therefore

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spend more time supervising unskilled staff to ensure that patients receive quality care during their final days. Nursing personnel are often anxious about addressing patients’ existential or spiritual needs. This study illuminates an expert hospice nursing team’s experience with existential and spiritual care, and their experience with transferring palliative and spiritual care competency to nursing staff in specialist, nonhospital and community-based services. Methods Data was gathered through a focus group interview with three expert hospice nurses. Data was analyzed using a qualitative phenomenologicalhermeneutical method. Results The key spiritual care themes identified were: working with one’s heart, managing emotions (fear and courage), Identifying spiritual needs, acting as door openers to existential and spiritual conversations, using intuition to seize the right moment and the right approach, Talking, listening, being silent, being with the patient in the ‘Room of Death’ Spiritual care was intuitively embedded in other care practices. The team observed that nursing staff became more courageous and skillful in addressing patients’ spiritual and existential needs through situated ‘bedside’ supervision and reflective dialogue. Conclusions The findings suggest that developing work place learning strategies may be an efficient way to transfer palliative and spiritual care competency to unskilled care workers in non-hospital and community based services. Employers should support expert nurses to develop their roles as competency transmitters, rather than forcing them to take on generalist roles.

MASCC-0342 Palliative Care 4 COMPARISON OF THREE SHORTENED QUESTIONNAIRES FOR ASSESSMENT OF QUALITY OF LIFE IN ADVANCED CANCER

L. Chiu1, N. Chiu1, E. Chow1, D. Cella2, J.L. Beaumont2, H. Lam1, M. Popovic1, G. Bedard1, M. Poon1, E. Wong1, L. Zeng1, A. Bottomley3 1 Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA; 3European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels, Belgium Background and Aims Quality of life (QoL) assessment questionnaires can be burdensome to advanced cancer patients, thus necessitating the need for shorter assessment instruments than traditionally available. The objective of this review is to compare three shortened QoL questionnaires in regards to their characteristics, validity, and reliability. Methods A literature search was conducted to identify studies that employed or discussed three abridged QoL questionnaires: the EORTC QLQ-C15PAL, the FACT-G7, or the FACIT-PAL-14. Articles that discussed questionnaire length, intended use, scoring procedure and validation were included. Results The 7 item FACT-G7 is the shortest instrument, while the EORTC QLQC15-PAL and the FACIT-PAL-14 contain 15 and 14 items, respectively. All three questionnaires have similar recall periods, item organization, and subscale components. Designed as core questionnaires, all three maintain content and concurrent validity of their unabridged original questionnaires. Both the EORTC QLQ-C15-PAL and the FACT-G7 demonstrate good internal consistency and reliability, with Cronbach’s alpha

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of greater or equal to 0.7 deemed acceptable. The developmental study for the FACIT-PAL-14 was published in 2013 and subsequent validation studies are not yet available. Conclusions The EORTC QLQ-C15-PAL and the FACT-G7 were found to be reliable and appropriate for assessing health-related QoL issues—the former for palliative cancer patients and the latter for advanced cancer patients receiving chemotherapy. Conceptually, the FACIT-PAL-14 holds promise to cover social and emotional support issues that are not completely addressed by the other two questionnaires; however, further validation is needed.

MASCC-0338 Palliative Care 4 RADIOTHERAPY FOR A CERVIX CANCER PATIENT WITH EHLERS-DANLOS SYNDROME: A CASE REPORT

L. Chiu1, N. Chiu1, M. Poon1, G. Bedard1, M. Popovic1, E. Wong1, H. Lam1, E. Chow1, E. Barnes1 1 Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Early stage cervix cancer can be treated successfully with radiotherapy or surgery. Ehlers-Danlos syndrome Type IV is a rare connective tissue disorder associated with vascular tear due to mutation in the gene for type III procollagen. Due to the rare incidence of cervix cancer and Ehlers-Danlos syndrome concurrently, documentation of more cases with both diseases may be of use to health-care professionals in managing the multiple risks involved and choosing the most appropriate treatment. Methods The current case report outlines the management of a patient with stage IB2 cervical cancer and Ehlers-Danlos Type IV Syndrome. Results The patient received 45 Gy in 25 fractions to the pelvis using a 4 field box technique followed by a 2 field parametrial boost of 5.4 Gy in 3 fractions with a 4 cm midline shield to treat her cervical cancer. Five cycles of concurrent weekly cisplatin (40 mg/m2) were also given. As of 24 months before completion of chemoradiotherapy, the patient had complete local response to treatment with eradication of her cervical disease and no evidence of local or distant disease. Conclusions Given the risk of excessive hemorrhage from surgery, this case report demonstrates that radical chemoradiotherapy was an effective and appropriate treatment option for this patient with cervix cancer and EhlersDanlos Type IV Syndrome. For such patients, referral to a rheumatologist and further consultation with surgeons and oncologists should aid in choosing the most appropriate treatment.

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Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; 3 Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; 4Department of Clinical Oncology, Tanta University Hospital Tanta Faculty of Medicine, Tanta, Egypt; 5Department of Orthopedic Oncology, Federal University of São Paulo, São Paulo, Brazil; 6Department of Pharmacy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France; 7Department of Surgery, Taipei Veterans General Hospital National Yang-Ming University, Taipei, Taiwan; 8Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 9 Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan; 10Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan; 11 Department of Clinical Oncology, Prince of Wales Hospital, Shatin New Territories, Hong Kong China; 12European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels, Belgium Background and Aims Examining the patterns of synergy between concurrent symptoms through symptom cluster research can lead to increased understanding of symptom management in the oncology setting. The objective of this study was to compare the symptom cluster compositions of bone metastases patients undergoing radiotherapy and/or bisphosphonate treatment at baseline. Second, to examine whether symptom cluster composition in the patient cohort changed over time. Methods Principal component analysis (PCA) was used to extract symptom clusters in data collected from patients with bone metastases using the EORTC QLQ-BM22. A total of 626 patients across 8 countries participated in this study with questionnaires administered to the patients at baseline and followup. Patients undergoing radiotherapy and/or bisphosphonates were isolated from the sample and PCAwas used to identify clusters in these groups. Results At baseline, bone metastases patients rarely had symptom clusters that included both psychosocial and pain symptoms concurrently while the subset of radiotherapy and/or bisphosphonates patients did exhibit this trend. At follow-up, all patients, with the exception of bisphosphonate patients, had similar symptom cluster composition with all psychosocial items separated from pain symptoms. Conclusions Psychosocial items and symptom items of the QLQ-BM22 are more likely to coexist in symptom clusters of radiotherapy and bisphosphonates patients than those of general bone metastases patients. Treatment from baseline until follow-up seemed to influence most patients to reduce the association of painful symptoms with worries about how their illnesses would affect their life; bisphosphonates patients did not experience this effect from treatment.

MASCC-0354 Palliative Care 4

Palliative Care 4

DEVELOPMENT OF EVIDENCE-BASED ORAL CARE GUIDELINES FOR PATIENTS WITH ADVANCED CANCER

SYMPTOM CLUSTERS ANALYSIS IN BONE METASTASES PATIENTS USING THE EUROPEAN ORGANIZATION FOR RESEARCH AND TREATMENT OF CANCER QUALITY OF LIFE QUESTIONNAIRE BONE METASTASES MODULE (EORTC-QLQ-BM22)

A. Davies1, S. Hall1, M.P. Sweeney2, A. Dickman3, E. Sills4, S. Patel1 1 Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s Cancer Centre, Guildford, United Kingdom; 2Dental School, University of Glasgow, Glasgow, United Kingdom; 3Pharmacy, Royal Victoria Hospital, Blackpool, United Kingdom; 4Palliative Care, Woking Hospice, Woking, United Kingdom

L. Chiu1, E. Chow1, N. Chiu1, L. Zhang1, G. Bedard1, A. Fairchild2, V. Vassiliou3, M.A. Alm El-Din4, R. Jesus-Garcia5, F. Forges6, L.M. Tseng7, M.F. Hou8, W.C. Chie9, T. Satoh10, B. Ma11, H. Lam1, A. Bottomley12

Background and Aims Oral problems are common in patients with advanced cancer. However, there are no evidence-based guidelines for the management of oral

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problems in this group of patients. The aim of this project was to develop such guidelines. Methods ATask Group of the Science Committee of the Association of Palliative Medicine for Great Britain and Ireland was convened to produce guidelines for the management of oral problems in patients with advanced cancer. The Task Group included Consultants in Palliative Medicine, a Clinical Nurse Specialist in Palliative Care, a Senior Lecturer in Special Care Dentistry, and a Consultant Pharmacist. The medical/nursing/dental literature was searched, and relevant articles reviewed. On the basis of the literature review a series of recommendations were produced, and these were graded using the levels of evidence endorsed by the National Institute for Health and Care Excellence (UK). Results The guidelines contain a series of recommendations about the assessment, management and reassessment of common oral problems in patients with advanced cancer including advice about routine oral hygiene measures. It includes tables about recommended oral care products, and ones that should be avoided. It also discusses the role of various members of the MDT, i.e. palliative care professionals and dental professionals. Conclusions It is hoped that these evidence based guidelines will reduce the use of inappropriate interventions for oral care problems in patients with advanced cancer that are treated in the palliative care setting. The use of evidence-based interventions should lead to improved symptom control and quality of life for this group of patients.

MASCC-0284 Palliative Care 4 MISSED DELIRIUM (MD) IN PATIENTS REFERRED TO PALLIATIVE CARE IN A COMPREHENSIVE CANCER CENTER

M. de la cruz1, J. Fan1, S. Yennu1, K. Tanco1, S. Shin1, J. Wu2, D. Liu2, E. Bruera1 1 Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, USA; 2Biostatistics, UT MD Anderson Cancer Center, Houston, USA Background and Aims Delirium is one of the most common neuropsychiatric complications in advanced cancer patients with a frequency of up to 85 % before death and is associated with increased morbidity, mortality, and family distress. This study aims to determine the frequency of MD and its associated factors. Methods Seven hundred seventy-one consecutive Palliative Care inpatient consults from August 2009- January 2010 were reviewed. Demographics, Memorial Delirium Assessment Scale (MDAS), Edmonton Symptom Assessment Scale (ESAS), primary referral symptom, ECOG, Palliative Medicine specialist (PMS) diagnosis of delirium, delirium etiology, subtype and reversibility were collected. Delirium was diagnosed with MDAS score≥7 or by a PMS using DSM-IV TR Criteria. MD was reported if delirium was diagnosed by PMS but referred by the primary referring team (PT) for other reasons besides delirium. Chi-Squared and WilcoxonMann–Whitney tests were used to examine differences among groups. Univariate regression analysis was done to assess associations for MD. Results Two hundred fifty-two (33 %) had a diagnosis of delirium by the PMS. One hundred fifty-three (61 %) were missed by the PT. Hypoactive delirium was the most common subtype of delirium in MD (n=47, 63 %). Opioid related delirium was the most common etiology of MD

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(n=47, 31 %). Patients referred for pain were more likely to have MD (OR=2.57, p=0.0109). Of the 82 patients with delirium that was reversed, 67 % (n=55) had MD. Conclusions MD was found in 61 % of patients with a diagnosis of delirium by a PMS. Patients with MD were frequently referred for pain. Universal screening of cancer patients for delirium is recommended.

MASCC-0308 Palliative Care 4 THORACIC REIRRADIATION FOR LUNG CANCER: A LITERATURE REVIEW

C.S. Drodge1, S. Ghosh2, A. Fairchild1 1 Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; 2 University of Alberta, Cross Cancer Institute, Edmonton, Canada Background and Aims Approximately half of all patients with lung cancer (LC) experience locoregional failure after initial treatment. Historically, thoracic reirradation (ReRT) has been limited by toxicity concerns and lack of robust evidence. Our objective was to perform a systematic literature review regarding ReRT. Methods Search of the English-language literature related to best-practice thoracic ReRT (Medline and Embase; 2003–2013) was performed. Clinical practice guidelines and consensus statements were also reviewed. Data was abstracted regarding patient, tumour and radiotherapy characteristics; response rate; overall survival (OS); and toxicity. In addition to descriptive analysis, Spearman’s test explored relationships between RT dose and OS. Results Three hundred seventy-nine patients (89 % non-small cell; 11 % small cell LC) retreated with radical or palliative intent have been described by 13 publications (1982–2014). Eighty-six percent were symptomatic at the time of ReRT; rate of symptom improvement was 69 %. Median OS was 15 months (95 %CI: 3–58 months) for radical versus 3 months (95 %CI:1–14 months) for palliative intent ReRT. Median initial (59 Gy; range 12–80 Gy), ReRT (36 Gy; range 12–70 Gy) and combined dose (86 Gy; range 58–120 Gy) significantly correlated with OS, with Spearman’s rho values of 0.85 (p=0.002), 0.72 (p=0.006), and 0.88 (p= 0.001) respectively. Toxicity after ReRT was reported in 17 % (esophagitis) and 12 % (pneumonitis), with RT complications contributing to 2 % of deaths. Conclusions Despite heterogeneity of patient cohorts, RT techniques and duration of follow-up, ReRT appears to be a feasible option for recurrent thoracic disease. Treatment guidelines will be developed from this data to guide clinical decision-making.

MASCC-0290 Palliative Care 4 EARLY PALLIATIVE CARE AND QUALITY OF DEATH IN PATIENTS WITH ADVANCED CANCER

B. Hannon1, N. Swami1, A. Pope1, L. Le1, C. Zimmermann1 1 Psychosocial Oncology & Palliative Care, Princess Margaret Hospital, Toronto, Canada

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Background and Aims Early palliative care (PC) interventions have been shown to improve the quality of life of patients with advanced cancer. However, it is unclear whether early PC can improve quality of death. We aimed to evaluate the quality of death and dying experienced by patients with advanced cancer who received early PC, as perceived by their informal caregivers. Methods Bereaved caregivers (N=128) of patients who had participated in a cluster randomized controlled trial of an early PC intervention versus standard care (SC) at the Princess Margaret Cancer Centre, Toronto, between December 2006 and February 2011, were recruited 6 months to 5 years following the patient’s death. Caregivers completed the Quality of Dying and Death (QODD) questionnaire. Results There were no differences between PC (N=72) and SC (N=56) participants based on age, gender, relationship to patient, tumour site or time since death. QODD total and subscale scores were moderate to high for both the PC and SC groups, with no statistically significant differences between groups (all p>0.25) (see Table). Although the SC group did not receive early PC, the majority received PC at some point during the patients’ illness (N=45, 82 %). Table - Caregiver demographics and QODD scores| Early Palliative Care (N=72)

Standard Care (N=56)

N (%)

N (%)

Age in years, Median (range)

62 (30–88)

59 (29–84)

Female

51 (70.8)

37 (66.1)

Relationship to patient Spouse

48 (66.7)

37 (66.1)

Son/daughter

13 (18.0)

12 (21.4)

Sibling

4 (5.6)

3 (5.4)

Other

7 (9.7)

4 (7.1)

Breast

8 (11.1)

8 (14.3)

Gastrointestinal

25 (34.7)

18 (32.1)

Tumour site

MASCC-0254 Palliative Care 4 TIMELY REFERRAL OF CANCER PATIENTS FROM ONCOLOGY-HEMATOLOGY TO PALLIATIVE CARE-QATAR EXPERIENCE

A. Hassan1, M. Mufid M. El Mistiri1, R. Negmeldin1, S.A.A.D. Eziada1, A. Begum1, K. Aboudi1, A.M.R.A. Alkhalil1, H. Al Ayoubi1 1 Oncology, Hamad General Hospital, Doha, Qatar Background and Aims Early palliative care access improves metrics perceived for high quality cancer care. In Qatar, the timing of referral to palliative care service was late, around 55 % stayed for a period of time of less than 30 days, while almost 15 % stayed for no more than 48 h from the time of referral. Methods This Project was held from March 2012 until September 2012 as a Clinical Care Improvement initiative where the problem was clearly defined as a) the Cancer patients of National Center for Cancer Care & Research (NCCC R) are not referred from acute care to palliative care on time. b) ‘End of life patients’ care was being provided at acute care rather than palliative setting, which compromised patients’ quality of care & Quality of good death. An objective one-page scoring tool (adopted from NCCN Palliative Guidelines Referral Criteria) was developed & used to review medical records. Results More than 30 % of barrier for palliative care consultation & referral stemmed from unawareness of referral criteria. The process value analysis did confirm that adding a subjective scoring tool to guide referral eliminated 40 % waste in the process. We reduced the percentage of patients with score≥5 without palliative consultation from mean of 68 to 16 % &≥7 without care in palliative setting from mean of 32 to 2 %. Aim was achieved & sustained. Conclusions Our project proved that standardizing referral process & objective referral tools are needed to facilitate the transfer of care from one level to another.

MASCC-0322

Genitourinary

12 (16.7)

10 (17.9)

Gynecological

8 (11.1)

14 (25.0)

Lung

19 (26.4)

6 (10.7)

Months since death, Median (range)

39.5 (22.0–58.7)

39.4 (26.5–55.6)

QODD scores, Mean (SD) Total score

61.2 (21.8)

60.8 (18.6)

Symptom control subscle

55.8 (24.7)

55.9 (23.6)

Preparation subscale

73.0 (24.1)

68.3 (18.9)

Connectedness subscale

77.6 (22.1)

77.3 (20.9)

Transcendence subscale

53.6 (31.4)

47.4 (27.7)

QODD, Quality of Dying and Death questionnaire, range 0–100, higher scores are better; PC, Palliative Care; SD, Standard Deviation.

Conclusions Although early PC improves quality of life among patients with advanced cancer, in this study it did not influence the quality of death and dying. The quality of death and dying may be more affected by receiving PC at all rather than by early involvement.

Palliative Care 4 PAIN RELIEF FROM PALLIATIVE RADIATION THERAPY IN A PATIENT WITH CERVICAL SPINE BONE METASTASES

R. Jamani 1 , L. Zeng 1 , L. Probyn 2 , N. Lauzon 1 , L. Holden 1 , N. Thavarajah1, E. Wong1, E. Chow1 1 Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; 2Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims In up to 75 % of cases, prostate cancer metastasizes to the bone. When metastatic destruction occurs in the spine, it often leads to a loss of vertebral body structural integrity, thus leading to instability. As a result, patients often experience intense pain. Radiation therapy is known to provide pain relief and tumour control for patients with bone metastases; however, it does not improve bone stability. This report discusses the case of a prostate cancer patient presenting with bone metastases to the cervical spine. Methods A 67 year-old male patient presented at the Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre with prostate adenocarcinoma and painful bone metastases.

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Results Due to bone metastases to the cervical spine, the patient experienced basilar invagination, which resulted in limited neck motion and severe pain. The patient was prescribed a soft collar. The metastases were treated with 20 Gray of external beam radiation in 5 fractions. At the most recent follow-up, the patient had regained neck movement, no longer required the use of a collar, and had experienced significant pain relief.

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Conclusions This case demonstrates the effectiveness of radiotherapy as a method of relieving pain and restoring mobility in certain cases, thus improving overall quality of life.

MASCC-0318 Palliative Care 4 USE OFA SOCIAL CAPITAL QUESTIONNAIRE TO UNDERSTA ND NETWORKS OF CARE SUPPORT: OUTCOMES IN A DISADVANTAGED PALLIATIVE CARE POPULATION

J. Lewis1, M. DiGiacomo1 1 Faculty of Health, University of Technology Sydney, Sydney, Australia

Figure 1: Axial CT image through the C1 level on bone window (W3000, L600) pretreatment demonstrating a predominately lytic lesion in the right C1 lateral mass.

Background and Aims Background: The capacity and nature of formal and informal networks and relations determine the context of end of life care. Networks and relations of support are particularly important in lower socioeconomic populations whereby they are seen to buffer the effects of disadvantage, but are underexplored in the literature. Aims: To measure and explore the nature of networks and relations in a socioeconomically disadvantaged group of palliative care patients and carers. Methods Methods: A mixed methods study utilising a social capital questionnaire for inquiry of qualitative (core themes for resources in relations) and quantitative data (levels of engagement and network structures) to identify individual, community and civic care giving contexts. Results Results: Overall individual and community networks and relations of support were limited. Specifically; informal caregiver networks and relations were small and fragile due to the nature of conflict and crisis; community trust and engagement was limited and shifted by illness and care giving; and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government support enabled access to welfare resources. Conclusions Conclusions: Lower socioeconomic groups are at a distinct disadvantage where networks and relations of support are limited. Understanding of the nature of assets and limitations in end of life care contexts is necessary to inform interventions to improve end of life care in disadvantaged populations.

MASCC-0332 Palliative Care 4 IMPLEMENTING AND EVALUATING VIDEO DIGNITY THERAPY IN AN UNDERSERVED AND ETHNICALLY DIVERSE ADVANCED CANCER PATIENT POPULATION

S. Okuyama1, S. Fischer2, D. Bekelman2 1 Oncology, Denver Health, Denver, USA; 2Medicine, University of Colorado, Denver, USA

Figure 2: Axial CT image through the C1 vertebra on bone window (W3000, L600) post-treatment demonstrating increased sclerosis of the lesion involving the C1 lateral mass.

Background and Aims Underserved, ethnically diverse cancer patients have increased spiritual needs, including existential suffering. Dignity Therapy (DT), is a brief, meaning-focused intervention to address existential suffering for those facing advanced illness. Patients receive a transcript of the interview that is a legacy gift to share with loved ones.

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To assess the feasibility and patient satisfaction of DT in ethnically diverse oncology patients, where the interview is videotaped and the legacy gift is in video for this low literacy population. Methods Intervention-only, pilot study of DT with video legacy gift. English-speaking patients with stage IV cancer were recruited from a safety-net hospital. Contact with trained personnel included an introductory call, the videotaped interview and another meeting to review/edit the video. Feasibility was measured by participation and retention rates. Patient satisfaction was measured by postintervention survey. Results Seventeen eligible patients were approached for participation, 13 enrolled (76 % participation rate). So far, 9 have completed the program, 4 have withdrawn (69 % retention rate). Demographics for the 9 who completed included 5 females, 4 males; 5 Caucasian, 3 Hispanic and one African-American; ages from 31 to 80 years. All participants agreed/strongly agreed that the program was helpful, 7 participants (78 %) stated that the program made their lives more meaningful. Eight (89 %) agreed/strongly agreed with the statement that the program gave them a heightened sense of dignity and would probably or definitely recommend this to other patients. Conclusions Video-DT is an innovative intervention, feasible to implement in an underserved and ethnically diverse cancer patient population, with high levels of satisfaction.

MASCC-0345 Palliative Care 4 THE EFFECT OF SYMPTOM MANAGEMENT PROGRAM FOCUSING ON CHANTING ON PAIN OF TERMINAL CANCER PATIENTS

B. Trakoolngamden1, M.S. Benchamart2 1 Nursing, navamindradhiraj university, Bangkok, Thailand; 2Nursing, Navamindradhiraj university, Bangkok, Thailand Background and Aims To test the effect of symptom management program focusing on praying on pain of terminal cancer patients and to compare the mean score of prepost pain tin the experimental and controlled groups. Methods The participants in this study were 60 terminal cancer patients who had been diagnosed as cancer stage 3, 4 or had been cancer metastasis to multiple organs, buddhism and treated at Arokayasala Wat Khampramong, Skon Nakhon Province, Thailand. Discussion The mean score of pain in the terminal cancer patients who received the Symptom Management Program focusing Chanting after 4 days and 7 days were lower than that of the controlled group because of gaining more knowledge and received proper information as individual needed which assisting them having effectively and constantly developing skills and ability of self-care in the pain palliation causing from disease and complications. Likewise, the program assisted to reduce pain in terminal cancer patients because of chanting that can be affected to the patients who chanting for them may develop spiritual well being and beneficial effects on the immune system, central nervous system or endocrine system. The finally meditative relaxing aspects of chanter have beneficial effects such as lowering blood pressure. This finding indicated that the Symptom Management focusing Chanting Program could relief pain in terminal cancer patients.

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MASCC-0371 Palliative Care 4 THE ROLE OF INTERVENTIONAL RADIOLOGY IN CANCER PATIENTS, A CROSS SECTIONAL STUDY

F. Kose1, A. Besen2, M. Ulas3, L. Oguzkurt4, O. Ozyilkan1 1 Medical Oncology, Baskent University, Adana, Turkey; 2Medical Oncology, Van Training and Research Hospital, Van, Turkey; 3Internal Medicine, Baskent University, Adana, Turkey; 4Interventional Radiology, Baskent University, Adana, Turkey Background and Aims The aim of this study is to evaluate the role of interventional radiology (IR) in clinical practice of oncology and define types and frequency of the IR procedures performed in cancer patients. Methods Medical charts of the cancer patients admitted to oncology clinic from December 2012 to May 2013, were analyzed retrospectively. The data including patient demographics, cancer characteristics, type of intervention and time to intervention were recorded. Interventional procedures were classified as diagnostic, palliative care and treatment. Results There were 1,120 new admissions to Medical Oncology department in the study period. There were 240 IR procedures performed in 147 patients (65 % male; mean age, 57 years). Stage IV disease constitutes 85 % of the cases. The median time to intervention was 3.8 month. Number of interventions for diagnosis, palliative care, and treatment were 27 (11.2 %), 211 (87.5 %), and 3 (1.3 %), respectively. Most frequently performed intervention was port catheter placement (29.5 %). Hepatobiliary-pancreatic tumors, thoracic malignancies, and breast cancer ranked first places which needed IR interventions in 36 (25.7 %), 34 (24.3 %), and 19 (13.6 %), respectively. The median time to intervention for hepato-biliary-pancreatic tumors was significantly shorter compared to others (p<0.0001). Conclusions Department of IR has an uprising place in the care of patients with cancer. We showed that over 20 % of patients required consultation with IR department after cancer diagnosis. Most of the patients were stage IV disease and need intervention for palliative care not curative intent.

MASCC-0297 Palliative Care 4 DISTRICT DOCTORS’ SELF-CONFIDENCE AND CONCERNS IN PROVIDING END-OF-LIFE CARE FOR CANCER PATIENTS

E. Vvedenskaia1 1 Palliative Care, State Medical University, Nizhny Novgorod, Russia Background and Aims The elderly made 29.9 % of population in 2013. 87.0 % of all adult cancer deaths occur at home. That is why palliative and end-of-life care for cancer patients today is a challenge. The aim of the study was to assess district doctors’ self-confidence in performance of 17 different end-of-life clinical skills and comfort with difficult end-of-life clinical decisions (e.g. treatment and hydration withdrawing, shifting in treatment approach from curative to comfort care) and also their interest in learning about end-oflife clinical and ethical topics. Methods We used a tool ‘A Survey Instrument to Measure Physician SelfConfidence and Concerns about End-Of-Life Clinical Skills and Decision-Making’ designed by David E. Weissman and Bruce Ambuel and surveyed more than 400 physicians who are responsible for providing community medical care for the elderly.

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Results The results of our study showed that most of district doctors were competent to perform patient management at the end of life only with close (50 %) and minimal (32 %) supervision/coaching. All respondents had difficulties while responding to the questions regarding decisionmaking at the end of life. Almost all respondents (98 %) noted that such issues, as symptom control, communication and decision-making at the end of life should be included in the Medical Universities Curriculums. Conclusions District doctors who provide care for cancer patients were not enough competent to perform patient management at the end of life. Although education in palliative care has made clear progress within the country it is still to be incorporated fully into the fabric of medical education.

MASCC-0444 Palliative Care 5 EVALUATION OF AN EDUCATION PROGRAM FOR PATIENTS WITH ADVANCED CANCER AND CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY (CIPN)

C. Cranston1, R. Bhargava1, M. Chasen1 1 Palliative Care, Elisabeth Bruyere, Ottawa, Canada Background and Aims The incidence of chemotherapy induced peripheral neuropathy (CIPN) disrupts function, safety, and quality of life (QOL) of patients with advanced cancer. The objective of this study is to evaluate the effectiveness of a brief education program for patients suffering from CIPN. Methods One-hour education session was developed to address safety, function, and various approaches to reduce distress in patients with advanced cancer having CIPN. Questionnaire Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT) was used to evaluate effectiveness of these interventions, degree of distress and interference with activities of daily living. A specifically designed novel tool was also used to assess current knowledge of CIPN and the usefulness of the educational program. Results Seven participants have completed the study; (M: 4; F: 3). Diagnoses: rectal, ovarian, breast cancers. Questionnaires revealed that all seven patients had some prior knowledge of CIPN and they were using at least some measures to protect skin and avoid accidents. Six reported learning new measures from the education program. Interference and distress continued for six; reduced for one patient. Conclusions The educational program is beneficial, the patients learned new measures to cope with CIPN thereby improving their own quality of life.

MASCC-0389 Palliative Care 5 THE FREQUENCY OF FALLS IN PATIENTS WITH ADVANCED CANCER FOLLOWED IN AN OUTPATIENT PALLIATIVE CARE CENTER

M. de la cruz1, N. Didwaniya1, K. Tanco1, S. Shin1, A. Reddy1, M. San Miguel-Arregui1, G. Chisholm2, J. Williams1, E. Bruera1 1 Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, USA; 2Biostatistics, UT MD Anderson Cancer Center, Houston, USA

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Background and Aims Falls are a concern in patients who are frail, have advanced age or severe underlying medical condition as a significant cause of morbidity and reduced quality of life. It has been reported to occur in up to 50 % of palliative care patients in different settings. Our aim was to determine the frequency of falls and identify its predictors and correlates in patients with advanced cancer. Methods We reviewed 1,984 consecutive patients with advanced cancer seen in the outpatient supportive care center and determined the frequency of patient reported falls within the last month prior to the visit. Demographics, Edmonton Symptom Assessment Scale (ESAS), medication use, functional status, and use of assistive devices were used to identify factors that are predictive of falls using backwards stepwise logistic regression. Results One thousand forty-one (52 %) were female, 1,377 (69 %) were nonHispanic white, 343 (17 %) had peripheral neuropathy, 237 (12 %) were on psychotropic medications, and 1,140 (58 %) were on strong opioids. There were 211 (11 %) patient reported falls. Presence of brain metastasis, use of assistive device, ECOG, ESAS depression, and weight prior to visit were significantly associated with patient reported falls in the multivariate model. Conclusions Only about one tenth of patients seen in the outpatient supportive care clinic reported falls in the last month. Our findings showing that falls to be associated with brain metastasis, assistive device, functional status, ESAS depression and weight are useful in stratifying high risk patients. They also show that certain medications deemed as risk factors in other populations were not associated with falls.

MASCC-0429 Palliative Care 5 A PALLIATIVE REHABILITATION PROGRAM IMPROVES PATIENT FUNCTIONING

A. Feldstain1, M. Chasen2, R. Bhargava3, J. Pereira2 1 School of Psychology, University of Ottawa, Ottawa, Canada; 2 Palliative Care, Bruyère Continuing Care, Ottawa, Canada; 3Palliative Care, Bruyère Research Institute, Ottawa, Canada Background and Aims After treatment, patients with active cancer face a considerable burden from the effects of both the disease and its treatment. Symptom burden has been found to remain consistent until a few weeks before death, when it worsens. The Palliative Rehabilitation Program (PRP) is an interdisciplinary program designed to ameliorate disease effects and to improve the patient’s functioning. It strives for a more holistic approach by incorporating many aspects of wellness. The present study evaluated pre-post changes in functioning, symptoms, and well-being. Methods There were 171 patients with advanced cancer who enrolled in the 8week interprofessional PRP; 108 completed the program. Measures of physical, nutritional, social, and psychological functioning were evaluated prior to beginning the program and at completion. Results Significant improvements were revealed in performance status (p<0.000), nutrition (p=0.003), symptom severity (p=0.021 to 0.000), symptom interference with functioning (p=0.001 to 0.000), fatigue (p= 0.008 to 0.000), and physical endurance, mobility, and balance or function (p=0.002 to 0.000). Conclusions Patients living with advanced cancers who underwent the interprofessional PRP experienced significant improvement in functioning across several domains.

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MASCC-0436 Palliative Care 5 COMMUNICATION AND SATISFACTION WITH CARE ON PALLIATIVE CARE UNITS

D. Seccareccia1, K. Wentlandt2, N. Kevork3, K. Workentin4, S. Blacker5, D. Grossman6, C. Zimmermann7 1 Psychosocial Oncology, Sunnybrook Hospital, Toronto, Canada; 2 Family and Community Medicine, Toronto General Hospital, Toronto, Canada; 3Psychosocial Oncology and Palliative Care, University Health Network, Toronto, Canada; 4Family Medicine, Toronto East General Hospital, Toronto, Canada; 5Cancer Services Planning and Performance, St. Michael’s Hospital, Toronto, Canada; 6Family Medicine, Baycrest, Toronto, Canada; 7Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada Background and Aims Background: Communication with patients is an important aspect of satisfaction with care, but this has not been described specifically on palliative care units (PCUs). Aims: To identify elements of quality of care and satisfaction with care in PCU inpatient settings, as described by inpatients, family caregivers and healthcare professionals. Methods: Qualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. All interviews and focus groups were semi-structured to elicit thoughts about the characteristics of satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method of analysis with an inductive, constant comparison approach to identify themes, which were coded to saturation. Results: Communication was identified as the most prevalent theme. Five subthemes described elements of communication that were deemed important by patients, caregivers and staff. These included: 1) developing rapport with patients and caregivers to build trust and kinship; 2) clarifying the plan of care to establish realistic expectations; 3) keeping patients and families informed about the patient’s illness and decisions about care; 4) listening actively to validate patients’ concerns and individual needs; and 5) creating a safe space where conversations about death and dying can occur. Conclusion: Communication is a crucial component of satisfaction with care on PCUs, as identified by patients, family caregivers and healthcare professionals. Palliative care education should focus on both general communication skills, and specific techniques required when providing end-of-life care.

MASCC-0439 Palliative Care 5 ELEMENTS OF SATISFACTION WITH CARE ON PALLIATIVE CARE UNITS: A QUALITATIVE STUDY

K. Wentlandt1, D. Seccareccia2, N. Kevork3, K. Workentin4, S. Blacker5, D. Grossman6, C. Zimmermann7 1 Family and Community Medicine, Toronto General Hospital, Toronto, Canada; 2Psychosocial Oncology, Sunnybrook Hospital, Toronto, Canada; 3Psychosocial Oncology and Palliative Care, University Health Network, Toronto, Canada; 4Family Medicine, Toronto East General Hospital, Toronto, Canada; 5Cancer Services Planning and Performance, St. Michael’s Hospital, Toronto, Canada; 6Family Medicine, Baycrest, Toronto, Canada; 7Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada Background and Aims Background: Satisfaction with care is an important indicator of quality of care, but there is little research in this area specific to palliative care units (PCUs).

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Aims: To delineate important aspects of satisfaction with care on a PCU, as described by inpatients, family-caregivers and healthcare professionals Methods Qualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. Interviews and focus groups were semi-structured to elicit comments about satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method, with an inductive, constant comparison approach to identify themes, and were coded to saturation. Results Themes identified as important to quality care and patient satisfaction were grouped into seven domains: 1) team approach, whereby an interdisciplinary staff delivers care and interacts effectively; 2) responsiveness, referring to provision of immediate and attentive care; 3) palliative philosophy, prioritizing patients’ comfort and dignity; 4) competency, emphasizing specialized palliative care knowledge and staff professionalism; 5) familycentered care, supporting families and allowing family-caregivers to participate in care decisions; 6) efficient and equitable care, ensuring PCU provides adequate resources and access to consistent care; and 7) supportive setting, referring to unit’s physical atmosphere and mood. Conclusions Key elements of quality care and patient satisfaction for PCUs have been identified. Further research will develop and validate a tool to evaluate patient and caregiver satisfaction with care on PCUs.

MASCC-0414 Palliative Care 5 DOES CUMULATIVE DOSE OF REPEAT WHOLE BRAIN RADIOTHERAPY CORRELATE WITH SURVIVAL: A POOLED MULTICENTRE ANALYSIS

N. Logie1, R. Jimenez2, N. Pulenzas3, D. Ciafone4, E. Wong3, S. Ghosh1, C. Son5, H. Shih2, W. Wong4, E. Chow3, A. Fairchild1 1 Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; 2 Radiation Oncology, Massachusetts General Hospital, Boston, USA; 3 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 4 Radiation Oncology, Mayo Clinic Arizona, Scottsdale, USA; 5Radiation Oncology, University of Chicago, Chicago, USA Background and Aims For multiple brain metastases (BM), the primary treatment remains whole brain radiotherapy (WBRT). Patients with intracranial progression after initial WBRT may receive a repeat course. Early data suggests improvement in overall survival (OS) if reirradiation dose is >20 Gy. We investigated the relationship between dose and OS in patients receiving repeat WBRT for multiple BM. Methods A pooled database included patients with any solid primary tumor; those receiving stereotactic radiosurgery, partial cranial RT, or surgery were excluded. Demographics, disease characteristics, and RT doses were collected. Spearman correlation coefficients, along with OS using the Kaplan-Meier method, were calculated. Results Eighty-one patients (4 centres) met inclusion criteria: median age 55 years, 64 % female (n=52), 48.1 % with lung and 39.5 % with breast cancer. Median interval between courses was 8.2 months. Thirty-nine WBRT schedules were used (7.95 Gy/4 to 48 Gy/24). 58.0 % (47/81) received 20Gy/5 initially, and 37.0 % (30/81) received 20Gy/10 subsequently. Median survival from the first WBRT was 13.3 mos (95 %CI 11.2–15.4 mos) and from the second was 5.0 months (95 %CI 3.9– 6.1 months). There was a significant positive correlation between dose and survival for both courses, with rho=0.32 (p=0.004) and rho=0.26

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(p=0.02), respectively. Cumulative dose did not correlate with OS except for survival from second WBRT for the subgroup with breast cancer (rho=0.40; p=0.02). Conclusions For some patients experiencing recurrent BM, repeat WBRT may be the only therapeutic option. Dose of each course correlated with survival but cumulative dose did not, except for those with breast cancer, suggesting other factors are more predictive.

MASCC-0422 Palliative Care 5 BREAKTHROUGH CANCER PAIN: A COMPARISON OF SURVEYS WITH EUROPEAN AND CANADIAN PATIENTS

R. McDonald1, G. Bedard1, P. Hawyley2, A. Davies3, A. Buchanan3, M. Popovic1, E. Wong1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2 Palliative Medicine, British Columbia Cancer Agency, Vancouver, Canada; 3Palliative Medicine, Royal Surrey County Hospital, Surrey, United Kingdom Background and Aims Breakthrough cancer pain is defined as a transient exacerbation of pain that occurs spontaneously or in response to a trigger, despite stable and controlled background pain. Breakthrough pain often causes significant impairments for patients and can decrease quality of life. The objective of this study was to determine differences between breakthrough cancer pain incidence and management in Canada and Europe. Methods Data collected from a previous study of breakthrough cancer pain in Canada was compared to the data published on breakthrough cancer pain in Europe. A standard survey was utilized for both patient populations. Inclusion and exclusion criteria were the same for both patient populations. Results Both groups of patients had similar number and duration of breakthrough pain episodes, and similar pain intensity and pain interference with their activities of daily living. European patients reported better analgesic efficacy and satisfaction with management, and a greater percentage of European patients reported being prescribed a transmucosal fentanyl formulation (19.5 % vs 2.9 %). More European patients (53 %) than Canadian patients (32.5 %) took their rescue medication every time they had a breakthrough pain episode. Conclusions Breakthrough cancer pain in both Canadian and European patients greatly impacts their daily living, and both groups of patients had similar experiences with breakthrough cancer pain. Currently, for many patients this pain is not adequately managed. The role for new analgesic treatments in management of breakthrough cancer pain needs further study.

MASCC-0434 Palliative Care 5 QUALITY OF LIFE AFTER PALLIATIVE RADIOTHERAPY IN BONE METASTASES: A LITERATURE REVIEW

R. McDonald1, H. Lam2, G. Bedard1, E. Wong1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Library Services, Sunnybrook Health Sciences Centre, Toronto, Canada

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Background and Aims Bone metastases are a common cause of pain among advanced cancer patients and often lead to increased morbidity. Palliative radiotherapy is an accepted treatment for bone metastases in reducing pain and improving quality of life (QOL). The objective of this literature review was to investigate change in pain and QOL following palliative radiotherapy for painful bone metastases. Methods A literature search was conducted in OvidSP Medline (1946 – Jan Week 4 2014), Embase (1947 – Week 5 2014), and the Cochrane Central Register of Controlled Trials (Dec 2013) databases. The search was limited to English only but not restricted to any time period. Subject headings and keywords utilized for the search included “palliative radiation”, “cancer palliative therapy”, “bone metastases”, “quality of life”, and “pain”. Articles determining change in pain and QOL in patients were included. Results Twenty-two articles were selected from a total of 1,730. The most commonly used tool to evaluate pain and QOL was the Brief Pain Inventory. Thirteen articles reported pain relief and improved QOL compared to baseline in only those who responded to radiotherapy; these did not report on quality of life for non responders. The remaining nine articles reported on QOL following radiotherapy in both responders and non responders. Eight articles demonstrated statistically significant improved QOL in responders compared to non responders. One article showed improvement in QOL in responders, and an irregular pattern during follow-up for non responders. Conclusions Palliative radiotherapy for symptomatic bone metastases improves pain and quality of life in responders.

MASCC-0423 Palliative Care 5 RELATIVELYASYMPTOMATIC PRESENTATION IN AYOUNG MAN WITH WIDESPREAD RENAL CELL CARCINOMA

R. McDonald1, G. Bedard1, E. Wong1, D.J. Lee1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Renal cell carcinoma is an uncommon form of cancer that only contributes to approximately 2 % of all cancer diagnoses. Often, renal cell carcinoma presents asymptomatically which can result in advanced stage diagnosis in about 20 % of cases. Cancer screening initiatives and improved patient education are crucial in identifying early stage cancer. The purpose of this case report is to provide an example supporting the initiation of robust cancer screening tools for those at high risk of renal cell carcinoma. Methods A 40-year-old male presented to a walk-in clinic in December 2013 with pain in his left shoulder, presumably originating from a previous hockey injury. A chest x-ray revealed a lesion in his shoulder and extensive cannonball metastases in his lungs. The man was then referred to the Rapid Response Radiotherapy Clinic at the Sunnybrook Health Sciences Center. Results From the Rapid Response Radiotherapy Program, the patient was referred immediately to a medical oncologist who treated him the same day with Sutent and Dexamethasone for suspected metastatic renal cell carcinoma. A later biopsy confirmed this primary and further imaging revealed widespread metastases in the bones, lungs, and brain. In addition, the patient was referred to Radiation Oncology for consideration of stereotactic body radiotherapy for his bone and brain metastases.

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Conclusions This case highlights the importance of early cancer screening tools. Although promising progress has been made in terms of screening for renal cell carcinoma, no robust methods exist that can be employed for all high risk groups.

MASCC-0441 Palliative Care 5 ACCOMPLISHMENTS OF STUDENTS WORKING IN THE RAPID RESPONSE RADIOTHERAPY CLINIC: A TEN YEAR REVIEW

R. McDonald1, N. Pulenzas1, B. Lechner1, G. Bedard1, E. Wong1, L. Holden1, M. Tsao1, E. Barnes1, E. Szumacher1, G. Fenton1, E. Chow1, M. Popovic1, C. Danjoux1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims In 1996, the Toronto-Sunnybrook Regional Cancer Center developed the Rapid Response Radiotherapy Program (RRRP). The objective of this clinic is to consult, simulate, plan, and treat patients with palliative radiotherapy on the same day. In 2004, the clinic began to incorporate undergraduate students interested in health sciences with the goal of providing clinical and research experience. The purpose of this study is to review the 10 year (2004–2013) experience of the RRRP and to examine whether the goals of the student program have been met. Methods Students who worked in the RRRP from 2004 to 2013 were contacted to complete a short survey regarding their overall experience with the program and their current endeavors. Student accomplishments were collected from our database, as well as PubMed. Results A total of 54 students from ten post-secondary institutions have worked in the RRRP, 29 were from the University of Waterloo undergraduate co-op program. In total, articles were published, 93 of which can be found on PubMed. Other accomplishments include 40 book chapters, 232 oral, poster, and invited presentations, and 99 awards cumulatively. Qualitative data regarding student perspectives of their experience in the RRRP has also been analyzed. Conclusions Over the past 10 years, the RRRP has achieved its goal of providing quality medical and research experience to students interested in the health sciences. Through gaining the perspectives of past and present students, we hope to continue to shape our program and provide unique opportunities to future students.

MASCC-0404 Palliative Care 5 SPINAL CORD COMPRESSION AS A FIRST PRESENTATION OF CANCER: A CASE REPORT

L. Nicholas1, M. Poon1, M. Popovic1, C. Yip1, E. Chow1 1 Odette Cancer Centre, Sunnybrook Hospital, Toronto, Canada Background and Aims Bone metastases can cause extreme pain and skeletal-related events such as fracture and spinal cord compression (SCC). Considered an oncologic emergency, SCC can result in a loss of feeling, motor control, and

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eventually paralysis if left untreated. In most cases, cancer will be diagnosed in early stages and very infrequently will it be first diagnosed with both bone metastases and SCC. The purpose of the present case report is to discuss the management of a patient with spinal cord compression as a first presentation of cancer. Methods A 71 year-old male was referred to the Odette Cancer Centre at Sunnybrook Hospital. He presented with lower extremity weakness and increased gait difficulty beginning roughly 24 h prior to his visit. Results At Sunnybrook, A CAT scan showed probable diffuse metastatic disease and cord compression at T3 confirmed by a MRI of the spine. Surgical decompression of the spine was performed followed by post-operative radiation therapy consisting of 20 Gy in five fractions to the T1-T5 thoracic area for palliative consolidation. Subsequently, the patient started hormonal therapy for his prostate cancer. Conclusions When treating SCC, two main treatment modalities exist: surgical decompression followed by post-operative radiotherapy, or radiotherapy alone. Patients with SCC and without completed tissue diagnosis benefit from the option of surgical decompression and tissue diagnosis to prevent the possible radiation of a benign tumour.

MASCC-0402 Palliative Care 5 PARTICLE DISEASE VERSUS BONE METASTASES: A CASE REPORT

L. Nicholas1, M. Poon1, M. Popovic1, C. Yip1, E. Chow1 1 Odette Cancer Centre, Sunnybrook Hospital, Toronto, Canada Background and Aims Following arthroplasty, complications resulting from wear of the prosthesis can arise. One such complication, particle disease, can be mistaken for a lytic lesion resulting from metastases because of its rarity and similar appearance on x-ray imaging. Both particle disease and lytic lesions from cancer can cause significant bone pain. The purpose of this present case report is to discuss the assessment and possible diagnosis of particle disease in patients with prosthesis presenting in oncology settings. Methods In this report, we present the case of a 47 year-old woman who was referred to Odette Cancer Centre, Sunnybrook Hospital. She presented with what was believed to be a lytic lesion secondary to cancer, but was found to be consistent with particle disease. Results An x-ray of her hip and right femur was taken and showed what was believed to be a lytic lesion. A secondary x-ray of the bilateral femurs and hip was taken at Sunnybrook Hospital. The prosthetic showed wear of the polyethylene as well as two areas of osteolysis, consistent with small particle disease. Therefore, the patient was referred to orthopaedic care and was informed that she would require a revision of her total hip arthroplasty. Conclusions Employing the use of a 3-phase bone scan and 18F-Fluoride PET/ CT can be an effective method to differentiate metastases and particle disease. Oncologists should take extra care when assessing patients with prosthesis and should explore the possible diagnosis of particle disease.

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MASCC-0411 Palliative Care 5 THE INCIDENCE OF “NO CPR DOCUMENTATION” IN PATIENTS REFERRED FOR PALLIATIVE RADIOTHERAPY IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM

N. Pulenzas1, B. Lechner1, L. Zhang1, N. Thavarajah1, N. Lauzon1, L. Holden1, P. Sheehan1, G. Bedard1, E. Wong1, R. McDonald1, E. Bain1, M. Tsao1, E. Barnes1, C. Danjoux1, E. Chow1 1 Rapid Response Radiotherapy Program Radiation Oncology, Odette Cancer Centre, Toronto, Canada Introduction: The concept of having a do-not-resuscitate (DNR) order, also known as a no cardiopulmonary resuscitation (CPR) code status, is used to spare unnecessary trauma resulting from CPR and extreme lifesaving measures. Objective: To explore the prevalence of DNR orders in advanced cancer patients referred for palliative radiotherapy to the Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Odette Cancer Centre. Methods: Patients seen in the RRRP between January-April 2013 were assessed for code status documentation. Patients were recorded as having a DNR order if there was written documentation. Those with no DNR documentation were reported as no code status. Results: One hundred and forty-five patients had code status data collected. Median age was 71, and 78 (54 %) participants were female. Ninety-two patients (64 %) were living at home, 50 (35 %) were inpatients, and 3 (2 %) were in supportive housing or a nursing home. One hundred and twenty-one patients (83.5 %) did not have a documented DNR order, and 24 patients (16.5 %) had documented DNR status. Patients with a DNR order were more likely to come from hospital (38 % of total inpatients), than from home (5 % of outpatients) (p<0.0001). Conclusions: Compared to previously collected data, the incidence of DNR documentation has increased. Continuation of promoting patient education and awareness, improving care teams’ awareness of DNR status and more effectively reaching outpatients are key areas of future focus.

MASCC-0388 Palliative Care 5 A RETROSPECTIVE STUDY OF CANCER PATIENTS’ TREATMENTS IN SIX MONTHS BEFORE DEATH

J. Rao1, Q. Fu1, Q.S. Wu2, S.Y. Yu1 1 Oncology, Tongji Hospital Tongji Medical College Hua Zhong University of Science and Tec, Wuhan, China; 2Biliary & Pancreatic Surgery, Tongji Hospital Tongji Medical College Hua Zhong University of Science and Tec, Wuhan, China Background and Aims Whether cancer patients received treatments before death could be benefited or not, it has been a controversial topic and become a hotspot. The aim of this study is to investigate cancer patients’ treatment status in 6 months before death. Methods A retrospective study of cancer patients’ treatments in 6 months before death, which from January 2010 to July 2013 in cancer center and ICU (161 and 55 cases respectively) of Tongji Hospital, was conducted, and the differences of projects were compared by chi-square test.

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Results The differences of surgeries (in 6 months/3 months/1 month before death) and radiotherapies and chemotherapies (in 3 months before death) between the two groups were statistically significant, all pvalues are less than 0.0001. In addition, some patients in 1 month/ 2 weeks before death were undergoing chemotherapy, targeted therapy. The ratios of blood products (except albumin) transfused in ICU were significantly higher than cancer center (P<0.0001), the same with various punctures and cavity mirror examinations. The proportions of patients, who refused invasive rescue, cardiopulmonary resuscitation or gave up the rescue on the day of death in cancer center were 31.68 %?19.88 % and 6.83 % respectively, but in ICU there were only 3.64 %, 5.45 % and 5.45 %. Conclusions The patients had less invasive examinations and treatments within 6 months before death in cancer center than ICU, however, the excessive treatments still exist. Hospice care and doctor-patient communication should be further strengthened.

MASCC-0433 Paraneoplastic EFFICACY OF TOLVAPTAN IN CANCER PATIENTS WITH HYPONATREMIA DUE TO SIADH: POST-HOC ANALYSIS OF SALT (STUDY OF ASCENDING LEVELS OF TOLVAPTAN)

J. Blais1, F. Ahmad2, J. Chiodo3, L.A. Glaser4, R.J. Gralla5, W. Zhou6, F.C. Czerwiec7 1 Global Medical Affairs, Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, USA; 2Medical Information, Otsuka America Pharmaceutical Inc., Princeton, USA; 3Medical Affairs, Otsuka America Pharmaceutical Inc., Princeton, USA; 4Medical Director, Coastal Biomedical Research Inc, Santa Monica, USA; 5Professor of Medicine, Albert Einstein College of Medicine, Bronx, USA; 6Biostatistics, Otsuka Pharmaceutical Development and Commercialization Inc, Rockville, USA; 7Global Clinical Development, Otsuka Pharmaceutical Development and Commercialization Inc, Rockville, USA Background and Aims Hyponatremia is common in cancer due to the underlying syndrome of inappropriate anti-diuretic hormone (SIADH). The 2 identical RCT SALT studies evaluated hyper- or eu-volemic hyponatremia attributed to chronic heart failure, cirrhosis or SIADH. This posthoc analysis evaluated the subset of SIADH patients with an etiology of cancer to determine the efficacy of tolvaptan relative to the overall SIADH population. Methods Patients with SIADH and an etiology likely attributable to cancer (n=28) were identified. The change from baseline in serum sodium AUC between tolvaptan and placebo were derived from an ANCOVA model. The percentage of patients having normalized serum sodium (>135 mEq/L) was analyzed and stratified by baseline disease severity. Results Baseline serum sodium levels in this cohort were 130 and 128 mEq/L for tolvaptan and placebo, respectively. The mean change from baseline in serum sodium AUC for tolvaptan versus placebo was 5.0 versus −0.3 (p= <0.0001) at day 4, and 6.9 versus 1.0 (p<0.0001) at day 30, consistent with the response seen in the total SIADH population (Figure). Serum sodium normalization was observed in 6/12 and 0/13 patients at day 4, and 7/8 and 2/6 patients at day 30 (tolvaptan versus placebo respectively; p<0.05). Common treatment emergent AEs for tolvaptan were consistent with previously reported results.

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results to routine therapies, further inquiries were done. Clinical examinations revealed a newly enlarged cervical lymph node and the patient was referred to a hematologist. Results Although initial investigations were negative, 3 months later the patient developed frank Hodgkin’s Lymphoma. Conclusions OLP is very rare in men, especially in young adults. Generally, poor responses to common treatments are indicators of mismatch between the expected pathophysiology and existing manifestations of a disease. Since OLP is an immune-mediated disorder, any unusual case of it should be approached with caution as if it might be a paraneoplastic condition.

MASCC-0560 Pediatrics OLANZAPINE FOR TREATMENT AND PREVENTION OF ACUTE CHEMOTHERAPY-INDUCED VOMITING (CIV) IN CHILDREN: A RETROSPECTIVE, MULTI-CENTRE REVIEW

Conclusions Results of this post-hoc analysis support the use of tolvaptan for the treatment of hyponatremia due to para-neoplastic SIADH. Our conclusions are limited by the relatively small sample size.

MASCC-0050 Paraneoplastic ATYPICAL ORAL LICHEN PLANUS MAY PREDICT IMMUNE SYSTEM RELATED MALIGNANCIES

H. Ahadian1, N. Mirjalili1, M.H. Akhavan Karbassi1 1 Oral Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Background and Aims Oral Lichen Planus (OLP) is a chronic immuno-inflammatory condition that varies in appearance from keratotic lesions to erythematous and ulcerative ones. OLP mostly affects middle-aged females, and usually presents as asymptomatic reticular plaques. Asymptomatic lesions do not need any intervention but regular follow-ups. However, In case of pain or burning sensation paliative prescriptions are treatments of choice. Methods A 28-year old man with the chief complaint of oral burning sensation, for about 1 month, came to our clinic. Present illness history had no significant point, as well as his medical history. In clinical examinations, bilateral reticular white plaques of buccal and gingival mucosa were significant. Since there was no amalgam filing in close contact with his mucosa, he was just instructed to use Teriamcinolone mouth-wash. After 2 weeks, symptoms showed minimal response to the treatment. Switching to topical Beclamethasone inhaler for next 2 weeks also resulted in moderate relief of the burning sensation. In the next session, due to poor

J. Flank1, J. Thackray2, D. Nielson3, A. August4, T. Schechter5, S. Alexander5, L. Sung5, L.L. Dupuis6 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; 2Pharmacy, Memorial Sloan-Kettering Cancer Center, New York, USA; 3Nursing, Children’s Medical Center Dallas, Dallas, USA; 4 Pharmacy, The Children’s Mercy Hospital, Kansas City, USA; 5 Pediatrics, The Hospital for Sick Children, Toronto, Canada; 6 Pharmacy, The Hospital for Sick Children, Toronto, Canada Background and Aims The addition of olanzapine to standard antiemetic prophylaxis improves chemotherapy-induced nausea and vomiting (CINV) control in adults. Published experience in children with cancer is lacking. This study describes the safety and efficacy of olanzapine for CIV control in children. Methods Children <18 years old who received olanzapine for acute CINV control from December 2010 to August 2013 at 4 institutions were identified. Data regarding patient characteristics, chemotherapy, antiemetic prophylaxis, olanzapine dosing, CIV control, liver function and adverse events were abstracted from the health record. Complete CIV control was defined as the absence of vomiting or retching throughout the acute phase. Toxicity was graded using CTCAEv4.03. Results Sixty children (median age 13.2 years; range: 3.1–18) who received olanzapine during 158 chemotherapy blocks were identified. Olanzapine was most often (59 %) initiated due to a history of poorly controlled CINV. The median initial olanzapine dose was 0.09 mg/kg/day (range: 0.026–0.210). Most children who received olanzapine daily for the entire acute phase experienced complete acute CIV control (83/128; 65 %). Grade 1–2 sedation was reported in 11/158 (7 %) of chemotherapy blocks. Of the 25 chemotherapy blocks where liver function tests were reported more than once, grade 1–3 elevations in ALT and/or AST were observed in 5. Bilirubin was unaffected. The median weight change in 31 children who received olanzapine during more than one chemotherapy block was −1 % (range: −16–18). Conclusions Olanzapine is likely to improve CIV control in children with little toxicity. Prospective controlled evaluation of olanzapine for CINV prophylaxis in children is warranted.

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MASCC-0458 Pediatrics PERIPHERALLY INSERTED CENTRALVENOUS CATHETER (PICC) IN PEDIATRIC ONCOLOGY UNIT: A DEVELOPING WORLD EXPERIENCE

A. Kumar1, V. Chinnabhandar1, S.P. Yadav1, A.K. Gupta1, A. Gupta2, N. Radhakrishnan1, D. Thakkar1, D. Tarangini1, A. Sachdeva1 1 Pediatric Hematology-Oncology and Bone Marrow Transplant Centre, Sir Ganga Ram Hospital, Delhi, India; 2Interventional Radiology, Sir Ganga Ram Hospital, Delhi, India Background and Aims PICCs are attractive, economical alternative for prolonged administration of chemotherapy in pediatric oncology kids. But there are few disadvantages also-infections, block, thrombosis etc. Here we describe our experience with regard to patients demographics and complications. Methods Combined retrospective and prospective analysis of data of patients in whom PICCs were inserted at our center from January-2011 to November-2013. Results One hundred seventeen PICCs inserted in 82 patients admitted.73 PICCs analysed (35-inserted more than once, 8-lost to follow up,1-cause for removal of PICC not found were excluded).48-males (65 %),25-females(35 %). Median age-5.7 yr (0.4–18 yr).55 (75.3 %) -Hemato-lymphoid (ALL-most common), 18(24.7 %)-solid tumors (Neuroblastoma-most common). Majority basilic veins inserted (n=73,92 %). Total number of catheter days-4856 (median time-71.5 days; range-1–222 days). Causes for removal of PICCs6(8.2 %) -completed treatment, 14(20 %)- fever, with no proven sepsis,46(63 %)-complications.7 (9.5 %) PICCs in situ. Catheter related blood stream infections (CRBSI)-23 (31.5 %)-5.01 episodes/1,000 catheter days, most common complication. Staphylococci, Acenetobacter, and Candida are the most commonly isolated organism. Other complications- line site infections(9),catheter thrombosis (5),accidental removal(5),line blocks(4)1.96,1.09,1.0,0.87 episodes/1,000 catheter days respectively. Conclusions CRBSI are major morbidity and a significant problem of developing countries, otherwise PICCS are safe and cost effective here. Pain relief was the major benefit and trade off for increased risk of infections.

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Methods A core research group formed a list of relevant topics regarding supportive care in childhood cancer. These topics were incorporated in a modified two-round Delphi questionnaire to determine the order of development of CPGs for all topics in supportive care in childhood cancer (see figure 1). The Delphi method is a well-recognized process to achieve consensus among a group of experts (pediatric oncologists, pediatric oncology nurses and pediatricians involved in care for childhood cancer patients), based on anonymity, iteration, controlled feedback and statistical group response. Results In both rounds, 36 panellists (80 %) responded. The five topics with the highest score in round 2 were infection, sepsis, febrile neutropenia, pain and nausea/vomiting. Conclusions We successfully used a Delphi questionnaire to prioritize childhood cancer supportive care topics for the development of clinical practice guidelines. This is a first step towards uniform and evidence based Dutch guidelines in supportive care in childhood cancer. Figure 1. Outline of the Delphi method used in the questionnaire

MASCC-0492 Pediatrics DEVELOPMENT OF CLINICAL PRACTICE GUIDELINES REGARDING SUPPORTIVE CARE IN CHILDHOOD CANCER IN THE NETHERLANDS – PRIORITIZATION OF TOPICS USING A DELPHI QUESTIONNAIRE

E.A.H. Loeffen1, R.L. Mulder2, M.D. van de Wetering2, L.C.M. Kremer2, W.J.E. Tissing1 1 Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital University Medical Center Groningen University of Groningen, Groningen, Netherlands; 2Department of Pediatric Oncology, Emma Children’s Hospital Academic Medical Center, Amsterdam, Netherlands

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Background and Aims Currently, nationwide Dutch guidelines for supportive care for children with cancer are over 10 years old and not evidence based. There is growing support and need for clinical practice guidelines (CPGs), which bridge the gap between research and clinical practice. However development of CPGs is time consuming, therefore it is important to prioritise subjects for which the clinical importance is the greatest. The objective of this study was to prioritise childhood cancer supportive care topics for development of CPGs.

A. Majorana1, E. Bardellini1, G. Conti2, M.G. Cagetti3, G. Campus4, G. Piana5, L. Strohmenger6, A. Polimeni7 1 oral pathology, University of Brescia, Brescia, Italy; 2Maxillo Facial Surgery and Dentistry, University of Milano, Milano, Italy; 3Pediatric Dentistry, University of Milano, Milano, Italy; 4Pediatric Dentistry, University of Sassari, Sassari, Italy; 5Special Needs Dentistry, University of Bologna, Bologna, Italy; 6Community Dentistry, University of Milano, Milano, Italy; 7 Pediatric Dentistry, University of Roma La Sapienza, Roma, Italy

Pediatrics CLINICAL EVALUATION ON TASTE PERCEPTION IN HEALTHY CHILDREN AND IN PAEDIATRIC CANCER PATIENTS

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Background and Aims INTRODUCTION: Taste sensitivity test provides information about the chemical characteristics of the substances coming in contact with the oral mucosa. The oral cavity is frequently associated with the typical side effects of anticancer therapy. Diagnosis and management of taste alterations depend on knowledge of taste sensitivity among healthy children. OBJECTIVES: The aim of this project is to analyse the different taste sensitivity and the possible dysgeusia among healthy children and children undergoing chemo -radiotherapy. Methods MATERIALS AND METHODS: A sample of 507 healthy children and 51 children in cancer therapy (age range 5–12 years) was selected among the children population attending the Paediatric Dentistry Department of the University of Brescia, Bologna and Roma and the Paediatrics Department of Brescia and Bologna (Italy). A taste sensitivity test, performed using 8 solutions with 4 flavours at different concentrations, plus the placebo solution, was performed following a standardised protocol. The test was repeated at baseline and after 20–30 days for healthy children, and before, during and after the therapy for cancer children patients. Results RESULTS: In healthy children, the mean of the threshold was 1.83 for bitter, 2.56 for sour, 1.56 for the sweet and 2.04 for the salty taste; in children in cancer therapy the means were (before, during and after therapy): 1, 3 and 1.5 for bitter; 1.5, 3.75 and 2.25 for acid; 1, 2.875 and 1.125 for sweet and 1.5, 3.25 and 2.375 for salty. Conclusions CONCLUSIONS : this study showed significative alterations in taste perception (disgeusia) in children in cancer therapy, with a Gaussian way.

MASCC-0380 Pediatrics MANAGEMENT OF CHILDREN WITH END STAGE DISEASE IN A BURKITTS LYMPHOMA TREATMENT PROGRAM IN WESTERN KENYA REGION

A.P. Were1, M. Liru2, C. Kasera2, L. John2, W. Aketch2, B. Weluchio3, S.A. Obuya4, C. Tenge1 1 AMPATH Program EMBLEM Project, Moi University, Eldoret, Kenya; 2 EMBLEM Project, Homabay District Hospital, Homabay, Kenya; 3 EMBLEM Project, Webuye District Hospital, Webuye, Kenya; 4AMPATH Program- EMBLEM Project, Moi teaching & Referral Hospital, Eldoret, Kenya Background and Aims 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 Health Center but also a huge number of children with end stage disease presenting to these facilities and needing attention. A child with Life limiting conditions not only face the challenges of pain but of 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. Methods This is an experience paper highlighting the plight of children that presented with life challenging conditions in a BL treatment program in Western Kenya region. Pain management, management of distressing symptoms is provided by a team of health workers that include physicians, nurses, social workers, physiotherapists and nutritionists who see these children both in the clinic and in the community during outreach activities.

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Results Out of the 258 spotted cases, 110 have been enrolled in the research program with the remaining being ineligible due to advanced disease or other terminal conditions that presented as tumors and referred to us for management. Conclusions This has initiated the palliative care activities being provided with very minimal resources and skills. A number of parents and their children have reported improved comfort as far as the distressing symptoms are concerned. This initiative registered marked improvement in quality of life to the suffering.

MASCC-0316 Pediatrics 2 UNDERSTANDING THE SUPPORTIVE CARE NEEDS OF ADOLESCENTS WITH CANCER

H.Y.L. Chan1, C.W.H. Chan1, W.Y. Ip1, D.Y.P. Leung1, M.K.Y. Lin2 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong China; 2Palliative and Home Care Service, Children’s Cancer Foundation, Kowloon, Hong Kong China Background and Aims In addition to the developmental tasks, adolescents with cancer are confronted by additional stresses brought about by the disease and its treatment. Yet, little is known about their needs and concerns in coping with all these challenges. The purpose of this study was to identify the supportive care needs of adolescents with cancer in Hong Kong. Methods A cross-sectional descriptive study was conducted. A questionnaire that included the Chinese version of the Pediatric Quality of Life InventoryTM 4.0 (PedsQLTM) for adolescents, the Brief Symptom Inventory-18 (BSI18) and the Medical Outcomes Study Social Support Survey (MOS-SSS) was used to assess their health-related quality of life, psychological symptoms and social support respectively. Results Twenty eight adolescents with a cancer diagnosis were recruited from five paediatric oncology units. Their mean age was 15.6 years (SD 1.9). The physical functioning (1.39±1.05)in health-related quality of life was reported as the most overwhelming aspect, in particular on symptoms related to nausea (1.67±1.30) and pain/hurt (1.04±1.15), whereas somatization was the most severe psychological symptom (4.00±4.41). They perceived the least support in emotional and information support (3.56±0.90). Conclusions Findings of this study suggest that adolescents with cancer experienced a high level of symptom burdens and a lower level of emotional and information support. This heightened the importance of understanding their illness experiences and provided insights in developing psychosocial intervention that address their needs.

MASCC-0094 Pediatrics 2 PREFERENCES AND SATURATION OF THE NEEDS OF PARENTS OF CHILDREN WITH ONCOLOGICAL DISEASES

L. Sikorova1, R. Buzgova1, A. Filova1 1 Faculty of Medicine Department of Nursing and Midwifery, University of Ostrava, Ostrava, Czech Republic Background and Aims If a child falls ill with an oncological disease, needs and priorities of parents may change. The objective was to identify preferences of the

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needs of parents of children hospitalized with an oncological disease and the perception of the needs of parents by nurses. Another objective was to determine whether the needs of parents were saturated in their opinion and how the saturation of their needs is perceived by nurses. Methods The sample included 100 parents of children with an oncological disease (3–10 years old) who were hospitalized together with their children. The second sample consisted of 70 nurses. The Needs of Parents Questionnaire (NPQ) was used. Statistical evaluation–a median test, chi-squared test and Fisher’s exact test. Results Parents and nurses unanimously evaluated the need to be sure that the child will receive the best possible medical and nursing care even in their absence as the most important. They evaluated the need to have sufficient amount of sleep and to have a possibility to meet a social worker to address their financial problems as the least important. Unlike nurses, psychological support of parents by nurses (p=0.006), expressing the hope (p=0.029), timely provision of information about examinations (p=0.026) and quality education of the child (p=0.004) were important for parents. Unlike nurses, parents much more frequently evaluated their needs as saturated and fulfilled. Conclusions Nurses taking care of oncologically ill children and their parents should focus more on the perception and saturation of psychological-social needs of parents.

MASCC-0175 Pediatrics 2 PROVIDING CARE TO A CHILD WITH CANCER: A LONGITUDINAL STUDY ON THE COURSE, PREDICTORS, AND IMPACT OF CAREGIVING STRESS DURING THE FIRST YEAR AFTER DIAGNOSIS

E. Sulkers1, W.E. Tissing2, A. Brinksma1, P.F. Roodbol3, W.A. Kamps2, R.E. Stewart4, J. Fleer4, R. Sanderman4 1 UMCG School of Nursing and Health Department of Pediatric Oncology/Hematology Beatrix Children’s Hospital, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 2 Department of Pediatric Oncology/Hematology Beatrix Children’s Hospital, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 3UMCG School of Nursing and Health, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 4Department of Health Sciences Health Psychology Section, University of Groningen University Medical Center Groningen, Groningen, Netherlands Background and Aims Caring for a child with cancer is potentially stressful. Parents of children with cancer are confronted with several extra demands (e.g. responsibility for disease related tasks, dealing with role conflicts, and communication with the healthcare personnel). This may contribute to their already existing stress. The aim of the present study was to describe the course, predictors and impact of caregiving stress on the functioning of mothers of children with cancer during the 1st year post diagnosis. Methods Mothers (N=95, 86 % response rate) of consecutive newly diagnosed pediatric cancer patients (0–18 years) completed measures of caregiving stress, depressive symptoms anxiety and self-reported health at diagnosis, and 3, 6, and 12 months thereafter.

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Results Results indicated a significant decrease in caregiving stress (especially during the first 3 months after diagnosis), and improvement of mothers’ functioning across the 12 months follow-up. Caregiving stress was predicted by marital status and the ill child being the mother’s only child. Multilevel analyses, controlled for socio-demographic and medical covariates, showed that, over time, the decline in caregiving stress was accompanied by a reduction in depressive symptoms and anxiety. The amount of variance explained by caregiving stress was 53 % for depressive symptoms, 32 % for anxiety, and 7 % for self-reported health. Conclusions The findings of the present study indicate that caregiving stress is an important factor related to maternal adjustment in pediatric oncology. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening parents’ confidence in their ability to provide good care.

MASCC-0185 Pediatrics 2 REDUCTION OF CENTRALVENOUS CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN PEDIATRIC ONCOLOGY PATIENTS USING 70 % ETHANOL LOCKS: A RANDOMIZED CONTROLLED MULTI-CENTER TRIAL

R.A. Schoot1, M. van de Wetering1, C.H. van Ommen2, T. Stijnen3, W.J. Tissing4, E.M. Michiels5, F. Abbink6, M.F. Raphael7, H. Heij8, J. Lieverst9, L. Spanjaard10, C.M. Zwaan5, H.N. Caron11 1 paediatric oncology, Academic Medical Center, Amsterdam, Netherlands; 2paediatric haematology, Academic Medical Center, Amsterdam, Netherlands; 3Medical Statistics and Bioinformatics, university of Leiden, Leiden, Netherlands; 4paediatric haematology/oncology, University of Groningen, Groningen, Netherlands; 5paediatric haematology/ oncology, Erasmus University of Rotterdam, Rotterdam, Netherlands; 6 paediatric haematology/oncology, VUMC University of Amsterdam, Amsterdam, Netherlands; 7paediatric haematology/oncology, WKZ University of Utrecht, Utrecht, Netherlands; 8paediatric surgery, Academic Medical Center, Amsterdam, Netherlands; 9datamanagement, Dutch Childhood oncology group, The Hague, Netherlands; 10Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands; 11paediatric haematology/oncology, Academic Medical Center, Amsterdam, Netherlands Background and Aims The prevention of central venous catheter- (CVC-) associated bloodstream infection (CABSI) in pediatric oncology patients is essential. Ethanol locks can eliminate biofilm embedded pathogens and have no known microbial resistance. Objective To determine whether 70 % ethanol locks can cause a 50 % reduction in CABSI in pediatric oncology patients. Methods We conducted a randomized, double blind, multicenter trial in pediatric oncology patients (1–18 years) with newly inserted CVCs. Patients were randomly assigned to receive 2 h ethanol locks (3 ml 70 %) or heparin locks (3 ml 100 IU/ml), maximum frequency once weekly. Primary outcomes were catheter-associated bloodstream infection (CABSI), catheter removal or death due to CABSI. Results We included 307 patients, 153 were allocated to ethanol and 154 to heparin locks. In the ethanol group 16/153 (10 %) patients were diagnosed with CABSI versus 29/154 (19 %) in the heparin group; incidence was

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0.77/1,000 and 1.46/1,000 catheter days respectively (p=0.04), resulting in a number-needed-to-treat of 12 patients. Particularly Gram-positive CABSIs (ethanol, N=8; heparin, N=21, p=0.01) were reduced. Less CVCs were removed because of CABSI in the ethanol group (ethanol, N=5; heparin, N=12, p=0.08). No patients died because of CABSI. During ethanol locks patients experienced significantly more transient symptoms compared to heparin locks (maximum grade 2) (nausea; p= 0.03, taste alteration; p<0.001, dizziness; p=0.001, blushing; p<0.001), no suspected unexpected serious adverse reactions (SUSAR) occurred. Conclusions This is the first RCT to show that ethanol locks can prevent CABSI in pediatric oncology patients, in particular CABSI caused by Grampositive bacteria. Implementation of ethanol locks in daily practice should be considered.

MASCC-0167 Pharmacology TARGETING OF RAC1-SIGNALING FOR THE PREVENTION OF ANTHRACYCLINE-INDUCED CARDIO- AND HEPATOTOXICITY

C. Henninger1, J. Ohlig2, A. Bopp1, F. Wartlick1, M. Merx2, G. Fritz1 1 Toxicology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 2Cardiology Pneumology and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany Background and Aims Ras-homologous (=Rho) small GTPases regulate numerous functions associated with malignant disease. Pharmacological inhibition of Rho GTPases counteracts tumor progression and potentiates the antitumor efficacy of various anticancer drugs in preclinical models. Yet, consequences of inhibition of Rho signalling on normal tissue damage provoked by anticancer drugs is unknown. We aimed to elucidate the influence of inhibition of Rac1 on stress responses and cell death of normal cells/tissues following treatment with the anthracycline derivative doxorubicin (Doxo). Methods Rat cardiomyoblasts (H9c2) and human liver cells (HepG2) were pretreated with lovastatin (Lova) or Rac1-specific small-molecule inhibitors (EHT1864, NSC23766). Following Doxo exposure, DNA damage response (DDR) and cytotoxicity were monitored. Moreover, the influence of Lova and NSC23766 on Doxo-induced early and late cardio- and hepatotoxicity was analyzed in vivo (B6 mice). In addition, we investigated the influence of hepatic knock-out of the rac1 gene on doxorubicininduced stress responses. Results Both Lova and EHT1864 blocked the DDR and promoted the survival of H9c2 and HepG2 cells following Doxo treatment1,2. Pharmacological inhibition of Rac1 and liver-specific rac1 ko reduced the level of DNA damage induced by Doxo3,4. Notably, Lova and NSC23766 also protect the mouse heart from anthracycline-induced damage5,6. The data show that inferfering with Rac1-signaling protects against anthracyclineinduced normal tissue damage. 1 Huelsenbeck et al. (2012) JBC 278, 38590-99; Wartlick et al. (2013) BBA 1833, 3093-04; 3Henninger et al. (2012) TAAP 261, 66-73; 4Bopp et al. (2013), CDDIS 4,e558; 5Hulsenbeck et al. (2011) CDDIS 2:e190; 6 unpublished Conclusions Targeting of Rac1 signaling attenuates the cardiotoxic and hepatotoxic side effects of Doxo-based anticancer therapy.

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MASCC-0091 Pharmacology ADJUVANT CHEMOTHERAPY OF ADVANCED OVARY CARCINOMA: SYSTEMIC REVIEW OF MODE OF ADMINISTRATION

I. Chang1, J.Y. Lee1, M.K. Kim2, B.G. Kim1, D.S. Bae1 1 Obstetrics and Gynecology, Samsung Medical Center Sungkyunkwan University of Medicine, Seoul, Korea; 2Obstetrics and Gynecology, Samsung Changwon Hospital Sungkyunkwan University of Medicine, Changwon-Si, Korea Background and Aims To review the literature regarding adjuvant chemotherapy in women with advanced ovary carcinoma in terms of mode of administration. Methods A systematic search of MEDLINE, EMBASE and the Cochrane Library databases was conducted for studies. Results Nine randomized trials were identified that evaluated adjuvant chemotherapy in women with advanced ovary carcinoma in terms of mode of administration. Among them 8 was eligible for evaluation of survival results and hazard ratio was 0.80 (95 % CI 0.71~0.90). Besides survival differences, toxicity results were compared, too. Intraperitoneal (IP) chemotherapy has low or moderate evidence regarding thrombocytopenia, leucopenia, febrile neutropenia, gastro intestinal problem from analysis. Conclusions The benefits of IP chemotherapy need to be weighed against the toxicity of treatment. Patients should be informed of the benefits and risks of IP chemotherapy. Additional analysis would be helpful. More clinical trials are warranted to further define the role of IP chemotherapy in subgroups of patients and to clarify the role of IP chemotherapy.

MASCC-0040 Pharmacy ADHERENCE TO ANTIEMETICS THERAPY IN ASIAN HEAD AND NECK CANCER PATIENTS

A. Chan1, M. Shwe1, Y.X. Gan2, X.H. Low1, K. Yap1, D. Lim3 1 Pharmacy, National University of Singapore, Singapore, Singapore; 2 Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; 3 Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore Background and Aims In Asia, head and neck cancers are highly prevalent. Currently, there is little prevalence data in the literature describing non-adherence to outpatient antiemetic regimens for prophylaxis of chemotherapyinduced nausea and vomiting (CINV) among Asians. Hence, this study was designed to evaluate the impact of adherence to delayed antiemetics (3–4 days after cisplatin-based chemotherapy) on CINV control in head and neck cancer patients after cisplatin-based chemotherapy and (b) identify patient-related factors associated with nonadherence to delayed antiemetics. Methods This was a single-center, prospective, observational study conducted between September 2008 and May 2013. Adult head and neck cancer patients planning to receive cisplatin-based chemotherapy were recruited in this study. A standardized diary was used to collate clinical events.

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Primary endpoints included overall significant nausea, overall vomiting and complete response to antiemetics. Results Two hundred thirty-five patients were included in the analyses. The majority (75.7 %) was male and Chinese (81.7 %), manifested nasopharyngeal cancer (83.4 %), with the median age of 49.5 (19–81) years, and 62.1 % received aprepitant with their chemotherapy. A total of 150 patients (63.8 %) self-reported nonadherent use of delayed antiemetics. Patients who were nonadherent to antiemetics had a higher incidence of overall vomiting (31.4 % vs. 16.5 %, p=0.013), but similar incidence of significant nausea (56.4 % vs. 52.9 %, p=0.61) than those patients who were adherent to their antiemetics. After adjusting for potential confounders, patients receiving radiotherapy were more adherent to their antiemetics (OR=8.4; CI 95 %=2.4–29, p=0.001). Conclusions Asian head and neck cancer patients are poorly adherent to their prescribed antiemetic regimens, which results in poor control of chemotherapy-induced vomiting.

MASCC-0328 Pharmacy THE EFFECTS OF DENOSUMAB ON CALCIUM PROFILES IN ADVANCED CANCER PATIENTS WITH BONE METASTASES

B. Lechner1, C. DeAngelis2, N. Jamal2, U. Emmenegger3, N. Pulenzas1, A. Giotis2, P. Sheehan1, M. Tsao1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada; 2Department of Pharmacy, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada; 3Department of Medical Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Denosumab is a bone targeted agent that is effective for prevention of skeletal related events in cancer patients with bone metastases. Denosumab may result in hypocalcemia. The purpose of this study was to retrospectively examine the incidence and management of hypocalcemia for cancer patients with bone metastases treated with denosumab. Methods Patients who filled a denosumab prescription for treatment of bone metastases at the Odette Cancer Centre outpatient pharmacy from May 2011 to February 2013 were included. An incidence of hypocalcemia was defined as a corrected calcium value below 2.0 mmol/L within 28±7 days after the last injection of denosumab, corresponding to grade≥2 hypocalcemia as per Common Terminology Criteria for Adverse Events v4.0 (CTCAE). Results Fifty-five patients filled a prescription for denosumab; 18 (32.7 %) males and 37 (67.3 %) females. Most common primary cancer sites were breast (52.7 %), prostate (21.8 %), and lung (18.2 %). Serum calcium levels were missing for 3 patients, leaving 52 patients for analysis. Seventeen (32.7 %) patients experienced grade 1, 4 (7.7 %) patients grade 2, 4 (7.7 %) patients grade 3, and 1 (1.9 %) patient grade 4 hypocalcemia. Two patients required intravenous calcium and hospitalization for hypocalcemia. Median number of injections before hypocalcemia was 1 (range 1 to 14). The median time from first hypocalcemic value to normocalcemia was 33 days. Conclusions Nine of 52 (17.3 %) of patients had at least one incidence of grade≥2 hypocalcemia, suggesting that cautionary measures should be taken to avoid hypocalcemia in patients receiving denosumab.

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MASCC-0386 Pharmacy CLINICAL PHARMACY SERVICES IN UNITS : IMPACT ON THE PHYSICIAN ORDERS IN A CANCER CENTER

G. Marliot1, E. Tresch2, I. Sakji1, G. Lefebvre3, I. Rodrigues3, S. Delbey1 1 Clinical Pharmacy Department, Centre Oscar Lambret, Lille, France; 2 Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille, France; 3Oncology Supportive Care Department, Centre Oscar Lambret, Lille, France Background and Aims Since the computerization of physician orders, 2 intern pharmacists have been associated with order verifications and have made rounds with the medical team in two units. Our work was to evaluate the impact of this clinical pharmacy service. Methods The computerized physician orders of ten units have been verified for 6 months and two interns have made rounds in two medical oncology units. After verification, the orders were divided in three groups : ‘accepted’, ‘refused’ or ‘replaced’. These proportions were compared using Khi-2 test. An analysis of the evolution of the conformity of the orders was performed comparing the two quarters of the study. Results In 6 months, 23,608 orders were verified. For each month, the conformity of orders was significantly higher in the units with an intern pharmacist. In the 2 populations (units with/without intern), the conformity of the orders was significantly higher in the 2nd quarter. The improvement in the conformity of the orders between the 2 quarters is significantly more important in the units with intern.

Conclusions The development of clinical pharmacy services in the units was connected to a rate of conformity of orders significantly higher than in units without interns. That can be explained by a communication increased between oncologists, pharmacists and nurses, resulting in an optimization of the orders. Moreover, the best knowledge of the patients and their clinical status can also explain an increased relevance of the emitted pharmaceutical interventions.

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MASCC-0292 Pharmacy VENOUS THROMBOEMBOLISM: WHAT PHARMACISTS KNOW? WHAT DO THEY NEED?

J.B. Rey1, P. Kreit2, D. Parent3, J. Sicard4, D. Hettler5, N. Jovenin6, P. Nguyen7, J.L. Ducrocq8 1 Faculté de Pharmacie, Université de Reims, Reims, France; 2 -, Pharmacie, Vanault les Dames, France; 3Département de Pharmacie, Institut Jean Godinot, Reims, France; 4-, Pharmacie Principale, Chalons en Champagne, France; 5OMEDIT, ARS Champagne-Ardenne, Chalons en Champagne, France; 6-, Réseau ONCOCHA, Reims, France; 7 Laboratoire d’Hématologie, CHU de Reims, Reims, France; 8Medical affairs, Léo Pharma, Voisins le Bretonneux, France Background and Aims Venous thromboembolism is frequent in cancer. Low molecular weight heparins (LMWH) are recommended for prevention/treatment of thrombosis in cancer. Community pharmacists are very often faced with patients’ questions (dosage, tolerance, treatment duration). The aim of this study was to assess the community pharmacists’ knowledge regarding ‘thrombosis in cancer’. Methods A web-questionnaire (built by a multidisciplinary group) was open between October and November 2013 to community pharmacists in Champgne-Ardenne region. Collected data were 1) pharmacy’s general organization for cancer patients’ management, 2) management of ambulatory patients with ‘thrombosis and cancer’ and 3) pharmacists‘ knowledge assessment through a simple case report: after an initial 10-days hospital prescription, what should a patient receive as anticoagulant treatment?’ Results One hundred eighty (38 %) community pharmacists answered the questionnaire. Among those, in 65 %, the number of patients with cancer was 6–15/pharmacy. In 70 % the number of patients with thrombosis and cancer was 1-10/pharmacy. In 93 %, the pharmacists had no specific competency in oncology and/or supportive care. Moreover, 96 % were not aware of the existence of national/international recommendations regarding ‘thrombosis in cancer’. At last, only 49 % gave the correct answer to the case report (LMWH). The most expressed needs were information, continuous education, and information booklets for patients. Conclusions This regional questionnaire will be extended to all French regions. Continuous education sessions are being put in place. Another questionnaire will be launched at the end of 2014 to assess education sessions’ efficacy.

MASCC-0281 Population Research INFLUENCE OF SMOKING CESSATION IN EFFECTIVENESS OF CHEMOTHERAPY IN LUNG CANCER PATIENTS

M. Kiagia1, I. Gkiozos1, G. Krommidas1, A. Charpidou1, S. Tsagkouli1, K. Syrigos1 1 Oncology Unit GPP, Sotiria General Hospital, Athens, Greece Background and Aims Despite the established causal relationship between tobacco smoking and cancer many cancer patients continue to smoke after diagnosis. This partly reflects the ignorance of the beneficial effects of smoking cessation even after diagnosis. The aim of the study is to demonstrate the impact of continuing or quitting smoking in patients with diagnosed cancer.

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Methods This study is based on a review of medical databases (Pub Med CENTRAL, MEDLINE, Cochrane Library) of the last 30 years. All articles included in the present analysis were in English. Results Research has demonstrated significant difference in overall survival favoring the non-smoking group among patients with lung cancer. There is also evidence that tobacco smoking exacerbates and prolongs radiotherapy induced complications. Continuing smoking is associated with adverse effects during anticancer treatment. Smoking increases tumor progression and resistance to chemotherapy due to nicotine-induced resistance to apoptosis by modulating mitochondrial signaling. Continuing smoking is also related with inferior outcomes during treatment with novel targeted therapies such as erlotinib. Quitting smoking after lung cancer diagnosis is associated with better performance status. Patients who continued to smoke despite being diagnosed with cancer report more severe pain. Conclusions Continuing smoking after cancer diagnosis is related with reduced treatment efficacy and reduced survival, risk for more secondary malignancies and deterioration in quality of life.

MASCC-0570 Population Research WHY PATIENTS WITH CHOLANGIOCARCINOMA ARE DOOMED TO PALLIATIVE CARE: RETROSPECTIVE STUDY OF DIAGNOSIS AND TREATMENT

I. Kuznecovs1, S. kuznecovs1, D. Baltina2 1 Cancer Research, Institute of Preventive Medicine, Riga, Latvia; 2 Epidemiology, Oncology Center, Riga, Latvia Background and Aims Morbidity and mortality from biliary tract cancer is increasing worldwide. The purpose of this study was to investigate and assess the clinical features, diagnosis and therapy of the patients, treated for cholangiocarcinoma at the Latvian Oncology Center. Methods Retrospective study of 17 cholangiocarcinoma patients’ medical records between January 2001 and December 2007at the Latvian Oncology Centre. Statistical calculations were performed using MedCalc 12.4.0.0. for Windows. Results Mean age of 17 patients was 66.0±9.2 years. Five of the 17 (29.4 %) had intra-hepatic tumor localization, eight (47.1 %) had perihilar and four (23.59 %) distal. The initial clinical manifestations of 13 (76.5 %) patients was jaundice, 12 (70.6 %) — right upper abdominal pain, 3 (17.6 %) had severe weight loss. All patients with jaundice had only extrahepatic tumor localization. Risk factors were assessed in 10 (58.8 %) patients: liver cirrhosis, chronic hepatitis B, biliary malignancy in first-degree relative, resection of the stomach due to ulcer disease, work in the chemical industry, diabetes, a history of the use of isoniazid. Extrahepatic tumors were diagnosed by computed tomography and magnetic resonance. Seven of 17 patients (41.2 %) had stage III disease, ten (58.8 %) - stage IV. Only in single case tumor was evaluated as resectable, and radical surgical approach was used left liver lobe hemihepatectomy. In the rest of the cases palliative treatment was indicated. Conclusions In patients with bile duct tumors complete tumor resection achieving a negative resection margin is the only potentially curable method. Comorbidities, advanced age and very poor performance status significantly limited tumor resectability. Are patients with cholangiocarcinoma doomed to palliative care?

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MASCC-0490 Population Research CO-MORBIDITIES IN ELDERLY BREAST CANCER PATIENTS TREATED WITH CHEMOTHERAPY

R. Sosa1, J. Molony2, S. Li2, R. Barron3, P. Morrow4, W. Stryker5, J. Liu2, A. Collins2, J. Acquavella6 1 Division of Hematology and Oncology, Vanderbilt University, Nashville, USA; 2Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, USA; 3Global Health Economics, Amgen Inc., Thousand Oaks, USA; 4Amgen Global Development, Amgen Inc., Thousand Oaks, USA; 5Center for Observational Research, Amgen Inc., San Francisco, USA; 6Center for Observational Research, Amgen Inc., Thousand Oaks, USA Background and Aims Comorbidity may influence how providers decide the aggressiveness of chemotherapy (AoC) for patients and likely impacts the risk of febrile neutropenia (FN)/infection (IF) hospitalizations. We characterized the relationship between the AoC and comorbidity in elderly breast cancer (BC) patients on chemotherapy from Medicare claims data. Methods The BC study population was identified from the 20 % Medicare sample with Parts A and B coverage who initiated their first course of chemotherapy between 06/01/2007-to-11/30/2011. The AoC was approximated by the number of different IVagents reported on claims during the first course of therapy and classified into low (1 agent), medium (2 agents), and high (3+ agents). Comorbidity, prior hospitalizations and age were defined in the 6 months before chemotherapy initiation. Counts and proportions were estimated. Results We identified 16,829 BC patients. Compared with those treated with only 1 agent, those treated with 2 and 3+ agents were younger and less likely to have CVD, GI disease, CKD, arthritis, history of anemia, prior IF hospitalizations, and prior hospital stay≥7 days; these results were more pronounced in patients treated with 3+ agents (table). Table Distribution of Demographics Comorbidities by Aggresiveness of Chemotherapy in Elderly Breast Cancer Patients Characteristics Total Number

All patients 16,829

Aggressiveness of Chemotherapy Low, n (%)

Medium, n (%)

High, n (%)

4,613

6,109

6,107

Demographics Age, years 65–69

5,200 (30.9)

812 (17.6)

1,983 (32.5)

2,405 (39.4)

70–74

5,010

880 (19.1)

2,087 (34.2)

2, 043 (33.5)

75–79

3,346 (19.9)

1,000 (21.7)

1,251 (20.5)

1,095 (17.9)

80+

3,273 (19.4)

1,921 (41.6)

788 (12.9)

564 (9.2)

16,624 (98.8)

4,572 (99.1)

6,037 (98.8)

6,015 (98.5)

Cardiovascular

7,425 (44.1)

2,587 (56.1)

2,664 (43.6)

2,174 (35.6)

GI Diseases

348 (2.1)

127 (2.8)

111 (1.8)

110 (1.8)

Female sex Comorbidities*

Diabetes

3,640 (21.6)

1,058 (22.9)

1,287 (21.1)

1,295 (21.2)

Chronic renal disease

926 (5.5)

387 (8.4)

298 (4.9)

241 (3.9)

Chronic obstructive lung disease Arthritis

1,991 (11.8)

485 (10.5)

832 (13.6)

674 (11)

2,239 (13.3)

740 (16)

756 (12.4)

743 (12.2)

Thyroid disease

2,581 (15.3)

654 (14.2)

997 (16.3)

930 (15.2)

Anemia

2,174 (12.9)

834 (18.1)

733 (12)

607 (9.9)

Other cancer

1,272 (7.6)

362 (7.8)

588 (9.6)

322 (5.3)

Infectious disease

590 (3.5)

227 (4.9)

196 (3.2)

167 (2.7)

CV disease

539 (3.2)

206 (4.5)

167 (2.7)

166 (2.7)

Other

5,206 (30.9)

1,043 (22.6)

2,108 (34.5)

2,055 (33.6) 3,887 (63.6)

Primary cause of hospitalization*

LOS of any hospitalization, days* 0

11,031 (65.5)

3,324 (72.1)

3,820 (62.5)

1–3

2,905 (17.3)

371 (8)

1,205 (19.7)

1,329 (21.8)

4–6

1,377 (8.2)

381 (8.3)

533 (8.7)

463 (7.6)

=7

1,516 (9)

537 (11.6)

551 (9)

427 (7)

*Defined based on 6 months prior to chemotherapy initiation

Conclusions In the Medicare BC population, the comorbidities studied were more prevalent in patients on less aggressive chemotherapy and less prevalent in those on more aggressive treatment. Further studies are warranted to examine the potential risk of FN/IF hospitalization related to the AoC.

MASCC-0021 Population Research SKIN CANCER KNOWLEDGE AND SUN PROTECTION BEHAVIORS IN MEDICAL AND NON-MEDICAL UNIVERSITY STUDENTS IN KARACHI, PAKISTAN

R. Rafaqat1 1 Medicine, dow medical college, Karachi, Pakistan Background and Aims To examine skin cancer knowledge and sun protection behaviors in Medical and Non-Medical university students in Karachi, Pakistan Methods We surveyed 768 students (16–27 years) at two large public sector universities (401 Medical Students and 367 Non-Medical Students) in Karachi, Pakistan. Survey data were collected regarding skin cancer knowledge and sun protection behaviors. Differences between the 2 groups were compared with chi-squared test. Results Of all the respondents, sun exposure as a risk factor for skin cancer was identified by 77.7 %, genetics by 44 %, ultraviolet radiation by 87.1 %, multiple skin moles by 19.1 % and fair complexion by 27.7 %. Knowledge of risk factors was greater among the Medical Students as compared to the Non-Medical Students. Of the total, 56 % of the participants ‘always’ wears sun-protective clothing, 41.4 % ‘always’ wears hat/dupatta, 13.2 % ‘always’ seeks shade, 10.5 % ‘always’ wears sun glasses, and 27.9 % ‘always or most of times’ apply sunscreen with sun protection factor of≥15. The most frequent method of sun protection was found to be wearing sunprotective clothing, which was significantly more common among the Medical Students (64.1 % vs. 47.1, p). Conclusions University programs for increasing knowledge of skin cancer risk are warranted. Changing attitude and behaviors regarding exposure and protective measures is increasingly important.

MASCC-0334 Population Research SUPPORTIVE CARE ORGANIZATION: A NATIONAL MEDICAL SURVEY

F. Scotté1, F. Farsi2, N. Jovenin3, M.E. Bugat4, M. Namer5, C. Herve6, J.M. Tourani7, R. Bugat4, C. Tournigand8, P. Leroy9, I. Krakowski10 1 Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 2Oncology Department, Leon Berard Cancer Center, Lyon, France; 3Oncology Department, Jean Godinot Institute, Reims, France; 4Oncology Department, Claudius Regaud Institute, Toulouse, France; 5Oncology Department, Clinique Mougins, Mougins, France; 6Ethics Department, Paris Descartes University, Paris, France; 7Oncology Department, Centre Hospitalier Universitaire La Miletrie, Poitiers, France; 8Oncology Department, Henri Mondor Hospital, Creteil, France; 9Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France;10oncology Department, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims The French Supportive Care in Cancer (SCC) organization was evaluated in 2010, i.e. individual physicians (MDs). MDs awareness was promoted in a new national survey. Methods The French Speaking Association for SCC (AFSOS) conducted an observational study to evaluate practices, organizations and information delivered to patients (pts) on SCC. A 30 points questionnaire was sent to 2,263 physicians caring for cancer patients (oncologists (MO), radiotherapists, haematologists, gastroenterologists). Results MDs returned 711 questionnaires (31 %) with a majority of MO (47 %) and a SCC organization was identified in 81 % of structures (71 % in 2010), primarily developed in CCC (96 %; p<0.05) specifically through out-patient departments (66 %). In 78 % of centres, patient care was organised as a combination of hospitalisation and consultation dedicated to supportive care (55 % in 2010). Cross-disciplinary co-ordination meetings dedicated to supportive care were developed in 40 % of structures but unchanged compared to 2010 (39 %). Homecare was developed with specific organizations in 57 % (40 % in 2010). More than 90 % of the respondents considered care as mainly supportive, i.e.: palliative care (98 %), psychological care (98 %), social care (98 %), dietary care (98 %), cancer announcement (98 %) and physiotherapy (94 %). Supportive care was enhanced at diagnosis and in adjuvant settings compared to 2010. Adverse event information was better delivered in 2013 specifically for erythropoiesis stimulating agents (72 % vs 54 % in 2010). Conclusions SCC organization and information to pts were enhanced from 2010 to 2013 in public and private centres, with disparities. The most developed were social care, nutrition management, cancer announcement and homecare organization.

MASCC-0336 Population Research SUPPORTIVE CARE ORGANIZATION: A NATIONAL PATIENT VIEW

F. Scotté1, C. Herve2, N. Jovenin3, F. Farsi4, M.E. Bugat5, R. Bugat5, M. Namer6, J.M. Tourani7, C. Tournigand8, P. Leroy9, I. Krakowski10 1 Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 2Ethics Department, Paris Descartes University, Paris, France; 3Oncology Department, Jean Godinot Institute, Reims, France; 4Oncology Department, Leon Berard Cancer Center, Lyon, France; 5Oncology Department, Claudius Regaud Institute, Toulouse, France; 6Oncology Department, Clinique Mougins, Mougins, France; 7 Oncology Department, Centre Hospitalier Universitaire La Miletrie, Poitiers, France; 8Oncology Department, Henri Mondor Hospital, Creteil, France; 9Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 10Oncology Department, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France Background and Aims The Medical Doctor’s perspective of supportive care in cancer (SCC) in France was previously assessed based on two national surveys. However, the opinion of patients has never been evaluated. Promote patient awareness via a national survey. Methods The French Speaking Association for SCC (AFSOS) conducted an observational study from October 2013 to January 2014, to evaluate practices, organizations and information delivered to patients on SCC. A 40 point questionnaire was performed by physicians using a face-to-face method and analyzed with a Chi2 test.

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Results Interviews were conducted with 1,562 patients. The majority had a favorable opinion (measured on a numerical scale) of their management and 34 % knew the term SCC, most frequently described as complementary care to specific treatments (55 %). The offer to benefit from the SCC organization was proposed to 19 % of patients (represented by 54 % at diagnosis, 35 % after complication) and supportive treatment was prescribed for 63 %, mostly by their oncologist (74 %). When prescribed, 64 % of patients received information on side-effects (usually verbally (96 %)). Epoetin was prescribed for 25 % and analgesics for 73 %. The term “Palliative Care” was previously heard mentioned by 80 % frequently considered as care to improve quality of life during cancer treatment (59 %). The top 3 supportive care offers were psychology (61 %), nutrition (55 %) and announcement organization (55 %). Professional resources outside the hospital were: General Practitioners (84 %), Nurses (58 %), Pharmacists (52 %). Conclusions Information on supportive organization as well as treatment must be developed to further enhance SCC.

MASCC-0352 Procedures MINIMALLY INVASIVE PALLIATIVE PROCEDURES IN ONCOLOGY: A REVIEW OF A MULTIDISCIPLINARY COLLABORATION

P. Hawley1, L.L. Chu2, P. Munk3, P. Mallinson3 1 Pain & Symptom Management/Palliative Care, BC Cancer Agency, Vancouver, Canada; 2Yr 2 Medicine, University of British Columbia, Vancouver, Canada; 3Musculoskeletal Interventional Radiology, Vancouver General Hospital, Vancouver, Canada Background and Aims Minimally Invasive Palliative Procedures (MIPPs) are sometimes considered step four of the World Health Organization’s three-step ladder. A case conference was created at the BC Cancer Agency to facilitate access to MIPPs for advanced cancer patients with severe pain unresponsive to conventional analgesics. The twice-monthly conference discusses referrals for pain control procedures and reviews imaging, with palliative care, musculoskeletal interventional radiology, radiation oncology, medical oncology and anesthesia experts in attendance. This study aimed to determine the benefit to patients from the procedures recommended by the case conference and assess the impact of the case conference on management. Methods A retrospective review of electronic charts of all cancer patients referred to the case conference between December 20, 2011 and June 25, 2013. Results There were 103 referrals, resulting in 69 procedures performed among 63 patients. Procedures included cementoplasty, cryoablation, nerve blocks, etc. Over 80 % of procedures provided analgesic benefit. Pain scores fell across all categories post-procedure. Mean worst pain scores fell from 8.1 ±1.4 to 4.6±2.8 (P<0.001). Patient function, mobility, and symptoms measured by the Edmonton Symptom Assessment System also improved post-procedure. At time of abstract submission, 37/63 (58.7 %) patients had died. Mean survival post-procedure was 200 days. The documented rate of major adverse events attributable to MIPPs was 2/69 (2.9 %). Conclusions MIPPs are valuable treatment options in patients with severe cancer pain despite use of appropriate step three WHO ladder medications. The case conference facilitates excellent communication and sharing of expertise, ensuring optimal patient care.

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MASCC-0201 Procedures SAFETYAND EFFECTIVENESS OF PERIPHERALLY INSERTED CENTRALVENOUS CATHETERS IN TERMINALLY ILL CANCER PATIENTS

K. Park1, H.G. Lim2 1 Hematology-Oncology, KEPCO Medical Center, Seoul, Korea; 2 Radiology, KEPCO Medical Center, Seoul, Korea Background and Aims Terminally ill cancer patients were limited or no peripheral venous access due to edema or long term intravascular therapy including chemotherapy, so intravenous access has been often provided by central venous access. The purpose of this study was to investigate the safety and efficacy of the peripherally inserted central venous catheter (PICC) in terminally ill cancer patients. Methods A retrospective review was conducted on patients who underwent PICC at hospice-palliative unit of KEPCO medical center between January 2013 and December 2013. All PICCs were inserted by interventional radiologist. Results A total of 30 terminally ill cancer patients underwent PICC during the study period. One patient had two PICC insertions, hence totally 31 episodes of catheterization and 571 PICC days were analyzed. The median catheter life span was 14.0 days (range, 1–90). Twenty five cases were maintained until intended time (discharge, transfer, or death), the other of 6 cases (19 %, 10.5/1,000 PICC days) experienced premature PICC removals. So, catheter maintenance success rate was 81 %. Of these 6 premature PICC removal cases, self-remove due to derilium were 4 cases (13 %, 7.0/1,000 PICC days), cathter-related blood stream infection and thrombosis were 1 case, respectively (3 %, 1.8/1,000 PICC days). Totally 8 complications (26 %, 14.1/1,000 PICC days) occurred. The median time to complication was 7 days (range, 2–14). There was no PICC complication-related death. Conclusions Our study showed relatively acceptable results for maintenance and safety in terminally ill cancer patients. However, PICC insertion should be considered cautiously in delirious patients who have high risk of self removal.

MASCC-0465

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

settings. The current systematic review and meta-analysis aims to determine the factors influencing HTO presence in patients receiving prophylactic radiotherapy. Methods A systematic search of the literature was conducted on Ovid MEDLINE, EMBASE and CENTRAL. Studies were included if they reported the percentage of patients developing heterotopic ossification after receiving a specified dose of prophylactic radiotherapy. Weighted linear regression analysis was conducted for continuous or categorical predictors. Results Extracted from 528 articles, a total of 5,464 patients were included, spanning 85 separate study arms. Most patients (55.2 %) were from the United States, had radiation performed on the hip (97.7 %), and had radiation prescribed postoperatively (61.6 %) and at a dose of 700 cGy (61.0 %). After adjusting for radiation site, there was no statistically significant relationship between the percentage of patients developing HTO and radiation dose (p=0.1) or whether radiation was administered preoperatively or postoperatively (p=0.1). Patients with previous HTO formation were more likely to develop recurrent HTO than those without previous HTO formation (p=0.04). There was a statistically significant negative relationship between HTO development and the cohort mean year of treatment (Figure 1; p=0.007).

Conclusions Decreases in rates of HTO over time in this patient population may be a function of more efficacious surgical regimens and prophylactic radiotherapy.

Procedures A SYSTEMATIC REVIEWAND META-ANALYSIS OF RADIOTHERAPY FOR THE PROPHYLAXIS OF HETEROTOPIC OSSIFICATION

MASCC-0331

M. Popovic 1 , A. Agarwal 1 , L. Zhang 1 , C. Yip 1 , H.J. Kreder 2 , M.T. Nousiainen2, R. Jenkinson2, M. Tsao1, H. Lam1, M. Milakovic1, E. Wong1, E. Chow1 1 Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Division of Orthopaedics, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada

EVALUATION OF BURNOUT AND WORK SATISFACTION OF MEDICAL ONCOLOGISTS IN TURKEY

Background and Aims Following surgery, the formation of heterotopic ossification (HTO) can limit mobility and impair quality of life. Radiotherapy has been proven to provide efficacious prophylaxis against HTO, especially in high-risk

Psychooncology

T. Akman1, T. Yavuzsen2, O. Tanriverdi3, F. Cay Senler4, S. Komurcu5, O. Ozyilkan6, H. Ellidokuz7 1 Medical Oncology, Izmir Tepecik Research and Training Hospital, Izmir, Turkey; 2Medical Oncology, Dokuz Eylul Medical Faculty, Izmir, Turkey; 3 Medical Oncology, Sitki Kocman University Faculty of Medicine, Mugla, Turkey; 4Medical Oncology, Ankara University Faculty of medicine, Ankara, Turkey; 5Medical Oncology, Bayindir Hospital, Ankara, Turkey; 6Medical Oncology, Baskent University Faculty of Medicine, Adana, Turkey; 7Basic Oncology, Dokuz Eylul University faculty of medicine, Izmir, Turkey

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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Background and Aims Burnout is defined as a syndrome characterized by depersonalization(D), emotional exhaustion(EE), and sense of low personal accomplishment(PA). Many different personal or environmental factors may lead to decrease in work satisfaction and burnout. Our aim is to determine the work satisfaction and level of burnout in medical oncologists(MO). Methods All MO working in different areas were invited to fill in the questionnaire in the internet. In the questionnaire forms, first part included questions on sociodemographic properties and in the second part, there was the Turkish version of Maslach Burnout Inventory(MBI) and in the third part Minnesota Work Satisfaction Scale. 129 questionnaires were evaluated. Results Sociodemographic properties of MO who had participated to the study were given (Table 1). Burnout sub-groups and average of Minnesota scores, burnout and work satisfaction results were given (Table 2). Burnout and work satisfaction was found significantly lower in young oncologists with no academic titles, PA and work satisfaction were significantly higher as the age increased (Table 3).

Table 1. The socio-demographic features of Medical Oncologist

Age Working Year Gender Marital status Academic title Work stress management Institutional training Willing to do job

1–5 >5 Female Male Married Single Present Absent Present Absent Present Absent Yes

N(%) 129 (100) 87 (67,4) 42 (32,6) 71 (55) 58 (45) 112 (86,8) 17 (13,2) 41 (31,8) 88 (68,2) 13 (10,1) 96 (74,4) 26 (20,4) 103 (79,8) 111 (91,5)

Mean ± SD 37,8±5,9

Table 3. MBI subscales and MSQ according to socio-demographic feature in physicians D Gender Female Male p* NS Work experience 1–5 year > 5 year p* < 0,001 Academic title Present Absent p* 0,01 Work stress management Present Absent p* < 0,001 Willing to do job Yes No p* NS

EE

PA

MSQ

0,0024

0,009

NS

NS

<0,001

<0,001

NS

0,023

0,001

NS

<0,001

<0,001

<0,001

< 0,001

<0,001

* Independent samples t-test EE: emotional exhaustion, D: depersonalization, PA: personal accomplishment Conclusions This study is the first and widest ranged national study which burnout and work satisfaction of MO has been evaluated in Turkey. We have determined that burnout was seen more in MO with female gender, younger age, no academic title and the work satisfaction was lower significantly in accordance with the literature. More wide ranged studies and training about burnout to MO are necessary in our country.

MASCC-0294 Psychooncology MULTIDIMENSIONAL FATIGUE SYMPTOM INVENTORY-SHORT FORM: A SYSTEMATIC REVIEW OF ITS PSYCHOMETRIC PROPERTIES

Table 2. The mean of MBI and MSQ Mean ± SD* MBI EE D PA MSQ

16,38±5,6 5,97±2,97 21,28±3,34 68,25±11,76

Mean ± SD (mean ± standard deviation), EE: Emotional exhaustion, D: depersonalization, PA: personal accomplish

K. Donovan 1 , K. Stein 2 , M. Lee 3 , C. Leach 3 , O. Ilozumba 3 , P.B. Jacobsen.3 1 Psychosocial and Palliative Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA; 2Research, American Cancer Society, Atlanta, USA; 3Population Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA Background and Aims Fatigue is among the most common problems experienced by cancer patients. The Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), a 30-item self-report measure, assesses five empiricallyderived dimensions: general, physical, emotional and mental fatigue and vigor. We reviewed and evaluated the MFSI-SF’s psychometic properties based on its use in published research studies.

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Methods We identified 70 studies published between 1998 and 2013. Alpha coefficients and test-retest correlations were summarized to characterize internal consistency reliability and test-retest reliability, respectively. Correlation coefficients between subscales and other published measures were summarized to characterize concurrent, convergent and divergent validity. The mean difference statistic (d) was calculated to characterize sensitivity to change and discriminative validity. Results Mean alpha coefficients for subscales ranged from 0.83 to 0.93 and mean test-retest correlations from 0.48 to 0.67. Correlations between subscales and other fatigue measures ranged from 0.36 to 0.91. The mean correlation between MRFI-SF vigor and other measures of vitality/vigor was .64. Correlations with depression and anxiety measures were small to large and in the expected direction (range=0.10–0.80). Effect sizes for sensitivity to change and discriminative validity ranged from very small to very large. Conclusions The MFSI-SF has been widely used to assess fatigue. Its psychometric properties include high internal consistency and moderate test-retest reliability. Its concurrent validity is moderate to high; there is good evidence for its convergent and divergent validity. Evidence for its sensitivity to change and discriminative validity is positive. These findings encourage continued use of the MFSI-SF in fatigue research studies.

MASCC-0407 Psychooncology LONGITUDINAL DEPRESSION SCORES FOR PATIENTS WHO HAVE UNDERGONE A PALLIATIVE REHABILITATION PROGRAM

A. Feldstain1, S. Lebel1, M. Chasen2 1 School of Psychology, University of Ottawa, Ottawa, Canada; 2 Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, Canada Background and Aims Patients with advanced cancer who have completed anti-cancer treatment need a coordinated plan to encourage healthy lifestyle changes in order to alleviate subsequent late-effects. Palliative rehabilitation is one such avenue but depression affects program adherence each year. The Palliative Rehabilitation Program (PRP) offers holistic and patient-centered rehabilitation, with one of its goals being to reduce depression. The current presentation will examine improvements in depression scores during and after the PRP. Methods Patients underwent a thorough interdisciplinary assessment and 2-month interdisciplinary intervention. The Problem Checklist (PCL) was administered to assess patient’s subjective impression of depression as a problem and the Hospital Anxiety and Depression Scale (HADS) was administered for a quantitative depression score; both at initial assessment (T1), upon completion of the PRP (T2), and 3-months following completion (T3). Twenty patients completed all three time points. PCL was analyzed descriptively. HADS was analyzed using a repeated-measures for longitudinal changes in depression. Results The number of patients endorsing “depression” as a problem decreased from baseline. Patients who underwent to PRP reported alleviation of their depression symptoms at the end of the program and continue to benefit after 3 months, F(1)=13.41, p=0.002. Conclusions Our pilot data suggest that patients who have undergone the PRP experience relief from their symptoms of depression throughout the program, and continue to benefit 3 months after completion.

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MASCC-0582 Psychooncology PSYCHOLOGICAL DISTRESS IN PATIENTS WITH PANCREATIC CANCER COMPARED TO OTHER ADVANCED CANCERS

P. Fitzgerald1, Y. Yeung1, M. Li1, G. Rodin1 1 Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada Background and Aims Pancreatic cancer is reported to have higher prevalence of depression and anxiety compared to other cancers. While a possible shared underlying pathophysiology has been proposed to explain this association, past studies have been small in size and have not accounted for the potential roles of differing prognosis and physical symptom burden when comparing psychological distress between pancreatic and other cancers. Methods Cross-sectional analysis of patient responses on the psychosocial distress screening tool (D.A.R.T.) at Princess Margaret Cancer Centre, Toronto over 2 year period. Pancreatic cancer patients (n=184) were compared to other advanced (i.e. stage 4) cancer patients (n=895). Study variables included age, gender, time from diagnosis to DARTcompletion, physical symptom burden (ESAS), depression (PHQ-9), anxiety (GAD-7) and social difficulties (SDI21). Univariate tests investigated for differences between groups on study measures, and subsequent poisson regressions investigated for independent relationships between depression, anxiety and pancreatic cancer. Results Pancreatic cancer patients had significantly elevated depressive (p<0.001) and anxiety (p<0.001) scores compared to other advanced cancers: 26 % of pancreatic patients had clinically significant depressive symptoms, versus 15 % of patients with other advanced cancers (p<0.005), with corresponding anxiety results being 16 % and 9 % respectively (p=0.01). Regression analyses indicated that pancreatic cancer diagnosis remained a significant predictor of elevated depressive and anxiety scores (p<0.0002 and p<0.0001, respectively), and this was independent of physical symptom severity. Conclusions Pancreatic cancer patients have significantly elevated depression and anxiety scores compared to other advanced cancers, and this is independent of physical burden.

MASCC-0246 Psychooncology SAVORING AS A DAILY LIFE PROCESS MEDIATES THE ASSOCIATION BETWEEN HEALTH PROMOTION AND DEPRESSIVE AND PHYSICAL SYMPTOMS IN PEOPLE NEWLY DIAGNOSED WITH CANCER

W.K. Hou1, K.M. Lau1, S.M. Ng1, S.T. Cheng1 1 Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong, Hong Kong China Background and Aims Limited is known about the daily life processes in the association between health promotion and outcomes in cancer patients. This study aimed to examine the nature of associations among cancer-specific health engagement control strategies, savoring, and psychological and physical symptoms in Chinese people with colorectal cancer (CRC). Methods A total of 157 newly diagnosed CRC patients were recruited and administered (1) back-translated items on control strategies (i.e., active

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processes counteracting physical health problems) (Wrosch et al., 2003), (2) back-translated savoring the moment subscale of Savoring Belief Inventory (i.e., enjoyment of pleasant experiences in the moment (Bryant, 2003), and (3) the Chinese version of Hospital Anxiety and Depression Scale (Ho et al., 1993) and Memorial Symptom Assessment ScalePhysical Symptom Subscale (Cheng et al., 2009). Results The 157 participants ranged in age between 25 and 90 years (M=65.97, SD=12.02); 65 (41 %) were female and 114 (73 %) were married. Twentyfour (15 %) participants reported receiving no formal education. Forty-one (26 %) participants were diagnosed with rectal cancer, 81 (52 %) with colon cancer, and 35 with other cancers (22 %). Structural equation modeling using Mplus 6.1 revealed that savoring significantly mediated the association of control strategies with depressive symptoms (B=−0.050, p=0.034) and cancer-specific physical symptoms (B=−0.188, p=0.019). Conclusions To maximize holistic health in cancer patients, symptom management and health behavior change intervention should be integrated with well-being intervention that targets daily life psychological functioning.

MASCC-0489 Psychooncology EFFECTS OF SLEEP DYSFUNCTION ON SELF-REPORTED MEMORY PROBLEMS IN ADULT CANCER SURVIVORS IN THE UNITED STATES: A CROSS-SECTIONAL STUDY

P. Jean-Pierre1, M. Grandner2 1 Psychology, University of Notre Dame, Notre Dame, USA; 2Psychiatry, University of Pennsylvania, Philadelphia, USA Background and Aims Cancer survivors generally struggled with many treatment adverse effects such as self-reported memory problems (SRMP). Despite its importance to memory function, studies on the effects of sleep dysfunction on memory in cancer survivors are lacking. Methods We examined data from 151 cancer survivors, age 41–46 years, who completed the 2007–2008 National Health and Nutrition Examination Survey. We excluded people with history of brain cancer/stroke since these conditions are expected to result in cognitive difficulties. Population-weighted binary logistic regression analyses were performed using sleep (i.e., Insomnia and sleep duration) to predict SRMP; with age, sex, race/ethnicity, education, income, and overall health as covariates. We categorized sleep duration as very short (<=4 h), short (5–6 h), normal (7–8 h) or long (> = 9 h); and insomnia as combined, and with different subtypes (i.e., initial = difficulty falling asleep, middle = difficulty maintaining sleep, and late = waking too early). Each type of insomnia was classified as none, mild (<15 days/month) and severe (>=15 days/month). The combined insomnia variable categorized individuals as insomnia if they had severe insomnia of any type (early, middle, late). Results Insomnia predicted SRMP (p<0.0001). Specifically, severe initial insomnia (p = 0.006), mild and severe middle insomnia (p = 0.007 and p<0.0001), and late mild-insomnia (p=0.037) predicted SRMP. Only long-sleep had a negative associated with SRMP (p=0.019). A comparative analysis with 2,001 age-matched participants without a cancer history no effects of sleep on SRMP (p>0.05). Conclusions Insomnia and long sleep predicted SRMP only in participants with a cancer history, suggesting sleep might be a pathway through which cancer impact memory function.

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MASCC-0566 Psychooncology MINDFULNESS-BASED STRESS REDUCTION PROGRAM IN NEWLY DIAGNOSED PATIENTS WITH EARLY STAGE BREAST CANCER

A. Koumarianou1, Z. Tsovou2, K. Syrigos3, C. Darviri2 1 Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece; 2Postgraduate Course Stress Management and Health Promotion, Athens University, Athens, Greece; 3Medical Oncology Unit Third Department of Internal Medicine “Sotiria” General Hospital, Athens University, Athens, Greece Background and Aims Breast cancer diagnosis and its treatment may induce intense psychological stress, particularly during the first year of diagnosis. The purpose of this study was to investigate whether the application of mindfulnessbased stress reduction (MBSR) program in women with newly diagnosed early stage breast cancer, reduces stress and its symptoms, improves patients’ quality of life and self-esteem. Methods Newly diagnosed breast cancer patients with early stage disease were randomly assigned to no intervention (control group; n=30) or to an 8week MBSR program including diaphragmatic breathing, progressive muscle relaxation and guided imagery (intervention group; n=35). Validated questionnaires including Perceived Stress Scale, Health Locus of Control Scale, Rosenberg Self-esteem Scale, Self-esteem Questionnaire and cortisol levels in the saliva were assessed at the beginning and the end of the study. Participants’ demographic and clinical data were included in the statistical analyses. Results Our study shows a significant stress reduction in patients included in the intervention group, improvement in relation to their eating choices (p= 0.012), their general satisfaction (p=0.008), sleep satisfaction (p=0.001), perceived social support (p=0.003), quality of diet (p=0.049) and physical activity (p=0.001). We found no differences in the levels of selfesteem or cortisol among the two groups but patients in the intervention group had lower median levels of cortisol. Conclusions Our MBSR program proved to promote psychosocial adaptation in newly diagnosed patients with early stage breast cancer. We deem that these results encourage for further studies aiming to address the psychosocial well-being, relevant for health outcomes, in breast cancer patients.

MASCC-0589 Psychooncology TARGETS FOR PSYCHOSOCIAL SUPPORT: FAMILYAND WORK IN BREAST CANCER PATIENTS

G. Kuznecova1, S. Kuznecovs 1, L. Gromcakova1, I. Kuznecovs1, G. Kuznecova1 1 Supportive Care, Institute of Preventive Medicine, Riga, Latvia Background and Aims Breast cancer is a chronic disease that may often have a relapse. The aim of the present study was to identify priorities and targets for psychosocial support. In the focus were work and family in women with breast cancer. Methods Monitoring was spent from the 1997 to 2013 in Latvia. There were 1,308 women in the age of 28–75 years old with breast cancer. The Occupational Psychosocial Monitoring Questionnaire was used to detect the cause and level of victimization.

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Results Leading factors promoting occurrence of relapses and reduction of a life were conflicts at work, overtime hours, shift work, work in a night shift. Findings reveal that 54 % (32 % in 1997) of women with relapse in cancer treatment and recurrence of the disease perceived themselves as victims of the conflicts at work. The positive influence of returning to labor activity on life expectancy was established only in 8 % of cases. The most vulnerable group are the single or divorced women in the age of 40– 50 years. The maximal positive influence of family attitudes was established in the women who were married more than 20 years, having adult children and steady communication. In 28 % of cases the obvious and latent uncooperative altitudes in family caused development of relapses of disease and reduction of life expectancy. Conclusions Leading psychosocial factors, such as emotional distress at work and in family attitudes which could be provoking in occurrence of breast cancer, continue to render essential influence on development of relapses of breast cancer and life expectancy of women.

MASCC-0413 Psychooncology DISTRESS IN BREAST CANCER SURVIVORS: SELF-REPORTED ISSUES IN ACUTE SURVIVORSHIP

J. Lester1, K. Crosthwaite2, R. Stout2, R. Jones3, C. Shapiro4, C. Holloman5, B. Andersen1 1 Department of Psychology, The Ohio State University Comprehensive Cancer Center, Columbus, USA; 2Division of Nursing, The Ohio State University James Cancer Hospital & Solove Research Institute, Columbus, USA; 3College of Nursing, The Ohio State University, Columbus, USA; 4Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA; 5Department of Mathematics, The Ohio State University Comprehensive Cancer Center, Columbus, USA Background and Aims Distress is prevalent in breast cancer survivors with psychosocial or physical issues. Their concerns may go unnoticed unless distress screening is performed and further assessment and discussion occurs. Research about distress is most helpful when performed in a designated group and time period using validated, clinically-relevant instruments. The aim of this study was to observe self-reported distress in breast cancer survivors during acute survivorship to inform a future survivorship intervention. Methods A descriptive, cross-sectional design compared the level and sources of distress from breast cancer survivors (n=100) across four time periods in acute survivorship. Measures included distress thermometer & 38-item problem list with five subscales: practical, family, emotional, physical, & spiritual. Chi-square & analysis variance (ANOVA) were applied to data to determine significant relationships between groups, time periods, & distress scores; post hoc tests were applied to determine significant relationships to specific pairs of time periods. Results Participants scored in range of cutoff score (≥4) during time periods of active treatment, end of treatment, & 3 months post. At 6 months post treatment, distress levels were significantly lower (M=3.6, sd=3.2). Significant differences between groups were noted on total problem list score (P=0.007), and emotional (P=0.01) and physical (P=0.003) subscale scores.

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Conclusions Comparison of groups at different points in the cancer trajectory found elevated levels of distress from diagnosis through 3 months post treatment. Distress significantly decreased at 6 months post treatment. These findings will be used for a future intervention study although validated that distress screening should occur for breast cancer survivors from diagnosis forward.

MASCC-0477 Psychooncology IMPLEMENTING AND SUSTAINING SCREENING FOR DISTRESS IN 14 COMMUNITY ONCOLOGY CLINICS: A GOOD NEWS STORY!

C. Mayer1, D. Damore-Petingola1, M. Conlon2, K. George1 1 Supportive Care Oncology Research Unit, Health Sciences North North East Cancer Center, sudbury, Canada; 2Epidemiology Outcomes & Evaluative Research, Health Sciences North North East Cancer Center, sudbury, Canada Background and Aims The Northeast Cancer Centre is a tertiary cancer centre with a population of 563,590 spread across 400,000 km2. Approximately 35 to 45 % of the chemotherapy is delivered in community hospitals permitting patients to receive treatment closer to home. This presentation will describe how screening for distress was implemented in rural and remote community oncology clinics from 2009 to 2011 and how the initiative continues to be sustained. Methods Using principles of participatory action research, the clinics were asked to implement a screening for distress program. Patients completed the Edmonton Symptom Assessment Symptom scale and the Canadian Problem Checklist at every cycle of chemotherapy. Nurses were responsible to review patient scores, assess for further clinical intervention and refer patients to other health care professionals as necessary. Results During the implementation of the project, 607 patients were eligible to be screened. Eighty-percent (n=505) of the patients who received at least one cycle of chemotherapy were screened once or more for distress. The overall screening rate was 80.7 % with a range of 39.7– 100 %. Of the 27 % (n=163) of patients who scored 7 or higher on ESAS, 41 % (n=67) were identified as having some of their symptoms reduced by their next completed screen. Over 2,000 screens have been completed since the implementation phase and most clinics are screening at 80 % or higher. Conclusions Changing the clinical practice of oncology clinicians to screen patients for cancer distress requires a well-developed knowledge translation plan with continuous outcome evaluation.

MASCC-0537 Psychooncology SUPPORTING ONE ANOTHER THROUGH CANCER: THE DYADIC PATIENT AND FAMILY CAREGIVER RELATIONSHIP

C.J. McPherson1, A. Devereaux1, M.M. Lobchuk2, W. Petrcich3 1 Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; 2 Faculty of Nursing, University of Manitoba, Winnipeg, Canada; 3 Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Canada

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Background and Aims Families play an important role in supporting patients with cancer to cope with the disease, its treatment and symptoms. Research indicates that mutually supportive interactions between patients and their caregivers can have a positive effect on physical health and well-being of both members of the dyad. However, few studies have examined how patient and caregiver personality characteristics intersect within the patient-caregiver relationship to determine the care given and received. Using an attachment theory perspective, the aim was to examine the synergistic effects of patient and caregiver attachment styles on supportive interactions within the caregiving relationship, and dyadic adjustment. Methods One hundred and three adult patients receiving outpatient cancer care and their primary family caregivers completed a survey that comprised various measures including dyadic adjustment (Relationship Assessment Scale Generic; RAS-G), attachment style (Experiences in Close Relationships Modified scale; ECR-M16) and supportive interactions (Shared Care Inventory; SCI-R). Results The Actor-Partner Interdependence Model (APIM) was used was used to examine caregiver and patient ECR-S scores on SCI-R taking into account interdependence within the patient-caregiver relationship. The findings revealed that patient and caregiver attachment styles contributed significantly (P>.05) to supportive interactions. Attachment styles that were characterised as avoidant and anxious were negatively associated with supportive interactions (communication, reciprocity and decision-making) and dyadic adjustment. Conclusions The findings underscore the importance of understanding how individual styles of responding in relationships can facilitate or hinder supportive interactions and dyadic adjustment in cancer. Attachment theory provides a framework for interventions aimed at those at risk for unsupportive exchanges.

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Methods CRC patients were divided into 4 groups (n=20 each): 1. Patients who did not undergo surgical resection of CRC. 2. Patients who underwent surgical resection but did not start adjuvant chemotherapy. 3. Patients receiving adjuvant chemotherapy. 4. Patients who completed chemotherapy. Healthy volunteers comprised the control group (n=20). Depression and anxiety were analyzed using the Hospital Anxiety and Depression Scale (HADS). Cytokine serum levels were measured by CBA. Results Approximately 60 % of CRC patients manifested a combination of severe anxiety and depression. Regardless of surgical resection, patients who did not start chemotherapy had increased levels of the pro-inflammatory cytokines IL-1, IL-6, IL-8, and TNF-α, but lower IL-10 concentrations. Compared to these patients, those who were receiving or completed chemotherapy had lower pro-inflammatory cytokine levels. Correlation analysis revealed a positive association of anxiety and/or depression with IL-1, IL-6, IL-8, and TNF-α, and a negative correlation with IL-10 for CRC patients. Conclusions These results suggest that pro-inflammatory cytokines are involved in the pathophysiology of anxiety and depression in CRC patients. A better understanding of these intricate relationships may contribute to the development of therapeutic strategies to assist in alleviating anxiety/ depression symptoms in cancer patients. Supported by FAPESP .

MASCC-0507 Psychooncology COMPARISON OF ZOLPIDEM AND LORAZEPAM EFFECT ON INSOMNIA IN HEMATOPOIETIC STEM CELLS TRAN SPLANT RECIPIENTS

M. Tavakoli-Ardakani1 1 clinical pharmacy, School of pharmacy, Tehran, Iran

MASCC-0260 Psychooncology PRO-INFLAMMATORY CYTOKINES CORRELATE WITH ANXIETYAND DEPRESSION IN PATIENTS WITH COLORECTAL CANCER

G. Silva Bisson1 , D.O. Miranda2 , L.R. Azevedo 3 , T.A.S. Lima 4, F.M. Peria5, M. Flória-Santos1 1 Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil; 2 Postgraduate program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil; 3Postgraduate program in Basic and Applied Immunology, School of Medicine of Ribeirão Preto University of São Paulo, Ribeirão Preto, Brazil; 4Undergraduate student, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil; 5Division of Clinical Oncology, School of Medicine of Ribeirão Preto University of São Paulo, Ribeirão Preto, Brazil Background and Aims Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. Anxiety and depression are the most prevalent psychological disorders in CRC, impairing patients’ quality of life. Nevertheless, mechanisms underlying these disorders are poorly understood. This study aimed to investigate whether serum cytokine levels correlate with anxiety and depression in CRC patients.

Background and Aims Hematopoietic Stem Cells Transplantation (HSCT) is associated with sleep disturbances. Also residual sedation is a concern of hypnotic drugs in patients. Zolpidem is a short acting hypnotic that has less side effects as compared with BDZs. Main objective of this study is comparison of Zolpidem and Lorazepam effect on insomnia in HSCT recipients. Methods In a randomized, single blind trial, 35 inpatients, aged 18–65, from 2009 till 2011 in HSCT ward of Taleghani hospital with insomnia were allocated into Zolpidem or Lorazepam group. Epworth Sleepiness Scale (ESS) questionnaire and Hospital Anxiety and Depression scale (HADS) were completed at baseline, weekly, and end of 1 month treatment. Medication was initiated with 5 mg Zolpidem or 1 mg Lorazepam. Side effects of drugs were assessed by clinical observations. Results ESS score showed no significant difference between groups (p=0.17). SMI score significantly decreased at the end of fourth week in zolpidem group (p=0.047). At the end of first week, zolpidem decreased latancy of sleep onset (p=0.046). Up to end of the second week, Lorazepam decreased disrupted sleep (p=0.04). At the end of treatment, more significant patients had normal sleep in zolpidem group and there was no anxious or depressed patient in both groups. Rate of side effect were similar in both groups. Conclusions Based on this study, It is better to use zolpidem for long sleep onset time and lorazepam for disrupted sleep in HSCT recipients during first 2 weeks of insomnia. After that, zolpidem is preferred.

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MASCC-0482 Psychooncology FACTORS AFFECTING THE EFFECTS OF REMINISCENCE THERAPY IN CANCER PATIENTS WITH RECURRENCE

K. Ueno1, T. Kataoka2, H. Okamura2 1 nursing, Japanese Red Cross Hiroshima College of Nursing, Hiroshima, Japan; 2Graduate school of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan Background and Aims The psychosocial intervention for mental anguish such as anxiety and depression in cancer patients has been variously examined in Japan. However, effective interventions for cancer patients with recurrence have not been provided. Thus, we conducted a randomized controlled study to evaluate the efficacy of reminiscence therapy in cancer patients with recurrence. In this study, we also attempted to identify factors that might influence the effects of the therapy. Methods The subjects were 30 cancer patients with recurrence, who received individual reminiscence programs for about 60 min each, 8 times in all. All of the subjects were assessed using the Profile of Mood States (POMS) both before the intervention and immediately after the intervention. I examined it what kind of factor was related to group which total score improved of POMS (total mood disturbance: TMD) and the group which were not improved by intervention. Results Immediately after the interventions, improvement was observed in the scores for all of the items. The scores for depression (p=0.015), fatigue (p=0.007), TMD (p=0.027) on the POMS before the intervention were significantly related to the TMD score after the intervention, suggesting the impact of each of these items on the effects of the intervention. Conclusions We found significant relationships between the effects of the intervention and the baseline scores for depression, fatigue and TMD; the score for tension-anxiety also appeared to have some influence. In other words, patients in a worse emotional state at the baseline showed a greater tendency towards improvement.

successfully connected from multiple settings. Several satisfaction surveys and the California Psychotherapy Alliance Scale for Group (CALPAS) were administered 2 weeks and 6 months post-intervention. Results: Early data appear to confirm Cascade’s feasibility and acceptability, with high levels of satisfaction (Figure 1) and group cohesion (Figure 2) across participants. Cascade participants reported that: the ‘online format was easy to use’ (100 % ‘agreed’), ‘I learnt new skills’ (94 %), ‘I enjoyed talking to other parents’ (94 %) and ‘the homework helped me’ (84 %).

Conclusions: Cascade is acceptable to parents of children recovering from cancer and is feasible to deliver. Cascade has the potential to yield positive outcomes for parents, particularly with regard to quality of life in the first months after cancer treatment completion.

MASCC-0370 Psychooncology FEASIBILITYAND ACCEPTABILITY OF CASCADE (‘COPE, ADAPT, SURVIVE: LIFE AFTER CANCER’): AN ONLINE PSYCHOLOGICAL INTERVENTION FOR PARENTS AFTER THEIR CHILD’S CANCER TREATMENT 1

1

2

1

C.E. Wakefield , U.M. Sansom-Daly , E.L. Doolan , R.J. Cohn 1 School of Women’s and Children’s Health, University of NSW, Sydney, Australia; 2Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia Background and Aims Introduction: Few cost-effective psychological interventions are available for parents of young cancer survivors aged <15 years. Our team developed an online program called ‘Cascade’ (Cope, Adapt, Survive: life after CAncEr’), which aims to improve parental quality of life. Cascade is delivered live by a psychologist over three 2 h videoconferencing modules, with 3–5 parents/group. Methods: 177 eligible parents were invited, 50 of whom opted in (24 parents randomly allocated to Cascade, 26 allocated to a waitlist control). To date, 21 parents have completed Cascade, 22 have completed the waitlist, 3 have dropped out and 4 are awaiting group allocation. 90 % of participants have completed every module, and parents have

MASCC-0533 Psychooncology PERCEPTIONS OF THE “VENTURING OUT PACK PROGRAM” AS TANGIBLE SUPPORT FOR YOUNG ADULTS WITH CANCER

L. Wazneh1, A. Tsimicalis2, C.G. Loiselle3 1 Ingram School of Nursing (RN MSc(A)), Faculty of Medicine McGill University, Montreal, Canada; 2 Ingram School of Nursing (RNPHD)Associate Professor, Faculty of Medicine McGill University, Montreal, Canada; 3Christine and Herschel Victor/Hope & Cope Chair in Psychosocial Oncology School of Nursing and Dept. of Oncology Associate Professor at Faculty of Medicine McGill University (PHD) Senior Scientist Lady Davis Institute Jewish General Hospital, Faculty of Medicine McGill University/Jewish General Hospital, Montreal, Canada Background and Aims Within the cancer community, young adults (YAs) with cancer have been increasingly recognized as a distinct group with unmet supportive care needs. “Venturing Out Beyond Our Cancer” is a non-profit community

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agency committed to providing YAs with tangible support services to address their cancer-related needs. One of these services called the “Venturing Out Pack (Vo-Pak) Program” provides backpacks containing resources to help YAs throughout their cancer journey. To explore: (a) the needs of YAs newly diagnosed with cancer; (b) the extent to which Vo-Pak helps them meet their practical, psychosocial and informational needs; and (c) how the Vo-Pak could be further enhanced. Methods A qualitative descriptive study was conducted with a purposive sample of 12 YAs treated for cancer at a university-affiliated tertiary hospital. Semi-structured interviews were audio-recorded, transcribed, coded and thematically analyzed. Results Overall, YAs positively perceived the Vo-Pak as a welcoming ready-to-use timely package. The Hospital Comfort Kit was seen as a “hands on” resource that reduced their illness-related uncertainty. The Venturing Out Kit was construed as a catalyst for connecting with similar others and offering them “guilt-free” complimentary outings. The Friends of Lara Information Kit was commended for its relevance as a dispatcher to important support resources. Conclusions Enhancing the Vo-Pak program by promoting it and increasing awareness of its purposes is critical in meeting the needs of YAs with cancer. More systematic dissemination of programs such as this one would add to the overarching goal of providing comprehensive person-centered cancer care to an underserved segment of the cancer population.

MASCC-0017 Psychooncology 2 PSYCHOLOGICAL INTERVENTION UTILIZING EDUCATIONAL MATERIALS AS A MEAN FOR IMPROVING PSYCHOSEXUAL HEALTH OF BREAST CANCER WOMEN

S. Abasher1 1 Education and Psychology College, King Faisal University, Alhassa, Saudi Arabia Background and Aims This study is to provide psycho-educational materials as an 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 measure 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 pre and 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 The study concluded that, as patients cease to visit the hospital regularly until their first follow-up, 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.

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MASCC-0096 Psychooncology 2 EXPRESSIVE WRITING IN CANCER PATIENTS: EXPERIMENTAL EVIDENCE FOR ITS FEASIBILITYAND EFFECTIVENESS

B. Muzzatti1, A. Surbone2, M.A. Annunziata1 1 Unit of Oncological Psychology, Centro di Riferimento Oncologico National Cancer Institute, Aviano (PN), Italy; 2Medicine, University of New York, New York, USA Background and Aims Expressive writing (EW) is a brief supportive intervention aimed at helping people in managing stressful or traumatic events. Its effectiveness and feasibility have been tested regarding different settings. In this work, experimental studies testing the effectiveness of expressive writing in oncological settings have been reviewed to evaluate EW feasibility with cancer patients, and its effectiveness both overall and in specific domains. Methods A computer-based literature search was performed in PubMed and PsychINFO to identify pertinent articles published between January 2000 and August 2013. The search was restricted to articles written in English and related to adults cancer patients only. Results Twenty-one papers were analyzed; they were very heterogeneous in terms of enrolled patient samples, procedures, and pursued objectives. Despite many different investigated domains, little evidence has been found for the EWeffectiveness. This seemed to be limited to a reduction in hospital stay, better reported physical health, and improvement in perceived support (including mental health services). EW was welcomed by most participants who described it as useful in reflecting about cancer and its meanings and as having positive effect on their own emotional mood. Conclusions When analyzed in isolation, most of the reviewed studies sounded encouraging. However, considering all published articles together, the available literature suggests caution in proposing EWas an approved method to help cancer patients in managing their own emotions. As culture may greatly influence patients’ ability to use EW and its consequent effectiveness, results will be also presented with reference to different cultural settings.

MASCC-0200 Psychooncology 2 MENTAL HEALTH LITERACY IN EARLY-STAGE ASIAN BREAST CANCER PATIENTS: ABILITY TO RECOGNIZE PSYCHOSOCIAL DISTRESS AND PREFERENCES OF TREATMENTS

Y.T. Cheung1, Y.Y. Ong1, T.R.D. Ng1, M. Shwe1, H.K. Ho1, Y.P. Tan2, G. Fan2, W.S. Yong3, P. Madhukumar3, M. Wong4, W.S. Ooi4, W.Y. Chay4, R.A. Dent4, S.F. Ang4, R. Ng4, J.A. Lee5, M.T. Cham5, C.W. Chan6, A. Molassiotis6, A. Chan1 1 Pharmacy, National University of Singapore, Singapore, Singapore; 2 Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore; 3Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 4Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 5Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore; 6School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong China Background and Aims Psychosocial distress in breast cancer patients is often under diagnosed and undertreated due to lack of recognition of symptoms and knowledge

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about treatments available. This study was designed to evaluate the mental health literacy (MHL) of Asian breast cancer patients, through assessing their ability to recognise symptoms of anxiety, fatigue, depression and cognitive disturbance, and their knowledge of help-seeking options and professional treatments. Methods This is an ongoing, cross-sectional, multi-centered study. Chemotherapyreceiving early-stage Asian breast cancer patients completed four tools to measure their levels of anxiety, depression, fatigue and cognitive disturbances. With the aid of cancer-specific vignettes, a modified questionnaire (Jorm et.-al 1997) was administered to evaluate patients’ MHL. Descriptive statistics were used to summarise the data. Results Fifty-four patients were analyzed (77.7 % Chinese, age: 52.7±8.5 years). Clinically-significant anxiety (15.1 %), fatigue (27.8 %) and cognitive disturbances (25.9 %) were prevalent, compared to depression (5.6 %). Majority of the patients could recognize the symptoms of fatigue accurately (75.9 %), but less than half of them could identify the symptoms of anxiety (35.2 %), depression (48.1 %) and cognitive disturbances (48.1 %). Patients were more receptive to help from oncologists (29.6 %) and their family members (24.1 %), as compared to other mental health specialists such as psychiatrists (5.6 %) and psychologists (5.6 %) for the management of their psychosocial distress. Approximately half of the patients indicated embarrassment and fear as their main barrier to seeking professional treatment. Conclusions Asian breast cancer patients’ MHL was inadequate. Interventions and management strategies could be implemented to educate Asian breast cancer patients on recognising the symptoms of psychosocial distress and evidence-based treatment that are specific to mental disorders.

MASCC-0013 Psychooncology 2 EVALUATING A PSYCHO-EDUCATIONAL INTERVENTION PROGRAMME FOR GYNECOLOGICAL CANCER PATIENTS IN HONG KONG

K.M. Chow1, C.W.H. Chan1, J.C.Y. Chan1 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China Background and Aims A diagnosis and treatment of gynecological cancer have adverse effects on the sexual functioning, quality of life and psychological outcomes of the patients. Psycho-educational interventions are recommended to be provided for them to improve their outcomes. This study aims to explore the experience, opinions and feelings towards a psycho-educational intervention programme from the intervention recipients and health-care providers. Methods This study adopts a qualitative semi-structured interview approach. Samples were newly diagnosed gynecological cancer patients with surgery as the first-line treatment in Hong Kong. They were randomly assigned to the intervention group to receive a psycho-educational intervention programme, or to the attention control group. Interviews were arranged to gather views on the interventions from the participants in the intervention group and nurses working at the study site. Content analysis was performed to analyze the data. Results A total of 13 participants and three nurses were interviewed. From the perspective of the participants, the programme was regarded as helpful for their psychological status by providing emotional and informational support. The design of the programme was appropriate and they had positive

feelings towards such interventions. From the perspective of the nurses, the interventions were regarded as useful for newly diagnosed gynecological cancer patients. They believed the interventions were feasible and practical to be incorporated into routine practice in Hong Kong clinical settings. Conclusions The findings indicated that the psycho-educational intervention programme was desired and appreciated by the gynecological cancer patients, and it was feasible to be delivered in Hong Kong.

MASCC-0101 Psychooncology 2 MAKING THE CASE FOR PSYCHOSOCIAL ONCOLOGY ACTIONS IN ROMANIA: EVIDENCE FROM REPEATED CROSS-SECTIONAL DATA

C. Dégi1, E. Kallay2, I. Lukacs1, M. Cimpianu1, C. Burz3 1 Sociology and Social Work, Babes Bolyai University, CLUJ-NAPOCA, Romania; 2Department of Psychology, Babes Bolyai University, CLUJNAPOCA, Romania; 3Medical Oncology - Chemotherapy, Oncology Institute “Prof. Dr. Ion Chiricuta”, CLUJ-NAPOCA, Romania Background and Aims Seven years after acceding to the European Union and endorsement of several cancer control agendas (e.g. including EPAAC) the Romanian National Cancer Program, as there is not an integrated plan yet, does not include or cover psychosocial cancer care. In this situation we aim to analyse prevalence of diagnosis non-disclosure, cancer distress and quality of life in Romanian cancer patients prior and post EU accession. Methods APSCO - Assessment of Psycho-Social and Communication needs in Oncology - is the first extensive questionnaire based study in Romania on psychosocial aspects of cancer. APSCO has a repeated cross-sectional design using proportionate quota sampling in order to be representative for all main cancer centres. A mixed and various sample of 784 oncology patients was screened in 2013, and 420 in 2006. Instruments included: BDI, STAI-T, and FACT-G. Results Preliminary data show that prevalence of cancer diagnosis non-disclosure halved in Romania between 2006 and 2013 (16.9 % vs. 8.2 %). However, psychosocial distress is highly elevated and symptoms are relatively unchanged, especially depression (47.5 % vs. 42.2 %) and anxiety (46.7 % vs. 47.2 %). All aspects of quality of life (Ms=63.37 vs. 70.63) — including physical, social, emotional and functional well-being - show clinically meaningful shifts but still under normative levels indicated by FACIT. Conclusions Our results about moderate to high cancer distress and undermet wellbeing needs among Romanian cancer patients, burdened by tendencies of non-disclosure, support current efforts to put psychosocial cancer care on Romania’s priority health agenda. Study was supported by CNCS – UEFISCDI grant PN-II-RUTE-2012-30011 and UBB no. GTC 34020/2013.

MASCC-0006 Psychooncology 2 ANTIPSYCHOTIC DRUGS: PRO-CANCER OR ANTI-CANCER?

G. Fond1 1 pav hartmann, INSERM U955, Créteil, France Background and Aims Important data was recently published on the potential genotoxic or carcinogenic effects of antipsychotics, as well as on their cytotoxic

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properties on cancer cells, that must be considered by psychiatrists in the benefit/risk ratio of their prescriptions. Aim of the study: To answer whether or not antipsychotics, as a class or only some specific molecules, may influence cancer risk among treated patients. Methods Eligibility criteria: All studies (in vitro, animal studies and human studies) concerning effects of antipsychotic drugs on cancer development were included. Results Results can be summarized as follows: (1) patients with schizophrenia may be less likely to develop cancer than the general population, (2) antipsychotics as a class cannot be considered at the moment as at risk for cancer, even if some antipsychotics have shown carcinogenic properties among rodents, (3) phenothiazines seem to have antiproliferative properties that may be useful in multidrug augmentation strategies in various cancer treatments, but their bad tolerance may decrease usage amongst non-psychotic patients, and (4) clozapine appears to have a separate status given that this molecule shows antiproliferative effects implied in agranulocytosis as well as a potential increased risk for leukemia. Conclusions Benefit/risk ratio regarding cancer risk is in favor of treating patients with schizophrenia with antipsychotic drugs. The practicing clinician should be reassuring on the subject of cancer risk due to antipsychotic drugs. acknowledgments : this work was supported by INSERM, AP-HP, Foundation Fundamental and by Investissement d’avenir under the ANR reference ANR-IDEX-0004-02

MASCC-0208 Psychooncology 2 SLEEP DISTURBANCES AND DEPRESSION IN PATIENTS WITH PANCREATIC CANCER

P. Heras1, V. Natsis1, T. Sirbilantze1, V. Niarou1, M. Hera1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece

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MASCC-0210 Psychooncology 2 THE DEGREE OF PSYCHOLOGICAL DISTRESS IN GASTRIC CANCER PATIENTS

P. Heras1, V. Natsis1, T. Sirbilantze1, K. Grigoriou1, A. Papadopoulos1, V. Niarou1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece

Background and Aims The diagnosis and treatment of gastric cancer (gc) may be associated with increased psychological distress and can subsequently increase the risk of developing a range of negative health outcomes. Despite this, remarkably little is known about the degree of psychological distress experienced by gc patients. Methods In a cross-sectional study, 25 patients with gc and 31 patients with other hematological malignancies completed the Brief Symptom Inventory (BSI/BSI-18) and the Problem Common Checklist (PCL) during outpatient registration. Sociodemographic characteristics were collected from patients’ clinical files. Results A higher percentage of gc patients reported elevated distress across each subscale of the BSI and BSI-18 when compared to those diagnosed with other hematological malignancies as a group. The most notable difference was established on the depression subscale, 29,1 % of gc patients reporting elevated depression compared to 19,2 % of other hematological malignancies. In addition, a significant difference was found in the percentage of males endorsing high depression levels when compared to females (35 % vs 23.4 %, p<0.04). Conclusions Despite the small number of patients examined in our study, gc patients demonstrated elevated levels of psychological distress in comparison to those ones diagnosed with other hematological malignancies.

MASCC-0206 Psychooncology 2

Background and Aims Aim of this study is to estimate the degree of sleep disturbances, as well as the possible contributing factors in patients with pancreatic cancer. Methods Thirty-two patients were concluded in our study. Fourteen were female and 18 male with mean age of 61 (range: 55–74). These patients underwent through a clinical psychiatric interview according to the diagnostic criteria of ICD-10. The degree of sleep disturbances during the month prior to the patients’ evaluation was assessed through the Athens Insomnia Scale (AIS) and psychopathology was assessed through the Montgomery Asberg Depression Rating Scale (MADRS) Results There was a strong correlation between the score of AIS and the one of the MADRS for all 32 patients (r:0,40, p<0.01). 13 of our patients complained of insomnia. These patients scored higher on the MADRS than the ones without sleep difficulties. (z:-3.032, p=0.002) Conclusions The results of our study suggest that sleep disturbance (insomnia) in patients with pancreatic cancer is a probable indicator of depression. Furthermore, these data suggest that insomnia in these patients is one of the factors mediating the association between depression and impairment in their functioning

PREVENTING ANXIETYAND DEPRESSION IN BREAST CANCER: A RANDOMIZED CONTROLLED TRIAL

P. Heras1, V. Natsis1, T. Sirbilantze1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece Background and Aims To examine the effects of counseling and relaxation intervention on psychological symptoms displayed on patients with breast cancer between the post –operative period and that after the 2-month review Methods Thirty-two patients were randomized and completed the baseline Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-28 (GHQ-28) questionnaires. The intervention consisted of a relaxation and a counseling session performed by a senior doctor. Follow up questionnaires were completed after 2 months. Demographic and tumor data were examined and compared independently. Results Complete data were available on 30 patients. There were no significant differences in demographic, social support or tumor characteristics

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between the two groups. Multivariable analysis showed that only the intervention and baseline score were significant predictors of outcome. The intervention was associated with a significant reduction of the total HADS score (p=0.002). The reduction was evident in both anxiety and moderate depression subscales (p=0.001 and p=0.02). The intervention was also associated with a significant reduction in total GHQ-28 score and with three of the four subscale scores (somatization, anxiety and personality development-all p<0.02) However, no significant difference was found in the fourth subscale of major depression. Conclusions The relaxation and counseling intervention performed by a specially trained doctor reduces psychological symptoms in patients with a diagnosis of breast cancer.

MASCC-0209 Psychooncology 2 STRESSFUL LIFE EVENTS BEFORE THE DEVELOPMENT OF PANCREATIC CANCER

P. Heras1, V. Natsis1, T. Sirbilantze1 1 Hellenic Medical society for the study of Psychosomatic Problems, Hellenic Medical society for the study of Psychosomatic Problems, Athens, Greece Background and Aims The aim of this study was to describe stressful events before development of pancreatic cancer. Methods Retrospective chart review study of all first time hospitalized patients for pancreatic cancer treated at the General Hospital of Nafplio during 3 year period of time. During the first year that followed the diagnosis, patients were assessed using standardized instruments. (Holmes and Rache stress scale). Results Twenty-nine pancreatic cancer patients were hospitalized. Stressful life events before the diagnosis of pancreatic cancer were found in 44 %. Death of significant other was present in 13 %, separation/divorce 16 % patients, change of job in 29 %, serious illness/operation in 16 % and moving house in 13 % of patients, serious problems in family 22 %, at work 17 %, major journey 16 %. Conclusions We found that a large part of our patients had stressful life events before pancreatic cancer, so we can conclude that it is an important factor, which can facilitate development of disease.

MASCC-0211 Psychooncology 2 THE PREVALENCE OF TYPE D PERSONALITYAMONG PROSTATE CANCER SURVIVORS

P. Heras1, V. Natsis1, T. Sirbilantze1, M. Hera1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece Background and Aims Type D personality is defined as the joint tendency towards negative affectivity. We aimed to investigate the prevalence of type D personality among prostate cancer (pc) survivors and to obtain insight into its effect on health status, impact of cancer and health care utilization and social inhibition.

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Methods We selected 47 patients diagnosed with pc from 2004 to 2013. We asked them to complete a questionnaire containing type D personality scale (DS14), Impact of Cancer Questionnaire (IOC) and SF-36 and 80 % responded. Results Twenty-two percent survivors were classified as type D. They reported a clinically and statistically significant worse general health (57.9 vs 75.4), social functioning (73.2 vs 89.1), mental health (62 vs 81), more emotional role limitations (67.2 vs 89.1) and less vitality (54.6 vs 73) than non-type D patients. Additionally, they reported a statistically and clinically relevant higher impact of cancer on body changes, negative selfevaluation, negative outlook on life, life interferences and health worry. No differences were found in health care utilization. Conclusions Our study provided insight into the role of type D personality on health status and impact of cancer among pc survivors 1–10 years after diagnosis. The type D scale has proven to be a useful screening tool in pc survivors to identify subgroups at risk for impaired health status and impact of cancer.

MASCC-0212 Psychooncology 2 THE RELATION OF GENERAL SELF-EFFICACY WITH STRESS, THE SYMPTOMS AND THE QUALITY OF LIFE IN PATIENTS WITH BREAST CANCER

P. Heras1, V. Natsis1, K. Grigoriou1, T. Sirbilantze1, K. Kritikos1, A. Hatzopoulos1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece Background and Aims The symptoms that are related with breast cancer (bc), may increase the psychological and corporal suffering and change the quality of patients’ life. This prospective study evaluates the symptoms, the general selfefficacy, stress and the quality of patients’ life. Additionally, it investigates the correlation of general self-efficacy with other parameters, in the initial measurement and the actual modification 2 months after the diagnosis. Methods We selected 90 patients with bc. The general self-efficacy was examined with the “General Perceived Self-Efficacy Scale” (GSE). The quality of life was measured with the “Linear Analoque Scale Assessment” (LASA). Stress was evaluated with the HADS, the aggravation and involvement of the symptoms were measured with the questionnaire “MD Anderson Symptom Inventory” (MDASI). The scales were completed initially at the time of the diagnosis and then 2 months later. Results The measurements 2 months after diagnosis showed that the general self-efficacy decreased (28.86±6.42),stress increased(9.56±4.42),the quality of life aggravated(6.74±1.81) the same as the severity of symptoms (3.24±2.62). The actual modification at the time of diagnosis and 2 months later show important negative correlation between the general self-efficacy and stress (p<0.0005). Moderate negative correlation was observed between general self-efficacy and the symptoms (MDASI severity of symptoms:p=0.003, intervention of symptoms:p=0.002),while low positive correlation was found between self-efficacy and energy LASA scale(p=0.048). Conclusions The results of this study show that the sense of general self-efficacy, like stress and the corporal symptoms and the energy of the patients are crucial factors for patients with bc and thus, the ministrants of health should consider these psychological and corporal dimensions.

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MASCC-0207 Psychooncology 2 QUALITY OF LIFE IN PATIENTS WITH BREAST CANCER A YEAR AFTER ADJUVANT CHEMOTHERAPY

P. Heras1, V. Natsis1, K. Grigoriou1, T. Sirbilantze1, A. Hatzopoulos1, K. Kritikos1 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece

Background and Aims This report is based on the assessment of the health-related quality of life in patients with breast cancer (bc) 1 year after adjuvant chemotherapy. This assessment focused on the three main dimensions of physical, mental and social health Methods Data collection was carried in 2007–2013 with the use of the selfadministered “instrument health survey SF-36”, which consists of 36 questions constituting 8 scales of physical and social-mental health. The sample consisted of 100 patients with bc a year after 6 cycles of adjuvant chemotherapy. The majority of patients were women aged over 65 years (47 %) and between 56 and 64 years old (25 %). Results The rating of the scales of the review SF-36 gave the following results:“phys ical fun ctio ning”:70 .8 (SD = 18.6),“phy sical role”:63.7(SD = 38.6),“physical pain”:48.5(SD = 4.7),“general health”:62.2(SD=14.1),“vitality”:73.3(SD=22.3),“social functioning”: 6 8. 3( SD = 2 6 . 6 ) ,“emotiona l role ”: 6 4 . 2 ( S D = 3 6. 2) ,“me ntal health”:78.4 (SD=18.8). Linear regression analysis showed that 6 of the 8 scales of the health survey SF-36:“physical functioning” (B= 0.860, t = 5.901, p = 0.0000),“physical role”(B = 0.658,t = 3.378,p = 0.002),“general health” (B=0.639,t=4.097,p=0.000),“vitality” (B= 0.662,t = 3.638,p = 0.001),“social operability”(B =0.608,t= 4.097,p = 0.000),“mental health”(B=0.653,t=3.231, p=0.003) were related to patients’ satisfaction with the quality of life, while in addition, “physical functioning” (B = −0.380, t = −2.986, p = 0.005) and “social functioning”(B=−0.425, t=−3.282, p=0.002) showed an inverse relationship with age. Conclusions Patients with bc a year after adjuvant chemotherapy appear to assess their socio-mental health (average 71.0) as more important than their physical health (average 61.3). This finding raises the issue of non-concurrence of the individual assessment of patients between the objective (physical functioning, physical role, physical pain, general health) and the subjective (vitality, mental role, social functioning, mental health) dimension of health related quality of life.

MASCC-0156 Psychooncology 2 LIVING WITH ADVANCED CANCER AND AN UNCERTAIN DISEASE TRAJECTORY: AN EMERGING PATIENT POPULATION IN PALLIATIVE CARE?

L. Lobb1, J. Lacey2, J. Kearsley3, W. Liauw4, L. White1, A. Hosie1 1 Palliative Care, Calvary Health Care Sydney, Sydney, Australia; 2 Palliative Care, Calvary Health Care Sydney and St George Private Hospital, Sydney, Australia; 3Radiation Oncology, St George Hospital

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Cancer Care Centre, Sydney, Australia; 4Medical Oncology, St George Hospital Cancer Care Centre, Sydney, Australia Background and Aims This study explored how patients diagnosed with advanced cancer cope with an uncertain disease trajectory with the aim of identifying health care services and practices that can best address this complex and growing patient group’s needs. Methods Twenty-seven patients with advanced cancer and with a prognosis of 12 months or more were recruited from the medical/radiation oncology and palliative care service at three metropolitan hospitals. A semi structured face-to-face interview was conducted. Interviews were audio- taped and transcribed verbatim. Data analysis was based on Grounded Theory using the constant comparison method. Results Results indicate that patients cope by avoidance, remaining positive, maintaining as normal a life as possible, minimising the impact of the disease on their daily lives, comparing themselves favourably with others in a similar situation and focusing on the outcome of treatment to control disease progression. Most did not wish to discuss prognosis or have detailed information on disease progression. Conclusions Participants in this study represent an emerging cancer patient population who are receiving palliative therapies. While they have incurable cancer, they self-report as clinically well, they describe a good quality of life and the trajectory of their disease, while unpredictable, may extend over many months to years. Our study suggests that a flexible model of care is needed to support the needs of people who may still be receiving anti cancer therapies and remain well. A traditional palliative care service may not be suitable for this emerging patient group.

MASCC-0139 Psychooncology 2 REVERSIBILITY OF COGNITIVE IMPAIRMENT AMONG ASIAN EARLY STAGE BREAST CANCER PATIENTS RECEIVING CHEMOTHERAPY: A ONE YEAR LONGITUDINAL STUDY

T. Ng1, Y.T. Cheung1, S.Y. Tan1, M. Shwe2, H.K. Ho1, W.K. Chui1, G. Fan3, Y.P. Tan3, W.S. Yong4, M. Preetha4, M. Wong5, W.S. Ooi5, W.Y. Chay5, R. Dent6, S.K. Lo5, Y.S. Yap5, R. Ng5, M.T. Cham7, J.A. Lee7, A. Chan1 1 Department of Pharmacy, National University of Singapore, Singapore, Singapore; 2Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; 3Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore; 4Department of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 5Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 6Office of Clinical Sciences, DukeNUS Graduate Medical School Singapore, Singapore, Singapore; 7Breast Department, KK Women and Children’s Hospital, Singapore, Singapore Background and Aims Background: There is a lack of long-term evaluation on cognitive impairment among Asian early-stage breast cancer (ESBC) patients after chemotherapy. Aim: To evaluate the reversibility of cognitive impairment in Asian ESBC patients 1 year post-chemotherapy. Methods This was a multicenter, prospective longitudinal study conducted in Singapore. Newly diagnosed Asian ESBC patients were recruited.

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Cognitive function was assessed using a subjective tool, FACT-Cog, and an objective computerized tool, Headminder® at four time points: Prior to chemotherapy, at midpoint, end of chemotherapy (T3) and 1 year after the completion of chemotherapy (T4). Headminder® evaluated four cognitive domains namely attention, memory, processing and response speed. Statistical tests were conducted to compare (i) the FACT-Cog scores and (ii) proportions of patients suffering cognitive impairment in various domains between T3 and T4. Results One hundred and five patients were analyzed. Among the 59 patients who completed follow-up at T4, median FACT-Cog score was lower at T3 than T4 (T3: 129.5 vs T4: 133.0, p=0.819) but the difference was not statistically significant. However, through objective assessment, more patients had impairment in the memory (T3: 32.8 % vs T4: 7.0 %, p=0.001) and response domains (T3: 18.0 % vs T4: 1.8 %, p=0.004) at T3 than T4. All patients experiencing impaired attention at T3 (29.5 %) returned to normal by T4. Conclusions Both subjective and objective cognitive functioning tests suggest that reversibility of chemotherapy-induced cognitive impairment is possible 1 year after chemotherapy. Larger sample size and longer follow up are required to validate these findings.

MASCC-0109 Psychooncology 2 THE EXPERIENCE OF HAVING CANCER WHILE RAISING MINOR CHILDREN

C. Rashi1, T. Wittman1, C. Loiselle2 1 Nursing, McGill University, Montreal, Canada; 2Psycho-oncology, Jewish General Hospital, Montreal, Canada Background and Aims Cancer poses unique and pressing challenges to patients who are also juggling the demands of raising minor children. The purpose of this qualitative study was to gain a rich understanding of parents’ cancer experience and explore recommendations to address cancer-related and family challenges. Methods Five mothers and seven fathers were recruited from a university affiliated cancer care center in Montreal, Quebec. Researchers conducted face-toface, audio-recorded, semi-structured interviews. Content, transcribed verbatim, underwent thematic analysis. Results Participants highlighted ways to cope with their illness, protect the family, and preserve family equilibrium. The findings are organized into three distinct but related categories. The first describes parental self- activated strategies, including maintaining child routines, selective disclosure of cancer-related information, projecting strength and positivity, and adapting to physical impairments while parenting. The second category captures how parents tap into an already existing social network to meet transportation, child care, meal care, and psycho-emotional support needs. The last category involves seeking to match parents’ needs with cancer care resources, including the health care providers needing to listen to patient and family needs, coordination of appointments, timing of services offered, and the need for instrumental support. Conclusions The findings reveal interrelated facets of the patients’ experience: coping with an illness affecting the self and the family, (re)activating an already cohesive personal social network and interacting and navigating a complex health care system. Participants identified key elements that may allow more person/family-centered interventions and the development of programs to meet their unique needs.

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MASCC-0562 Quality of Life ITALIAN VERSION OF THE M.D. ANDERSON SYMPTOM INVENTORY HEAD AND NECK MODULE: LINGUISTIC VALIDATION

A. Greco1, E. Orlandi2, A. Mirabile3, P. Steca1, M. Sala1, E. Russi4, S. Takanen5, A. Rimedio6, D. Alterio7, C. Fallai2, P. Bossi3, B. Gunn8, D. Rosenthal9 1 Psychology, University of Milan-Bicocca, Milano, Italy; 2Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 4Radiotherapy, AO S Croce e Carle, Cuneo, Italy; 5 Radiotherapy, Policlinico Umberto I - University “Sapienza” of Rome, Rome, Italy; 6Ethical Committee, AO S Croce e Carle, Cuneo, Italy; 7 Radiotherapy, Istituto Europeo Oncologia, Milano, Italy Background and Aims Head and neck cancer (HNC) patients can experience symptoms due to the tumor itself or to the treatment and this experience may decrease their health-related quality of life (HRQoL). The construct of HRQoL, progressively accepted as an important outcome parameter, is used, along with others, in medical research to support clinical decisions. HRQoL applicability and cultural adaptation must be tested for each population. Aim of this study is to linguistically validate the Italian translation of the M.D. Anderson Symptom Inventory – Head and Neck Module (MDASI-HN). Methods Following forward and backward translation of the items of the English MDASI-HN into Italian, it was administered along with a cognitive debriefing to HNC patients able to read and understand Italian language. Individual and group responses are presented using descriptive statistics. Results From May 2013 through September 2013 56 patients with HNC answered to the MDASI-HN followed by completion of the accompanying cognitive debriefing. Ninety-nine percent of the individual MDASI-HN items were completed. Average time to complete the MDASI-HN was 8.5 min (range 3–15). Results suggested overall ease of completion, relevance, and comprehensibleness of this translated self-report instrument in this Italian patient population. Conclusions The Italian version of the MDASI-HN is linguistically valid; future research should explore dimensionality, reliability, convergent, discriminant, and predictive validity of this patient-reported instrument, in order to use the scale properly in outcomes research and in clinical setting.

MASCC-0621 Quality of Life PSYCHOLOGICAL INTERVENTION AND ITS EFFECTS ON THE QUALITY OF LIFE IN WOMEN WITH BREAST CANCER, AND WITH MODERATE DEPRESSION

H. Fernández Suárez1, B. Blum Grynberg1 1 Facultad de Psicologia, Universidad Nacional Autónoma de México, Mexico City, Mexico Background and Aims Women with breast cancer, depression and chemotherapy have a very poor quality of life while being medically treated for cancer. The objective of this study was to assess quantitatively and qualitatively the effects of psychological intervention on the quality of life of women with breast cancer and moderate depression.

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Methods From a sample of 142 patients diagnosed recently with nonmetastatic breast cancer, ten patients with moderate symptoms of depression participated in a prospective study. Four of these patients received 12 sessions of cognitive behavioral therapy. The ten patients answered the FACT-B and the Beck Depression and Anxiety Inventory before, during and after chemotherapy. Non parametric statistical analysis were carried out. When the medical treatment was over, 6 patients were interviewed (4 who had received psychological support and 2 who had not). Results The quantitative study showed that women with psychological support (group 1) had a better quality of life, greater emotional and functional well-being, and less depression. Interviews showed that their quality of life was improved during medical treatments, and 4 months after they were concluded. A significant decrease of physical well-being during chemotherapy was observed in patients who only were assessed (group 2) Conclusions The psychological intervention brought about benefits, since patients who received it had a statistically significant better quality of life than those who did not receive it. Other variables contributing to these results were: adherence to the model of the psychological intervention, the therapistpatient relationship, the way of implementing the psychological support, and the patients’ spirituality.

MASCC-0579 Quality of Life PATIENTS AND THEIR ADVOCATES ASK FOR INTEGRATIVE ONCOLOGY IN SUPPORTIVE CARE

A. Fonfa1 1 Patient Advocacy, Annie Appleseed Project, Delray Beach, USA Background and Aims Supportive cancer care lends itself perfectly to the blend of complementary and conventional therapies and treatments. With the MASCC mission of “enhancing the lives of people coping with cancer”, patient advocates focus on exactly the same goals, hoping for the best possible outcomes. Methods Since 1999 Annie Appleseed Project volunteers have gathered and shared information about the less toxic, non-toxic and natural approaches that constitute complementary therapies. We will share the latest, most updated studies and concepts in our poster. Results 2013 brought more studies, few at level 1, but a preponderance of information nonetheless. More evidence than ever showed the value of ginger for nausea; yoga for energy, relaxation, balance and strength; fish oils for cachexia and as radio-protectant, curcumin for radiation protection, and more. The 2013 meeting of the Society for Integrative Oncology, attended by two board members of Annie Appleseed Project, featured a variety of talks demonstrating the value of integrating these two areas — there is now truly no reason for separation between conventional and complementary. Conclusions At most patient/advocacy group meetings we do hear talks on complementary treatments, we believe it is absolutely time for full inclusion in medical meetings. Therefore we will show a poster full of study references and well-accepted therapies already in use by up to 80 % of those with cancer.

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MASCC-0513 Quality of Life THE GENERIC AND STOMA-SPECIFIC QUALITY OF LIFE OF CANCER AND NON-CANCER PATIENTS WITH A COLOSTOMY, ILEOSTOMY OR UROSTOMY

F. Jansen 1 , C.F. van Uden-Kraan 2 , A. Braakman 3 , B.I. Witte 4 , I.M. Verdonck-de Leeuw2 1 Dept. of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU University Medical Center, Amsterdam, Netherlands; 3, Dutch Ostomy Association, Maarssen, Netherlands; 4Dept. of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands Background and Aims Several studies in cancer and non-cancer patients with a colostomy, ileostomy or urostomy have reported limitations in patient-reported quality of life (QoL). However, few studies have focused on differences in the generic and stoma-specific QoL between patients with a stoma due to cancer and patients with a stoma due to benign causes such as inflammatory diseases. Objectives To compare the generic and stoma-specific QoL between cancer and noncancer patients with a stoma. Methods All patients with a stoma participating in the Stomapanel of the Dutch Ostomy Association in August 2012 were asked to complete a generic (RAND-36) and stoma-specific QoL (stoma-QoL) questionnaire. The domain scores of the RAND-36 and total stoma-QoL score of cancer stoma patients were compared with non-cancer stoma patients using linear regression analyses. Results In total, 668 patients were included: 379 cancer patients (80 % colorectal, 17 % bladder and 3 % other) and 289 non-cancer patients (38 % Colitis Ulcerosa, 22 % Crohn’s disease and 40 % other) with a colostomy (55 %), ileostomy (31 %) and/or urostomy (16 %). Adjusted for gender, age, type of stoma and time elapsed since stoma-operation, cancer stoma patients scored higher (better) on stoma-QoL (β=2.1) and all RAND-36 domains (9.1 <β≤19.5) except on mental health, compared to non-cancer stoma patients. Conclusions Cancer patients reported a better generic and stoma-specific QoL than patients with a stoma due to non-cancer causes. Potential explanations will be sought by comparing qualitative data, reported by cancer and noncancer stoma patients, on factors influencing QoL and the influence of their stoma on daily life.

MASCC-0545 Quality of Life THE EORTC QLQ-BN20 FOR ASSESSMENT OF QUALITY OF LIFE IN PATIENTS RECEIVING TREATMENT OR PROPHYLAXIS FOR BRAIN METASTASES: A LITERATURE REVIEW

A. Leung1, K. Lien1, L. Zeng1, J. Nguyen1, A. Caissie1, S. Culleton1, L. Holden1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Brain metastases occur in approximately 20–40 % of all cancer patients during the course of disease. As treatment for brain metastases is palliative rather than curative, quality of life (QoL) is emphasized over

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prolonged survival. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-BN20 is a QoL assessment tool specific to brain neoplasms. We aim to provide a review of the current use of the EORTC QLQ-BN20 for patients with brain metastases. Methods All studies using the EORTC QLQ-BN20 for QoL assessment in patients receiving treatments related to brain metastases were included. Study information including treatment type, assessment periods, patient enrolment and information pertaining to the QLQ-BN20 were extracted. Results A total of 13 studies were identified, five of which were randomized trials assessing prophylactic whole brain radiation for patients with small-cell lung cancer. The QLQ-BN20 was used in conjunction with the core QLQC30 questionnaire in all but one of the studies and together these comprised the entire QoL assessment for 11 of the 13 studies. Neurocognitive function assessments supplemented QoL in four studies and accompanying performance status indices used with the QLQ-BN20 varied. Compliance issues were commonly cited. QoL changes during study periods varied as improvements, deteriorations and stabilizations were all observed. Conclusions QoL assessments should be conducted using disease-specific tools. Future studies should minimize patient burden in order to maximize data collection and accrual. A common set of QoL endpoints for patients with brain metastases should be created.

MASCC-0588 Quality of Life QUALITY OF LIFE AND UNMET NEEDS OF PATIENTS WITH BRAIN TUMORS: A DYADIC PERSPECTIVE

C. lucchiari1, A. Botturi2, G. Pravettoni3 1 Health Sciences, Università degli studi di Milano, Milan, Italy; 2Neurooncology, Istituto Nazionale Neurologico “Carlo Besta”, Milan, Italy; 3 Health Sciences, Università degli Studi di Milano, Milan, Italy Background and Aims During the last 10 years, numerous studies have highlighted the need to consider Quality of Life (QOL) issues in the treatment of brain cancer. However, gaps in scientific knowledge are still present, since we have poor data about the whole experience of patients and about their needs. The present study was aimed at evaluating quality of life mood state and unmet needs, in order to describe the psychological adjustment process. Since the proxies are particular important in the context of brain tumors, we also aimed to study the proxies’ perspective. Methods We obtained data from 85 patient-proxy couples during chemotherapy treatment. We used standardized questionnaires to assess different aspects of patients’ quality of life. In particular, the FACT-Br, the NEQ and the HAD scales were used, to evaluate both patients and proxies perspectives. Results Our date depict a difficult adjustment process to the illness, even though positive elements emerged. Indeed, patients reported a satisficing selfperceived quality of life. Further, depression symptoms seem to affect a minority of our patients. Our data also suggest that proxies might not be always considered reliable information carriers, since the perspectives of patients and proxies may be greatly different. Conclusions Brain tumors may heavily affect patients’ QoL and psychological wellbeing. However, some element of the context may improve the adjustment to the disease. In particular, when a good emotional sharing between proxies and patients is achieved, this process seem to be significantly improved. This issue deserves further studies in order to obtain significant clinical recommendations.

MASCC-0469 Quality of Life DISEASE BURDEN OF CANCER PATIENTS SUFFERING FROM ANEMIA AND THEIR CAREGIVERS IN THE US, ITALY, AND FRANCE

N. McGarvey 1 , P. Corey-Lisle 2 , E. Donahue 3 , M.P. Desrosiers4 , G.C. Bohac5, S. Hunter6, S. Hubbard3 1 Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, USA; 2Global Health Economics, Amgen Inc., Thousand Oaks, USA; 3Clinical Operations, United Biosource Corporation, Lexington, USA; 4Clinical Operations, United Biosource Corporation, Dorval, Canada; 5Hematology/Oncology, Amgen Inc., Thousand Oaks, USA; 6Global Biostatistical Science, Amgen Inc., Thousand Oaks, USA Background and Aims Chemotherapy-induced anemia (CIA), prevalent in cancer patients, may contribute to patient fatigue, declining functional capacity and health-related quality of life (HRQoL), potentially increasing the need for caregiver assistance and caregiver burden. The study aims to explore the burden of disease among patients with CIA and their caregivers. Methods This cross-sectional study was conducted in 9 oncology centers in the United States, Italy, and France (3 centers each) among consecutively presenting adult cancer patients with anemia (Hb<12.0 g/dL) currently receiving myelosuppressive chemotherapy and their caregivers from March 2012 through July 2013. Patients and caregivers completed surveys with questions on socio-demographics, time spent providing caregiving assistance, perceived burden, work productivity, anemia-related symptoms, hospitalization, fatigue, and HRQoL. Descriptive statistical analysis was conducted. Results A total of 182 patients and their caregivers were enrolled. Patients (74.7 % female and 50.5 % ≥65 years) had a mean Hb level of 10.4 g/ dL and reported a FACT-Fatigue mean score of 30.1. Caregivers (50 % female and 65.4 % <65 years) reported a daily mean of 4.4 h providing assistance with instrumental activities and 7.9 h with activities of daily living. Caregivers reported a Zarit Burden mean score of 10.02. Additionally, caregivers reported impacts to work productivity (among employed, mean overall work impairment=31 %) and activity (mean activity impairment=23.43 %) in the past week. Conclusions Data supports that patients with CIA and their caregivers are experiencing moderate disease burden. Research of this kind aids health care providers, patients, and caregivers in making more informed decisions related to patient and caregiver needs.

MASCC-0456 Quality of Life REVIEW OF RADIATION INDUCED NAUSEA AND VOMITING IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM

N. Pulenzas1, B. Lechner1, N. Thavarajah1, E. Chow1 1 Department of Radiation Oncology, Odette Cancer Centre, Toronto, Canada Introduction: Radiation induced nausea and vomiting (RINV) develops in approximately 50–80 % of patients, and severity is dependent on factors such as treatment volume, chemotherapy, and pre-existing nausea and vomiting (N/V).

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Objective: To review research conducted by the Rapid Response Radiotherapy Program (RRRP) on RINV. Methods: Past studies in the RRRP that investigated the effectiveness and optimal timing of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists (RA) in the prophylaxis or rescue of RINV were reviewed. Results: RINV has an acute phase, during and immediately after radiation, and a delayed phase in the days following treatment. The most commonly prescribed anti-emetic in practice was 5-HT3RA, which is highly recommended in practice. The international patterns of awareness of guidelines and standard of practice varied across radiation oncologists and trainees. Prospective studies that used 5HT3 RAs for the prophylaxis of RINV resulted in low control rates of N/V, most markedly in the delayed phase. A prospective study used the Functional Living Index of Emesis (FLIE), and developed a daily diary to assess N/V. However this study had a very low compliance rate due to no follow-up calls and complicated instructions. Conclusion: There is no current standardized assessment for RINV that is applicable to palliative cancer patients. Complete control of nausea has historically been lower than vomiting, suggesting that it is a more difficult symptom to prevent. Further investigation should focus on the use of other 5-HT3 RAs, or use in combination with other medications.

MASCC-0457 Quality of Life REVIEW OF BRAIN METASTASES RESEARCH IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM (RRRP)

N. Pulenzas1, B. Lechner1, N. Thavarajah1, E. Chow1 1 Department of Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Introduction: Brain metastases develop in approximately 20-40 % of patients, and are frequently treated with whole brain radiation therapy (WBRT) for patients ineligible for aggressive treatment. The Rapid Response Radiotherapy Program (RRRP) provides timely radiotherapy for palliative cancer patients, focusing on quality of life (QOL) as an important endpoint. Objective: To review and discuss the past research conducted in the RRRP on brain metastases patients. Methods Methods: A retrospective review was conducted of research from the RRRP involving brain metastases from 2004 – present. Results Results: Research in the RRRP has focused on QOL, prognostic factors, and use of corticosteroids. Past studies have used a wide variety of tools to assess QOL in this patient population. Conclusions Conclusions: The effect of WBRT on QOL is widely variable, ranging from decreased QOL to improvement. There is not a current standardized QOL questionnaire that has been created and validated in the brain metastases population. Research in the RRRP is lacking in other treatment options for brain metastases such as stereotactic radiosurgery (SRS), likely due to the palliative nature of our patients. Future research should focus on creating a standard QOL instrument, measuring QOL following SRS, and better determining prognostic factors of brain metastases patients before treatment.

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MASCC-0615 Quality of Life HORMONE REPLACEMENT THERAPYAND ENDOMETRIAL CANCER RECURRENCE: META-ANALYSIS OF AVAILABLE DATA

M. Teramoto1, Y. Eboras1, M. Cadungog2 1 Department of Health Sciences, Drexel University, Philadelphia, USA; 2 Department of Obstetrics & Gynecology, Christiana Care Health Services, Newark, USA Background and Aims Hormone replacement therapy (HRT) after the treatment of endometrial cancer could alleviate menopausal symptoms often experienced by cancer survivors. Meanwhile, evidence is limited regarding the safety of HRT after endometrial cancer. The aim of this study is to examine whether HRT is associated with an increased risk of endometrial cancer recurrence. Methods A meta-analysis was performed on the studies published in the past that investigated HRT and recurrence of endometrial cancer. A pooled odds ratio (OR) with 95 % confidence interval (CI) was calculated to determine the overall effect. Results A total of eight studies, including cohort studies and case–control studies, along with one randomized-controlled trial, were identified for the data analysis (total sample size = 3,134). No significant difference was found in the risk of endometrial cancer recurrence between cancer survivors receiving HRT and those not receiving HRT (pooled OR = 0.456, 95 % CI = 0.204–1.021). Interestingly, there was a tendency that HRT was associated with a lower risk of endometrial cancer recurrence. Conclusions Based on available data, it does not appear that HRT is associated with an increased risk of endometrial cancer recurrence. Hence, HRT could be used to alleviate menopausal symptoms in patients after the treatment of endometrial cancer, helping them maintain quality of life without adverse consequences on their survival. On the other hand, due to limited research, physicians should carefully consider possible benefits and risks associated with HRT for each patient.

MASCC-0554 Quality of Life COVER MAKEUP IS HELPFUL AND IMPORTANT FOR PATIENTS’ GOOD DAILY LIVING

T. Wakeda1, Y. Heike2, Y. Kikuchi1, T. Ogawa1 1 Breast Surgery, Tokyo University Hospital, Tokyo, Japan; 2Exploratory oncology research & clinical trial center, National Cancer Center, Tokyo, Japan Background and Aims Cancer therapy causes appearance changes related to patients’ Quality of Life (QoL), it is well-known that alopecia caused by chemotherapy depresses the patients and wigs should be needed. Recently, National Cancer Center in Japan showed that patients were suffered from various appearance changes, not only alopecia but also surgical wound, pigmentation by chemotherapy and so on. And it is noteworthy that not a few patients said that the appearance problems were more painful than physical symptom such as nausea and cancer pain. Our previous interview survey also showed that skin changes decreased patients’ QoL, e.g. ‘I

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cannot go swimming with this wound’ and ‘I don’t want to see anyone with this pigmented face’. Therefore, we introduced ‘cover makeup’ to skin changes caused by cancer to contribute to the patients’ QoL. Methods Cover makeup was performed for the applicants with the skin-like color cream that our group had developed based on the patients’ demand, that is easy to use, good covering and strongly water-resistant (available for swimming). Results Most patients were satisfied with their skin changes concealed almost perfectly (See pictures). Some patients could retrieve even their confidence thanks to cover makeup.

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maintaining and improving HRQOL is often the main focus of palliative treatment. This study aims to determine factors that may influence HRQOL, which may in turn influence treatment and care of bone metastases patients. Methods Three hundred and ninety six patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastases Module (EORTC-QLQ BM22) at baseline. EORTC QLQ-BM22 data and sociodemographic and medical factors were analyzed by univariate analysis of variance (ANOVA). Items of significance were determined through backward selection, which were then put through multivariate analysis to determine the most significant factors. Results Through ANOVA, Karnofsky Performance Status (KPS)>80 and breast primary histology were predictive of better HRQOL in the painful site (PS) scale, while KPS>80, female gender, and breast primary were predictive of better HRQOL in the pain characteristics (PC) and functional interference (FI) scales. KPS>80 and prostate primary were predictive of better HRQOL in the psychosocial aspect (PA) scale. KPS>80 and primary cancer site were confirmed as the most significant predictive factors through multivariate analysis. Conclusions This study identified gender, performance status, and primary histology as determinants of HRQOL in patients with bone metastases. Further study focusing on current treatment and spiritual well-being may identify additional factors affecting HRQOL. Understanding the influence of these factors will allow health care professionals to provide more effective palliative care.

MASCC-0531 Quality of Life

Conclusions Our results suggest that cover make up is helpful and important for patients’ good daily living. Now we perform the service of cover makeup advice for any patients other than cancer sufferers upon receiving numerous inquiries.

PROGNOSTIC VALUE OF PRE-TREATMENT AND CHANGES IN HEALTH-RELATED QUALITY OF LIFE FOR SURVIVAL IN PATIENTS WITH MULTIPLE BRAIN METASTASES TREATED WITH WHOLE BRAIN RADIOTHERAPY

MASCC-0467

E. Wong1, M. Tsao1, L. Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1, E. Barnes1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada

Quality of Life FACTORS INFLUENCING HEALTH RELATED QUALITY OF LIFE IN CANCER PATIENTS WITH BONE METASTASES

E. Wong1, E. Chow1, L. Zhang1, G. Bedard1, K. Lam1, A. Fairchild2, V. Vassiliou3, M.A. Alm El-Din4, R. Jesus-Garcia5, A. Kumar6, F. Forges7, L. Tseng8, M. Hou9, W. Chie10, A. Bottomley11 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2 Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; 3 Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; 4 Clinical Oncology, Tanta University Hospital, Tanta, Egypt; 5Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo, Brazil; 6 Radiation Oncology, Regional Cancer Center, Trivandrum, India; 7 Pharmacy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France; 8Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; 9 Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 10Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan; 11 Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium Background and Aims Health related quality of life (HRQOL) is a multidimensional concept that is especially important for cancer patients with bone metastases, as

Background and Aims Health-related quality of life (HRQOL) is commonly assessed. The objective of this study was to determine the prognostic survival value of HRQOL and its domains in patients with brain metastases. Methods Patients with brain metastases treated with whole brain radiotherapy who completed a HRQOL questionnaire were included. HRQOL and its domains were classified as improved, no change or deteriorated. Overall survival (OS) was calculated from baseline to date of death or censored at last follow-up date. Univariate and multivariate cox proportional hazard model of OS was conducted with demographic factors, baseline and changes in HRQOL and its domains. Results Two hundred sixty-nine patients at baseline and 179 patients at follow-up were included. Median OS at baseline was 3.8 months (95 % CI: 3.2– 4.6 months), while for patients with month 1, 2, and 3 follow-ups was 4.8 months (95 % CI: 4.0–6.9), 7.1 months (95 % CI: 5.1–9.5) and 9.5 months (95 % CI: 6.1–11.5), respectively. Patients of older age, lower Karnofsky Performance Status, primary cancer site of gastrointestinal and genitourinary in comparison to breast were more predictive of poorer survival outcome. At baseline, patients with lower overall HRQOL, especially lower physical functioning and motor dysfunction domains, were found to have a poorer survival outcome. Changes in overall HRQOL and its domains were not significantly related to OS.

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Conclusions Pre-treatment HRQOL has prognostic survival value in patients with brain metastases. Our study was limited by small sample size and high attrition rates. Prognostic survival value of changes in HRQOL following treatment should be investigated in a larger sample size.

MASCC-0079 PSYCHOMETRIC PROPERTIES OF THE PERSIAN VERSION OF SATISFACTION WITH CARE QUESTIONNAIRE AMONG IRANIAN CANCER PATIENTS: VALIDATION OF THE EORTC IN-PATSAT32 MODULE

M. Ahmadi1, M. Asadilari2 1 school of health, tehran university of medical sciences, Tehran, Iran; 2 school of health, Iran university of medical sciences, Tehran, Iran Background and Aims The aim of this study was to assess the psychometric properties of the Persian version of EORTC IN-PATSAT32 questionnaire when applied to a sample of Iranian cancer patients to prepare a valid and reliable instrument to evaluate satisfaction with care to identify the points where improvements can be implemented into the cancer care organizations. Methods The survey was conducted over 380 patients. We evaluated covergent, discriminant, and divergent validity of the Persian version of EORTC-inpatsat32 questionnaire using multitrait scaling analysis and using CFA to assess the construct validity. Then we tested the reliability by intraclass correlation coefficient. For assessing the test-retest reliability and the questionnaire responsiveness to change, a consecutive sample of 70 patients was asked to complete the form twice within 2 weeks interval. Results Results show well-acceptance and high sensitivity of the questionnaire to be used in Iran. Low obtained floor effect and high ceiling effect represent the power of the instrument in detecting differences between groups with heterogeneous levels of satisfaction. Multitrait scaling analyses support considerable convergent and discriminant validity. Divergent validity was satisfactory resulted from low correlation between EORTC in-patsat32 module scales and the EORTC-C3o scales (Spearman Rho<0.30). Confirmatory factor analysis (CFA) suggested five components explaining 71.1 % of variance. The test-retest reliability was excellent (intraclass correlation coefficient ranged within 0.859 to 0.958). Conclusions The Persian version of the EORTC-in-patsat32 module is a reliable and valid instrument to measure cancer patients’ satisfaction with care received during their hospitalization period and can be utilized in clinical cancer research in Iran.

MASCC-0080 MEASURING SATISFACTION OF CARE IN CANCER PATIENTS ADMITTED TO DIFFERENT ONCOLOGY DEPARTMENTS IN TEHRAN-2013: EORTC IN-PATSAT32 AND SATISFACTION IN IRANIAN PATIENT WITH CANCER

M. Ahmadi1, M. Asadilari2 1 school of health, tehran university of medical sciences, Tehran, Iran; 2 school of health, Iran university of medical sciences, Tehran, Iran Background and Aims The worldwide increasing trend of cancer incidence highlights the importance of paying a special attention on cancer patients’ determinants of health, quality of life and satisfaction with care. The EORTC IN-PATSA

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T32 was used for assessing psychometric properties of patients’ satisfaction with provided care and the relevant issues such as the quality of hospital doctors and nurses, as well as selected aspects of the care organization and hospital environment to evaluate Iranian cancer inpatients’ satisfaction with care in Tehran hospitals. Methods A descriptive study was conducted in two Tehran educational hospitals over 380 cancer patients who completed the study pack of questionnaires (EORTC IN-PATSAT32, EORTC QLQ C30 and sociodemographic questionnaires). Data were analyzed by using statistical software (SPSS) to determine factors associate with patients’ satisfaction. Results Details of the age distribution of the sample shows 77.6 % of patients were bellow 65 years old and 79.7 % were married. Younger patients mentioned higher scores while their marital and occupation status did not influenced their satisfaction. Results show a significant correlation between patients’ overall satisfaction and their quality of life (rho=0.263 and p<0.001). Patients’satisfaction mean scores for all scales were higher than 56 except for the scales of information provision. All individual scales of satisfaction with care contributed significantly to the overall satisfaction score (P<0· 001). Crude mean scores show higher level of satisfaction in developed areas and average level for Iran and a lower level for morocco. Conclusions These findings highlight the areas of care services which requiring attention to improve.

MASCC-0064 TITLE: COMMUNITYACUPUNCTURE PILOT STUDY: UTILIZATION AND CLINICAL OUTCOMES IN AN INTEGRATIVE ONCOLOGY HOSPITAL MODEL OF CARE

K. Anderson1, K. Anderson1, T.E.R.I. Applegate1, B. Valentine1 1 Naturopathic Medicine, Cancer Treatment Centers of America, Tulsa, USA Background and Aims Acupuncture utilization has increased and there is good evidence to support it’s use with cancer patients to manage side effects often resulting from conventional therapy. Community acupuncture is a delivery model that with a low cost to implement, is easily accessible and allows for a greater number of patients to receive treatment on a more frequent basis than the traditional one room treatment model design. Methods Data were employed from cancer patients at SRMC from MarchSeptember 2013 through survey analysis determining patient’s frequency and satisfaction with treatment, QOL scoring metrics and clinical outcomes. Patients eligible for group acupuncture were returning patients that were ambulatory and able to stay comfortably seated in a chair. The group classes were offered twice weekly with a maximum of 10 patients to each hour long class. The classes were led by an L.Ac. EHR charting and documentation occurred at each visit. Results We saw 73 unique patients with 152 visits total in the pilot study. We treated a variety of symptoms including fatigue, xerostomia, anxiety, allergies, smoking cessation, nausea, peripheral neuropathy, pain and headaches. The average number of patients that attended each day was about 5, with an average of 2.5 patients in each class. With group acupuncture we treated 100 % more patients and had availability to treat 400 % more when compared to the traditional setting. Patient satisfaction scores were 99 %. Conclusions Community acupuncture has good application to improve patient care, allowing frequent treatments and meeting the space and staffing challenges often present in a hospital environment.

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MASCC-0174 THE IMPACT OF NUTRITIONAL STATUS ON HEALTH-RELATED QUALITY OF LIFE IN CHILDREN TREATED FOR CANCER

A. Brinksma1, R. Sanderman2, P.F. Roodbol3, E. Sulkers3, J.G.M. Burgerhof4, E.S.J.M. de Bont5, W.J.E. Tissing5 1 Department of Pediatric Oncology and Hematology/School of Nursing and Health, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 2Department of Health Sciences Health Psychology Section, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 3School of Nursing and Health, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 4Department of Epidemiology, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 5 Department of Pediatric Oncology and Hematology, University of Groningen University Medical Center Groningen, Groningen, Netherlands Background and Aims It is generally assumed that malnutrition in childhood cancer patients is associated with lower levels of health related quality of life (HRQL). However, this association has never been tested. Therefore, we aimed to quantify the impact of nutritional status on HRQL in children treated for cancer. Methods At diagnosis, and at 3, 6, and 12 months nutritional status and HRQL were assessed using the child- and parent-report versions of the PedsQL 4.0 Generic Core scale and the PedsQL 3.0 Cancer Module in 104 children (2–18 years) with hematological, solid, and brain malignancies. Scores of both scales range from 0 to 100. Results Undernourished children (BMI/FFM<-2SDS) reported significantly lower PedsQL scores compared with well-nourished children on the domains physical (−13.3), and social functioning (−7.0), cancer summary scale (−5.9), and nausea (−14.7). Overnourished children (BMI/FM>2SDS) reported lower scores on emotional (−8.0) and cognitive functioning (−9.2), and cancer summary scale (−6.6); whereas parent-report scores were lower on social functioning (−7.5). Weight loss (>0.5 SDS) was associated with lower values on physical functioning (−13.9 child-report and −10.7 parent-report), emotional (−7.4) and social functioning (−6.0) (child-report), pain (−11.6), and nausea (−7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS). Conclusions Undernutrition and weight loss were associated with worse physical and social functioning; whereas overnutrition and weight gain affected the emotional and social domain of HRQL. Measures that improve nutritional status will contribute to enhanced health outcomes in children treated for cancer.

MASCC-0075 LITERATURE REVIEW OF THE DEVELOPMENT, CHAR ACTERISTICS AND VALIDITY OF THE EORTC QLQ-PR25 AND THE FACT-P FOR ASSESSMENT OF QUALITY OF LIFE IN PROSTATE CANCER PATIENTS

D. Chu1, M. Popovic1, E. Chow1, D. Cella2, J.L. Beaumont2, H. Lam1, J. Nguyen1, J. Di Giovanni1, N. Pulenzas1, G. Bedard1, A. Bottomley3 1 Rapid Response Radiotherapy Program Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA; 3Quality of Life, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium

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Background and Aims Measuring quality of life (QOL) is of utmost importance in prostate cancer patients as treatment side-effects and prostate cancer itself can cause debilitating, persistent problems, affecting overall health and wellbeing. This study aims to compare and contrast the development, characteristics and validity of two of the most widely used QOL assessment tools in patients with prostate cancers: the EORTC QLQ-PR25 and FACT-P. Methods A literature search was conducted on Ovid EMBASE (1947 to 2013 Week 28), Ovid MEDLINE (1946 to July Week 1, 2013), and the Cochrane Central Register of Controlled Trials (June 2013) to identify studies that described the development, characteristics, validity, reliability, and use of either the EORTC QLQ-PR25 or the FACT-P. Results The EORTC QLQ-PR25 is a 25-item questionnaire that assesses urinary symptoms, bowel symptoms, sexual activity and function, and the sideeffects of treatment. In reliability and validity field testing, this module surpassed Cronbach’s alpha coefficient standard of 0.70 for most items and displayed good responses to performance status (PS) change over time. The FACT-P is a 12-item questionnaire that assesses pain, bowel function, micturition, and sexual function. Validity and reliability testing was subsequently conducted; Cronbach’s alpha criterion of 0.60 was met and the module demonstrated sensitivity to changes in PS. Conclusions Both questionnaires present several strengths as well as limitations in measuring the QOL of prostate cancer patients. Each tool may be selected accordingly based on study design and needs.

MASCC-0059 REVIEW OF PALLIATIVE CARE INTERVENTIONS IN GYNAECOLOGICAL CANCER PATIENTS MANAGED ATA UK CANCER CENTRE. CAN LESSONS BE LEARNT FOR FUTURE PRACTICE?

S.C. Henry1, A. Derbyshire2, B. Lee3, R.J.W. Henry2 1 General Medicine, Western General Hospital., Edinburgh., United Kingdom; 2Gynaecology, Dorset cancer Centre, Poole, United Kingdom; 3 Palliative Care., Dorset cancer Centre, Poole, United Kingdom Background and Aims Timing is everything in maximising symptom control. Are there lessons to be gained from analysis of previous clinical interventions by the Palliative care Physicians helping to manage patients with Gynaecological malignancy at the Dorset Cancer Centre, UK. Is the timing of referral to the service always optimal? Advanced pelvic malignancy often involves GI, Genito-Urinary and Haemorrhagic problems necessitating a Multidisciplinary Clinical approach which requires appropriate planning and communication to ensure effective symptom control. Can study of past practice help plan and produce future improvements? Methods Retrospective review of the Palliative Care Service Database with regard to historical involvement dealing with patients with advanced Pelvic cancers. Analysis of case notes with regard to type, timing and effectiveness of clinical interventions set against Patient’s cancer journey. Results Results will be analysed, tabulated and discussed in written and diagramatic form as a poster presentation. Conclusions Neutral, positive and negative findings will be distilled into definitive conclusions. Recommendations for potential changes in clinical practice will be made.

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MASCC-0146 THE ASSOCIATION OF SYMPTOM PROFILES WITH HEALTH-RELATED QUALITY OF LIFE IN ADULT CANCER SURVIVORS AND NON-CANCER GENERAL POPULATION: THE 2010 NATIONAL HEALTH INTERVIEW SURVEY

I. Huang1, Z. Li1, E. Shenkman2, K. Krull3 1 Health Outcomes and Policy, University of Florida, Gainesville, USA; 2 Health Outcomes and Policy, University of Florida, Memphis, USA; 3 Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, USA Background and Aims We aimed to compare symptom profiles and health-related quality of life (HRQOL) between survivors of adult cancer and non-cancer populations using data from the 2010 National Health Interview Survey (NHIS). Methods Reports from cancer survivors (N=604) and a non-cancer general adult sample (N=6,166) who were randomly selected to complete the Quality of Life module during the 2010 NHIS were used for analyses. Symptoms were categorized by items measuring vision, hearing, motor/movement, pain, learning/memory problems, anxiety, depressive symptoms, and fatigue. Physical and mental HRQOL was measured using the NIH PROMIS Global Health Scale. Regression analysis was performed to investigate the association of physical/mental HRQOL with survivors versus non-cancer population by accounting for the influence of symptoms and important covariates on HRQOL. Results Cancer survivors reported significantly higher prevalence of individual symptoms than the non-cancer sample (p-values<0.05), except for anxiety. Thirty-two percent of cancer survivors reported >3 symptom classes compared to 21 % of the non-cancer sample (p-values<0.05). Bivariate analyses revealed cancer survivors reported significantly lower physical and mental HRQOL than the non-cancer sample (p-values<0.05). Presence of individual symptoms was significantly associated with lower physical and mental HRQOL (p-values<0.05). However, regression analyses suggest that the significant associations between cancer survivorship and physical/mental HRQOL was chiefly explained by the prevalence of individual symptoms, older age, and a greater number of chronic conditions (p-values<0.05). Conclusions Compared to the general population, more cancer survivors suffer from multiple symptoms, which is associated with poor HRQOL. Interventions on symptoms especially for survivors with older ages and more chronic conditions might improve HRQOL.

MASCC-0066 EARLY REHABILITATION CAN IMPACT ON HEALTH-RELATED QUALITY OF LIFE OUTCOME IN RADICAL CYSTECTOMY: A RANDOMISED CONTROLLED TRIAL

B. Jensen1, J.B. Jensen2, A.K. Petsersen3, S. Laustsen4, I. Søndergaard2, M. Borre2 1 Department of Urology and Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Urology, Aarhus University Hospital, Aarhus N, Denmark; 3Department of Physiotherapy and Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus N, Denmark; 4Department of Thoraco -and Vascular diseases and Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus N, Denmark

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Background and Aims Health related quality of life (HRQoL) is an important outcome in treatment of cancer. The standard treatment for muscle invasive bladder cancer (MIBC) is radical cystectomy (RC). Cancer diagnosis, surgical procedure and loss of body-function considerably affect patients’ daily lives and MIBC patients have reported significantly worse body functioning compared to the general population. Proactive physical rehabilitation in RC with enhanced postoperative mobilisation and their impacts on patientreported outcome (PRO) have not been reported in a randomised design. Methods In total 107 patients were randomised to a physical- based intervention (nI =50) or standard treatment (ns =57). The intervention consisted of patient-tailored home-based exercises and step training preoperatively and progressive postoperative mobilisation and exercises. HRQoL and inpatient satisfaction was measured as defined by the European Organisation of the Research and Treatment of Cancer (EORTC). Efficacy was defined as the differences in HRQOL-scores between intervention and the standard group at the 4-month follow-up Results This study demonstrated that both pre- and post-rehabilitation could significantly improve HRQoL- scores in dimensions closely related to early recovery (e.g., dyspnoea, constipation and abdominal flatulence (p≤ 0.05). In contrast, the standard group reported significantly less symptoms concerning sleeping patterns (p≤0.04) and minor but clinically relevant differences in role-function and fatigue. The intervention did not compromise inpatient satisfaction. Conclusions In RC there have been uncertainties concerning the impact of physical interventions in relation to PRO. This study provides evidence that exercise based rehabilitation can positively impact HRQoL-aspects without compromise inpatient satisfaction suggesting physical interventions can proactively reduce loss of HRQoL.

MASCC-0092 EFFICACYAND TOXICITY OF IFOSFAMIDE AND CISPLATIN FOR THE TREATMENT OF RECURRENT OVARIAN CANCER

J.Y. Lee1, M. Kim2, B.G. Kim1, D.S. Bae1 1 Obstetrics and Gynecology, Samsung Medical CenterSungkyunkwan University of Medicine, Seoul, Korea; 2Obstetrics and Gynecology, Samsung Changwon HospitalSungkyunkwan University of Medicine, Changwon-si, Korea Background and Aims The aim of this phase II study was to investigate the efficacy and toxicity of ifosfamide combined cisplatin in patients with recurrent epithelial ovarian cancer (EOC) Methods Forty-seven patients with recurrent EOC were treated with ifosfamide 5 g/ m2/and cisplatin 50 mg/m2 on day 1, every 3 weeks for 6 cycles. The primary outcome was response rate (RR) and toxicity. Other measurements were duration of response, time to progression (TTP), and overall survival (OS). Results All 47 patients with 160 cycles were assessed for response and toxicity. The overall RR was 31.9 %; there were 3 complete responses (6.4 %) and 12 partial remission (25.5 %). Grade 3 and 4 hematologic toxicities included neutropenia (23.6 %), anemia (12.8 %) and thrombocytopenia (10.7 %). Nonhematologic toxicities were mild. There were no drugrelated toxic deaths. The median duration of response, TTP and OS were 5.1, 4.8, and 17.0 months, respectively. In initial platinum-sensitive group, RR and OS were 44.4 % and 20.4 months, while in initial platinum-resistant group these were 15.0 % and 8.7 months, respectively (P=0.027 and P=0.002).

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Conclusions Ifosfamide combined with cisplatin is a well-tolerated regimen with modest activity in recurrent EOC. In addition, this regimen is especially significant in patients with an initial platinum-sensitive disease.

MASCC-0169 PROFILE OF QUALITY OF LIFE AND THE INTERPLAY OF ANXIETY DISORDERS AMONG INDIVIDUALS WITH BREAST CANCER

A. Olagunju1, O. Fatiregun2, J.D. Adeyemi3 1 Department of Neuropsychiatry (psychooncology), Lagos University Teaching Hospital/College of Medicine University of Lagos, Lagos, Nigeria; 2Neuropsychiatry, Federal Neuropsychiatric Hospital Yaba, Lagos, Nigeria; 3Neuropsychiatry, Lagos University Teaching Hospital/ College of Medicine University of Lagos, Lagos, Nigeria Background and Aims Quality of life (QOL) is stimulatingly recognised as a useful measure of outcome in cancers. This study investigates the influence of anxiety disorders on QOL in cohorts with breast cancer in a developing context. Methods The study participants consisted of 200 consenting females with breast cancer. Designed questionnaire was used to elicit their socio-demographic and clinical profile. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was administered to assess QOL across functioning and symptom domains. This was followed by interview with the anxiety subscale of Hospital Anxiety and Depression rating Scale (HADS) to ascertain presence of anxiety disorders. Results The mean age of participants was 49.6±11.2 years, 76.5 % were married, and majority of them were employed (59.5 %). In terms of clinical factors, the mean duration of illness was 8.46 months, Chemotherapy (50.0 %) was the commonest mode of treatment and most of the subjects (97.5 %) were compliant with treatment. More than half of them (54 %) presented at the late stages (stage 3 and 4). Overall, more than a quarter of the participants (26.5 %) had anxiety based on HADS score of 8 and above. Anxiety disorders correlated positively with lower mean scores on all the breast cancer QOL functional scale domains, however with higher mean scores on the symptom scale (p<0.05). Conclusions In this study, varied degrees of impairment in functioning and worse experience of symptoms were observed; with anxiety disorders constituting determinant of QOL. Multidisciplinary-based management of breast cancer having full complement of supportive care is implied.

MASCC-0093 ASSOCIATION BETWEEN QUALITY OF LIFE AND MENTAL STATE OF HOSPITALIZED PATIENTS WITH ONCOLOGICAL DISEASE IN PALLIATIVE CARE

R. Bu?gová1, L. Sikorová1, D. Jaro?ová1 1 Department of Nursing and Midwifery, Ostrava University, Ostrava, Czech Republic Background and Aims The emphasis on the quality of life (QoL) and mental well-being of a patient is an important principle of the palliative care. The aim of the research was to determine the occurrence of anxiety and depression in hospitalized oncological patients no longer receiving anti-cancer treatment and their influence on QoL.

Methods The research sample consisted of 225 patients from the oncology department of the University Hospital in Ostrava, no longer receiving anticancer treatment, with Karnofsky score <60. The EORTC QLQ-C30 and HADS (Hospital Anxiety and Depression Scale) questionnaires were used for data collection. To evaluate relations between the monitored factors, the Pearson correlation coefficient was used. Results The average age of patients was 65.1 years. Anxiety was determined in 77 patients (33.9 %) and depression in 107 patients (46.6 %). The average total global health status/QoL score was 41.8 (95 % CI: 39.7–43.9). The functional scale QLQ-30 showed a low average score in the role functioning domain (39.2, SD=29.7) and higher scores in the emotional functioning domain (69.5, SD=22.9) and the cognitive functioning domain (72.8, SD=21.8). By correlation the relation between the lower QoL and the occurrence of anxiety was determined (r=0.43; p<0.001), depression (r=0.39; p<0.001), cognitive functioning (r=0.48; p<0.001), role functioning (r=0.45; p<0.001) and emotional functioning (r=0,46; p<0.001). The relation between QoL, HADS and the age of a patient was not determined. Conclusions The presence of anxiety, depression, negative evaluations of cognitive, emotional and role functioning of oncological patients is connected with a lower evaluation of QoL.

MASCC-0026 BODY IMAGE-RELATED ISSUES FOR BREAST CANCER SURVIVORS WITH LYMPHEDEMA

B. Rhoten1, E. Radina2, M. Adair3, V. Sinclair3, S. Ridner3 1 School of Nursing, Vanderbilt University, Nashville, USA; 2College of Education Health and Society, Miami University, Oxford, USA; 3School of Nursing, Vanderbilt University, Nashville, USA Background and Aims Lymphedema affects approximately 40 % of breast cancer survivors. It can develop at any time after breast cancer treatment, thus remaining a threat for the rest of a survivor’s life. Subsequently, survivors with lymphedema often have a loss of confidence in body image as a result of this chronic condition. Aim: To present focus group findings related to body image in breast cancer survivors with lymphedema (BCS-LE). Methods Individuals age 18 years or older with a history of Stage II lymphedema subsequent to breast cancer living in the Nashville area were recruited to participate in four focus groups at Vanderbilt University School of Nursing. Discussions were audio recorded and transcribed verbatim. Transcribed data were analyzed by three independent reviewers using ATLAS.ti software. A fourth non-biased outside consultant independently reviewed the transcripts and codes resulting in additional conformation of thematic categories. Results Most participants were middle aged, Caucasian, postmenopausal women with private insurance coverage. Sixty-seven percent (n=14) spoke about some aspect of body image. Two body image-related themes emerged. More than half of participants (n=9, 64 %) had a sense of uneasiness in public. Subthemes included embarrassment and avoidance. A second theme mentioned by 57 % of participants (n=8) was difficulty with apparel. Subthemes included limited clothing options and difficulty wearing clothes. Conclusions BCS-LE have body image-related concerns including a sense of uneasiness in public and difficulty with apparel. These types of body image concerns affect survivors’ every day lives. Intervention studies that address these issues are needed to enhance the quality of life of BCS-LE.

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MASCC-0144 PALLIATIVE RADIOTHERAPY IN LOCALLYADVANCED HEAD AND NECK CANCER: A QUALITY OF LIFE STUDY

C. Singh1, S. Gupta1 1 Department of Radiotherapy and Clinical Oncology, S.M.S. Medical College and Hospital, Jaipur, India Background and Aims To evaluate feasibility of a novel, short duration, palliative radiotherapy schedule for advanced inoperable head and neck cancer in terms of palliation of cancer related symptoms and occurrence of acute toxicities. The study also analysed improvement in head and cancer specific quality of life (QoL) after completion of radiotherapy. Methods 40 patients with inoperable head and neck cancer, not fit for radical treatment were included in the study. They received 40 Gy in 10 fractions with two fractions per week. Treatment related toxicity was assessed using common toxicity criteria. Functional assessment of cancer therapy QoL tool was administered before starting and after completion of radiotherapy. The mean value before and after treatment was compared. Results Distressing pain at primary site, dysphagia, neck swelling and hoarseness of voice were common presentations. Incidence of grade III mucositis, dermatitis and pain was 15 %, 5 %, and 30 % respectively. There was no swallowing impact during treatment among 40 % patients and 60 % patients required nasogastric tube placement during treatment. QoL assessment showed improvement in general well-being (summation of physical, social and functional status) but no significant change was observed in head and neck specific score after treatment. Reduction of pain was observed in 90 % patients. Conclusions Short duration palliative radiotherapy is comparable option for advanced inoperable head and neck cancer to achieve significant palliation and is well tolerated with good patient compliance. There was improvement in quality of physical, social, functional well-being.

MASCC-0214 Quality of Life 3 MULTIDISCIPLINARY TEAM FOR ADOLESCENTS AND YOUNG ADULTS(AYA,15–25 YEARS-OLD) WITH CANCER ASSESSMENT: OSCAR LAMBRET CANCER CENTER (COL) IN LILLE EXPERIENCE

G. Carbonnelle1, C. Lervat2, N. Penel3, A.S. Defachelles2, F. Ait-kaci4, J. Jacquot4, M. Mangenot4, M. Delbarre2, H. Sudour-Bonnange2 1 urologic and digestive oncology, Centre Oscar Lambret, Lille, France; 2 pediatric oncology, Centre Oscar Lambret, Lille, France; 3medical oncology, Centre Oscar Lambret, Lille, France; 4supportive care, Centre Oscar Lambret, Lille, France Background and Aims As stressed by many recent publications, Initial management and longterm follow-up of AYAwith cancers require specific and inter-disciplinary supportive care; including psycho-social care. The French National Cancer Institute (INCa) had funded the implementation of some interdisciplinary teams dedicated to AYAwith cancer. In this context, we created a multidisciplinary team including 1 general practitioner, 2 pediatric oncologists, 1 medical oncologist, 1 social worker, 1 special education teacher, 1 psychologist and 1 art-therapist. We describe here the activity done in the first 12 months.

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Methods This team has contributed to the management of 50 AYAwith cancer. Each patient could benefit from an individual evaluation of his unique social, educational or psychological support needs, and then multidisciplinary case discussion before treatment. Medical management had been focused on supportive care, especially fertility preservation. Inclusion in clinical trial has been systematically discussed. Results Seventy-four percent (37/50) of patients who have been discussed in interdisciplinary meeting benefited from a specific AYA supportive care meeting 32 % (16/50) was included in a clinical trial 76 % (38/50) had social worker need 70 % (35/50) had special education teacher need Psychologist and art-therapist was necessary for respectively 58 % (29/ 50) and 52 % (26/50) of the cases. Conclusions Implementation of interdisciplinary team dedicated to AYA is feasible and provide useful expertise for the management of social, educational and psychological needs. More inclusions in clinical research are needed to reach pediatric or adult rate. The AYA’s perspective should be interesting. That’s why we developed a questionnaire regarding our activities to gather opinion of AYAs.

MASCC-0279 Quality of Life 3 FREQUENCY, INTENSITYAND CORRELATES OF SPIRITUAL PAIN AMONG ADVANCED CANCER PATIENTS ASSESSED IN A SUPPORTIVE CARE OUTPATIENT CENTER (SCOC)

M. Delgado-Guay1, H. Moreno1, G. Chisholm1, J. Williams1, S. FrisbeeHume1, E. Bruera1 1 Palliative Care and Rehabilitation, The University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Regular assessments of spiritual distress/spiritual pain in the SCOC setting are limited or no available. We modified the Edmonton Symptom Assessment Scale(ESAS-sf) adding two items following the same scale(0=best, 10=worst) to evaluate: Spiritual Pain(SP) and FinancialDistress(FD). Methods We reviewed 282 consults of AdCa evaluated at our SCOC between October-2012 and January-2013. Symptoms were assessed using ESAS-sf. We determined the frequency, intensity and correlates of selfreported SP(pain deep in your soul/being that is not physical) among these AdCa. Results Mean age (range): 60 years (22–92). 53 % were male. One hundred eighty-nine (65 %) were White, 45 (15 %) African-American, and 34(12 %) Hispanic. 123/282 (44 %) AdCa had SP: mean (95 % Confidence-Interval) 4(3.5–4.4). AdCa with SP had worse Pain [mean(95 %CI) 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p=0.03), depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p<0.0001], anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p<0.0001], drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p<0.0001], Well-Being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p= 0.0136], and FD [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p<0.0001]. SP correlated (Spearman) with Depression r=0.45, p<0.0001; Anxiety r=0.34, p<0.0001; Drowsiness r=0.26, p<0.0001, and FD r=0.44, p<0.0001. Multivariate-analysis showed association with FD [OR (95 % Wald CI) 1.204(1.104–1.313), p<0.0001] and Depression [1.218(1.110–1.336), p<0.0001]. The odds of patients with SP at baseline being also SP at follow

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up were 182 % higher (OR=2.82) than for patients for SP-negative at baseline (p=0.0029). SP at follow up correlates with depression(r=0.35, p<0.0001), anxiety (r=0.25, p=0.001), Well-being (r=0.27, p=0.0006), nausea (r=0.29, p=0.0002), and FD (r=0.42, p<0.0001). Conclusions SP was reported in more than 40 % of AdCa. It correlates with physical and psychological distress. The use of ESAS-sf allows identifying AdCa with SP evaluated in a SCOC. More research is needed.

MASCC-0282 Quality of Life 3 FINANCIAL DISTRESS (FD) AND ITS ASSOCIATIONS WITH PHYSICAL AND EMOTIONAL SYMPTOMS AND QUALITY OF LIFE AMONG ADVANCED CANCER PATIENTS (ADCA)

M. Delgado-Guay1, J. Ferrer2, A. Rieber3, W. Rhondali4, J. Ochoa1, H. Cantu1, G. Chisholm1, J. Williams1, S. Frisbee-Hume1, E. Bruera1 1 Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; 2Geriatrics and Palliative Medicine, The University of Texas Health Science Medical School, Houston, USA; 3General Oncology Medicine, The University of Texas MD Andeson Cancer Center, Houston, USA; 4Hospices Civils de Lyon, Centre de Soins Palliatifs Centre Hospitalier de Lyon Sud., Lyon, France Background and Aims Financial problems are frequent and severe for AdCa and caregivers. There is limited data on the effects of FD on overall suffering and quality of life(QOL) of AdCa. In this prospective cross sectional study, we examined the frequency of FD and its correlates in AdCa. Methods We interviewed 149 AdCa, 77 at a Comprehensive Cancer Center(CCC) and 72 at a General Public Hospital(GPH). AdCa completed self-rated FD(subjective experience of distress attributed to financial problems) numeric rating scale(0=best, 10=worst) and validated questionnaires assessing symptoms(ESAS), psychosocial-distress(HADS), and QOL(FACT-G). Results Median age (Interquartile range:IQR): 60 years(55–65). 74/149 (50 %) were female. 78/149 (52 %) were married. 48/77 (62 %) at CCC vs. 13/ 72(18 %) at GPH were white (p<0.0001); 21/77 (27 %) vs. 32/72 (38 %) were African American (p<0.0001), and 7/77 (9 %) vs. 27/72 (38 %) were Hispanics (p<0.0001). 44/77 (58 %) at CCC vs. 14/72 (19 %) at GPH had college-education and an advanced-degree(p<0.0001). The median (IQR) current-income was $3000 ($1,400–$7,000) for CCC vs. $940 ($350–$1,300) at GPH, p=0.0017. FD was present in 65/75 [86 % (95 %CI=76–93 %)] at CCC vs. 65/72 [90 % (81–96 %)] p=0.45. However the median-intensity of FD (IQR) at CCC was 4(1–7) vs. 8(3–10), p=0.0003. FD was reported as more severe than physicaldistress, distress about physical-functioning, social/family distress and emotional distress by 45 (31 %), 46 (32 %), 64 (43 %), and 55 (37 %) AdCa respectively (all significantly worse for GPH). AdCa reported that FD was affecting their general-well-being (0=not at all, 10=very much) with a median (IQR) of 5(1–8). Spearman-Correlation of FD with FACTG(r =−0.23, p =0.005); HADS-Anxiety(r = 0.27, p = 0.001), ESASAnxiety(r=0.2, p=0.01), and ESAS-depression(r=0.18 p=0.03). Conclusions FD was very frequent in both groups but intensity was double among GPH patients. FD was associated with worse anxiety, depression and poor-QOL. More research is warranted.

MASCC-0225 Quality of Life 3 COMPARISON OF THE EORTC QLQ-LC13 AND THE FACT-L FOR ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH LUNG CANCER

J. Digiovanni1, M. Popovic2, E. Chow2, D. Cella3, J. Beaumont4, S. Gretz4, J. Nguyen4, D. Chu4, N. Pulenzas4, B. Lechner4, H. Lam4, A. Bottomley4 1 Rapid Response Radiotherapy Program, Odette Cancer Centre, Toronto, Canada; 21Rapid Response Radiotherapy Program, Odette Cancer Centre, Toronto, Canada; 3Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Toronto, Canada; 4Rapid Response Radiotherapy Program, Odette Cancer Center, Toronto, Canada Background and Aims Introduction: Quality of life (QOL) remains an important endpoint in lung cancer research. Purpose: To compare and contrast the development, characteristics, validity and reliability of two widely used QOL assessment tools in lung cancer: the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer (EORTC QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). Methods Methods: A literature search was conducted using Ovid MEDLINE, EMBASE, and CENTRAL to identify studies that detailed the use of the EORTC QLQ-LC13 or the FACT-L. Results Results: For the QLQ-LC13, the development process led to a 13- item instrument that assessed coughing, haemoptysis, dyspnoea and pain, as well as the side effects of treatment. International field-testing confirmed the multi-item dyspnoea scale met the minimal standards for reliability (Cronbach’s α>0.70), while the pain items did not form scale with reliability estimates acceptable for group comparisons. Currently, the EORTC QLQ-LC13 is being updated to reflect newer treatments. Conversely, in version 4 of the FACT-L, general QOL concerns and nine lung cancer-specific items, such as shortness of breath and breathing, weight loss, cough, hair loss, and smoking, are assessed. Validity and reliability testing was done using a linear test for trend which showed a highly reliable Trial Outcome Index (TOI) of α = 0.89. Conclusions Conclusion: Inclusion of QOL assessments in clinical trials for lung cancer is important in evaluating patient-reported outcomes for various treatments. Both QOL reported herein have been appropriately validated; thus, choice is dependent on the specific needs of the investigation.

MASCC-0301 Quality of Life 3 COPING WITH A LIFE-THREATENING MALIGNANCYAND ITS TREATMENT: SIMILARITIES AND DIFFERENCES IN YOUNGER AND OLDER ACUTE MYELOID LEUKEMIA (AML) SURVIVORS

V. Ghodraty Jabloo1, H. Breunis2, S. Alibhai2, M. Puts1 1 Nursing, University of Toronto, Toronto, Canada; 2Medicine, University Health Network, Toronto, Canada Background and Aims Few studies have examined coping in AML patients while this disease onset is usually sudden and unexpected, and treatment requires intense

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regimens with significant toxicities. Therefore, our aim was to examine coping with the diagnosis and treatment of AML and 6-month recovery in younger (<60) and older (>60) AML patients. Methods A qualitative prospective study was conducted with participants of an ongoing larger study on quality of life and fatigue. Thirty-one participants were recruited (19 younger and 12 older). Participants were interviewed at 6 months after diagnosis and had just completed treatment as well as 6 months later. Semi-structured interviews were conducting using a topic guide, transcribed verbatim and analysed using the grounded theory approach. Results Both younger and older adults experienced several health problems immediately following treatment completion including fatigue and weakness, and this was still present in many participants 6 months after treatment completion. In all patients the AML diagnosis and treatment led to a reduction in their daily activities; for younger patients with work and family responsibilities this was more bothersome compared to older patients who often reduced their activities due to other health conditions and had fewer demands as most were retired. Most patients were hesitant to initiate long-term plans and were afraid of disease relapse. Fear of relapse was slightly higher in younger patients. Conclusions AML and its treatment had a significant impact on coping and this lasts at least up until 6 months after treatment completion in both older and younger patients.

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Table 1. Concepts and Items in Final Questionnaire Concept 1: Relationship with Health Care Providers - 9 items Examples of Individual Items: Please rate how well you think your oncologist treated your cancer. My oncologists listened to my concerns. My oncologists took good care of me. My oncologist spent right amount of time with me. My nurses listened to my concerns. My nurses took good care of me. Concept 2: Medical Information - 11 items Examples of Individual Items: My health care providers gave me useful information about my cancer. My health care providers gave me useful information about potential side effects of infusion treatment. When I asked for information from a health care provider, I received it in a timely manner. My health care providers explained the purpose of medical tests and procedures I underwent. My health care providers discussed home health services for care after this course of infusion treatment. Concept 3. Communication Regarding Medical Treatment - 6 items Examples of Individual Items: In general, the health care providers involved in my care worked together to coordinate my care. In general, my oncologist discussed decisions regarding my treatment with me. In general, I felt in control of decisions regarding my infusion treatment.

DEVELOPMENT OF A PATIENT-REPORTED OUTCOME QUESTIONNAIRE TO MEASURE SATISFACTION WITH ONCOLOGY CARE

S.D. Mathias1, M.D. Fisher2, J.J. Stephenson3, Y.M. Yim4 1 Patient Reported Outcomes, Health Outcomes Solutions, Winter Park, USA; 2Health Economics & Outcomes Research, HealthCore Inc, Wilmington, USA; 3Research Operations, HealthCore Inc, Wilmington, USA; 4 Health Economics & Outcomes Research, Genentech Inc, South San Francisco, USA Background and Aims Patient satisfaction is a multidimensional concept, consisting of emotional support, communication, side effect management, accessibility, and coordination and continuity of care. In oncology, care has shifted from community cancer clinics to larger hospital-based networks. Patient satisfaction with care received in various treatment settings is largely unknown. To evaluate the content, clarity, and relevance of a new patient-reported outcome questionnaire assessing satisfaction with cancer treatment setting. Methods Questionnaire items were drafted based on a literature review and clinical input. Patients receiving treatment for non-Hodgkin’s lymphoma, breast, lung, or colon cancer with≥1 infusion treatment in the previous 3 months completed a draft questionnaire and participated in a telephone cognitive debriefing interview to evaluate its face and content validity. Results Ten patients were enrolled (mean age: 54.4±12.0 years, 3 male, 3 nonwhite, 4 treated in physician office). All patients felt the questionnaire was ‘very easy’, ‘easy’, or ‘somewhat easy’ to complete (mean completion time: 21 min). Patients found the instructions, questions, ordering, recall period, and response options clear, relevant, and appropriate. Feedback informed revisions, including exclusion and rephrasing of instructions and some questions. The final questionnaire contains 44 items, including 7 concepts, with a 3-month recall period (Table 1).

Concept 4. Cancer Care and Environment - 2 items In general, the atmosphere where I received by infusion treatment was comfortable. In general, the number of other patients receiving infusion treatments when I did was acceptable. Concept 5. Access to Health Care Providers - 10 items Examples of Individual Items: In general, I found the time I spent traveling to receive my infusion treatment was acceptable. In general, I found the time I spent in the waiting room before my infusion treatment was acceptable. In general, I found the total amount of time I spent in the infusion treatment center acceptable. In general, my health care providers were available by phone, if needed. In general, scheduling an appointment was easy. Concept 6. Financial Burden - 2 items Overall, what has been your average monthly out-of-pocket cost related to your infusion treatment only? How much of a financial burden were the out-of-pocket infusion treatment costs to you and your family? Concept 7. Overall Satisfaction - 4 items Examples of individual items: Overall, how satisfied have you been with the care you received during your infusion treatments? Overall, how satisfied have you been with the center where you received your infusion treatments?

Conclusions This study confirmed the content, clarity, and relevance of the questionnaire in a sample of recently or actively-treated cancer patients. The final questionnaire will be valuable in exploring satisfaction of different settings for receipt of cancer care.

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MASCC-0274 Quality of Life 3 COMPARISON OF THE EORTC QLQ-BR23 AND THE FACT-B FOR THE ASSESSMENT OF QUALITY OF LIFE IN PATIENTS FACING BREAST CANCER: A LITERATURE REVIEW

J. Nguyen1, M. Popovic1, E. Chow1, D. Cella2, J.L. Beaumont2, D. Chu1, J. DiGiovanni1, H. Lam1, N. Pulenzas1, A. Bottomley3 1 Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA; 3Quality of Life Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium Background and Aims Quality of life is an established prognostic indicator and study endpoint in breast cancer. Two widely used assessment modules in this patient population are the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Breast Cancer Module (EORTC QLQ-BR23) and the Functional Assessment of Cancer Therapy-Breast (FACT-B). This study compares the development, characteristics, and validity of the EORTC QLQ-BR23 and the FACT-B in the breast cancer population. Findings are related to module use in clinical trials worldwide. Methods A literature search was conducted using Ovid MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify studies that discussed the development, validation, reliability, use and characteristics of the EORTC QLQ-BR23 and the FACT-B. Results Both the EORTC QLQ-BR23 and the FACT-B were developed through patient interviews, literature searches, and expert opinion. Both questionnaires subsequently underwent formal item reduction, resulting in 23 items for the QLQ-BR23 (which is paired with a 30 item general cancer questionnaire) and 10 items for the Breast Cancer Subscale within the 37item FACT-B. Each questionnaire was well received and was found to be both reliable and valid. Scoring, item format, organization and response options differ between the two questionnaires. Conclusions There are similarities and differences between the two questionnaires. Ultimately, decision-making between the questionnaires should be based on the purpose and design of the study or clinical evaluation. Keywords: breast cancer, quality of life, EORTC, FACT

MASCC-0198 Quality of Life 3 INVESTIGATING THE CLINICAL RELEVANCE OF SPIRITUALWELLBEING DOMAINS IN QUALITY OF LIFE ASSESSMENT

I. Olver1, H. Whitford1 1 Research, Cancer Council Australia, Sydney, Australia Background and Aims The bio-psycho-social-spiritual model attests spiritual wellbeing improves quality-of-life (QOL) assessment accuracy, providing clinical utility. Given our mixed attempts to replicate the clinical significance of spiritual wellbeing assessment, we assessed 883 female cancer survivors from a larger study.

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Methods Survivors completed the Depression Anxiety Stress Scale (DASS21); Functional Assessment of Cancer Therapy – General (FACT-G); and Functional Assessment of Chronic Illness Therapy – Spiritual Wellbeing - Expanded (FACIT-Sp-Ex) that assesses spiritual domains of Peace, Meaning, Faith, and the under-researched Relational factor. Results Survivors reporting high life enjoyment at baseline (n=435) reported elevated Peace despite fatigue (?=.46), nausea, (?=.41), and pain (?=.11), all p<.05. Importantly, these findings were only evident for the high Peace/high symptom group combinations. The same significant pattern was evident for those reporting elevated Meaning despite nausea (?=.35), pain (?=.28), and fatigue (?=.25). Results were not significant for Faith or Relational domains. Findings were further supported by low reports of Depression severity (13.7 %) and Anxiety (15.0 %) alongside high reports of symptoms (93–95 %), compared to controls and norms. Conclusions Findings support our previous outcomes in a larger, more homogenous group. Survivors with cancer suffering chronic symptoms appear to make the most of their lives, experiencing elevated peace and/or meaning, lending support to Park and Folkman’s (1997) model of meaning in the context of stress and coping. Peace appears the most neglected construct as a clinically significant influence in QOL in oncology warranting further exploration.

MASCC-0248 Quality of Life 3 HOME CHEMOTHERAPY FOR BONE MARROW CANCER PATIENTS – A QUALITATIVE STUDY OF HOW PATIENTS EXPERIENCE TREATMENT AT HOME

B. Overgaard1, J.C. Froelund1 1 Hematology Ward, Vejle Hospital, Vejle, Denmark Background and Aims The project is about patients with bone marrow cancer who receive chemotherapy at home. The treatment is physically and emotionally stressful for the patients. Patients receiving chemotherapy have also reported diminished quality of life. Therefore it is relevant to develop alternative models of health service delivery, and the belief that treatment at home has fewer detrimental effects have led to the development of home treatment. The purpose of the project is to study how the patients experience home treatment and what significance that has for their daily life. Methods The project consists of a qualitative interview survey, comprising six semi-structured interviews with the patients. The interview analyses have been inspired by the French philosopher Poul Ricoeur ’s text interpretation. Results The results show that the patients prefer home treatment with chemotherapy over hospital treatment, that the patients are less fatigue and stressed, and thus that home treatment has less adverse impact on the patients’ daily lives, that the patients have more energy left over for social relationships and, accordingly, home treatment increases the patients’ quality of life. Furthermore the patients emphasize the importance of having an experienced nurse providing the treatment, as that provides a sense of security. Conclusions The conclusion is that home treatment with chemotherapy can be a safe alternative to hospital treatment, provided there is a close cooperation among patients, nurses and physicians. Home treatment with chemotherapy could be considered as an alternative or addition to the traditional hospital treatment for patients with bone marrow cancer.

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MASCC-0215 Quality of Life 3 COMPLEMENTARYAND ALTERNATIVE MEDICINE IN THE PRIMARY BRAIN TUMOR POPULATION AND ITS ASSOCIATION WITH HEALTH-REPORTED QUALITY OF LIFE

D.M. Randazzo1, M.L. Affronti1, E. Lipp1, F. McSherry2, J.E. Herndon II2, C. Flahiff1 , E. Miller1 , S. Woodring 1 , M. Freeman 1 , P. Healy 2 , J. Minchew1, S. Boulton1, A. Desjardins3, T. Ranjan3, G. Vlahovic4, H.S. Friedman1, K. Peters3 1 Surgery, Duke University Medical Center, Durham, USA; 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA; 3 Neurology, Duke University Medical Center, Durham, USA; 4Medicine, Duke University Medical Center, Durham, USA Background and Aims Complementary and Alternative Medicine (CAM) refers to a nonmainstream approach to health care. This holistic field of healthcare is growing, not only among the general public, but also in oncology. Use of CAMs occurs in the brain tumor population, but little is known about its effect on health-related quality of life (HRQoL), an increasingly important outcome in clinical trials. The purpose of this study to identify the percentage of brain tumor patients using CAMs, what modalities they are using, and whether or not there is a significant difference in their HRQoL. Methods A database of primary brain tumor patients (PRoGREss) from the Preston Robert Tisch Brain Tumor Center will be used to examine retrospectively CAM usage. Data collected via the modified International CAM Questionnaire (I-CAM-Q) will assess CAM usage such as botanicals, supplements, meditation, massage, yoga, Osteopathy, and Reiki. Assessment of HRQoL is routinely collected in concert with standard medical care and includes FACT-Br, FACIT-F, and Godin-Leisure surveys. Regression analyses will examine the impact of CAM usage on HRQoL with adjustment for other potential confounders such as histologic grade and recurrence status. Results To date, 2,639 primary brain tumor patients have consented for PRoGREss. Data in regards to CAM usage will be analyzed and presented at a later date. Conclusions Brain tumor patients are using CAMs and association with HRQoL will be determined. Because of the increased interest and the limited availability of data with CAMs in oncology, more research is needed.

MASCC-0179 Quality of Life 3 COMPARISON OF THE EORTC QLQ-BN20 AND THE FACT-BR QUALITY OF LIFE QUESTIONNAIRES FOR PATIENTS WITH PRIMARY BRAIN TUMORS: A LITERATURE REVIEW

C. Ronald1, N. Lao1, M. Popovic1, E. Chow1, D. Cella2, J. Beaumont2, H. Lam1, N. Pulenzas1, G. Bedard1, C. DeAngelis1, A. Bottomley3 1 Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA; 3Quality of Life Group, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium Background and Aims For advanced brain tumor patients, quality of life (QOL) has been recognized as a significant treatment outcome which can assist shared

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decision-making. Two commonly used QOL assessment tools for brain tumor patients are the EORTC QLQ-BN20 and FACT-Br. The purpose of this review is to compare and contrast the development, validity and characteristics of the EORTC QLQ-BN20 and FACT-Br QOL assessment tools in patients with brain tumors. Methods A literature search was conducted using the Cochrane Central Register of Controlled Trials, Ovid EMBASE and Ovid MEDLINE to identify studies that discussed the development, characteristics, validity and reliability of the EORTC QLQ-BN20 or the FACT-Br. Results Both assessment tools have been validated for use with primary brain tumor patients, however, the FACT-Br has also been validated for use with patients who have brain metastases from other primary sites. The QLQBN20 assesses the subscales of future uncertainty, visual disorder, motor dysfunction, and communication deficit while the FACT-Br evaluates the subscales of physical, social/family, emotional, and functional well-being. Conclusions Both the EORTC and FACT organizations provide valid measurement options for patients with brain tumors. Questionnaire selection should be based on the suitability of the tool for particular clinical or research needs.

MASCC-0181 Quality of Life 3 HEAD AND NECK CANCER - PATIENTS’ EXPERIENCES BEFORE, DURING AND AFTER TREATMENT WITH RADIOTHERAPY

J. Gornitzka1, C.W. Saevarsson1, L. Sigaard1 1 Department of Oncology, University Hospital Odense, Odense, Denmark Background and Aims Patients have compact and accelerated treatment courses. This study focuses on patients’ experiences related to this. The purpose is to investigate head and neck cancer patients’ experience of treatment course with radiotherapy. Methods Seventeen patients (age range 56–90, mean 65) who had completed radiotherapy were interviewed in three focus groups focusing different aspects related to the treatment course. Results Before treatment Physical impact of disease: Hoarseness, Sore throat, Loosing teeth Psychosocial impact of disease: Switching between hope and fear - Hope concerning treatment, Fear of dying The need of sharing information with relatives During treatment Physical impact of treatment: Side effects after 2 weeks Psychosocial impact of treatment: Busy time – like having a job or go to school everything is scheduled, Accelerators and fixation can be daunting but must be accepted Need of relatives who have overview and practical coping After treatment Late physical effects: Fatigue, Reduced appetite, Dry mouth, Bad swallowing function, Modified voice, Lack of taste and smell Late psychosocial effects: Continued uncertainty The new normal life Social interactions are a challenge

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Conclusions Unpleasant symptoms from throat and mouth changes from being signs of disease to late effects that need coping. In the beginning patients psychological status switch between hope and fear to a more permanent uncertainty at the end of the treatment. Initially, the patient needs assistance from close relationships to cope information and for practical help. Later social interactions are challenged.

MASCC-0417 Quality of Life 4 USING A PERSONALIZED MEASURE (PATIENT GENERATED INDEX (PGI)) TO IDENTIFY WHAT MATTERS TO PEOPLE WITH CANCER

A. Aburub1, A. Rodri’guez1, S. Ahmed1, B. Gagnon2, N. Mayo1 1 Faculty of Medicine School of Rehabilitation Sciences, McGill University Health Centre, montreal, Canada; 2Department of Medicine and Oncology, McGill University Health Centre, montreal, Canada Background and Aims Quality of life (QOL) concerns are not often queried, let alone documented, during a typical clinical encounter yet the information is important to guide care. The Patient Generated Index (PGI), a personalized measure designed to both ask and document QOL concerns could potentially be a valuable clinical and research tool in cancer care. However, but its validity with respect to more standard QOL measures has not been fully established. The purpose of this study is to estimate extent to which information gathered using the PGI is concordant with information gathered from standardized measures of cancer QOL. Methods The data came from a Terry Fox funded study of people with advanced cancer (mean age 64±12 years; 59 % men). Results The most common tumors were pancreas (23 %), lung (17 %), and colorectal (12 %). 192 completed the PGI at baseline and 139 participants 1 year later. At study entry, the most frequent areas affecting QOL were fatigue (39 %), sleep (23 %), pain (22 %), appetite (18 %), and emotional function (15 %). PGI QOL rating was substantially lower (mean 37±25) than ratings from generic measures, EQ-5D (mean 66±17) and SF-6D (mean 65±14), cancer specific measures, the McGill QOL Index – Existential Subscale (mean 81±15) and single items, mean 64±28). The correlation between the PGI and other QOL measures was low <0.3, the other measures intercorrelated somewhat higher, <0.55. Conclusions QOL is by definition a personal construct and as such is best captured using a personal measure rather than a standardized onesize-all measure.

MASCC-0325 Quality of Life 4 REVIEW OF BONE METASTASES RESEARCH IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM (RRRP)

B. Lechner1, N. Pulenzas1, N. Thavarajah1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada

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Background and Aims Bone metastases are a common occurrence in patients with advanced cancer. Complications of bone metastases can include pain, pathological fractures, spinal cord compression, and immobility. Palliative radiotherapy (RT) is an effective treatment option for symptomatic bone metastases. The Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre provides timely RT for palliative cancer patients, focusing on quality of life (QOL) as an important endpoint. To review past research on bone metastases in the RRRP and to discuss the findings and conclusions of these studies. Methods A literature search was performed to identify studies investigating bone metastases in cancer patients referred to the RRRP from 2000 to 2013. All publications pertaining to patients with metastatic bone disease were included. Results Studies in the RRRP have focused on topics including QOL in patients with bone metastases, the incidence and methods to prevent pain flare following RT, optimal treatment regimens for bone metastases, and various patient population subgroups. Conclusions Avast amount of research has been completed and is currently ongoing in the RRRP regarding bone metastases. Substantial work has been accomplished over the years in the RRRP to aid in the development of a bone metastases-specific QOL module, establish standard definitions for RT response and pain assessment, determine ideal RT treatment schedules, and prevent or treat pain flare in patients with bone metastases receiving RT.

MASCC-0344 Populations & Health Services THE RELATIONSHIP BETWEEN CAREGIVING BURDEN AND THE QUALITY OF LIFE AMONG FAMILY CAREGIVERS OF CANCER PATIENTS

S. Rha1, J. Lee2, Y. Park2, S. Song3, C. Lee3 1 Medicine, Yonsei University, Seoul, Korea; 2Nursing, Eulji University, Daejeon, Korea; 3Yonsei Cancer Hospital, Severance Hospital, Seoul, Korea Background and Aims Current cancer care engage family members as caregivers of cancer patients which creates considerable caregiving burden and influence to their quality of life (QOL). The purpose of this study was to describe the influence of caregiving burden on QOL among family caregivers of cancer patients controlling for determinants of caregiving burden and the QOL. Methods A total of 212 caregivers had participated in this descriptive study. Instruments included the Korean version of the Zarit Burden Interview (K-ZBI) and WHOQOL brief (WHOQOL BREF). Caregivers’ demographics as well as cancer patients’ disease and treatment related information were inquired to identify determinants of caregiving burden and QOL. Descriptive statistics, t-test, ANOVA and Pearson correlation, and multiple regression were used to analyze the data. Results Caregiving burden explained 30.6 % of variance of the total WHOQOL (β=−0.590, p<.001). Higher caregiving burden was experienced by caregivers residing with patients (β=.197, p=.041), caring patients with functional deterioration (β=.280, p<.001), and older patients (β=.155,

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p<.034). Caregivers' educational level (receiving college education) was the only contributing caregiver related factor for the total WHOQOL (β=.141, p=.026). Fig 1: WHOQOL-BREF mean scores

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item to total score correlations estimated the contribution of each item to the score. Rating scale efficacy was evaluated by comparing mean subject measures for each category of the rating sale. Results Of the 22-items in the scale, 20 exhibited sufficient infit MSEs (0.5–2.0) and correlated with total score (mean=0.57, lowest correlation 0.36). Two items had unacceptable infit MSEs (>2.0) and poor correlation to total score (−0.01 and 0.04). Estimate of reliability for subjects and items were high (α=0.91 and 0.99 respectively). The mean scores for subjects increased as the rating scale categories increased. Conclusions Due to the strong demonstrated reliability, the EORTC QLQ-BM22 is a useful tool with an efficacious rating scale. All items except two had fair to excellent MSEs and correlation to overall score. As these two items were at the end of the module and scored on a reversed scale, ways can be explored to improve the sub-scale scores and to improve individual item contribution.

Fig 2: Emotion thermometers tool

MASCC-0455 Quality of Life 4

Conclusions Caregiving burden was the most influential, negatively affecting factor for the QOL, whereas caregivers' educational level contributed to better QOL. Assessment of caregiving burden with special attention to caregivers residing with patients, caring patients with functional decline and older patients would identify caregivers in need of support. Caregivers’ educational level needs to be considered in the evaluation of the QOL. Supportive care which could ease caregiving burden and improve the QOL for at risk caregivers is recommended.

MASCC-0452 Quality of Life 4 RASCH ANALYSIS OF THE EORTC QLQ-BM22 MODULE TO ASSESS HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH BONE METASTASES

E. Wong1, A.H. Pakpour2, D.M. Lawson3, M. Popovic1, E. Chow1, A. Bottomley4 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Public Health, Qazvin University of Medical Sciences, Qazvin, Iran; 3 Chiropractic, D’Youville College, Buffalo, USA; 4Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium Background and Aims The European Organisation for Research and Treatment of Cancer Quality of Life Scale Bone Metastases Module (EORTC QLQ-BM22) is a quality of life tool used in conjunction with the general EORTC QLQC30. The objective of this study was to apply the Rasch mathematical model, which determines the performance of individual items, to the EORTC QLQ-BM22. Methods From 2010 to 2014, 565 subjects from 8 countries were included. Internal consistency was estimated with Cronbach’s α for subjects and items. Mean square estimates (MSEs) determined suitable fit of the items, and

MINIMAL CLINICALLY IMPORTANT DIFFERENCES IN THE EORTC QLQ-BN20 IN PATIENTS WITH BRAIN METASTASES

E. Wong1, L. Zhang1, G. Bedard1, R. McDonald1, M. Tsao1, C. Danjoux1, E. Barnes1, L. Holden1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Quality of life (QOL) is an important treatment endpoint in advanced cancer patients with brain metastases. In clinical trials, statistically significant changes can be reached in large enough populations, however these changes may not be clinically relevant. The objective of this study was to determine the minimal clinically important difference (MCID) for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Brain Module (EORTC QLQ-BN20) in patients with brain metastases. Methods Patients undergoing radiotherapy for brain metastases completed the EORTC QLQ-BN20 and QLQ-C30/C15 at baseline and 1 month follow-up. MCIDs were calculated for both improvement and deterioration using anchor and distribution based approaches. The anchor of overall QOL (as assessed by question 30 on the QLQ-C30 or question 15 on the QLQ-C15) was used to determine meaningful change. Results A total of 99 patients were included in the MCID calculation. Average age was 61 years and the most common primary cancer sites were lung and breast. Statistically significant meaningful differences were seen on two scales. A decrease of 6.1 (0.8 to 11.4) units and 13.8 (0.2 to 27.4) units were required to represent clinically relevant deterioration of seizures and weakness of legs. Distribution-based MCID estimates tended to be closer to 0.5 SD on the EORTC QLQ-BN20. Conclusions Understanding MCIDs allows physicians to determine impact of treatment on patients’ QOL and sample sizes for clinical trials. Future studies should be conducted to validate in a larger population of patients with brain metastases.

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MASCC-0408 Rehabilitation PREDICTORS OF WEIGHT CHANGE ON COMPLETION OF AN INTERPROFESSIONAL PALLIATIVE REHABILITATION PROGRAM

A.M. Burns1, A. Feldstain2, R. Bhargava3, M. Chasen1 1 Palliative Care, Bruyère Continuing Care, Ottawa, Canada; 2School of Psychology, University of Ottawa, Ottawa, Canada; 3Palliative Care, Bruyère Research Institute, Ottawa, Canada Background and Aims Weight change is often of concern to patients with advanced cancer having anorexia cachexia syndrome (ACS). This study aims to examine the predictors of weight change including fatigue, anxiety and appetite in patients enrolled in an 8 week interprofessional Palliative Rehabilitation Program (PRP). Methods Patients enrolled in the PRP were asked to complete several assessment measures prior to and following participation in an 8-week interprofessional program that included individualized nutritional counseling interventions. The Patient Generated Subjective Global Assessment (PGSGA), Hospital Anxiety and Depression Scale (HADS), and the Multidimentional Fatigue Inventory (MFI) completed by the patients enables the team to assess nutrition, anxiety and general fatigue respectively. Results Participants included 26 patients with heterogeneous advanced cancers (12 female, 14 male). The mean age of the sample was 63.69 (SD= 13.01). A linear regression indicated that this model accounted for 30 % of variance in weight change and was significant, F (3,22)=4.60, p= 0.012). Change in malnutrition (PGSGA: mean=−2.12, SD=4.90) was a significant predictor of weight change, (mean=−0.01, SD=3.12, p= 0.015). Changes in anxiety (HADS: mean=−1.62, SD=2.70) and general fatigue (MFI subscale: mean=-1.04, SD=4.09) were not significant predictors. Conclusions An interdisciplinary Palliative Rehabilitation Program that includes nutritional guidance and counseling can help patients decrease malnutrition, gain weight, potentially improve functional outcome and overall quality of life.

MASCC-0496 Rehabilitation AN EXAMINATION OF PHYSICALTHERAPY PRACTICE PATTERNS IN THE REHABILITATION OF INDIVIDUALS WITH CANCER IN INDIA

K. Guru1, U. Manoor2, S. Supe3 1 Physiotherapy, Srinivas College of Physiotherapy & Research Center, Mangalore, India; 2Radiation Oncology, Bangalore Hospital, Bangalore, India; 3Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, India Background and Aims Physiotherapists contribute significantly to the maintenance of functional independence and quality of life among cancer patients through early intervention and community follow up. Very little has been documented about the extent Physiotherapists are involved in the care and management of individuals with functional deficits related to cancer in India although physiotherapists are mandatory to promote and maintain physical function. The aim was to examine and describe current practice patterns of Physiotherapists in cancer rehabilitation in India.

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Methods A descriptive study was performed using the survey method for data collection among 1120 randomly selected Physiotherapists licensed and practicing in 3 selected South Indian states. Following institutional review board approval, surveys with consent forms were e-mailed to subjects and subjects received follow-up e-mail reminders. Results One hundred eighty-eight (18.13 %) usable surveys were returned. 62.8 % of therapists reported treating individuals with a history of cancer while only 17.8 % were treating the cancer patients on regular basis. Most common patients were with breast cancer (75 %); common treatments were: home exercise programs and breathing exercises (both 77.1 %), range of motion exercises (68.6 %), chest clearance techniques (64.6 %), strengthening and education (both 60.4 %), and stretching (56.3 %), Monitoring methods were: heart rates (58.3 %), blood pressure (54.2 %), pain scale and O2 saturation levels (47.9 %), Functional outcome measures were: 6 min walk test (41.7 %), quality of life (20.8 %), SF-36 (18.8 %), and Functional Independence Measure (14.6 %). Conclusions We found that, only very few physiotherapists are practicing exclusively in cancer care setting in South India. Intervention types were satisfying while monitoring and functional outcome measures were inconsistently used.

MASCC-0397 Rehabilitation DESIGNING A SELF-MANAGEMENT APPLICATION SUPPORTING (EARLY) REHABILITATION IN PATIENTS AFTER TOTAL LARYNGECTOMY

I.M. Verdonck-de Leeuw1, I.C. Cnossen1, C.F. van Uden-Kraan1, S.E. Eerenstein1, R. de Bree1, C.R. Leemans1 1 Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands Background and Aims Patients after total laryngectomy (surgical removal of the larynx for advanced laryngeal cancer) have to deal with altered speech, swallowing and breathing function, with a major impact on daily life. The aim is to develop a self-management application to support patients in their rehabilitation process. Methods A participatory design process was followed. We conducted a needs assessment with patients (N=9) by means of a focus group interview. In four group meetings, a multidisciplinary team of care professionals (N= 11) discussed the intervention content and structure. A plan of requirements was formulated and translated into an intervention prototype “In Tune without Cords”. Usability of the prototype was tested by end-users (N=6). Speech therapists (N=10) participated in cognitive walkthroughs. Results Based on patients’ needs assessment and group meetings with care professionals, six main intervention topics were identified: 1) mobility exercises for neck and shoulders, 2) speech rehabilitation, 3) voice prosthesis care, 4) tracheostomy care, 5) nutrition, and 6) smell rehabilitation. Usability tests identified some points for improvement in the user interface that resulted in adjustments. Speech therapists were contented about the completeness of information offered and the way the information was offered (multimedia). Considerations appointed during the cognitive walkthroughs concerned the level of tailoring possible and remarks about exercises, animations and movies offered. All intended to implement the intervention in regular care when available. Conclusions Study results give insight into the characteristics needed to design a selfmanagement application for patients after total laryngectomy. A multicentre feasibility study is ongoing.

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MASCC-0379 Rehabilitation IMPLANT-PROSTHETIC REHABILITATION OF 26 POST-ONCOLOGICAL ORAL AND MAXILLOFACIAL PATIENTS

S. Jamshir1, E. Brauner1, G. Guarino1, S. Di Carlo1, G. Pompa1 1 Oral and Maxillo-Facial sciences, Sapienza University of Rome, Rome, Italy Background and Aims After oral cancer treatment, a prosthetic rehabilitation is usually necessary to restore oral functions and aesthetics. The removal of the tumor determines loss of soft and hard tissues and results in terms of rehabilitation are challenging to achieve. Aim of this study is to evaluate osteointegration and marginal bone loss of titanium implants with surfaces enhanced with tantalum (Zimmer Trabecular Metal®) 2 years after loading, in patents with compromised bone anatomy of the jaws, due to resection and/or reconstruction for oncological reasons. Methods Twenty-six patients were rehabilitated through implant-retained overdentures supported by two or four implants. All patients had at least one completely edentulous arch and 14 received radiotherapy. Implants were loaded 3 months after placement. Results

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Conclusions When, despite reconstruction, large bone defects remain, the risk of overload must be considered, because the poor quantity of bone prevents the dentist from placing implants in an ideal position. In such patients we need a strong osteointegration, resistant to overload. The tantalum surface of Zimmer Trabecular Metal® was chosen for its capability to promote bone ingrowth into the porous material.

MASCC-0462 Rehabilitation FUNCTIONAL OUTCOMES OF NEUROFIBROMATOSIS PATIENTS WHO RECEIVED INPATIENT REHABILITATION INTERVENTIONS

A. Ngo1, E. Bruera2, G. Chisholm3, Y. Guo1 1 Section of Physical Medicine and Rehabilitation, University of Texas MD Anderson Cancer Center, Houston, USA; 2Section of Palliative Care, University of Texas MD Anderson Cancer Center, Houston, USA; 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Neurofibromatosis (NF) type 1 and 2 are autosomal dominant disorders in which patients have multiple neurological and musculoskeletal-based impairments. Their rehabilitation outcomes have not been reported in the literature. In this study, we compared the functional outcomes of patients who received acute inpatient rehabilitation versus those who did not. Methods We retrospectively studied 81 consecutive NF patients at a tertiary cancer center who received inpatient Physical Medicine and Rehabilitation consultations in 2004 until 2012. Fifty were transferred to inpatient rehabilitation (Acute Rehab group) and 31 had alternative dispositions (Consult Only group). Functional independent measures (FIM) of transfers and gait post-operatively and on discharge, and length of stay (LOS) were compared between the groups. Results The mean age for the Acute Rehab and Consult Only groups was 35 and 31 years old, respectively. A significantly higher percentage of the Acute Rehab patients were unmarried (85 % vs. 46 %) (P=0.01). The percentage of patients whose FIM score was ≥6 (independent level) upon discharge was significantly higher in the Acute Rehab group for transfers activity (P=0.04) and near significant for gait (P=0.06). The discharge median FIM scores (transfers, gait) for the Acute Rehab group were significantly higher (P=0.01, P=0.01). The median LOS for the Acute Rehab and Consult Only groups was 22 days and 10 days, respectively (P=0.04) Conclusions Patients undergoing acute rehabilitation had longer lengths of stay, but experienced better functional outcomes. The investment of time and resources for acute inpatient rehabilitation is particularly important in these patients since they are young and single.

MASCC-0461 Rehabilitation

Patients were reappointed at 6, 12 and 24 months after loading. After 24 months the mean probing depth in non-irradiated patients (12) was 2.1 mm, the mean crestal bone loss was 0.41 mm; in irradiated patients the mean probing depth was 2.7, the mean crestal bone loss was 0,53 mm. No implant was lost.

THE EXPERIENCE OF ADVANCED CANCER PATIENTS ATTENDING AN INTERDISCIPLINARY CANCER NUTRITION REHABILITATION PROGRAM FOR THE TREATMENT OF CACHEXIA

M. Parmar Calislar1, Y.H. Luan2, K. Gartshore1 1 Ingram School of Nursing & Oncology, McGill University & Jewish General Hospital, Montreal, Canada; 2Ingram School of Nursing, McGill University, Montreal, Canada

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Background and Aims Cancer cachexia is a debilitating metabolic syndrome causing considerable physical, emotional, and psychosocial effects on patients. Ambulatory cancer nutrition rehabilitation (CNR) programs have been established for the management of cancer cachexia through a comprehensive interdisciplinary approach; though limited evidence on the experience of patients attending such services exists. Improved understanding of the experience of patients attending such programs is needed to further tailor interventions for this population, and to promote the integration of supportive interventions throughout the trajectory of cancer care. The aim of this research study was to explore the experience of patients with advanced cancer and cachexia attending a CNR program. Methods This study was guided by a qualitative descriptive design, and purposive sampling was used to recruit ten cancer patients with at least one clinic visit to a CNR program in an urban university-affiliated cancer center. Semi-structured interviews were audio-recorded, transcribed, and coded. Thematic analysis was conducted concurrently with the data collection. Results Three themes were described by participants: (1) “Being Known to Health Care Professionals” including individualized and accessible care and the element of human connection; (2) “Patient Empowerment” capturing the process of knowledge acquisition to facilitate self-management in care; (3) “Satisfaction with Care” highlighting the integration of cancer rehabilitation services within the broader system. Conclusions Overall, participants described a positive experience with tailored interdisciplinary interventions, and were interested in participating in cancer nutrition rehabilitation when integrated into their general oncology care.

MASCC-0539 Rehabilitation PHYSICALTHERAPY BASED EXERCISE INTERVENTIONS FOR CANCER SURVIVORS IN INDIA-A SYSTEMATIC REVIEW

S. Samuel1, S. Kumar V1, A. Maiya1, D. Fernandes2 1 Physiotherapy, School Of Allied Health Sciences, Manipal, India; 2 Radiotherapy, Kasturba Medical College, Manipal, India Background and Aims Studies show that Physical therapy based exercise interventions help in combating disease & treatment related factors like fatigue, impaired joint range of motion, lymphedema,retained secretions,etc. which decrease the Quality of Life (QoL) in patients with cancer. With the growing burden of Cancer in India there is a great need to know the state of research in exercise interventions for cancer survivors in India. Aims 1. To identify types of cancer in which physical therapy based exercise interventions have been researched in India. 2. To identify different forms of physical therapy based exercise interventions that have been studied among cancer survivors in India. 3. To identify different outcomes of physical therapy based exercise interventions in cancer survivors in India. Methods Search in scientific databases PubMed, IndMed, Scopus, CINAHL, PEDro, Cochrane Library and EMBASE using search terms in combination with Boolean operators, inclusion & exclusion criteria was undertaken.

Results Two studies were selected after screening 3,243 articles in the databases. The first was a physical therapy based exercise intervention in breast cancer patients which lead to improvement in limb girth measurement & QoL. While in the second a study physical therapy based exercise intervention led to improvement in QoL and functional capacity in head and neck cancer patients on chemo-radiotherapy. Conclusions There is a lack of physical therapy based exercise interventions in India with only two studies done till now. The need of the hour is to focus on more research in this area.

MASCC-0099 Rehabilitation 2 REHABILITATION IMPROVES URINARY IRRITATIVE PROBLEMS: REPCA – A RANDOMISED STUDYAMONG PROSTATE CANCER PATIENTS

K.B.D. Karin B. Dieperink1, C.J. Christoffer Johansen2, S.H. Steinbjørn Hansen1, L.W. Lis Wagner3, K.K.A. Klaus K. Andersen4, L.R.M. Lisbeth Rosenbek Minet5, O.H. Olfred Hansen1 1 Department of Oncology, University Hospital Odense, Odense, Denmark; 2Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark; 3University of Southern Denmark, Clinical Institute, Odense, Denmark; 4Statistics Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark; 5Department of Rehabilitation, University Hospital Odense, Odense, Denmark Background and Aims Prostate cancer is the most frequent male malignancy in the Western world. Following improvements in survival, clinical attention has been to counteract treatment-related adverse effects. The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects, quality of life and mental adjustment styles after radiotherapy in patients with prostate cancer. Methods In a single-center oncology unit in Odense, Denmark, 161 prostate cancer patients treated with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79), or to usual care (n=82). Primary outcome was EPIC-26 urinary irritative sum-score. Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported diseasespecific QoL (EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (SF-12), mental adjustment styles (Mini-MAC), pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor electromyography. Intension-to-treat analyses were made with adjusted linear regression. Results The intervention improved, as compared to controls, urinary irritative sum score 5.8 point (Cohen’s d=0.40; P=.011), urinary sum-score (d= 0.34; P=.023), hormonal sum-score (d=0.19; P=.018), the SF-12 Physical Component Summary (PCS) d=0.35; P=.002, and stabilized the fighting spirit P=.025. Patients with moderate or severe impairment gained most. Pelvic floor muscle strength measured by electromyography declined in both groups, P=.0001. Conclusions Rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, SF-12 physical QoL and remained positive adjustment styles stable.

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MASCC-0131 Rehabilitation 2 REHABILITATION AND ADULT ATTACHMENT IN WOMEN WITH NEWLY DIAGNOSED GYNAECOLOGICAL CANCER

K.A. Holt1, D. Gilsaa Hansen2, A. Elklit3, P.T. Jensen1, O. Mogensen1 1 Research Unit of Gynaecology and Obstetrics, Institute of Clinical Research University of Southern Denmark, Odense, Denmark; 2Research Unit of General practice, Institute of Public Health University of Southern Denmark, Odense, Denmark; 3Danish Research Unit of Psychological Trauma, Institute of Psychology University of Southern Denmark, Odense, Denmark Background and Aims Knowledge about rehabilitation of gynaecological cancer and the development of individually adjusted rehabilitation initiatives are needed. Research has shown that adult attachment is important and influence on humane experiences with chronic disease, health behaviour, symptom perception and health-care utilisation. Adult attachment is an individual characteristic and in the context of cancer rehabilitation it may contribute to understanding the expectations of the patient to individually adjusted cancer rehabilitation. The aim is to explore adult attachment among women newly diagnosed with gynaecological cancer, depression, post-traumatic stress disorder (PTSD) and quality of life (QLQ) with a 5-month follow up. Methods A longitudinal study including 151 women, aged 20–75 years, treated surgically for endometrial, cervical or ovarian cancer with data collection May 2012–November 2013. Attachment style and mental symptoms are measured using the Revised Adult Attachment Scale, Major Depression Inventory and Harvard Trauma Questionnaire. EORTC QLQ-C30 and specific symptom surveys are used to measure quality of life. Data were collected during the rehabilitation consisted of two nurse consultations and two telephone conversations. Results The results indicate occurrence of PTSD/depression among women close to surgery, spotted as a substantial psychological burden at the time for establishing the cancer rehabilitation in the clinical practice. The preliminary analysis on attachment dimensions showed significant correlation for depression at baseline. The 5 months follow up showed reduction of PTSD and no cases of depression among women with endometrial cancer. Conclusions The attachment dimensions contribute to rehabilitation with focus on individual approach for the rehabilitation.

MASCC-0120 Rehabilitation 2 BACK TO WORK – MANAGEMENT OF OCCUPATIONAL REINTEGRATION IN THE GERMAN SYSTEM OF SOCIAL SERVICES

C. Kerschgens1 1 Oncology, Vivantes Rehabilitation, Berlin, Germany Background and Aims The way back to work after cancer treatment is an important step towards participation in social life. On the other hand, disabling factors after cancer treatment regarding physical, psychological and mental well-being might reduce the ability to meet occupational requirements. This is an important factor after long-term disease which becomes especially apparent when having to cope with pre-existing work-related stress, especially in jobs with fast developing technologies. The German system of social services offers different means of support which take these factors into account.

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Methods In the German system of social services, there are various ways of support. These include structured programs for reintegration or special training and requalification. In general, during the rehabilitative phase, it is necessary to assess all existing physical, psychological or mental impairments potentially reducing the employee’s ability to meet the requirements of the job as well as potential special needs of the employee at work. Specific programs like the vocationally and medically oriented rehabilitation process (MBOR-concept) are supposed to prepare the patient for occupational reintegration. Results Different players in the German system of social services can be in charge to give financial support depending on the individual situation. Conclusions Due to the prevalence of cancer, the demographic changes and the longer period until retirement the need to keep all employees in their jobs as long as possible is obvious. Ways to reintegrate cancer survivors into working life by different means of occupational rehabilitation are one important instrument to reach this goal.

MASCC-0126 Rehabilitation 2 THE PROGRESSION OF MORBIDITIES (NECK-SHOULDER RANGE OF MOTION, CONSTANT SHOULDER SCORE, QUALITY OF LIFE AND LYMPHEDEMA) IN POST-RADIATION ORAL CANCER PATIENTS

S. Liao1, T. Chang2, K. Tsai3 1 Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan; 3Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Changhua, Taiwan Background and Aims The oral cancer is the 1st cancer happened in middle-age man in Taiwan. Radiation fibrosis syndrome and lymphedema were the common side effects in oral cancer patients, and will deteriorate cancer patients’ quality of life (QOL). The aim of this study is to identify the time-course of neck-shoulder range of motion (ROM), Constant shoulder score, QOL and lymphedema Methods The oral cancer patients who receive surgery and radiotherapy in Changhua Christian Hospital between Oct, 2012 and Sep, 2013 were prospectively followed up. Every patient received the evaluations including ROM, Constant shoulder score, maximal interincisal distance (MID), VAS pain scale, lymphedema scale, face distance for lymphedema, and EORTC QLQ (QLQ C30, H-N 35) when the patients receiving radiotherapy, finished radiotherapy, and every 3-month follow-up. Results Twenty-two patients were completed 1st and 2nd follow-up, and 12 patients was completed 3rd follow-up. 18 patients (88 %) were advanced cancer (stage IVa). The mean age was 58(9.8) years, the number of removed lymph nodes was 40(18), the radiation dose was 6,540 cGy. The flexion/extension/rotation of neck, right shoulder adduction, pain scale, lymphedema and Constant shoulder score significantly improved after radiation. The lymphedema was happened in all patients. The score of nausea, appetite, pain, sense, speech, and weight loss were the worst when finished radiation, then gradually improved. The symptom of dry mouth was progressed after radiotherapy. Conclusions The lymphedema happened in all advanced oral cancer patients even after surgery 6 months. The morbidities of oral cancer has significant improvement after radiotherapy except the symptom of dry mouth.

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MASCC-0012 Rehabilitation 2 EARLY-PHASE DIFFERENCES IN HEALTH-RELATED QOL, PSYCHOLOGICAL STATUS, AND PHYSICAL FUNCTION BETWEEN HLA-HAPLOIDENTICAL AND OTHER ALLO-HSCT RECIPIENTS

S. Morishita1, K. Kaida2, S. Yamauchi1, T. Wakasugi1, K. Ikegame2, N. Kodama3, H. Ogawa2, K. Domen3 1 Department of Rehabilitation, Hyogo College of Medicine Hospital, Kobe, Japan; 2Division of Hematology Department of Internal Medicine, Hyogo College of Medicine, Kobe, Japan; 3Department of Rehabilitation Medicine, Hyogo College of Medicine, Kobe, Japan Background and Aims The purpose of this study is to investigate the differences with respect to quality of life (QOL), psychological status, and physical function between allo-HSCT patients receiving from HLA haploidentical donor (HID) and other donors in the early phase after HSCT. Methods The study included 126 patients (HID group, N=100; other donor group, N=26) who underwent allo-HSCT between July 2007 and December 2012. Patients were evaluated for health-related QOL using the Medical Outcome Study 36-item Short Form Health Survey. Psychological status was measured by Hospital Anxiety and Depression Scale. Physical function was assessed using tests for hand-grip strength, knee-extensor strength, and the 6-min walk test. Results The HID group showed a significantly increased physical functioning, general health, and social functioning subscale score for QOL (P<0.01), greater decline in handgrip and knee-extensor muscle strength (P<0.05), and a trend towards lower depression score (P=0.051), compared to the other donors group. Multivariate analysis confirmed total corticosteroid dose was associated with decreased handgrip strength before and after HSCT (P<0.05). Conclusions Thus, the donor type affected QOL, psychological status, and physical function in allo-HSCT patients; these findings may provide insight into customized rehabilitation strategies for HSCT patients.

MASCC-0329 Rehabilitation 2 CHANGES IN PHYSICAL CAPACITY, NUTRITIONAL STATUS, AND SKELETAL MUSCLE MASS OF ELDERLY PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER RECEIVING CHEMOTHERAPY

T. Naito 1 , T. Okayama 2 , T. Ohashi 2 , Y. Masuda 2 , M. Kimura 3 , H. Murakami1, H. Kenmotsu1, T. Taira1, A. Ono1, H. Imai1, T. Oyakawa1, T. Ishii2, M. Mitsuda2, E. Morita2, K. Mori4, T. Takahashi1, A. Tanuma2 1 The division of thoracic oncology, shizuoka cancer centar, Shizuoka, Japan; 2Division of Rehabilitation Medicine, shizuoka cancer centar, Shizuoka, Japan; 3Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; 4 Clinical trial coordination office, shizuoka cancer centar, Shizuoka, Japan Background and Aims The number of elderly patients with non-small cell lung cancer (NSCLC) is increasing worldwide. The aim of this study is to explore the changes of physical and nutritional status in elderly patients with advanced NSCLC receiving chemotherapy. Methods Patients aged>=70 years with advanced NSCLC (stage III-IV) scheduled to commence first-line chemotherapy were prospectively enrolled. The

institutional review board approved the study protocol. At baseline and 6 weeks after initiating chemotherapy, we measured incremental shuttlewalk distance (ISWD), hand grip strength (HG), serum prealbumine (SPA),body weight (BW), and appendicular skeletal muscle mass (ASM) assessed by bioimpedance analyzer (Tanita BC-190). Cancer cachexia was diagnosed by the international consensus criteria (Fearon K, Lancet Oncol. 2011). Results Among 30 patients (11 women and 19 men) enrolled from Jan. 2013 to Jan. 2014, median age was 74 (range, 70–82) years. Platinum-based combination and single agent chemotherapy were administered in 14 and 16 patients, respectively. At baseline, sarcopenia and cancer cachexia were observed in 21(72.4 %) and 17 (56.7 %) patients. During the first 6 weeks, decline in ISWD (mean difference of -40 m, Wilcoxon signedrank test p=0.0029) and BW (−0.85 kg, p=0.0032) were observed, while there was no statistically significant changes in HG (−0.96 kg, p= 0.0986), SPA (+1.4 mg/dL, p=0.1295), and ASM (+0.47 kg, p=0.1950). Conclusions Majority of elderly patients with advanced NSCLC were sarcopenic and cachectic at baseline. Their walking capacity and BW declined during chemotherapy. (Clinical Trials Registry No. UMIN000009768)

MASCC-0015 Rehabilitation 2 REHABILITATION BY NURSING CONSULTATIONS

T. Nielsen1, M. Kjerholt Mette2, O.T.S. Toftdal-Sørensen Ole2 1 Department of Hematology, Region Sjaelland Sygehus Nord Roskilde, Roskilde, Denmark; 2Department of Hematology, Region Sjaelland Roskilde-Koege Hospital, Roskilde, Denmark Background and Aims The Danish Model of Quality indicates that rehabilitation at an early state must be conducted in the ward. The National Board of Health has published “Cancer Plan III” with a number of recommendations for rehabilitation and palliation. Nursing consultations with educated nurses were established to meet the new trends in the department of Hematoloy in Roskilde for all patients with an identified need. To uncover the effectiveness of new methods, the nursing consultations were established as Action Research Project. Aim: & To detect rehabilitation problems at an early stage & To qualify rehabilitation during and after treatment for hematological disease & To promote the health of individuals at all aspects of the patients life in order to prevent disabilities and improve health during and after treatments Methods • Patient oriented: Narrative approach, follow up by the same nurse, fluent booking • Organizational level: Consultation room with possibility to book patients according to their preferences, electronic documentation • Professional level: Nursing education according to narrative approach, nurses with independent responsibility for follow up Results Nursing consultations meant an earlier focus on rehabilitation and earlier intervention. Focuses in the consultations were patient oriented. To book patients according to their preferences was a big challenge, because the nurses had to organize their work themselves rather than the nursing leader did so. To use narrative approach was a success. Conclusions These results will be background organization of rehabilitation during and after treatment for hematological disease in the future.

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MASCC-0324 Rehabilitation 2 THE ASSOCIATION BETWEEN BASELINE WALKING CAPACITYAND FUNCTIONAL PROGNOSIS OF ELDERLY PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER

T. Okayama1, T. Naito2, T. Ohashi1, Y. Masuda1, M. Kimura3, T. Ishii1, M. Mitsuda1, E. Morita1, T. Oyakawa2, H. Murakami2, H. Imai2, H. Kenmotsu2, T. Taira2, A. Ono2, K. Mori4, T. Takahashi2, A. Tanuma1 1 Division of Rehabilitation Medicine, shizuoka cancer centar, Shizuoka, Japan; 2Division of Thoracic Oncology, shizuoka cancer centar, Shizuoka, Japan; 3Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Shizuoka, Japan; 4Clinical trial coordination office, shizuoka cancer centar, Shizuoka, Japan Background and Aims The number of elderly patients with non-small cell lung cancer (NSCLC) is increasing worldwide. However, there is little evidence about their functional capacity. The aim of this study is to elucidate the impact of baseline walking capacity on activity of daily living (ADL) in elderly patients with NSCLC. Methods Patients aged>=70 years with advanced NSCLC (stage III-IV) scheduled to commence first-line chemotherapy were prospectively enrolled. The institutional review board approved the study protocol. All patients had ECOG-PS of 0-2. Walking capacity was measured by incremental shuttlewalk distance (ISWD) before chemotherapy. ADL was assessed by Barthel index (BI). To assess the functional prognosis, we defined disability free survival (DFS) as the time between the date of the first assessment and the date of 10 points decline of BI, which was calculated by Kaplan-Meier method. Results Among 30 patients (11 women and 19 men) enrolled from Jan. 2013 to Jan. 2014, median age was 74 (range, 70–82) years and BI was 100 points in all patients. Platinum-based combination and single agent chemotherapy were administered in 14 and 16 patients, respectively. Median baseline ISWD was 285 (range, 80–640) m. Patients with high (ISWD>= 285 m) walking capacity tended to have longer DFS than those with low (ISWD<285 m) walking capacity (median DFS, >13.2 vs. 6.9 months, log-rank test p=0.0804). Conclusions Baseline walking capacity might predict functional prognosis of elderly patients receiving chemotherapy against advanced NSCLC. (Clinical Trials Registry No. UMIN000009768)

MASCC-0255 Surgical Oncology OUTCOMES OF ARTERIAL INTERVENTIONALTHERAPY FOR INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER

X. An1, J.B. Wang1 1 Neoplasms and Interventional Radiology, Shanghai First People’s Hospital School of Medicine Shanghai Jiao Tong Universit, Shanghai, China Background and Aims To evaluate efficacy of internal iliac arterial interventional chemotherapy and embolization for invasive bladder urothelial carcinoma. Methods 49 cases of invasive bladder cancer were recruited, including 30 patients with serious hematuria after ineffective conservative therapy. Except 16

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people who did not want surgery, the others could not tolerate radical cystectomy because of accompanying with severe heart or lung diseases. After transcatheter chemotherapy, superior and/or inferior vesical arteries supplying tumors were embolized by Lipiodol emulsion or PVA. Average interval time was 1.5 months and mean number of DSA procedure was 5 times. Results Short term effects were obvious. Twelve hours after DSA, urine color in 24 serious bleeding cases returned to yellow. Hematuria ceased in all patients including one centenarian 1 week later. Long term effects were not as good as short. Complete response in 6 and partial response in 21 patients were achieved. The 1, 3 and 5 year survival rates were 93.88 %, 81.63 % and 53.06 %, respectively. Conclusions Interventional chemoembolization is the preferred treatment for inoperable patients diagnosed as invasive urothelial carcinoma of bladder, especially complained about persistent hematuria. This therapeutics is a fast, safe, effective and bladder-preserving approach, rather than palliative treatment. In order to achieve immediate and reliable efficacy, permanent embolic agents are suggested to administer if angiography show extravasation of contrast or abundance of tumor blood vessels. Notice Lipiodol emulsion cannot be injected unless vesical artery super-selective catheterization. In addition injection speed must be under control in case nontarget embolization by reflux.

MASCC-0612 Surgical Oncology FEASIBILITY OF DIGITAL PHOTO ANALYSIS FOR OBJECTIVE MEASURE OF POSTURAL CHANGES AFTER SURGICAL MANAGEMENT OF HEAD AND NECK CANCERS

K. mannion1, B.A. Murphy2, S.H. Ridner3, J. Deng3, M.S. Dietrich4, K. Stevens5 1 Otolaryngology, Vanderbilt University Medical Center, Nashville, USA; 2 Oncology, Vanderbilt University Medical Center, Nashville, USA; 3 School of Nursing, Vanderbilt University Medical Center, Nashville, USA; 4Biostatistics, Vanderbilt University Medical Center, Nashville, USA; 5School of Medicine, Vanderbilt University Medical Center, Nashville, USA Background and Aims Introduction: The postural changes in head and neck cancer(HNC) patients is evident to medical practitioners, but there are no established methods for objectively studying these changes. Objectives: Evaluate available posture analysis software from the physical therapy discipline to determine the feasibility of use in objective measurement of posture changes in head and neck cancer patients. Methods Anterior, posterior, and lateral photographs of patients previously treated with head and neck cancer resection and reconstruction were captured in front of a posture grid. Trial analysis of these photographs with available software programs were carried out, before analyzing all patients with the software program deemed to be most utile. Results Twety-nine patients were evaluated with Biotonix posture analysis software. Four postural elements were identified as accurately measureable and applicable in head and neck cancer patients: head to shoulder angle on lateral view, shoulder asymmetry on anterior and posterior views, and head deviation from the vertical plane on anterior view. Tight fitting clothing, removing footwear, and placing reflective stickers on physical landmarks prior to photography increased the accuracy of the photo analysis. The horizontal and vertical planes can be used as normal for evaluation of shoulder position

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and lateral deviation of the head on anterior/posterior views. Normal values for deviation of the head from the vertical plane on lateral views are not well established. Conclusions Software photo analysis will be useful in evaluation postural changes in HNC patients; however, this will require standardization of techniques for photo capture and the establishment of grading systems

MASCC-0299 Surgical Oncology CARBON NANOTUBES AS INNOVATIVE DRUG DELIVERY SYSTEMS IN CANCER RECURRENCE PREVENTION AFTER SPARING TYPE SURGERY: MURINE MODEL EXPERIMENTAL STUDY

M.S. Nowacki1, M. Wisniewski2, K. Werengowska-Ciecwierz2, A.P. Terzyk2, T. Kloskowski3, A. Marszalek4, M. Bodnar4, M. Pokrywczynska3, K. Pietkun3, T.A. Drewa5 1 Tissue Engineering Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 2Physicochemistry of Carbon Materials Research Group, Nicolaus Copernicus University in Torun, Torun, Poland; 3Tissue Enginering Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 4 Department of Clinical Pathomorphology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 5Tissue Enginering Department/Urology Department Nicolaus Copernicus Hospital in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland Background and Aims Nanotechnology gives a new hope and possibility for obtaining the new precisely prepared and targeted drug delivery systems. The aim of our work was to evaluate the usefulness of carbon nanotubes combined with cisplatin as a new, self-developed experimental concept of innovative hemostatic dressings preventing local cancer recurrence in murine experimental study. Methods We have used 35 4 -week’s old, male BALB/c-Nude mouse’s. All experiments conducted due the study were approved by the relevant Local Ethical Committee. Animals were divided into five groups: CDDP (M-) CDDP (M+), CONTROL (M-) consisted of 10 mouses, and CONTROL (M+) consisted of 5 mouses. The 5 × 106 786-o cells were injected under the kidney fibrous capsule. When tumors reached the operative size, the NSS were performed. In CDDP (M-) and CONTROL (M-) the resection were performed with surgical parenchymal margin (M-) and in CDDP (M+) and CONTROL (M+) the margin was left (margin positive M+). In CDDP (M-) and CDDP (M+) groups we use the innovative carbon nanotubes filled with cisplatin. In CONTROL (M-) and CONTROL (M+) groups we use carbon nanotubes not filled with any chemical agent. Results In the CDDP (M-) group we haven’t observed any local tumor recurrences. In Group CDDP (M+) one animal were diagnosed with local tumor recurrence. In four of animals from CONTROL (M-) group and in all of animals from CONTROL (M+) the recurrent tumor formation were observed. Conclusions The preliminary results shows that carbon nanotubes can probably play in the future a significant role in the systemic surgical oncology development.

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MASCC-0173 Surgical Oncology DEVELOPMENT AND EVALUATION OF A NURSE COUNSELLING PROGRAM »WOMAN-PRO II« TO IMPROVE SELF-MANAGEMENT OF POSTSURGICAL SYMPTOMS IN WOMEN WITH VULVAR NEOPLASIA

S. Raphaelis1, H. Mayer1, B. Senn2 1 Department of Nursing Science, University of Vienna, Vienna, Austria; 2 Institute for Applied Nursing Science, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland Background and Aims In women with vulvar neoplasia, even minor surgical interventions cause multiple symptoms with illness-related uncertainty considered among the most prevalent. After hospital discharge, affected women face complex symptom self-care tasks. Therefore, counseling on this issue is a crucial intervention to be addressed in clinical practice. However, there is no literature concerning supportive interventions for these patients. The aim of this study is to develop a counseling program on symptom selfmanagement and to compare its efficacy with standardized care by overall symptom prevalence and different aspects of illness-related uncertainty. Methods Development and evaluation of the counseling program are guided by the Medical Research Council framework. Thus, intervention development draws on existing literature and new qualitative research in the field of vulvar neoplasia. Program evaluation takes place in a randomized controlled trial. Ninety women with vulvar neoplasia are recruited from six hospitals in Switzerland, Austria, and Australia and randomized into either standardized care or the counseling program. Patients in the intervention-group receive five consultations at predefined points in time from diagnosis until 6 months after treatment. Data collection is conducted concurrently at these specific checkpoints. Results Results of the intervention development phase indicate that counseling should be provided by an advanced practice nurse and should include information on decision making, specific symptoms, and available health care services. The randomized controlled trial started 2013 and is ongoing until 2015. Conclusions This study will provide first insights in the efficacy of counseling for women affected by this rare disease and will indicate future priorities for their symptom-management.

MASCC-0276 Surgical Oncology MULTIPLE MYELOMA AS SECOND PRIMARY MALIGNAN CIES IN A PROSTATE CANCER PATIENT: A CASE REPORT

X. WU1, M. Popovic1 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Introduction: Multiple myeloma is the most common primary bone malignancy and one of the most common hematologic malignancies that can produce a paraprotein. In the literature, it has never been reported as second primary malignancy after prostate cancer. Objective: To explore differential diagnoses of multiple lytic bones lesions and a soft tissue mass in a patient diagnosed with a 10-year history of prostate cancer treated with hormone therapy. Methods An 82-year-old male was referred to the Rapid Response Radiotherapy Program at Sunnybrook Health Sciences Centre for palliative

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radiotherapy. Due to the patient’s history of prostate cancer, complicated bone metastases was the most likely differential diagnosis. Results Right arm and shoulder were swollen and limited range of motion. Prostate-specific antigen (PSA) was undetectable. A plain film and MRI scan showed a lytic lesion in the proximal humerus and scapula with an extensive soft tissue component. The morphologic appearances of bony lesions did not support metastatic disease of prostate cancer. A CTguided biopsy of the soft tissue component of the lesion was ordered and this patient was instead diagnosed with multiple myeloma. Conclusions Multiple myeloma can be a second primary malignancy in a prostate cancer patient. This report exemplifies the need for further investigation of primary malignancies in metastatic sites when clinical, imaging and laboratory findings do not completely correlate.

MASCC-0277 Surgical Oncology

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Objectives: The purpose of the present case report is to discuss the diagnosis of a patient with moth-eaten destruction in the left distal femur as primary synovial sarcoma. Methods A 20-year-old female was referred to the Liaoning Cancer Hospital & Institute, China. She had presented with some pain in the lower left thigh for 6 months. Results She had a slightly swollen left knee joint and slight limited motion secondary to pain in the left leg. Alkaline phosphatase (ALP) was undetectable. Medical imaging reported the presence of a possible the left distal femur osteosarcoma (plain films, CTand MRI scan (low T1 and high T2). Bone scan showed bone abnormalities in the left distal femur and the left proximal tibia. Surgical pathology confirmed a primary synovial sarcoma in the left distal femur. The patient received one course of adjuvant chemotherapy pre-operatively to a wide surgical resection and reconstruction. Conclusions Synovial sarcoma arises primarily in the soft tissues, but also rarely in bone. This is the first reported case of primary synovial sarcoma in the distal femur.

OPTIMIZATION OF A SURGICAL APPROACH FOR VALIDATION STUDIES IN THE SPINE

X. Wu1, M. Popovic2 1 Department of Surgery, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada; 2Department of Radiation Oncology, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Introduction: Different surgical approaches exist for shrinking tumors in cancer patients while minimally invading the surrounding bone and connective tissue. Objective: To study a safety surgical approach for shrinking the tumor volume. Methods Porcine cervical vertebrae were used to optimize a surgical approach to minimize invasion. Vertebrae C3 and C4 were drilled to position using a radiofrequency ablation device (RFA) in both levels. RFA heated the treatment vertebrae until 70 °C, while there was no heating for vertebrae serving as controls. Results X-ray and MRI data showed no sign of bone fracture; rather, only drilling marks could be appreciated. The animals had no difficulty in normal daily activities after surgery. Conclusions The surgical approach proved successful in evaluating the initial safety of the RFA device.

MASCC-0268 Surgical Oncology PRIMARY SYNOVIAL SARCOMA OF THE DISTAL FEMUR: A RARE CASE REPORT

X. Zhang1, X.W. WU2, M.P. Popovic2 1 Department of Bone and Soft Tissue Tumor, Liaoning Cancer Hospital & Institute, Shenyang, China; 2Department of Radiation Oncology, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Introduction: Synovial sarcoma is a malignant mesenchymal spindle cell tumor which comprises 5–10 % of all soft-tissue sarcomas. Intraosseous presentation is very rare and has only been documented in 11 cases.

MASCC-0484 Survivorship PATIENTS’ EXPECTATIONS OF ONCOLOGISTS AND PRIMARY CARE PROVIDERS (PCPS) IN ADDRESSING REPRODUCTIVE AND SEXUAL HEALTH

W. Cheung1, Y. Wang1 1 Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada Background and Aims The risk of infertility and sexual dysfunction from cancer therapy is inadequately discussed at the time of cancer diagnosis. We surveyed young cancer patients to 1) ascertain their expectations of physicians in addressing these concerns and 2) characterize how patients’ expectations modify the likelihood of having discussions about reproductive and sexual health. Methods Patients aged 20 to 39 diagnosed with solid tumors and alive at >/= 2 years after diagnosis were surveyed to determine their views about oncologists’ and PCPs’ responsibilities for reproductive and sexual health. Using logistic regression, we explored for associations between expectations and whether or not patient-physician conversations had occurred. Results A total of 453 patients were included: median age was 35 years, 29 % were men, and 88 % had ECOG 0. Patients expected their PCPs to be more involved than their oncologists in addressing fertility and sexual function (82 % vs. 76 % and 73 % vs. 49 %, respectively). However, only 55 % and 7 % of individuals actually engaged in conversations about these issues. In multivariate models, higher patient expectations of oncologists’ involvement in reproductive and sexual health did not correlate with greater likelihood of having a discussion (OR 1.22 p = 0.49 and OR 0.99 p=0.98, respectively). Conversely, increased patient expectations of their PCPs correlated with receipt of a discussion about fertility (OR 2.44 p=0.01) but not about sexual function (OR 0.62 p=0.15). Conclusions Patients prefer to address their reproductive and sexual health concerns with their PCPs. Whereas most discussions appear to be driven by

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physician factors, fertility conversations with PCPs can be facilitated by increased patient engagement.

MASCC-0602 Survivorship COMPARISON OF HEAD AND NECK CANCER-RELATED LYMPHEDEMA PREVALENCE USING A PATIENT-REPORTED OUTCOME MEASURE AND CLINICIAN-REPORTED OUTCOME MEASURES

MASCC-0536 Survivorship ASSOCIATION BETWEEN ABDOMINAL FAT DISTRIBUTION AND CLINICAL OUTCOMES IN POSTMENOPAUSALWOMEN WITH OPERABLE STAGE BREAST CANCER

S. Dalal1, D. Hui1, S. Yeung2, I. Ihenacho1, R. Ogunti3, M. De La Cruz1, M. Vidal1, D. Bedi3, R. Dev1, E. Bruera1, J. Litton4 1 Palliative Care, UT MD Anderson Cancer Center, Houston, USA; 2 Emergency Medicine, UT MD Anderson Cancer Center, Houston, USA; 3Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, USA; 4Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA Background and Aims Visceral fat is considered more pathogenic than subcutaneous fat, and may contribute to the negative impact of obesity on breast cancer outcomes. This retrospective study was done to examine the association between abdominal fat distribution and key outcomes. Methods Postmenopausal women with stage I-III breast cancer who received neoadjuvant chemotherapy (NC) were included. Abdominal fat areas were quantified from pre-chemotherapy computed tomography images. Visceral to subcutaneous fat ratio (VSR) was used as metric for abdominal fat distribution, and categorized into quartiles. The association between VSR quartiles, BMI (WHO classification) and key outcomes (pathologic complete response [pCR], relapse-free [RFS], disease-specific [DSS] and overall survival [OS]) were examined, adjusting for relevant factors (age, race, stage, nuclear grade, lymphatic and vascular invasion, hormone receptor status, and NC). Results Of 1,233 patients, 63 % white; 32 % were overweight and 44 % obese. Median BMI was 29 and VSR 0.41. In multivariate analyses (Table), higher VSR quartiles, as compared to the lowest, was associated with lower likelihood of pCR, and worse RFS, DSS and OS.

J. Deng1, S.H. Ridner1, M.S. Dietrich1, N. Wells1, B.A. Murphy2 1 School of Nursing, Vanderbilt University, Nashville, USA; 2VanderbiltIngram Cancer Center, Vanderbilt University, Nashville, USA Background and Aims Recent data support that head and neck cancer (HNC) patients frequently experience secondary lymphedema post cancer treatment. HNC patients may have lymphedema externally (e.g., located at the face and neck) and internally (e.g., involving the pharynx and larynx). However, evaluation and measurement of lymphedema in HNC population is challenging. We report prevalence of external lymphedema involving the neck and face using a patient-reported outcome (PRO) measure as compared to clinician-reported outcome (CRO) measures. Methods A cross-sectional design was used. Study measures included: 1) demographic/medical data; 2) the Lymphedema Symptom Intensity & Distress Survey-Head & Neck (LSIDS-H&N) Soft Tissue Swelling Subscale (PRO); 3) CTCAE Criteria and Foldi’s Scale (CROs). Crosstabulation was used. Results One hundred three HNC patients completed the study. Thirty-five percent of patients reported swelling at least one anatomical site. Using the CTCAE and Foldi’s scale, 36 % and 47 % of patients were found to have lymphedema. There were substantial agreements identified between the PRO and CROs. Conclusions The findings indicate that strong concordance between patient reported and clinician reported soft tissue swelling secondary to lymphedema. Longitudinal studies are needed to determine if a PRO is capable of identifying lymphedema at an early stage when therapeutic interventions may be more effective.

MASCC-0559 Odd Ratio Visceral: (95 % CI)* subcutaneous Pathologic fat ratio complete quartile response P · First 1 · Second · Third · Fourth

0.62 (0.39– 0.98) 0.47 (0.28– 0.78)

Survivorship

#

Hazard Ratio (95 % CI) Relapse-free Diseasesurvival specific survival P 1

0.04 0.003 1.78 (1.15– 2.78)

Overall survival P

1 1.85 (1.11– 3.10) 0.01 2.00 (1.89– 3.38)

A PHASE II EXERCISE RCT FOR AML PATIENTS UNDERGOING INDUCTION CHEMOTHERAPY P

1 0.02

1.99 (1.28– 3.11) 0.009 2.03 (1.29– 3.19)

0.002 0.002

Adjusted Logistic* & Cox Proportional Hazards# Regression Models Conclusions Our study found higher visceral to subcutaneous fat ratio to be associated with worse breast cancer outcomes. The predisposition to accumulate fat viscerally versus subcutaneously may be a novel prognostic factor independent of BMI, absolute fat stores and tumor characteristics.

S.M.H. Alibhai 1 , S. Durbano 1 , N. Timilshina 1 , H. Breunis 1 , J. Brandwein2, G. Tomlinson3, P. Oh3, N. Culos-Reed4 1 General Medicine, University Health Network, Toronto, Canada; 2 Medicine, University of Alberta, Edmonton, Canada; 3Medicine, University Health Network, Toronto, Canada; 4Kinesiology, University of Calgary, Calgary, Canada Background and Aims Curative treatment for acute myeloid leukemia (AML) begins with induction chemotherapy (IC), which requires 4–6 weeks of admission and is associated with extended bed rest and toxicities, leading to worsening quality of life (QOL), fatigue, and physical fitness. Preventive exercise at the time of IC may ameliorate these declines. However, this approach has not been rigorously tested in this population.

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Our objective was to determine the efficacy of a supervised mixedmodality exercise program during IC on QOL, fatigue, and fitness. Methods Adult patients (age 18–80) with AML scheduled to receive IC who were medically cleared for exercise underwent randomization (2 exercise: 1 control). Fitness, QOL, and fatigue measures were completed at baseline and post-IC. The mixed-modality, moderateintensity program was offered 4–5 days per week, 30–45 min per session. Results 83 participants were enrolled. Baseline characteristics were similar in both groups. Recruitment was good (56 %), retention excellent (96 %), and participants were adherent 53 % of the time. QOL significantly improved in both groups from baseline to post-IC. Significant improvements in fatigue occurred in the exercise group alone (p=0.002). Aerobic fitness (6-min walk test) and lower (chair stands) and upper body (grip strength) strength all improved in the exercise group alone (between-group differences p=0.005, p<0.001, and p=0.03, respectively). Conclusions A supervised, mixed-modality exercise program for patients with AML undergoing IC is feasible, safe, and effective at managing side effects including fatigue and declines in fitness and function. A phase 3 RCT will definitively define the role of supervised exercise in this population.

MASCC-0510 Survivorship CANCER SURVIVORS’ PERCEIVED NEED FOR SUPPORTIVE CARE AND THEIR ATTITUDE TOWARDS SELF-MANAGEMENT AND EHEALTH

F. Jansen1 , C.F. van Uden-Kraan2 , V. van Zwieten1, B.I. Witte 3, C.R. Leemans1, I.M. Verdonck-de Leeuw2 1 Dept. of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU University Medical Center, Amsterdam, Netherlands; 3Dept. of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands Background and Aims Cancer survivors often experience unmet supportive care (SC) needs. To improve accessibility to SC, self-management and eHealth are promoted. Objectives To explore the perceived need for SC among cancer survivors and their attitude towards self-management and eHealth and to assess its’ association with socio-demographics, clinical variables, and quality of life (QoL). Methods An online questionnaire on the perceived SC need, and attitude towards self-management and eHealth was completed by 212 cancer survivors from an online panel. Results Participants reported some to strong SC needs, with highest needs reported on the physical domain (66 %), followed by the lifestyle (54 %), social (43 %), psychological (38 %) and life questions (24 %) domain. In general, cancer survivors had a positive attitude towards selfmanagement and eHealth. Higher SC needs were associated with male gender, lower age, treatment with chemotherapy or (chemo)radiotherapy (versus surgery alone), hematologic cancer (versus skin, breast and other

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types of cancer) and lower QoL. Lower age and breast cancer (versus prostate and testicular cancer) were associated with a more positive attitude towards self-management, while higher income, treatment with chemotherapy or (chemo)radiotherapy (versus surgery alone), prostate and testicular cancer (versus hematologic, skin and breast cancer) and lower QoL were associated with a more positive attitude towards eHealth. Conclusions The perceived need for SC among cancer survivors was high, and in general survivors had a positive attitude towards self-management and eHealth. Need and attitude were associated with socio-demographics, clinical variables, and QoL. Therefore, a personalized approach seems warranted to improve and innovate SC targeting cancer survivors.

MASCC-0514 Survivorship TRANSLATION AND VALIDATION OF THE SUPPORTIVE CARE NEEDS SURVEYAND CANCER-SPECIFIC MODULE IN HEAD AND NECK CANCER PATIENTS

F. Jansen1, A.M. Braspenning1, C.F. van Uden-Kraan2, B.I. Witte3, C.R. Leemans1, I.M. Verdonck-de Leeuw2 1 Dept. of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU University Medical Center, Amsterdam, Netherlands; 3Dept. of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands Background and Aims Information on the supportive care needs of head and neck cancer (HNC) patients is scarce. Patient Reported Outcome measures are increasingly being used in clinical practice to assess supportive care needs of patients. However, a valid and precise measure to assess supportive care needs among HNC patients was recently not available. Objectives To translate and validate the Supportive Care Needs Survey Short Form (SCNS-SF34) on the (extent of) need for supportive care and to develop and validate a head and neck cancer (HNC) module. Methods The SCNS-SF34 was translated according to the EORTC guidelines and validated in 127 HNC patients. The HNC-module was developed by a multidisciplinary team and was examined on completeness (i.e. content validity) using report forms of nursing consultations during aftercare. Spearman’s rank correlations were used (SCNS-SF34 and the HNCmodule in relation to several questionnaires (HADS, EORTC QLQC30/H&N35, SHI en SWAL-QOL)) to study convergent validity. The discriminatory validity of age, gender and (time since) treatment were studied using Mann–Whitney or Kruskall-Wallis. Hypotheses were formulated a priori. Results Preliminary findings showed that≥75 % of convergent validity hypotheses and none of the discriminant hypotheses were confirmed. Complementary to the HNC-module, pain in the mouth, problems with smelling/ tasting, coughing, shortness of breath, limited mouth opening and eating were reported. Conclusions The SCNS-SF34 and HNC-module showed good convergent validity; the discriminant validity regarding age, gender and (time since) treatment was limited. For completeness of the HNC-module some items need to be added or modified.

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MASCC-0614 Survivorship IMPROVING REACH AND UPTAKE OF PSYCHOSEXUAL SUPPORT: ASSESSMENT OF INTERVENTION PREFERENCES OF BREAST CANCER SURVIVORS REGARDING SEXUAL CONCERNS

C. Lawsin1, A. Ballard1, H. Dhillon1, K. Hobbs2, P. Butow3 1 Psychology, The University of Sydney, Sydney, Australia; 2Oncology, Westmead Hospital, Sydney, Australia; 3Psychology, University of Sydney, Sydney, Australia Background and Aims Changes to sexuality can lead to psychological distress for cancer survivors impacting the long-term quality of life for both them and their partners. Psychosocial and pharmaceutical interventions have proven beneficial in reducing this burden; however, due to resource limitations, psychosocial and pharmaceutical interventions are not accessible by most cancer survivors and their partners. Objectives: The current study assessed how best to provide psychosexual support and potential barriers to uptake amongst a sample of 141 Australian breast cancer survivors (ave age=50.2). Methods Participants completed an online survey distributed via national support groups and cancer research registries. Results Participants reported that they primarily sought psychosexual support from either a book/article (34 %) or the Internet (30 %) rather than their oncologist (17 %). While most participants utilized some type of medicinal intervention (77 %) many wanted further information regarding available medical treatments and how treatment can affect relationships (Table 1). When asked how participants would like to receive this support, the most popularly ranked modality was online education programs (27 %) followed by books (17 %). Contrary to expectations, only 32 % indicated they would like to participate in interventions with their partner. Similar to previous studies, embarrassment (28 %) and lack of privacy (22 %) were the most commonly cited barriers to uptake of psychosexual support. Conclusions Findings highlight the desire for cancer survivors to received additional psychosexual support, in a private manner. Participants’ preferences offer encouraging support that web-based interventions can reach survivors in need of psychosexual support while addressing feelings of embarrassment and enhancing privacy.

MASCC-0622 Survivorship PLANNED EXERCISE BEHAVIOR AND ITS RELATED FACTORS IN COLORECTAL CANCER SURVIVORS

S. Shun1, Y.H. Lai1 1 Department of nursing, College of Medicine/National Taiwan University, Taipei, Taiwan Background and Aims Although exercise has been recognized as an important factor associated with recurrence with colorectal cancer, the regular exercise participation is low in cancer survivors. Planned exercise behavior should be understood before conducting exercise program. The aims were to (1) explore current planned exercise behavior (i.e., intention, attitude, subjective norm and perceived behavior control), and (2) identify its associated factors in colorectal cancer survivors.

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Methods A cross-sectional design was used, with participants recruited from the outpatient clinics in Northern Taiwan. A set of structured questionnaires was used to assess participants’ demographic and disease related factors, reported exercise behavior, planned exercise behavior, symptom distress and depression. The t test, ANOVA, and Pearson’s correlation were used to examine the association. Results Two hundred and four patients were included in this study. About 67.6 % (n=138) patients reported taking regularly exercise. Those who were older age, with less number of children younger than 18 years, higher level of perceived importance and preference of exercise and with unemployment status tend to take regular exercise. Perceived the importance of exercise and preference with doing exercise were associated with the higher level of the planned exercise behavior including all the exercise intention, attitude, subjective norm, and perceived behavior control. Higher level of depression was only associated with lower level of subjective norm. Conclusions Healthcare providers should understand the cancer survivors’ exercise preferences before conducting exercise program to enhance exercise. Education about the importance of exercise and Understand patients’ exercise preferences are the key factors to enhance and maintain regular exercise.

MASCC-0616 Survivorship SELF-MANAGEMENT PRACTICES AMONG CHINESE BREAST CANCER SURVIVORS: IDENTIFICATION OF FOCI FOR EMPOWERING CANCER SURVIVORS TO LIVE WITH CANCER AS A CHRONIC ILLNESS

J. Sit1, H. Cheng2, C. Chan1, W. So1 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong China; 2School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong Kong China Background and Aims Cancer can be managed as a chronic illness in the survivorship phases of the cancer care continuum. With ongoing survivorship, cancer survivors often engage more actively in self-care and self-management to promote recovery and prevent recurrence. This has led to a paradigm shift in cancer survivorship care from paternalistic approach to collaborative care approach. However, little is known about self-management practice among the growing population of Chinese breast cancer survivors. The study aimed to explore the self-management practice of Chinese breast cancer survivors in the survivorship phases of the cancer care continuum. Methods Qualitative approach with in-depth semi-structured interviews was employed. Twenty-nine participants were selected by purposive sampling from local cancer self-help organizations. Individual Interviews were audio-taped and transcribed verbatim. Interview data were analysed using qualitative content analysis. Results Six categories emerged from the data include managing the residual symptoms; dietary and activity regulations for establishing balance of Yin-Yang and Qi; managing life roles; maintaining harmony between the self and the nature; re-establishing a sense of normalcy; and seeking for peer support. Findings also showed how culture beliefs shaped an individual’s self-management practice. Conclusions Findings were consistent with the Chinese holistic views about health which emphasized the harmony between the body, mind and spirit.

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Greater understanding of the cultural beliefs that underpinned the selfmanagement practice could enhance oncology nurses to develop cultural sensitive collaborative care intervention to empower breast cancer survivors to assume an active role in managing their follow-up care.

MASCC-0419 Survivorship CHANGES IN MARITAL STATUS IN SOUTHERN ITALIAN CANCER SURVIVORS: ROLE OF CULTURE AND RELIGION

P. Tralongo1, S. Roccaro1, S. Iemmolo1, V. Pumo1, A. Di Mari1, M. Iacono1, E. Puzzo1, S. Rametta Giuliano1, A. Surbone1 1 Medical Oncology, Umberto I Hospital, Siracusa, Italy Background and Aims Psycho-social issues in cancer survivorship include changes in roles and relations within couples. To assess how couple’s dynamics in cancer survivors are affected by cultural and religious values. Methods The study was conducted between May and June 2013 by Cancer Assistance Network (RAO) of Syarcuse, Italy, through a telephone survey of 81 long-term cancer survivors, 68 females and 13 males, age 31 to 65 (70.5 % aged 51–65). Seventy-five percent were women with breast cancer; 25 % were man and women with gastric or pulmonary or urogenital cancers, lymphomas and melanomas. Using an ad hoc, previously validated, questionnaire, consenting responders were asked about changes in couple relationship. Results Ninety-nine percent respondents were married on average for over 20 years; only 1 % for less than 5 years. Ninety-five percent couples were together at time of interview; 5 % had separated before cancer diagnosis. None of the respondents faced severe marital problems leading to separation or divorce. Seventy-seven percent respondents were Catholic: 11 % never attended Church, while 74 % did on main occasions. Conclusions No correlation between cancer and changes in marital status were found in Southern Italian long-term survivors. This unusually positive adaptation within couples reflects cultural and religious values and norms. Other contributing unexplored family dynamics deserve further studies.

MASCC-0481 Survivorship PROGNOSTIC SIGNIFICANCE OF CHANGES IN SYMPTOM SEVERITY WITH SURVIVAL FOLLOWING WHOLE BRAIN RADIOTHERAPY IN PATIENTS WITH MULTIPLE BRAIN METASTASES

E. Wong1, M. Tsao1, L. Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1, E. Barnes1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Predicting life expectancy of patients with brain metastases is a challenge. The objective of this study is to determine the significance of changes in symptoms severity following whole brain radiotherapy (WBRT) in predicting overall survival (OS) in patients with brain metastases. Methods From 1999 to 2013, patients who received WBRT and completed a symptoms questionnaire in an outpatient palliative radiotherapy clinic

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with at least one follow-up record were included. OS was calculated from the date of consultation for palliative radiotherapy to date of death or censored at last follow-up date. Symptom changes at follow up were defined as worsened, improved or no change. Univariate and multivariate cox proportional hazard model of OS was conducted for month 1, 2, and 3 follow-ups on changes in 14 symptoms. Results Two hundred and one patients were included. The median age of patients was 63 years with the most common primary cancer sites being the lung and breast. The median OS was 5.0 months (95 % CI: 4.3–7.0), 7.1 months (95 % CI: 5.2–9.5) and 8.8 months (95 % CI: 5.8–11.5) for patients with month 1, 2, and 3 follow-ups, respectively. The most common symptom changes following WBRT were: worsened fatigue, appetite loss and weakness. At follow-up, worsening in nausea, appetite loss, headache, concentration, fatigue and balance were found to be significantly related to OS. Worsened difficulty concentrating, fatigue, nausea and headaches were most predictive of a poorer survival outcome. Conclusions Deterioration of these symptoms at follow up predicts short survival. Appropriate palliative care arrangements should be made accordingly.

MASCC-0473 Survivorship SURVIVAL OF PATIENTS WITH MULTIPLE BRAIN METAST ASES TREATED WITH WHOLE BRAIN RADIOTHERAPY

E. Wong1, M. Tsao1, L. Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1, E. Barnes1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada

Background and Aims For patients with multiple brain metastases, the standard of care is whole brain radiotherapy (WBRT). The objective of this study was to report the outcomes of patients with brain metastases who were treated with WBRT. Methods Patients with brain metastases referred to the Rapid Response Radiotherapy Program at the Sunnybrook Health Sciences Centre from 2004 to 2012 and treated with WBRT were included. Overall survival (OS) was calculated from the start of radiation treatment. Univariate and multivariate cox proportional hazard model of OS was conducted with demographic and medical parameters. Results Nine-hundred-ninety-one patients were included. The mean age was 65.6 years and the most common primary cancer sites were the lung and breast. The median duration of follow-up was 2.6 months (range: 0.1–94). The actuarial median OS time was 2.7 months (95 % CI: 2.5– 2.9). Patients of older age (>60), lower performance status (Karnofsky Performance Status (KPS)<80), male gender, treated with a dose of 20 Gy in 5 fractions, and patients from hospital or arrived by ambulance were more likely to have a shorter survival. Age ≥65, KPS<80 and patients from hospital were the most predictive factors of impending death. Conclusions Patients with brain metastases who are treated with WBRT survive a median of 2.7 months following their treatment. Age, performance status, gender, radiation doses, patient location (home vs. hospital) are significant prognostic factors for survival. Such factors can be considered when recommending further treatment or palliative care for patients.

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MASCC-0472 Survivorship CORRELATING SYMPTOMS WITH SURVIVAL IN PATIENTS WITH MULTIPLE BRAIN METASTASES

E. Wong1, M. Tsao1, L. Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1, E. Barnes1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Having a clear prognosis for patients with brain metastases can allow health care practitioners (HCPs) to determine appropriate palliative management and patients to make informed treatment decisions and plan for the future. The objective of this study was to determine prognosis of symptoms experienced by patients with multiple brain metastases with their survival outcome. Methods Patients with brain metastases treated with whole brain radiotherapy in an outpatient palliative radiotherapy clinic and completed symptom-related questionnaires were included. Overall survival (OS) was calculated from the date of consultation for palliative radiotherapy to date of death or censored at last follow-up date. Univariate and multivariate cox proportional hazard model of OS was conducted on 14 symptoms. Results From 1999 to 2013, 1,662 patients were included. The median OS was 5.1 months (95 % CI: 4.6–5.8). The most common symptoms were: fatigue, insomnia, pain and appetite loss. Through univariate analysis, fatigue (p<0.0001), nausea (p=0.025), appetite loss (p<0.0001), coordination (p=0.011), concentration (p=0.0008), balance (p=0.013) and depression (p<0.0001) were significantly related to OS. Through multivariate analysis, fatigue and appetite loss were most predictive of short survival. Conclusions HCPs should be aware of the shorter prognosis associated with patients exhibiting one or more of these symptoms at consultation for palliation management of brain metastases. As a result, HCPs can tailor care accordingly to maximize patient’s remaining quality of life, help patients make informed decisions and planning, and ultimately improve patientcentered care.

MASCC-0118 Survivorship 2 QUALITY OF LIFE, ANXIETY, AND DEPRESSION IN LONG-TERM CANCER SURVIVORS: PRELIMINARY EVIDENCE FROM AN ITALIAN SURVEY

S. Surbone1, B. Muzzatti2, M.A. Annunziata2 1 Medicine, University of New York, New York, USA; 2Unit of Oncologica Psychology, Centro di Riferimento Oncologico - National Cencer Institute, Aviano (PN), Italy Background and Aims Since long-term survivorship is now a reality for an increasingly number of people diagnosed with cancer, understanding their quality of life (QoL) can inform health care policy as well as help in clinical practice. This study aims to assess QoL (physical and mental functioning), anxiety, and depression for this specific population, and their association with the main clinical and socio-demographic variables. Methods One-hundred and three Italian long-term cancer survivors (defined as persons who have been free from cancer and cancer treatments for at

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least 5 years and/or are undergoing only maintenance or preventive therapies) completed the Short Form 12 Health Survey Questionnaire, the State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale. Results Both physical (p<.001) and mental (p<.001) functioning were worse than those of the Italian general population. Of the people tested, 4.1 % were a probable case of state anxiety, and 20 % were depressed. Physical functioning was associated with age (p=.041). Mental functioning was associated with gender (p=.033). Anxiety was associated with gender (p=.013) and perceived social support (p=.038). Depression was associated with gender (p<.001), perceived social support (p<.001) and the presence of other health issues (p=.002). No associations between the four tested dimensions and education, occupational status, marital status, diagnosis (lymphoma vs. other cancers), or length of the survivorship were found. Conclusions These data support ongoing interest in quality of life, anxiety and depression of long-term cancer survivors and suggest the need for further study of multidimensional functioning in this population.

MASCC-0095 Survivorship 2 IMPACT OF CANCER IN ITALIAN LONG-TERM CANCER SURVIVORS: RELIABILITYAND CONVERGENT VALIDITY OF THE IMPACT OF CANCER SCALE, VERSION 2

M. Annunziata1, B. Muzzatti1, C. Flaiban1, A. Surbone2 1 Unit of Oncological Psychology, Centro di Riferimento Oncologico National Cancer Institute, Aviano (PN), Italy; 2Medicine, University of New York, New York, USA Background and Aims Impact of Cancer, Version 2 (IOC-V2; Ganz et al., 2008) is a questionnaire specifically developed to assess quality of life in cancer survivors. It is composed of 37 items grouped in 8 different factors: Altruism and empathy, Health awareness, Meaning of cancer, Positive self-evaluation, Appearance concerns, Body concerns, Life interference, Worry. Despite its growing diffusion, no data are yet available for Italian cancer survivors. In this work, preliminary psychometric results of a culturally sensitive Italian translation of IOC-V2 are provided. Methods Two-hundred and seventy Italian long-term cancer survivors (persons free from cancer and its treatments for at least 5 years, or undergoing only maintenance/preventive therapies) were administered a culturally sensitive translation of the IOC-V2 together with the Short Form 36 Health Survey Questionnaire, the EORTC Quality of Life Questionnaire Core 30, the Post-Traumatic Growth Inventory. For each IOC-V2 factor, internal consistency was assessed calculating Cronbach’s alpha; temporal stability was assessed calculating Spearman’s correlations between two subsequent administrations; whereas convergent validity was obtained correlating IOC-v2 factors with the subscales of the other administered tools with similar content. Results The internal consistency exceeded 0.70 in each factor excepting Health awareness and Positive self-evaluation. Temporal stability exceeded 0.60 in each subscales, excepting Health awareness, Positive self-evaluation, and Appearance concerns. Finally, the eight factors showed a moderate or substantial convergent validity with the other scales assessing similar constructs. Conclusions Despite their preliminary nature, present data encourage further studies to validate the Italian version of the Impact of Cancer Scale, Version 2.

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MASCC-0097 Survivorship 2 UTILIZATION OF SPERM BANKING IN YOUNG MEN UNDERGOING CHEMOTHERAPY FOR TESTIS CANCER

M. Brames1, S. Case-Eads1, L. Einhorn1 1 Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, USA Background and Aims Testicular cancer, the most common carcinoma in 15–35-year-olds, accounts for 1 % of male malignancies. Eighty percent with metastases achieve disease-free status with chemotherapy +/− surgical resection. Standard chemotherapy is BEP (bleomycin, etoposide, cisplatin) or EP for 3–4 courses. Forty percent of patients receiving chemotherapy have permanent oligospermia, even azoospermia. Impaired spermatogenesis is related to chemotherapy. Sperm banking, an effective method of collecting and storing sperm for future fertility is costly and not routinely covered by insurance. Banking facilities may not be available or may not have been offered. This retrospective study assessed whether sperm banking was done; if not, the reasons why. Methods Charts screened for eligibility. Patients completed 5-point questionnaire. Questions: Did you bank sperm prior to chemotherapy? If yes, have you utilized the stored sperm? Did it result in multiple births? If you did not bank sperm, what was the deciding factor? a) not offered b) time constraints c) cost d) not interested e) other. Eligiblity: > 18 years, 1 year postchemotherapy. Results One hundred fifty-nine questionnaire completions. Ages: 18–63. One hundred five (66 %) did not bank sperm, 30 not offered, 24 of those had advanced disease. 11 patients constrained due to cost, the rest declined, most stating they had children and not interested in further progeny. 54 banked sperm. 13 utilized banked sperm with 9 successful pregnancies, including 3 multiple births. Conclusions Sperm banking should be offered to testicular cancer patients when feasible and reasonable. This study will help identify barriers to routine utilization of sperm banking pre-chemotherapy.

MASCC-0100 Survivorship 2 WORK-RELATED CHALLENGES FOR CANCER PATIENTS DURING TREATMENT IN ROMANIA

C. Dégi1 1 Sociology and Social Work, Babes Bolyai University, CLUJ-NAPOCA, Romania Background and Aims Cancer and work emerged as an international field of research but still there are little data available so far from the non-Western European countries. We aim to address correlates of work ability and work satisfaction during cancer treatment. Methods Data were extracted from APSCO, the first extensive questionnaire based study in Romania, which has a repeated cross-sectional design using proportionate quota sampling in order to be representative for all cancer centres. A mixed and various sample of 784 oncology patients was assessed in 2013. Work-related items from the IIRS, BDI, Rahe’s life events, and FACT-G were selected.

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Results Self-reported work disability was 39.6 % among Romanian cancer patients. Patients perceived work (M=4.38, SD=2.43, max. 7) and health were primarily influenced by illness intrusiveness, compared to relations, recreation, diet or financial situation. Perceived work inability was correlated with being too tired (r/s=.51, ps<0.0001), trouble meeting needs along burden of present physical condition (0.44 and 0.40), forced to spend time in bed (0.43) and feelings of hopelessness (0.35). 56.7 % reported high levels of work satisfaction (including work at home), significantly correlated with work ability (0.67), being able to enjoy life (0.46) and doing things for fun (0.41). Experience of job loss prior to cancer diagnosis had an elevated negative impact on work-related aspects. Conclusions Addressing work and cancer issues from the moment of diagnosis can help to plan survivorship care and to fully determine the impact of cancer on work in Romania. Grants: UEFISCDI PN-II-RUTE-2012-3-0011; UBB GTC 34020/2013

MASCC-0105 Survivorship 2 PRELIMINARY EVALUATION OF HEAD AND NECK EXTERNAL LYMPHEDEMA AND FIBROSIS GRADING CRITERIA

J. Deng1, S.H. Ridner1, M.S. Dietrich1, A.C. Fleischer2, N. Wells1, B.A. Murphy3 1 School of Nursing, Vanderbilt University, Nashville, USA; 2Department of Radiology & Radiological Sciences, Vanderbilt University, Nashville, USA; 3Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, USA Background and Aims Our previous publication compared four available tools for evaluating skin/soft tissue lymphedema and fibrosis and concluded that no validated tools are available for clinicians to clearly document head and neck external lymphedema and fibrosis. To address this gap, we conducted a study to develop the Head and Neck External Lymphedema and Fibrosis (HN-LEF) Grading Criteria. The study aimed to provide an initial evaluation of the HN-LEF Grading Criteria. Methods A cross-sectional design was used. Study measures: 1) lymphedema/ fibrosis physical examination completed independently by two trained staff for interrater reliability (intrarater reliability completed by one of them); and 2) ultrasound examination of the head and neck skin. Reliability estimates used simple agreement and Kappa statistic. Validity assessed via Spearman correlations of HN-LEF grades with ultrasound measurements. Results 1) A total of 60 head and neck cancer (HNC) patients signed informed consent and 54 of them completed the study. 2) Interrater reliability: 91.0 % agreement with Kappa statistic=0.81 (p<0.001) on the presence of some types of lymphedema or fibrosis; 85.1 % agreement regarding the grade of lymphedema and fibrosis (Kappa= 0.70, p<0.001). 3) Intrarater reliability: 96.1 % agreement for type of lymphedema and fibrosis; and 91.4 % agreement for grade. 4) Patterns of increasing skin thickness under the ultrasound examination with the types and severities of lymphedema are apparent (particularly in the neck and cheek regions). Conclusions The study provided initial reliability and validity data for a clinicianreported tool evaluating lymphedema and fibrosis in the HNC population. Further measurement research of the tool is warranted.

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MASCC-0016 Survivorship 2 SELF-RATED HEALTH SUPERSEDES PATIENT SATISFACTION WITH SERVICE QUALITYAS A PREDICTOR OF SURVIVAL IN PROSTATE CANCER

D. Gupta1, K. Patel2, C. Lis1 1 Outcomes Research, Cancer Treatment Centers of America, Schaumburg, USA; 2Radiation Oncology, Cancer Treatment Centers of America, Zion, USA Background and Aims We previously reported higher satisfaction with service quality to be associated with better survival in prostate cancer. However, we cautioned that patients with greater satisfaction with service quality might be the ones with better self-rated health (SRH), a well-established prognosticator of cancer survival. We investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer. Methods Nine hundred seventeen prostate cancer patients (mean age 63 yrs) treated at four CTCA hospitals between July-2011 and March-2013. Patient satisfaction and SRH were measured on a 7-point scale ranging from “completely dissatisfied” to “completely satisfied” and “very poor” to “excellent” respectively. Cox regression was used to evaluate the association between patient satisfaction and survival. Results Majority of patients (n=517) had stage II disease. Seven hundred eightyseven (85.8 %) patients were “completely satisfied”. Three hundred nineteen (34.8 %) patients had “excellent” SRH. There was a weak but significant correlation between satisfaction and SRH (Spearman rho= 0.20; p<0.001). On univariate analysis, “completely satisfied” patients had a significantly lower risk of mortality (HR=0.46; 95 % CI: 0.25– 0.85; p=0.01). Similarly, patients with “excellent” SRH had a significantly lower risk of mortality (HR=0.25; 95 % CI: 0.11–0.58; p=0.001). On multivariate analysis, SRH was found to be a significant predictor of survival (HR=0.35; 95 % CI: 0.14–0.89; p=0.03) while patient satisfaction was not (HR=0.64; 95 % CI: 0.33–1.2; p=0.17). Conclusions SRH supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer. SRH should be used as a control variable in analyses involving patient satisfaction as a predictor of clinical cancer outcomes.

MASCC-0081 Survivorship 2 AN EXPLORATION OF THE EXPERIENCES OF NEWLY DIAGNOSED ORAL CANCER PATIENTS OVER THEIR CANCER ILLNESS TRAJECTORY

B. Noonan1, J. Hegarty1, M. O’Mahony1 1 School of Nursing and Midwifery, University College Cork, Cork, Ireland Background and Aims The main goal of treatment for oral cancer is to guarantee long-term tumour free survival with as little functional and cosmetic damage. Despite progress in developing treatment strategies, cancers of the oral cavity continue to have high mortality rates. The aim of this study was to uniquely explore the dynamic changes in the physical, psychological, social and existential experiences of newly diagnosed patients with oral cancer at the time of diagnosis and at the end of treatment.

Methods A qualitative prospective longitudinal design was employed. Nonprobability purposive sampling allowed the recruitment of 10 participants. The principal data collection method used was a digital audio taped semi-structured interview along with drawings produced by the participants. Data was analysed using latent content analyses. Results Three ‘dynamic’ themes, physical, psychosocial and existential experiences were revealed that interact and influence each other in a complex and compound whole. These experiences are present at different degrees and throughout the entire trajectory of care. Patients have a number of specific concerns and challenges that cannot be compartmentalised into unitary or discrete aspects of their daily lives. Conclusions An understanding of the patient’s experience of their illness at all stages of the disease trajectory, is essential to inform service providers’ decision making if the delivery of care is to be client centred. Dynamic and fluctuating changes in the patient’s personal experience of the cancer journey require dynamic, energetic and timely input from health care professionals.

MASCC-0030 Survivorship 2 BARRIERS TO LYMPHEDEMA SELF-CARE

B. Rhoten1, E. Radina2, M. Adair3, V. Sinclair3, S. Ridner3 1 School of Nursing, Vanderbilt Univeristy, Nashville, USA; 2College of Education Health & Society, Miami University, Oxford, USA; 3School of Nursing, Vanderbilt University, Nashville, USA Background and Aims Approximately 40 % of breast cancer survivors develop lymphedema. Self-care is essential in managing this chronic condition. Adherence to self-care has been less than optimal. To improve outcomes, it is important to identify and address barriers to lymphedema self-care. The aim of this presentation is present focus group findings concerning barriers to self-care in breast cancer survivors with lymphedema. Methods Individuals age 18 years or older with a history of stage II lymphedema subsequent to breast cancer were recruited to participate in four focus groups at Vanderbilt University School of Nursing. Discussions were audio recorded and transcribed verbatim. Data were analyzed by three independent reviewers using ATLAS.ti software. A fourth non-biased outside consultant independently reviewed the transcripts and codes providing additional conformation of themes. Results The majority of participants were middle aged, post-menopausal, urban dwelling, Caucasian females with private insurance. All had stage II lymphedema. Three themes regarding barriers to lymphedema self-care were garnered from the focus groups. The first theme was lack of social support. Subthemes included feeling abandoned, criticized, and misunderstood. A second theme was lack of resources for self-care activities. Subthemes included lack of tangible self-care support and lack of selfcare supplies. The third theme was self-advocacy by default: the need for knowledgeable and proactive healthcare workers. Subthemes included the need to proactively plan for lymphedema complications, educate healthcare workers, and for adequate treatment from the healthcare system. Conclusions Intervention studies are needed to improve social support, resources for self-care activities, and self-advocacy skills in this patient population.

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MASCC-0029 Survivorship 2 ROLE OF C-REACTIVE PROTEIN IN ADULT SOLID TUMOR PROGNOSTICATION

S. Shrotriya1, D. Walsh1, A. Nowacki2, N. Bennani-Baiti1, A. Aktas1, B. Estfan3 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA; 2Quantitative Health Sciences, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA; 3Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA Background and Aims C-reactive protein (CRP), a non-specific marker of inflammation may help cancer prognostication. CRP is secreted by liver due to interleukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF). It has been linked to shorter survival in some cancers. We examined associations between CRP levels and prognosis in solid tumors. Methods Retrospective study of electronic medical records (EMR). Multiple CRP levels at a tertiary cancer center reviewed from 2006 to 2012. Hematological cancer diagnoses excluded. Survival was defined as the time from cancer diagnosis to date of death. CRP reported as median (Quartile 1, Quartile 3). CRP reference range 0–10 mg/L. Results N=4931 with solid tumors identified. Forty-nine percent males. Eightythree percent Caucasian; 15 % African American. Common cancers — Breast 24 %, Prostate 21 %, Lung 13 %, Colorectal 12 %, Bladder 10 % and others. Sixty-six percent had high CRP level; 34 % were normal. Median (Q1, Q3) CRP level in normal group was 5 (3–7) and high was 62 (26–130) mg/L. Overall high CRP observed across solid tumor primary sites: 88 % Esophageal cancer, 81 % pancreas, 78 % colorectal and bladder each, 74 % liver and 72 % kidney and lung each. High CRP level experience shorter survival as compared to normal CRP level (p<0.001). Conclusions 1. Higher median CRP in most solid tumors. 2. Higher CRP associated with shorter prognosis across primary sites. 3. Inverse relationship between absolute CRP values and survival. 4. High CRP ? an adverse prognostic indicator in most solid tumors.

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Cochrane). Inclusion/Exclusion criteria developed. Two reviewers independently reviewed selected research papers. A quality Assessment (QA) score devised and utilized. Studies with QA scores <50 % deemed inadequate and excluded. Results Two hundred seventy-one articles selected for final review. Fortyfive percent prospective studies; 52 % retrospective. Seven had an adequate QA score (80–100 %); 264 intermediate QA score (≥50 % but <80 %). Elevated CRP predicted prognosis in 90 % (245/271) of studies; 80 % of 245 by multivariate analysis, 20 % univariate analysis. High CRP level was not prognostic in 10 % (26/271). Over half (52 %) of all articles were either in gastrointestinal malignancies (GI) or renal cell carcinoma (RCC). High CRP predicted prognosis in 90 % (127 of 141) of the articles in these two tumor groups. Most reports in other solid tumors supported CRP as a prognostic indicator. Conclusions 1. Elevated CRP was prognostic in 90 % of studies in solid tumors. 2. Most studies were in GI malignancies and RCC; a high CRP predicted prognosis in 90 % of both 3. High CRP predicted prognosis in other tumors (lung, pancreas, hepatocellular and bladder). 4. CRP may help determine treatment response and tumor recurrence.

MASCC-0069 Survivorship 2 UNMET NEEDS AND THEIR ASSOCIATED FACTORS AMONG CHINESE HEAD AND NECK CANCER SURVIVORS AT ONE YEAR AFTER TREATMENT: WHAT DOES IT IMPLY TO HEALTHCARE PROFESSIONALS?

W.K.W. So1, O.W.M. Fung2, J.C.Y. Chan2, K.C. Choi2, C.W.H. Chan1, S.Y. Chair2, R.W.M. Wan3, S.S.S. Mak3, W.M. Ling4, W.T. Ng4, B.W.L. Yu5, C.K. Pang5 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; 2The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 3 Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong China; 4Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong China; 5 Department of Surgery, Princess Margaret Hospital, Hong Kong, Hong Kong China

Survivorship 2 C-REACTIVE PROTEIN A PROGNOSTIC INDICATOR IN ADULT SOLID TUMORS: A SYSTEMATIC REVIEW

S. Shrotriya1, D. Walsh1, N. Bennani-Baiti1, S. Thomas1 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA Background and Aims Serum C-reactive protein (CRP) is an acute phase reactant and a stable downstream marker of inflammation. We conducted a systematic literature review to examine the relationship between elevated CRP and prognosis in solid tumors. The role of CRP in prediction of treatment response and tumor recurrence was also determined. Methods Related MeSH (Medical Subject Heading) terms used to search electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, EBM-

Background and Aims Studies have reported that patients with head and neck cancer (HNC) experience distress throughout the cancer trajectory and a significant proportion continue to endure distress after treatment. Examining unmet supportive care needs (SCNs) among these survivors can help healthcare professionals to tailor-make strategies to suit their needs. This study aimed to examine the most common SCNs among Chinese HNC survivors at one year after treatment and identify factors that are associated with various needs. Methods A total of 285 eligible subjects were recruited from the outpatient clinic of three public hospitals in Hong Kong. Data were collected from a survey consists of three parts: 1) demographic and clinical information, 2) the Chinese version of the Short-Form Supportive Care Needs Questionnaire (SCNS-SF34-C) and 3) the supplementary module ‘access to healthcare and ancillary support services.

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Results The most prevalent SCNs among HNC survivors were related to health system and information. Multivariate regression analysis found that age, marital status, education, time spent travelling from home to hospital, time since treatment, co-existing disease, number of symptoms and attitude towards life were significantly associated with various domains of SCN-SF34-C and the supplementary module. Conclusions Healthcare professionals should consider the type of information requested by these survivors. More attention should be paid to those who are younger age, obtained higher education levels, have more symptoms and more pessimistic to address their multiple needs.

MASCC-0335 Survivorship 3 VALUE OF ADVANCED PRACTICE PROVIDER (APP) LED TRANSITION TO SURVIVORSHIP VISITS (TSV) AT STANFORD CANCER INSTITUTE (SCI)

K. Bugos1, J. Foran1, K. Pose2, J. Petree1, C. Williamson1, B. Miralda1, K.G. Bailey1, D.W. Blayney3, M.L. Telli3 1 Nursing, Stanford University Medical Center, Stanford, USA; 2 Lymphoma, Stanford University Medical Center, Stanford, USA; 3 Medicine, Stanford University Medical Center, Stanford, USA Background and Aims Cancer survivorship care is becoming an essential care standard. The timing and elements of the care are still being determined. Since 2012, SCI offered APP led TSV for survivors of breast cancer, acute leukemia, lymphoma and Hodgkin’s disease. Eligibility criteria are complete remission following intensive chemotherapy, surgery and radiation. TSV includes Lickert-scale previsit assessments of common survivor symptoms. Our aim is to evaluate patients’ perception, knowledge and confidence gained from TSVand survivorship care plans (SCP). Methods TSV participants completed a clinic designed survey in Survey Monkey (94 %) or paper (6 %) immediately following their TSV. The anonymous responses were collected from November 5, 2012 to February 11, 2014. Results Of the 104 unique patients, 80 surveys were analyzed. Results are : A standard assessment form helped in communicating symptoms (78/ 80=98 %). The majority of SCP recipients (78/80=98 %) found the SCP increased their knowledge about past treatment and future health recommendations (75/78=96 %). Patients gained confidence about health care providers’ responsibility for each aspect of the patients’ health care (68/73=93 % confident or very confident). Satisfaction with the care received was high (78/80=98 %). Most would like future survivorship visits (52/73−=71 %). Specific to breast cancer survivors, the majority were<6 months from treatment end (66/70=94 %) and rated the optimal time to receive SCP as 1–3 months from treatment end (49/70=70 %). Conclusions Based on patient survey results, APP-led TSVadd a valuable component to patient care at SCI and SCP increase knowledge about past treatment and future health recommendations.

MASCC-0242 Survivorship 3 A QUALITATIVE EXPLORATION OF PERCEIVED SUPPORT CARE NEEDS AMONG BREAST CANCER SURVIVORS

K. Cheng1, E. Lim1, L. Ge1, C. Chan2, W.H. Wong3, C. Koh3 1 Nursing, National University of Singapore, Singapore, Singapore; 2 Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 3Nursing, National University Hospital, Singapore, Singapore Background and Aims There is little research investigating individual breast cancer survivors’ experience of supportive care service and perceived unmet needs following the completion of primary cancer treatment. This qualitative study explores the experiences of women who were in the first 5 years postbreast cancer treatment, and describes their perceived unmet needs. Methods Sixty breast cancer survivors were purposively selected from participants to a supportive care need survey for an in-depth face-to-face semi-structured interview, with the aim of achieving maximum variation on the basis of health information and system score. Interviews were audio recorded and fully transcribed verbatim. Data was analysed using inductive content analysis. Results The median age of participants was 55 years and was on average 2 years post treatment. Five themes, which subsumed a number of categories, were constructed: ‘Continuity of care’, ‘Interactions with health care team’, ‘Emotion issues and needs’, ‘Needs beyond providing and sharing of information’, and ‘Viable option for post-treatment care’. The majority of breast cancer survivors who have completed primary breast cancer treatments have decreased contact with health care professionals, and would hope to receive continuing information and emotional support from the health care professionals in dealing with their health problems and coping with the transition. They also expressed a need for multidelivery modes of supportive services including home-based and e-health options as they have infrequent clinical follow-up and full time work. Conclusions Multifaceted and multi-delivery modes of supportive services are important for women following the completion of primary cancer treatment.

MASCC-0393 Survivorship 3 DEVELOPING AND PILOTING AN EHEALTH APPLICATION FACILITATING SURVIVORSHIP CANCER CARE

I.M. Verdonck-de Leeuw1, C.F. van Uden-Kraan1, S. Lubberding1, F. Jansen1, P. Cuijpers2, C.R. Leemans1 1 Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands; 2Clinical Psychology, VU University, Amsterdam, Netherlands Background and Aims An eHealth application integrating use of patient-reported outcomes, provision of personalized advice and information on symptoms and supportive care, may help cancer survivors in obtaining optimal supportive care. The aim is to develop and test an eHealth application, OncoKompas, through a user-centred design approach. Methods We conducted a qualitative needs assessment among patients (N=30) and care professionals (N=11). Based on the results, OncoKompas 1.0 was developed. Usability of a prototype was tested by patients (N=18) and care professionals (N=20) in a cognitive walkthrough. Patients (N=62) participated in a multi-centre pilot study to assess feasibility.

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Results Needs assessments revealed that an eHealth application was appealing to most patients and care professionals. Patients requested OncoKompas to provide tumour specific information and supportive care options in their own environment. Requirements for usage were: easy to use, nonobligatory, and an addition to care as usual. Usability tests identified some weaknesses in the user interface. Care professionals appointed some considerations concerning the extensive scope and unclear final responsibility. They were pleased about the positive “approach”, complete list of supportive care, and design. The feasibility study showed that patients appreciated the increased insight in their well-being, the offered possibilities to improve their well-being, as well as the opportunity to immediately get started with the tailored advice and supportive care options provided. Conclusions Study results were used to design, build and implement a useful eHealth application. OncoKompas seems to be especially appreciated by patients who recently completed their treatment or continue to experience impaired quality of life.

MASCC-0273 Survivorship 3 IMPACT OF PARTICIPATION IN A COMMUNITY EXERCISE PROGRAM ON PHYSICAL AND PSYCHOLOGICAL HEALTH OF CANCER SURVIVORS

J. Kamath1, S. Victoria1 1 Psychiatry, University of Connecticut, Farmington, USA Background and Aims Patients with cancer experience numerous physical and psychological difficulties, including fatigue, depression, anxiety, and insomnia. Many of these comorbidities have been associated with inflammation and altered hypothalamic-pituitory-adrenal axis function. Evidence suggests that structured exercise can have a significant positive impact on physical/ psychological comorbidities and improve quality of life of cancer survivors. The YMCA of USA in collaboration with the LIVESTRONG foundation has piloted a specialized 12 week exercise program at several sites across the United States. To date, benefits of such community translation of exercise programs to cancer survivors have not been investigated. Objectives: To determine impact of exercise program participation as measured by validated physical, psychological, quality of Life, and immune/endocrine assessments at specific time points. Methods A total of 200 cancer survivors participating in the LIVESTRONG exercise program at the YMCA are being enrolled in the study. Participants undergo assessments at specific time points- prior to, during and after completion of their program participation. The evaluations include assessments of distress using distress thermometer, assessments of fatigue, depression/anxiety, sleep, pain, cogntive function, other physical comorbidities (e.g. lymphedema), quality of life, as well as assessments of cytokine and salivary cortisol levels. Results A total of 22 cancer survivors have undergone study assessments. Participants are primarily breast cancer survivors but also include other cancers. Demographic/clinical characteristics and outcomes of physical, psychological, immune/endocrine assessments of completed participants will be presented. Conclusions The present investigation is first of its kind evaluating benefits of a community exercise program to cancer survivors using comprehensive physical, psychological and biomarker assessments.

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MASCC-0152 Survivorship 3 SELF-REPORTED CHRONIC DISEASE IN THOSE WITH HISTORY OF CANCER – THE INFLUENCE OF SEX AND SOCIOECONOMIC STATUS

B. Koczwara1, M. Miller2, R.J. Woodman3, J. Coveney4, J. Dollman5, C. Mackenzie6, N.M. Berry7 1 Medical Oncology, Flinders Centre for Innovation in Cancer, Adelaide, Australia; 2Nutrition and Dietetics, Flinders University, Adelaide, Australia; 3Medicine, Flinders University, Adelaide, Australia; 4Public Health, Flinders University, Adelaide, Australia; 5School of Health Sciences, University of South Australia, Adelaide, Australia; 6Southgate Institute, Flinders University, Adelaide, Australia; 7Public Health Clinical Systems, Department of Health and Aging, Adelaide, Australia Background and Aims Chronic disease (CD) may be more prevalent after cancer. Low socioeconomic status (SES) is associated with higher incidence of some cancers, worse cancer outcomes and higher prevalence of CD. Little is known whether the association between cancer and CD differs according to sex, and whether it is further influenced by differences in SES. Objectives To examine prevalence of self-reported CD in those with cancer according to sex and SES. Methods We reviewed CD and lifestyle behaviours from a state-wide telephone survey conducted between January 2010 and March 2012 comparing adults who self-reported previous cancer diagnosis and randomly selected age and sex matched controls who did not. Analysis was stratified by sex and adjusted for socioeconomic status (SES). Results Two thousand one hundred three cases and 4,185 controls were included. In men, cancer cases had an increased odds of reporting a previous diagnosis of cardiovascular disease (OR1.39, 95 %CI 1.16, 1.67), high blood pressure (OR 1.30, 95 %CI 1.11, 1.53), high cholesterol (OR 1.35, 95 %CI 1.15, 1.59) and diabetes (OR1.24, 95 %CI 1.01, 1.52) which remained significant, after controlling for SES with the exception of high blood pressure. In women, cancer cases had increased odds of having reported high cholesterol (OR1.23, 95 %CI 1.07, 1.43), diabetes (OR 1.28, 95 %CI 1.04, 1.58) and osteoporosis (OR 1.31, 95 %CI 1.08, 1.58) which was no longer significant after adjusting for SES. Conclusions The prevalence of self-reported CD’s was significantly higher amongst those with history of cancer compared to controls but in women this was largely a result of differences in SES.

MASCC-0138 Survivorship 3 DEVELOPMENT OF AN INTERACTIVE PORTAL FOR BREAST AND LUNG CANCER SURVIVORS: DETERMINATION OF REQUIREMENTS AND EVALUATION OF CONTENT, VISUAL DESIGN AND USABILITY

W. Kuijpers1, W.G. Groen1, H.S.A. Oldenburg2, M.W.J.M. Wouters2, N.K. Aaronson1, W.H. van Harten1 1 Psychosocial research and epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; 2Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands

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Background and Aims In the Netherlands Cancer Institute an interactive portal will be introduced to empower cancer survivors. Possible features of this portal were determined by a literature review. We aimed to develop the portal using a stepwise approach involving end users. Methods We conducted focus groups with 35 cancer survivors and 31 health professionals to verify the features that were identified in the literature review. Subsequently, 16 survivors participated in an interview to evaluate content and visual design of a first prototype in PowerPoint. Finally, 7 survivors participated in a usability test with a functional prototype. Participants performed several tasks (e.g., logging in, filling out a questionnaire, searching for educational materials) while thinking aloud. A content analysis was used to analyse the data. Results Focus groups showed that survivors preferred features that fulfill their information needs (overview of appointments, educational materials, access to personal medical record), whereas health professionals preferred features that provide them with relevant information about the survivors. The interviews confirmed survivor preferences and showed that they preferred an accessible layout. Suggestions for improvement included explanation of medical jargon, using concise texts and adding a wallpaper. Usability tests showed that it was relatively easy to navigate through the website, although some buttons could be placed more logically. Participants also pointed out several textual mistakes. Conclusions Based on the results of the usability tests, a final version of the interactive portal has been developed. During the symposium, we also aim to present preliminary results of a more extensive feasibility study.

MASCC-0184 Survivorship 3 BONE AND LUNG METASTASES 13 YEARS AFTER INITIAL EARLY STAGE BREAST CANCER DIAGNOSIS: A CASE REPORT

D. Lee1, E. Wong2, G. Bedard2, R. McDonald2, M. Popovic2, M. Poon2, E. Chow2 1 Faculty of Medicine, University of Toronto, Toronto, Canada; 2 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Introduction: Although patients with early stage breast cancer can be treated with adjuvant tamoxifen therapy at an early stage with good prognosis, they can still have a risk of recurrence after 5 years of therapy. Evidence suggests that combining tamoxifen with letrozole improves disease-free survival. Objective: Case documentation of early stage breast cancer with metastatic recurrence following sequence therapy of adjuvant tamoxifen and letrozole would add to consequent follow-up recommendations. Methods Methods: The current report documents the case of a 73 year-old woman, who presented with bone and lung metastases 13 years after initial early stage breast cancer diagnosis and treatment. Results Results: The patient underwent a right modified radical mastectomy in 2000 due to early stage breast cancer, followed by 5 years of adjuvant tamoxifen and 2 years of extended-adjuvant letrozole. In January 2013, she started to experience significant pain in her back with no evidence of

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osseous metastatic disease. However, in August 2013, when she presented with increasing dyspnea and a significant weight loss, a CT scan showed multiple pulmonary lesions, which was confirmed to be adenocarcinoma compatible with a primary breast cancer. A bone scan revealed malignancy in the lower spine. Conclusions Conclusions: Early stage breast cancer often recurs within 5 years of adjuvant therapy. As such, the sequential use of tamoxifen and letrozole has been considered a more effective mode of therapy. However, more data regarding the long-term effects of this therapy would be required to optimize current guidelines to monitor for recurrence.

MASCC-0418 Survivorship 3 SELF-REPORTED DISTRESS IN ADULT ACUTE LEUKEMIA SURVIVORS: DURING & AFTER INDUCTION THERAPY

J. Lester1, R. Stout2, K. Crosthwaite2, R. Jones3, J. Flynn4, C. Holloman5, B.L. Andersen6 1 Department of Psychology, The Ohio State University Comprehensive Cancer Center, Columbus, USA; 2Division of Nursing, The Ohio State University James Cancer Hospital & Solove Research Institute, Columbus, USA; 3College of Nursing, The Ohio State University, Columbus, USA; 4Division of Hematology Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA; 5Department of Mathematics, The Ohio State University, Columbus, USA; 6Department of Psychology, The Ohio State University, Columbus, USA Background and Aims Acute leukemia in adults is a life-threatening cancer that is associated with significant morbidity and mortality, with critical distressing situations. The purpose of this study was to identify and compare distress among adult acute leukemia patient groups in acute survivorship & to compare gender differences. Methods A cross-sectional design compared distress in male (n=60) and female (n=40) acute leukemia patients & represented four time periods in acute survivorship. The distress thermometer & related 38-item problem list were used to measure the participants’ self-reported distress. Descriptive statistics summarized data. Relationships between time periods were tested with Chi-square or analysis of variance (ANOVA). For significant findings, post hoc tests were performed to identify relationships between variables & pairs of time periods. Results Participants (N=100) had a mean age of 52.3 years (SD=17.2) with age range from 19-84. Participants reported their perceived health status as excellent (3 %), good (39 %), fair (44 %), or poor (12 %) with a mean response of 2.3 (SD=0.7). Acute leukemia survivors reported a mean distress score of 4.3 (SD=2.8; possible range 0–10), which was not significant across time periods (ps=0.18). The subscales with the highest number of endorsements included emotional (M=2.6;SD=2) & physical (M=6.5, SD=4.5) scales. The practical, family, & spiritual subscales had lower total endorsements (Ms 0.07 to 0.92; possible range of 1–6). Distress was higher in women across time periods (M=5.3, SD=2.7) as compared to men (M=3.7, SD=2.8) Conclusions Psychosocial distress is understudied in adult acute leukemia patients. This study validates that significant distress exists in acute survivorship and should be measured and addressed.

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MASCC-0300 Survivorship 3 THE TRANSITION FROM LIVING DESPITE CANCER TO LIVING WITH CANCER - A QUALITATIVE STUDY ON THE SELF-PERCEPTION OF BREAST CANCER SURVIVORS

H. Mayer1, J. Breuer1 1 Department of Nursing Science, University of Vienna, Vienna, Austria Background and Aims Due to early detection and improved treatment methods, the rate of longterm Breast Cancer Survivors (BCS) has increased over the last years. Considering this fact, there is a broad discussion in the health related literature on whether cancer can be considered a chronic disease. The aim of this study was to clarify whether, from the perspective of the affected individuals, cancer can be considered a chronic disease. Methods Nine in-depth qualitative interviews with BCS were conducted and analyzed. Results An initial model of understanding the situation and the status of BCS emerged from the data. It shows that the breast cancer diagnosis means entering a new reality, without ever returning to their pre-diagnosis lives. Their perception is influenced by both illnessand health-related factors. The status of BCS is unstable; it is a shift between perspectives and a continuous challenge for the affected women. The results also showed two main transitions: living despite cancer turns into living with cancer, and suffering from cancer turns into having suffered from cancer. Conclusions Although the results show similarities to current theories of chronic disease, BCS did not define themselves as chronically ill; nevertheless, their reality had changed and they were never able return to a stable, ‘healthy’ status. Professional care must acknowledge these aspects of breast cancer survivorship, needs to be supportive and offer adequate guidance to BCS.

MASCC-0140 Survivorship 3 FOLLOW-UP CARE AND SURVIVORSHIP ISSUES FACED BY BREAST CANCER SURVIVORS: PERSPECTIVES FROM ASIAN ONCOLOGY PRACTITIONERS

T. Ng1, M.R. Toh1, Y.T. Cheung1, R. Dent2, R. Ng3, A. Chan4 1 Department of Pharmacy, National University of Singapore, Singapore, Singapore; 2Office of Clinical Sciences, Duke-Nus Graduate Medical School Singapore, Singapore, Singapore; 3Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; 4 Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore Background and Aims Introduction In Asia, there is a lack of comprehensive survivorship programs for breast cancer survivors (BCS). In order to design relevant programs for BCS, it is important to obtain insights from Asian oncology practitioners (OP). Objective: To assess the OP’ self-reported roles and barriers in providing cancerrelated follow-up care for BCS.

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Methods This was a cross-sectional survey study. OP were recruited through two regional cancer meetings that took place in Asia. A questionnaire was designed, based on the existing literature, to assess the frequency and severity of physical and psychosocial issues experienced by BCS, and the barriers to follow-up care. Results A total of 127 OP from various professions, with mostly nurses (57.5 %) and oncologists (19.7 %) participated in the survey. The most commonly reported survivorship issues that required management were fatigue (78.5 %) and anxiety (69.3 %). Financial burden (26.7 %) and fatigue (18.3 %) were the most severe issues encountered. Reported practitionerspecific barriers to follow-up care include a lack of time (61.6 %) and lack of communication with other healthcare professionals (53.6 %). For patient-specific barriers to follow-up care, patient’s lack of awareness (76.0 %), financial constraints (72.0 %) and unwillingness to discuss sensitive issues (72.0 %) were commonly cited. Conclusions In Asia, psychosocial issues are the highest priority issues that must be addressed in a survivorship program. Furthermore, additional resources are needed to overcome barriers to implementing survivorship programs for BCS.

MASCC-0310 Survivorship 3 WELLNESS BEYOND CANCER: A PROGRAM REVIEW

M. Rushton1, C. Liska2, G. Larocque2, R. Morash2, R. Segal2 1 Internal Medicine, The Ottawa Hospital, Ottawa, Canada; 2Regional Cancer Program, The Ottawa Hospital, Ottawa, Canada Background and Aims As our population ages and cancer care improves there is a growing population of survivors. These individuals require surveillance for recurrence and late effects of adjuvant therapy. In response, the Wellness Beyond Cancer Program (WBCP) was launched March 2012 at The Ottawa Hospital. The program includes breast and colorectal (CRC) patients. Follow-up by Primary Care Physician (PCP), Nurse Practitioner (NP), or Oncologist stream is determined by the treating Oncologist(s) based on the patients’ complexity of needs and/or risk of relapse. Our study objective was to evaluate success of the program by reviewing referral volumes and satisfaction of discharged patients. Methods All patients discharged were registered into one of three care provider streams. For CRC patients discharged to their PCP, 126 received a detailed survey, 56 (44 %) responded. The survey asked questions around knowledge of care received, program content and satisfaction. Questions were scored from 1 to 5 on level of agreement with each statement: 1=strongly disagree to 5=strongly agree. Results In the first 22 months of the program 1,466 patients were discharged. Summary of outcomes and comparison graphs per disease site are provided. Table 1: Patient Survey Care Plan

Satisfaction WBCP

Clear Useful to Pt Useful to PCP Support Number 50 52 50 49 Score (1–5) 3.9 4.0 3.9 3.9

Quality 50 4.9

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MASCC-0287 Survivorship 3 SUBCLINICAL LATE CARDIOTOXICITYAFTER DOXORUBICIN THERAPY IN CHILDHOOD CANCER SURVIVORS

A.M.A.L. Zidan1, L. Sherief2, A. Elshiekh3, M. Hisham2, S. Saleh4, H.E.B.A. Ahmad4 1 clinical pathology, Zagazig university, Zagazig, Egypt; 2pediatric hematology and oncology, Zagazig university, Zagazig, Egypt; 3Clinical pathology, Zagazig university, Zagazig, Egypt; 4pediatric, Zagazig university, Zagazig, Egypt Background and Aims Chemotherapy induced cardiotoxicity remain the unresolved problem strongly impacting the quality of life and overall survival. the aim of the study: To assess the role of N-terminal probrain natriuretic peptide(NT-pro-BNP) and tissue Doppler imaging(TDI) as early predictor of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin. Methods We carried out a retrospective study on 80 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols. All patients under went blood sampling to determine the levels of NT-proBNP, along with conventional echocardiography and TDI. Results Thirty percent of the survivors had abnormal NT-pro-BNP levels. Abnormal NT-pro-BNP were significantly related to age at diagnosis, duration of follow up and cumulative dose of doxorubicin. Diastolic dysfunction of the left ventricle was the most significant echocardiographic abnormalities. TDI was superior as it detected myocardial affection in 20 % more than conventional echocardiography. Conclusions NT-pro-BNP can be used as a sensitive cardiac biomarker in monitoring of doxorubicin- induced cardiotoxicity. Follow up is essential to validate the role of NT-pro-BNP as early marker for late onset doxorubicin- induced cardiotoxicity. TDI is marvelous as it could detect early cardiac dysfunction even in those with normal study by conventional echocardiography.

MASCC-0114 Symptoms DEPRESSION, INSOMNIA, PAIN IN ADVANCED CANCER – THE MYTH OF THE SYMPTOM CLUSTER

A. Aktas1, D. Walsh1, L. Rybicki1, A. Fitz1 1 The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland, USA

Figures 1–2: Number of patients in Breast & CRC WBCP streams

Conclusions Our program has found success offering different provider options for discharge allowing care to be tailored to meet individual patient needs in cancer survivorship.

Background and Aims Depression, insomnia, and pain (DIP) may cluster in advanced cancer. Direct evidence supporting this hypothesis is lacking. Our objectives were 1) to determine if DIP occur together 2) to determine if DIP is associated with survival after referral to the Palliative Medicine unit. Methods The study cohort included 1000 consecutive advanced cancer patients. Data was collected upon initial consultation by a 38-item symptom checklist. Symptom occurrence (the presence or absence of a symptom) and severity (mild, moderate, severe) were recorded. Correlations among pairs of symptoms (both prevalence and severity) were assessed with Spearman test (r). Cox proportional hazards analysis assessed the effect of

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each symptom on survival; results are summarized as the hazard ratio (HR), 95 % confidence interval (CI) for HR, and P-value. Results Twenty perent of patients have all 3 symptoms. Forty percent have 2 symptoms, 33 % have 1 symptoms, and 7 % have none. Correlations among pairs of symptoms were low; none of the r values exceeds 0.2; depression and insomnia r=0.105 (p=0.001) for prevalence, r=0.152 (p<0.001) for severity; insomnia and pain r=0.084 (p=0.009) for prevalence, r=0.132 (p<0.001) for severity; depression and pain r=0.064 (p= 0.046) for prevalence, r=0.039 (p=0.26) for severity. Pain prevalence was associated with decreased risk of mortality (HR 0.74, CI 0.61–0.89, p=0.001). Survival was not associated with insomnia (HR 0.96, CI 0.84– 1.10, p=0.58), depression (HR 1.03, CI 0.90–1.18, p=0.67), or the number of three symptoms present (HR 0.95, CI 0.88–1.03, p=0.18). Conclusions Co-occurrence was not associated with survival. DIP co-occurred in 20 %. DIP are not a symptom cluster in advanced cancer.

MASCC-0027 Symptoms WEIGHT LOSS: PREDICTORS AND PROGNOSTIC IMPORTANCE IN ADULT SOLID TUMORS

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MASCC-0362 Symptoms BRIEF HYPNOSIS INTERVENTION FOR TREATMENT OF HOT FLASHES AMONG BREAST CANCER SURVIVORS

J. Danis1, E. Barbier1, M.C. Falcou1, A. Burnod1, F. Campana2, C. Bouleuc1 1 Supportive Care, Curie, Paris, France; 2Oncology, Curie, Paris, France Background and Aims Hot flashes are a major problem for breast cancer survivors. They are frequent and can cause discomfort, anxiety, decreased quality of life and may lead to discontinuation of endocrine therapies (tamoxifen, aromatase inhibitors). This study was developed to evaluate the effect of a hypnosis intervention on hot flashes. Methods Fifty-eight female breast cancer survivors with hot flashes have received hypnosis interventions (five sessions weekly, with instruction in selfhypnosis). The major outcome measure was frequency of hot flashes and night sweats. Secondary outcomes measures were maximal discomfort of hot flashes and their impact on quality of life, by self-reports with Numerical Rating Scales. Results Median age 49 years, 55 % received endocrine therapies, 2 % anxiolytic and none antidepressant.

S. Shrotriya1, D. Walsh1, L. Rybicki2, A. Aktas1, B. Estfan3 1 The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA; 2Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; 3Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA Background and Aims Body weight change in adults with solid tumors was examined in outpatients. Objective was to determine if demographics, clinical and biochemical indices predicted weight loss (WL). Examine if WL and related parameters were prognostic for survival. Methods Electronic medical records (EMR) from a tertiary cancer center retrospectively reviewed from 2009 to 2011. Body weight and other clinical parameters on visit 1 - within a year post diagnosis; visit 2≥3 weeks after visit 1. Weight change categorized as: weight gain, 0–5 %, 5.01–10 %, >10 %. Logistic regression and Cox proportional hazards utilized for WL predictors and prognostic factors. Results N=5901; Mean age (±SD): 61±12 years; 82 % were Caucasians; 16 % African Americans. Common cancers were Prostate 19 %; Breast 15 %; Lung 15 %; Colorectal 6 %; Others 12 %. Metastatic disease was present in 18 %. Bone, brain, lymph nodes – common. 45 % had radiotherapy; 41 % chemotherapy. Median WL from visit 1 to visit 2=−1 (−48, 66) kgs. Proportionate reduction in systolic BP, diastolic BP, pulse rate, albumin, hematocrit and hemoglobin noted across WL categories. Median survival in 5.01–10.0 % WL=9.4 months, >10.0 %=5.3 months and not observed≤5 %. Conclusions 1. Majority lost ≤5 % of body weight by visit 2 2. Head & Neck and GI cancers (primary) - the greatest risk of WL; breast – lowest. 3. High BMI predicted greater WL compared to normal or underweight. 4. ≤5 % WL had a survival advantage compared to 5.01–10 % and >10 % 5. WL remained prognostic for survival after adjusting for other prognostic factors.

Hot flashes frequency during 24 h Hot flashes frequency during the day Night hot flashes or night sweats frequency Hot flashes maximal discomfort Hot flashness’s discomfort on quality of life

Before sessions Average (standard deviation)

After sessions Average (standard deviation)

AfterBefore sessions difference

P (Wilcoxon signed rank test with continuity correction)

13.1 (9.49)

8.30 (7.66)

4.77

<0.0001

9.3 (9.17)

5.2 (5.38)

4.1

<0.0001

3.93 (2.64)

2.75 (1.76)

1.18

0.0003

8.08 (1.48)

5.47 (1.78)

2.60

<0.0001

7.39 (1.75)

4.64 (1.81)

2.75

<0.0001

Conclusions Hypnosis appears to reduce frequency of hot flashes and may have benefits on comfort and on quality of life in breast cancer survivors.

MASCC-0377 Symptoms DEVELOPMENT OF A MULTIDISCIPLINARY, THREE PHASED SYMPTOM MANAGEMENT PATIENT CARE FACT SHEET FOR PATIENTS UNDERGOING HEAD AND NECK RADIATION THERAPY

D. Saunders1, S. Carter2, E. Koutsoukis2, V. Charette3, K. Hubert4, A. Pearce5, F. Ishak6, C. Szeto6, T. Rouleau1, T. Fetterly1

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Dental Oncology, Health Sciences North Northeast Cancer Center, Sudbury, Canada; 2Supportive Care, Health Sciences North Northeast Cancer Center, Sudbury, Canada; 3Health Sciences, Laurentian University, Sudbury, Canada; 4Systemic Care, Health Sciences North Northeast Cancer Center, Sudbury, Canada; 5Radiation Oncology, Health Sciences North Northeast Cancer Center, Sudbury, Canada; 6Surgical Oncology, Health Sciences North Northeast Cancer Center, Sudbury, Canada Background and Aims The Head and Neck team at Health Sciences North, Northeast Cancer Centre developed a Symptom Management Patient Care Fact Sheet (PCFS) to assist the patient on appropriate management of cancerrelated symptoms through the three phases of radiation therapy (RT), Before RT, During RT and After RT. The PCFS is categorized into 5 sections: Eating and Drinking, G-Tube Care, Swallowing, Oral Care, and Skin Care with specific reference to non-pharmacological interventions. Methods The PCFS tool was developed by a multidisciplinary panel of Dentists, Speech Language Pathologist, Dietician, Radiation Nurse, Radiation Oncologist, Radiation Therapist and Head and Neck Surgeons identifying existing guidelines using a systematic search strategy, selecting recommendations for inclusion and obtaining expert feedback. The overall goal of the PCFS is to promote a consistent multidisciplinary model of care to empower the patient to identify, assess, and manage symptoms in a timely manner, In order to reach a wide patient population, the PCFS are intended to be user-friendly in a double sided tear off pad with readability at 6–8 grade level. The format follows the concept of phased care instruction by the Cancer Patient Education Network (CPEN). Results This tool provides consistent and timely delivery of symptom management and instruction in all phases of RT to the head and Neck. Conclusions In conclusion, the overal results of this concept of patient based symptom management ensures the best supportive care possible.

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therapy planning 1 week later showed profound dilatation of the stomach and descending duodenum (Figures 1&2), with compression and invasion of the transverse duodenum by the uncinate mass. She was diagnosed with malignant gastric outlet obstruction that had progressed from transient to complete since the time of endoscopy. Several litres of fluid were immediately suctioned via nasogastric tube and she underwent urgent laparotomy and diverting gastrojejunostomy. She was discharged to home 1 week later and was able to receive subsequent chemotherapy. Other symptoms from advanced stage cancers of the pancreas include jaundice, dark urine, pale stools, abdominal and back pain, weight loss and fatigue.

MASCC-0586 Symptoms MALIGNANT GASTRIC OUTLET OBSTRUCTION FROM PANCREATIC CANCER: A REPORT OF AN EXCEPTIONAL CASE AND A NARRATIVE REVIEW OF SYMPTOMS CHAR ACTERISTIC OF ADVANCED STAGE DISEASE

E. Nguyen1, A. Tsang1, P. Ciesielski2, K. Dennis3 1 Faculty of Medicine, University of Ottawa, Ottawa, Canada; 2Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; 3 Radiation Oncology, Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada Background and Aims Patients with advanced stage pancreatic cancer are typically burdened by many symptoms which impair functioning and worsen quality of life. We report an exceptional case of malignant gastric outlet obstruction; a lesser known yet potentially life threatening complication of disease progression. We also review the other symptoms characteristic of advanced stage pancreatic cancer. Methods Case report and narrative review. Results A 73-year-old woman with known T4N1M0 adenocarcinoma of the uncinate process of the pancreas presented with worsening anorexia, nausea, emesis and distension. Endoscopy did not reveal convincing findings of external compression, but CT images obtained for radiation

Conclusions Patients with advanced stage pancreatic cancer typically carry a heavy symptom burden, and malignant gastric outlet obstruction must be included on the differential diagnosis when they present with obstructive upper gastrointestinal symptoms.

MASCC-0445 Symptoms EXPLORATORYANALYSIS OF CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY (CIPN), CONCURRENT SYMPTOMS AND INTERFERENCE WITH WALKING AND GENERAL ACTIVITY: A URCC CCOP RESEARCH BASE STUDY

M. Flannery1, J. Roscoe1, C. Heckler1, M. Janelsins1, L. Peppone2, C. Kamen2, J.L. Wade3, J.L. Berenberg4, J.T. D’Olimpio5, J. Keech6, G.R. Morrow1, K. Mustian1, S. Mohile1

Support Care Cancer (2014) 22 (Suppl 1):S1–S238 1 Cancer Control, University of Rochester, Rochester NY, USA; 2Cancer Control, University of Rochester, Rochester, USA; 3Oncology, Decatur Memorial Hospital, Decatur, USA; 4Oncology, Cancer Research Center of Hawaii, Honolulu, USA; 5Oncology, North Shore-LIJ Monter Cancer Center, Lake Success, USA; 6Oncology, NORTHWEST, Tacoma, USA

Background and Aims CIPN is a dose limiting chemotherapy toxicity with widely variable severity, impact on functioning and minimal treatment options. In this secondary analysis we explored the relationships between CIPN severity, concurrent symptoms and interference with walking and general activity. Methods Four hundred sixty-two individuals (71 % female, n=328) with mixed cancer diagnosis (40 % breast, n=184; 27 % gastrointestinal, n=125) and CIPN≥4, persisting 1 month post chemotherapy were randomized to receive investigational treatment or placebo. Using baseline data, CIPN severity was computed as the average pain from numbness and tingling (0–10) over a 1 week baseline screening period. Symptoms and interference with walking and general activity were evaluated with the Clinical Symptom Inventory using a 10-point scale. Summary number of symptoms was computed by adding additional symptoms reported (possible range 0–9). Results Patients reported a range in CIPN severity of 4–10 (M=6.51, SD= 1.51). 98.1 % (n=433) of individuals reported additional symptoms, with 84.7 % (n=383) reporting 4 to 9 (M=5.42, SD=2.05). Most commonly reported symptoms were: fatigue 93.3 % (n=421), disturbed sleep 83.8 % (n=379), drowsiness 82.3 % (n=372), trouble remembering 80.8 % (n=365), distress 74.3 % (n=74.3), and dyspnea 51.8 % (n=234). 89.6 % (n=394) of patients reported interference with walking (M=4.47, SD=2.90) and 87.8 % interference with general activity (M3.90, SD=2.60). Interference with walking was correlated with CIPN (r =.34) and number of symptoms (r =.35); interference with activity was correlated with CIPN (r = .42) and number of symptoms (r=.43), all p<.01. Conclusions Patients with moderate to severe CIPN experience multiple co-occurring symptoms; both CIPN severity and additional symptoms are significantly associated with the outcome measures of interference with walking and general activity.

MASCC-0359 Symptoms MANAGEMENT OF MALIGNANT ASICTES IN TERMINALLY ILL CANCER PATIENTS

D.R. Gu1, D.R. Cheng1 1 Department of Palliative Care, Department of Palliative Care Fudan University Shanghai Cancer Center Departme, Shanghai, China Background and Aims The aim of this research is to analyze the effectiveness of abdominal paracentesis and peritoneal drainage in management of malignant ascites of terminally ill cancer patients. Methods The data of 71 patients who received abdominal paracentesis in Palliative Care Department were collected during 2011.10–2012.10. CR(complete remission),PR(partial response),SD(stable disease) and PD (progressive Disease)were used to assess the effective of the paracentesis and drainage. Results Forty-three (60.56 %) patients got the paracentesis more than twice. The average volume of drainage fluid was 5400 ml. 58

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patients received intraperitoneal injection (DDP 60 mg and Thymopentin5 10 mg). 64 patients (90.14 %) got temporary symptoms relief. 60 patients (84.5 %) were considered effective (CR+ PR+SD), while 11 patients (15.49 %) were PD. The median relief time for ascites was 18 days. The biological characteristics of the ascites, primary tumor site have no relationship with the effect of the ascite control. Conclusions Abdominal paracentesis was still an effective method for relieving symptoms in terminally ill cancer patients with malignant ascites, although the median relief time is short. How to prolong the relief time with few adverse effects for these patients deserved to be studied.

MASCC-0494 Symptoms A PILOT RANDOMIZED CONTROLLED TRIAL OF A BEHAVIORAL SELF-MANAGEMENT INTERVENTION FOR BREATHLESSNESS IN LUNG CANCER

D. Howell1, A. Bezjak1, S. Sidani2, D. Dudgeon3, S. Mayo4, J. Bourbeau5, R. Goldstein6, C. Kitely7 1 Nursing, Princess Margaret Cancer Centre, Toronto, Canada; 2Nursing, Ryerson University, Toronto, Canada; 3Palliative Care, Kingston General Hospital, Kingston, Canada; 4Nursing, Princess Margaret Cancer Center, Toronto, Canada; 5Medicine, Montreal Chest Institute, Montreal, Canada; 6 Rehabilitation, West Park Hospital, Toronto, Canada; 7 Palliative Care, Trillium Health Care Center, Toronto, Canada Background and Aims Breathlessness is a prevalent and terrifying symptom of lung cancer. Little attention has been paid to the extensive responsibility of patients in daily management and high quality intervention trials that support the patient’s independent performance of selfmanagement behaviors to reduce breathlessness are needed. Study Aims: 1) To test the feasibility of randomization, recruitment, acceptability of the intervention; 2) Assess the variability of breathlessness severity, distress and with ADLs to calculate power for a full trial; 3) Explore the effects of the intervention on perceived self-efficacy and mastery of breathlessness. Methods A Phase II RCT, single blinded, two-group parallel assignment, with repeated measures was conducted. The home-based SMI targeted behaviors such as breathing control, stress/anxiety management and physical activity. Stage II-IV lung cancer patients were recruited from ambulatory lung cancer clinics at Princess Margaret Cancer Center. Using an intention to treat analysis, control and intervention group differences were examined using Wilcoxon rank sum test or Fisher’s Exact Test and GEE mixed models. Results Groups (n=22) were similar at baseline on demographic and disease variables. Improvements in breathlessness at “best” at 4 weeks (mean: 4.40 SD 1.96 (0–10 NRS) compared to the control group (mean of 2.89/ 1.62), breathlessness “distress” at 4 weeks (mean of 4.40/SD: 2.12 (0–10 NRS) versus 3.56/SD 2.65 for the intervention group). A more significant decline in breathlessness ADL was noted for the control group at 8 weeks (mean 3.20/SD: 1.32 control versus 3.13/SD: 1.13 for the intervention group). Conclusions This study provides preliminary data on the effectiveness of a SMI for lung cancer breathlessness.

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MASCC-0500 Symptoms SELF-MANAGEMENT INTERVENTIONS FOR BREATHLESSNESS IN ADULT CANCER PATIENTS: A SYSTEMATIC REVIEWAND META-ANALYSIS

D. Howell 1 , A. Bezjak 1 , S. Sidani 2 , D. Dudgeon 3 , A. Husain 4 , G. Fernandez5, E. Atenafu6, A. Molassiotis7 1 Nursing, Princess Margaret Cancer Centre, Toronto, Canada; 2Nursing, Ryerson University, Toronto, Canada; 3Palliative Care, Kingston General Hospital, Kingston, Canada; 4Palliative Care, Temmy Latner Palliative Care Centre, Toronto, Canada; 5Psychosocial Oncology, Princess Margaret Cancer Center, Toronto, Canada; 6Biostatistics, Princess Margaret Cancer Center, Toronto, Canada; 7Biostatistics, The Hong Kong Polytechnic University, Hong Kong, China Background and Aims Breathlessness is one of the most distressing cancer symptoms due to impacts on function and quality of life. Patients assume responsibility for daily self-management of this symptom. The primary objective of this systematic review was to assess the effectiveness of self-management interventions in reducing severity of breathlessness in adult cancer patients and on secondary outcomes i.e. emotional distress and quality-oflife at any disease stage or phase of treatment. Methods This systemic review followed Cochrane methods to identify randomized controlled trials (RCTs) and controlled clinical trials searching multiple empirical and gray literature databases up to June 2013. Quality assessment to identify risks of bias and an analysis of heterogeneity was conducted on all included studies. We calculated a pooled estimate of effect using a standardized mean difference (SMD) and 95 % Confidence Intervals (CI) based on a fixed-effect model. Results The literature search yielded a total of 3080 references from empirical data bases, forward referencing, and hand searching. Following removal of duplicated references (n=345), title scan of non-relevant references i.e. chemotherapy trials or not in cancer (n=2640), a total of 93 abstracts followed by a review of 33 full studies, four trials (n=246) of psychosocial counseling with breathing-relaxation training met the inclusion criteria. A large effect size of 0.62 (CI 0.36, 0.88) in favor of the intervention was demonstrated based on a SMD but the studies at moderate to high risk of bias and the point difference less than 1. Conclusions High quality RCTs for breathlessness are still needed and selfmanagement interventions may demonstrate meaningful change breathlessness reduction.

MASCC-0416 Symptoms WHAT BOTHERS LUNG CANCER PATIENTS THE MOST? A PROSPECTIVE, ELECTRONIC, PATIENT-REPORTED OUTCOMES STUDY IN ADVANCED NON-SMALL CELL LUNG CANCER

T.W. LeBlanc1, M.S. Nickolich2, C.N. Rushing3, G.P. Samsa3, S.C. Locke3, A.P. Abernethy3 1 Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Durham, USA; 2Department of Medicine, Program in Internal Medicine, Durham, USA; 3Duke Clinical Research Institute, Center for Learning Health Care, Durham, USA

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Background and Aims Patients with advanced lung cancer face a significant symptom burden, but little is known about changes in symptom prevalence over time. We aimed to longitudinally characterize symptoms in a cohort of patients with advanced lung cancer, using the Patient Care Monitor (PCM) version 2.0 electronic symptom assessment tool. Methods Ninety-nine patients with advanced non-small cell lung cancer were asked to complete the PCM electronic symptom assessment tool at up to 4 clinic visits between 2007 and 2009. Results Functional concerns were most prominent across study visits. Patients consistently reported significant difficulty (score of 7–10 out of 10) with running (33–43 %), doing hard work/activity (29–49 %), attending a paid job (20–31 %), and doing household work (17–22 %). Severe dyspnea and fatigue were the most prevalent non-functional symptoms; moderate or severe dyspnea (scores from 4 to 10 out of 10) was reported by at least 29 % of patients, and fatigue by over 50 %. Sexual dysfunction was also one of the ten most prevalent severe symptoms (20.8–29 %). Depression was reported infrequently, with over half of patients at each visit reporting “none;” moderate or severe difficulty was seen in just 2.5–9.3 % and 3.4– 6.2 % of patients, respectively, across all study visits. Conclusions Patients with advanced lung cancer report functional limitations as their most severe concerns. Dyspnea, fatigue, and sexual dysfunction also figured prominently and consistently. The persistence of these severe symptoms throughout the study suggests a need for more targeted attention to the most prevalent symptoms in this population.

MASCC-0323 Symptoms AVASCULAR NECROSIS OF THE FEMORAL HEAD IN A PATIENT WITH METASTATIC BREAST CANCER

B. Lechner1, N. Thavarajah1, L. Probyn2, N. Pulenzas1, L. Holden1, N. Lauzon1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada; 2Department of Diagnostic Radiology, Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Avascular necrosis (AVN) of the femoral head commonly presents as unilateral hip pain. AVN can be a complication of many treatments for cancer, including corticosteroids and radiation. This report discusses a breast cancer patient with AVN and explores possible causes and differential diagnoses. Methods A 70 year old female was referred to the Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre with metastatic breast cancer and AVN of the femoral head. Results The patient was diagnosed with breast cancer in 1987, with local recurrence in 1996. In 2008, metastatic disease was found at L5 vertebra and has since developed throughout the spine and liver. In June 2012, the patient was referred to the RRRP with left groin pain. Metastases were present in the left femoral head and acetabulum. The patient received radiotherapy of 30 Gy in 10 fractions. In December 2012, a CT scan demonstrated collapse of the anterior and superior articular surface within the left femoral head, with a large area of sclerosis. Previously identified as metastatic disease, it is now considered advanced AVN of the femoral head.

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research should aim to standardize statistical methods used for symptom cluster identification and validate symptom clusters in advanced cancer patients.

MASCC-0304 Symptoms PHASE II TRIAL OF SUBCUTANEOUS METHYLNALTREXONE IN THE TREATMENT OF SEVERE OPIOID-INDUCED CONSTIPATION (OIC) IN CANCER PATIENTS: AN EXPLORATORY STUDY

Figure 1: Axial CT image showing curvy linear sclerosis in the subchondral aspect of the anterior superior left femoral head. Conclusions The diagnosis of AVN can be difficult as it often appears as areas of sclerosis and can be mistaken for metastases. Possible factors contributing to AVN in this patient could include bisphosphonates, radiotherapy, or chemotherapy.

MASCC-0326 Symptoms REVIEW OF SYMPTOM CLUSTER RESEARCH IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM (RRRP)

B. Lechner1, N. Pulenzas1, N. Thavarajah1, E. Chow1 1 Rapid Response Radiotherapy Program Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada Background and Aims Patients with advanced cancer often experience various concurrent symptoms which can predict changes in patient functioning, treatment outcomes, and affect their quality of life. Clinical evidence of patients frequently experiencing multiple symptoms has prompted research in the identification and analysis of symptom clusters. The Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre provides timely radiotherapy for palliative cancer patients, focusing on quality of life (QOL) as an important endpoint. This paper reviewed the past research in the RRRP on symptom clusters in patients with advanced cancer. Methods A literature search was completed to identify studies investigating symptom clusters in cancer patients conducted in the RRRP from 2007 to 2013. All publications pertaining to symptom cluster research were included. Results Research in the RRRP has addressed symptom clusters in patients with brain metastases, bone metastases and has reviewed external publications concerning symptom clusters in cancer patients. Research in the RRRP has shown that methodological inconsistencies between studies have resulted in a lack of consensus among symptom clusters for certain patient populations. Conclusions The efforts of the RRRP have aimed to broaden the available information on symptom clusters in patients with advanced cancer and how these clusters are impacted by RT. There are still inconsistencies in research methodologies and results for patients with various cancer types. Further

M. Mori1, Y. Ji2, S. Kumar2, T. Ashikaga3, S. Ades2 1 Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; 2Hematology/Oncology, University of Vermont College of Medicine/Fletcher Allen Health Care, Burlington, USA; 3Medical Biostatistics, University of Vermont, Burlington, USA Background and Aims Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist shown to relieve severe OIC in patients with advanced disease receiving palliative care. Its efficacy remains unknown in those earlier in the disease trajectory. The objective of this phase II trial was to evaluate the efficacy of methylnaltrexone over 48 h in cancer patients at earlier stages or who are not receiving palliative care. Methods The primary endpoint was a rescue-free laxation ≤4 h after a single dose. Cancer patients with prognosis ≥3 months and OIC with <3 laxation during the preceding week were eligible. Exact 95 % confidence intervals for incidence rates, Friedman’s test for laxation over time, and univariate/ bivariate Cox proportional hazard models for laxation times were employed. Results Twelve patients received methylnaltrexone. Seven and 4 patients had ECOG performance status 1 and 2, respectively. Four (33.3 % [95 %CI:9.9–65.1 %]) and 5 (41.7 %[95 %CI:15.2–72.3 %]) patients had rescue-free laxation within 4 and 24 h, respectively, and 10 (83.3 %[95 %CI:51.6–97.9 %]) had laxation within 48 h (p=0.006). Mean time to laxation of those who had laxation within 4, 24, and 48 h was 3.3, 15.8, and 20.1 h, respectively. Bivariate Cox models revealed that shorter time to laxation was associated with higher baseline morphine equivalent daily dose (HR=1.02; p=0.018) and smaller number of laxations in the preceding week (HR=0.13; p=0.035). Patients tolerated methylnaltrexone well without evidence of opioid withdrawal. Conclusions Methylnaltrexone may relieve severe OIC in cancer patients who are not receiving palliative care. A larger prospective study is justified in this population.

MASCC-0321 Symptoms THE EFFECTS OF INSPIRATORY MUSCLE TRAINING IN THE MANAGEMENT OF BREATHLESSNESS IN PATIENTS WITH LUNG CANCER: A PILOT FEASIBILITY RANDOMIZED TRIAL

A. Molasiotis1, A. Charalambous2, P. Taylor3, Y. Summers3, Z. Stamataki4 1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong China; 2Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; 3Medical Oncology, Wythenshawe Hospital,

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Manchester, United Kingdom; 4Research & Development, Christie NHS Foundation Trust, Manchester, United Kingdom Background and Aims Breathlessness in patients with lung cancer is common, managing breathlessness is complex, treatment options are limited and treatments are sometimes unsuccessful. The aim of this study was to assess the feasibility of a trial with inspiratory muscle training (IMT) in lung cancer patients. Methods After randomisation, the experimental group received IMT using a pressure threshold device for 12 weeks. Patients in the control group received standard care. Outcome measures were completed at baseline and monthly fo r 3 mon ths (T1, T2, T3), inc lud ing : p hy sio log ical parameters(FEV1,FVC); breathlessness severity,distress,ability to cope,and satisfaction with breathlessness management;modified Borg scale;quality of life;anxiety,depression. Results Forty-six patients (M=37, F=9, mean age=69.5 years, mean=16 months post-diagnosis, 70 % NSCLC) were recruited from 3 centres in UK and Cyprus. There were no changes in FEV1 and FVC levels between groups. In paired comparisons, average and worst breathlessness over past 24-h were significantly better in the IMT group, only at T3 (p=0.019 & p= 0.003 respectively). Distress from breathlessness was also better in the IMT group, only at T3 (p=0.018). Statistically and clinically important differences over time (R-ANOVA) were seen with regards to ability to cope with breathlessness (p=0.02), satisfaction with breathlessness management (p=0.024), fatigue (p=0.007), emotional function (p=0.006), breathlessness mastery (p=0.031), anxiety (p=0.027) and depression (p= 0.048). The m-Borg difference between groups (T3) was 0.80, which is borderline clinically significant but not statistically significant. However, m-Borg at T2 was significantly lower in the IMT group (p=0.029). Conclusions IMT trial is feasible in lung cancer . The details of this trial allow us to refine the treatment protocol and findings guarantee a fully-powered larger trial.

MASCC-0540 Symptoms EFFECT OF COGNITIVE BEHAVIORALTHERAPY FOR INSOMNIA (CBT-I) AND/OR ARMODAFINIL ON INSOMNIA IN CANCER SURVIVORS

A.R. Peoples1, J.A. Roscoe1, C.E. Heckler1, M. Shayne2, L.J. Peppone1, G.R. Morrow1 1 Surgery, University of Rochester Medical Center, Rochester, USA; 2 Medicine, University of Rochester Medical Center, Rochester, USA Background and Aims Insomnia is an underreported distressing side effect of cancer and its treatment, which can persist for months post-treatment, reducing quality of life. Although CBT-I is considered the nonpharmacologic treatment of choice for insomnia in the general population, it often results in short-term daytime sleepiness. This study examines whether CBT-I in combination with a wakefulness-promoting agent, armodafinil, results in greater overall reduction in insomnia among cancer patients following completion of chemotherapy and or/radiotherapy. Methods We report on 88 cancer survivors (mean age 56, 88 % female, 68 % breast cancer) randomized to one of four 7-week long intervention conditions: 1) CBT-I+Armodafinil, 2) CBT-I+Placebo, 3) Armodafinil only, and 4) Placebo only. Insomnia severity was assessed by Insomnia Severity Index (ISI) at consent, following intervention (post), and 3 months later (followup), with higher scores indicating greater insomnia.

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Results Mean post ISI scores in groups 1–4 were 4.12, 5.61, 11.32, and 10.28, respectively. ANCOVA with multiple imputation and controlling for scores at time of consent showed that both CBT-I+Armodafinil (p= 0.001) and CBT-I+Placebo (p=0.01) groups had significantly less insomnia than placebo group, with effect sizes of 1.31 and 1.02, respectively. Armodafinil and placebo groups were not significantly different (p= 0.584); nor were CBT-I+Armodafinil and CBT-I+Placebo groups significantly different (p=0.421). Follow-up ISI scores were essentially the same as post scores. Conclusions These findings show that CBT-I results in clinically significant improvement in insomnia, with effects persisting long term. Armodafinil had no significant effect on insomnia nor on the efficacy of CBT-I. NCI Grant:R01CA126968. Study medication: Teva Pharmaceutical, USA.

MASCC-0454 Symptoms A CASE REPORT OF CHRONIC LYMPHOCYTIC LEUKEMIA AND MULTIPLE MYELOMA

N. Pulenzas1, A. Porwit2, K.J. Craddock2, N. Thavarajah1, B. Lechner1, L. Holden1, N. Lauzon1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2 Department of Pathology, University Health Network, Toronto, Canada Introduction: Association of chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in the same individual is rare. These malignancies may be related through a common clonal origin, or can exist as separate malignancies from different clones. Objective: The purpose of this report was to outline and discuss a rare case of associated CLL and MM in a palliative radiotherapy clinic. Methods: A 76 year old male was referred with biopsy-proven chronic lymphocytic leukemia and multiple myeloma for palliative radiotherapy. He was diagnosed with CLL in January 2009, and subsequently with MM in November of 2012. Results: As described in the literature, MM may exist simultaneously with CLL, or is diagnosed several months after CLL diagnosis. Common symptoms experienced in these rare cases are generally a combination of clinical features typically seen in CLL and MM separately. In our case, diagnosis of CLL preceded the diagnosis of MM by approximately 4 years and MM presented with translocation t(11;14) that was not found in CLL cells. Conclusion: Combined CLL and MM in one individual remain rare, and continuation of documented cases may facilitate for more knowledge obtained about this rarity. Further research should aim to detect if there are differences in disease progression between patients with CLL and MM from the same or different clones. Additional knowledge may guide physicians to make more informed treatment strategies and potential clinical markers to observe these malignancies.

MASCC-0620 Symptoms DISEASE-FREE OVARIAN CANCER PATIENTS REPORT SEVERE PAIN AND FATIGUE OVER TIME: PROSPECTIVE QUALITY OF LIFE ASSESSMENT IN A CONSECUTIVE SERIES

S. Shinde1, J. Aminah1 1 Hematology Oncology, Mayo Clinic, Rochester, USA

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Background and Aims Among ovarian cancer patients, treatment is aggressive and yet survival is often so limited. This study sought to measure quality of life with the ultimate goal of identifying ways of improving it over the duration of these patients’ lives. Methods All ovarian cancer patients who received some/all of their initial chemotherapy at the Mayo Clinic in Rochester, Minnesota from late 2010 through 2012 were included. Patient-reported quality of life was derived from the following 10-point linear analogue scale questions administered to all patients: How would you describe your average degree of 1) pain, 2) fatigue and 3) overall quality of life? The data was censored upon cancer recurrence. Results Among 59 eligible patients, 1.15 year (range: 3 months–3.2 years) was the median cumulative interval during which quality of life was assessed. Area under the curve for pain, fatigue, and global quality of life showed no significant differences between patients treated with dose-dense chemotherapy with carboplatin/paclitaxel (n=10) versus 3-week chemotherapy with carboplatin/paclitaxel (n = 36) versus other (n=13). Although pain, fatigue, and global quality of life improved over time, 35 of 59 patients reported grade ≥4 pain during follow up, and 47 of 59 reported grade ≥4 fatigue. After completion of cancer treatment, 30 described grade ≥4 pain or fatigue. The most common pain site was abdomen/pelvis, followed by back, hands, feet, fingers, and toes. Conclusions In ovarian cancer patients who remain cancer-free, severe pain and fatigue occur years after cancer treatment. Further research should focus on how best to address these symptoms.

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chemotoxicity risk and prophylaxis type. Prophylaxis was correctly initiated as either primary or secondary per EORTC guideline recommendations (considering chemo-related FN risk and patient-related factors) in 51 % of patients (Fig 1). EP-2006 was started on average 3.0±3.7 days after chemo and given for 5.1±2.3 days, mainly (54 %) as 30MIU/day. CIN occurred in 14.3 % of all cycles and 34.6 % of patients had ≥1 episodes. 22.8 % of patients had ≥1 episode of Grade 3 or 4 CIN and 5.9 % FN. CIN/FN-related hospitalizations were experienced by 6.0 % of pts. CIN/FN-related chemo disturbances (dose reduction, delay or cancellation) occurred in 9.2 %. Patients FN risk

>20 % 10–20 % <10 % Primary prophylaxis

Hematology 23 % 71 % 25 % 4% 74 %

Oncology 77 % 36 % 51 % 13 % 72 %

MASCC-0367 Symptoms PROPHYLAXIS OF CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIAWITH BIOSIMILAR FILGRASTIM: DESCRIPTION OF PATIENTS, TREATMENT PATTERNS AND OUTCOMES IN THE MONITOR-GCSF STUDY

M. Aapro1, H. Ludwig2, P. Gascón3, M. Boccadoro4, C. Bokemeyer5, M. Turner6, M. Muenzberg6, I. Abraham7, K. Denhaerynck7, K. MacDonald7 1 Institut Multidisciplinaire d’Oncologie, Clinique de Genolier, Genolier, Switzerland; 2Medizinische Abteilung I – Onkologie und Haematologie, Wilhelminenspital, Wien, Austria; 3Department of Hematology-Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; 4Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy; 5 Onkologisches Zentrum, Universitaetsklinikum Hamburg Eppendorf, Hamburg, Germany; 6 , Sandoz Biopharmaceuticals, Holzkirchen, Germany;7, Matrix45, Tuscon, USA Background and Aims MONITOR-GCSF is a study of practice patterns and outcomes with biosimilar filgrastim (EP-2006, Sandoz) in the prophylaxis of chemotherapy-induced febrile neutropenia (CIN/FN). Here we describe patients, EP-2006 treatment patterns and outcomes. Methods Prospective, observational study at 191 centers in 12 European countries of patients (n=1452) for up to 6 cycles within a single chemotherapy line (total of 8,324 cycles). Results Mean ± SD age in this predominantly female (61 %) sample was 61.3± 11.8y. Most common cancers were breast (32 %), lung (24 %), lymphoma (17 %). Table 1 compares hematology vs. oncology patients in terms of

Conclusions Variation in treatment with biosimilar GCSF is evident in terms of decision to treat with primary prophylaxis, day of initiation, duration and dose, yet incidence of CIN/FN and related events is low. Forthcoming analyses will determine whether treatment variability is associated with differential outcomes.

MASCC-0600 Symptoms PATIENTS’ REPORTED OUTCOMES ABOUT A SUPPORTIVE CARE SERVICE

I.M. Brunetti1, E. Vasile1, L. Ginocchi1, M. Lucchesi1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

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Background and Aims The management of uncontrolled symptoms or relevant toxicites is very important for many patients during active anticancer treatment. Our group has activated a supportive care service for these patients within our oncology outpatient service. The aim of this analysis was to evaluate the patients’ perspectives about this service. Methods We proposed to patients visited at the supportive care service a simple questionnaire investigating the reasons for the access to the service, the feeling about treatment of the symptoms and the alternative routes that patients would follow if the service would not be available. Questionnaires were answered anonymously and on a volountary basis. Results During a 1-month period, a total of 32 questionnaires have been completed. There was a good correlation between the symptoms indicated by patients and those registrered by physicians in the same period in an electronic database. All patients with exception of one reported good feeling about the understanding and treatment of symptoms. At the question of what patients would do if the service would not be available, half of patients answered that they would access emergency department, 3 would plan a medical oncology visit or would take home self-medication, ten would contact general practitioner. Conclusions The patients’ perceptions about a supportive care service are good. The integration of this service in oncology unit may reduce the access of cancer patients to emergency departments.

MASCC-0449 Symptoms GENDER DIFFERENCES IN SYMPTOMS EXPERIENCED BY ADVANCED CANCER PATIENTS: A LITERATURE REVIEW

E. Wong 1 , G. Bedard 1 , N. Pulenzas 1 , B. Lechner 1 , H. Lam 1 , N. Thavarajah1, L. Holden1, E. Chow1, N. Lauzon1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Advanced cancer patients are multi-symptomatic and require attentive palliative care. As gender differences are apparent in multiple aspects of everyday life, this literature review aims to determine the gender differences seen in the population of advanced cancer patients and the symptoms that they experience. Methods A literature review was conducted using the OvidSP Medline database from 1946 to November 2012. Randomized, prospective or retrospective cohort studies on advanced cancer patients who were undergoing any type of palliative treatments such as palliative radiation, chemotherapy, and antalgic treatment were included. The patient population, tools/ questionnaire used and gender differences in symptoms found statistically or qualitatively significant in the respective studies were extracted. Results Of the 163 studies resulting from the literature search, 19 publications were identified. Gender differences in multiple symptoms were discovered. Gender differences were commonly found in symptoms of emotional changes, fatigue, gastrointestinal symptoms (nausea, vomiting, and diarrhea) anxiety, tension, sleep problems and pain. Conclusions At present, gender differences are observed in symptoms experienced by advanced cancer patients however it continues to be inconclusive across

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studies. Further study investigating gender differences in the symptoms experienced by advanced cancer patients as the primary endpoint is recommended.

MASCC-0464 Symptoms SYMPTOM CLUSTERS IN PATIENTS WITH BRAIN METAST ASES TREATED WITH RADIATION – 3 DIFFERENT STATISTICAL ANALYSES

E. Wong1, L. Zhang1, G. Bedard1, R. McDonald1, M. Tsao1, C. Danjoux1, E. Barnes1, L. Holden1, M. Popovic1, E. Chow1 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada Background and Aims Advanced cancer patients often experience symptoms that may occur together in symptom clusters (SCs). The purpose of this study was to explore the presence of SCs using three different statistical analyses at both baseline and follow-up after radiotherapy treatment for brain metastases. Methods One hundred and fifty five patients at baseline and 100 patients at 1 month follow-up completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Brain Module (EORTC QLQ-BN20 or BN20+2). Three different statistical methods were applied: principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA). Cronbach’s alpha was used to assess internal consistency and reliability of derived clusters. Results At baseline, HCA and EFA identified the same two clusters while PCA split ‘itchy skin’ and ‘weakness of legs’ into a third cluster. Using the three methods, three clusters were identified: 1) ‘difficulty concentrating’, ‘motor dysfunction’, ‘seizures’, ‘drowsiness’ and ‘difficulty remembering,’ 2) ‘future uncertainty’, ‘headaches’, ‘hair loss’ and ‘bladder control’, 3) ‘itchy skin’ and ‘weakness of legs’. Post-radiation, five clusters were identified using the 3 methods: 1) ‘future uncertainty’, ‘drowsiness’ and ‘hair loss,’ 2) ‘difficulty communicating’ and ‘remembering difficulty,’ 3) ‘difficulty concentrating’ and ‘visual disorder’, 4) ‘motor dysfunction’ ‘weakness of legs’ and ‘bladder control,’ and 5) ‘headaches’ and ‘seizures.’ Consistency of grouping indicated higher correlation between symptoms. Conclusions Determining SCs is therapeutically important as treating one symptom in a cluster may serve to alleviate other symptoms. Our results suggest that SCs change after radiation treatment for brain metastases.

MASCC-0119 Symptoms 2 SYMPTOM CLUSTERS IN ADVANCED CANCER PATIENTS IN GREATER LISBON: AN INTERIM ANALYSIS

P.C. Barata1, A. Trindade1, A. Cardoso2, M. Alves3, A.L. Papoila3, D. Virella3, A. Barbosa4, P.G. Lawlor5 1 Medical Oncology, Centro Hospitalar Lisboa Central, Lisbon, Portugal; 2 Palliative Care, Centro Hospitalar Lisboa Central, Lisbon, Portugal; 3 Epidemiology and Statistics, Centro Hospitalar Lisboa Central, Lisbon, Portugal; 4Center for Bioethics, University of Lisbon, Lisbon, Portugal; 5 Palliative Care, University of Ottawa, Ottawa, Canada

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Background and Aims Cancer patients have been reported to experience concurrent or clustered symptoms that together may reflect an overlap or sharing of underlying pathological mechanisms, and cumulatively impact quality of life. However, there is a paucity of such studies in advanced cancer patients (ACPs) who are not receiving chemo- or radiotherapy. The primary aim was to estimate the prevalence of concurrent symptoms in ACPs and identify symptom clusters at referral. Methods Consecutive ACPs referred to a Tertiary Palliative Care Outpatient Clinic over 16 months rated the Edmonton Symptom Assessment System and 10 other symptom intensity (0–10) scores at initial consultation (T0). Data at T0 were subject to interim analysis, as part of a longitudinal cohort study. Exploratory factor analysis (EFA) was conducted using principal factor analysis. Four factors were chosen a priori to facilitate comparison with similar published studies, and 2 or more symptoms with factor loadings>0.4 and clinically meaningful interpretation were considered. Results Of 200 included ACPs with solid tumors and a median (range) age of 70 (37–94), 57.5 % were male. Tiredness (88.0 %, 95 % CI: 83–92.5), well-being (84.0 %, 78.9–88.7) and dry mouth (82.0 %, 76.5–87.0) were the most frequent symptoms while lack of memory (37.9 %, 31.8–44.9) and hiccups (19.1 %, 13.6–24.6) were less common. The Kaiser-Meyer-Olkin statistic was 0.68, reflecting adequate sampling. The 4 clusters identified in EFA are shown in Table 1. Item Pain Tiredness Somnolence Nausea Lack of appetite Dispnea** Depression Anxiety Well-being

Factor 1 0.41 0.68 0.33 0.28 0.46 0.31 0.67 0.46 0.80

Factor 2 0.42 −0.02 0.11 0.65 0.27 −0.33 0.16 0.20 0.02

Factor 3 -0.02 0.02 0.42 0.14 −0.04 0.40 0.16 0.20 0.10

Factor 4 −0.11 0.12 0.41 0.09 0.27 0.41 0.03 0.18 −0.02

Vomiting Constipation* Weight loss* Disphagia Dry mouth Hiccups Sweating* Insomnia Sleep disturbance Lack of memory*

0.02 0.28 0.37 0.05 0.25 −0.28 0.34 0.17 0.09 0.22

0.83 0.35 0.11 −0.04 0.13 0.45 0.15 0.08 0.12 0.22

0.03 −0.06 0.06 0.06 0.06 0.11 −0.05 0.88 0.85 0.11

0.11 0.15 0.29 0.74 0.64 0.53 0.22 0.07 0.10 −0.14

*symptom loading<0.4 on any factor **lack of meaningful interpretation Conclusions Clinically meaningful symptom clusters occur in in ACPs. Further research is needed to establish their consistency and their association with severity or survival.

MASCC-0049 Symptoms 2 PHYSIOLOGIC EFFECTS OF VAGINAL DEHYDROEPIANDOSTERONE (DHEA): ALLIANCE TRIAL N10C1

D.L. Barton1, J.A. Sloan2, L.T. Shuster3, T. Dockter2, J. Thielen4, P. Gill5, J.D. Bearden6, P.J. Atherton2, D.B. Johnson7, P.J. Stella8, S. Terstreip9, F.N. Rana10, D.M. Anderson11, C.L. Loprinzi12 1 Cancer Center, Mayo Clinic, Rochester, USA; 2Biostatistics, Mayo Clinic, Rochester, USA; 3Women’s Health, Mayo Clinic, Rochester, USA; 4Internal Medicine, Mayo Clinic, Rochester, USA; 5Cancer Center, Mayo Clinic Health System- Franciscan Healthcare, LaCrosse, USA; 6Oncology, Upstate Carolina CCOP, Spartanburg, USA; 7Oncology, Wichita CCOP, Wichita, USA; 8Oncology, Michigan Cancer Research Consortium, Ann Arbor, USA; 9Oncology, Sanford Community Cancer Consortium CCOP, Fargo, USA; 10 Oncology, University of Florida, Jacksonville, USA; 11Oncology, Metro MN CCOP, St. Louis Park, USA; 12Medical Oncology, Mayo Clinic, Rochester, USA

Background and Aims Effective treatments for female sexual dysfunction are needed. This analysis of secondary endpoints evaluated the impact of vaginal DHEA on vaginal health, hormone concentrations, bone turnover and sexual function. Methods Postmenopausal women, diagnosed with breast or gynecologic cancer, were eligible if they reported ≥ moderate vaginal symptoms. Women were randomized to 3.25 versus 6.5 mg of DHEA versus plain moisturizer (PM). DHEA was compounded into a bioadhesive vaginal moisturizer. Women inserted the study moisturizer using a pre-filled syringe daily for 12 weeks, just before sleep, after sexual activity. Laboratory tests, vaginal pH and maturation index were done at baseline and 12 weeks. Analysis included independent t-tests and Wilcoxon rank tests, comparing each DHEA arm with PM. Results One hundred forty-seven women on each arm provided blood samples; 47 total provided pre/post vaginal samples. Vaginal cell maturation was 100 % (3.25 mg), 86 % (6.5 mg) and 64 % (moisturizer); pH decreased more in DHEA arms. Total score improvement on the female sexual function index was better in those using 6.5 mg (p=.001). Mean changes from baseline in lab values are shown below:

Osteocalcin Estradiol DHEA-Sulfate

Aromatase Inhibitor Use 3.25 mg 6.5 mg −0.5 −0.3 0 −0.2 11.4* 24.1*

PM 0.5 0.3 −1.6

No Aromatase Inhibitor Use 3.25 mg 6.5 mg 0.2 0.1 2.1* 1.4* 21.6* 34*

PM 0.2 0.1 1.6

*Significantly different from plain moisturizer (p<0.05) Conclusions This study provides evidence of some systemic absorption of DHEA, but given no improvement in bone biomarkers, not estrogenic activity. DHEA improves physiologic vaginal health and sexual function more than a moisturizer alone.

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MASCC-0067

MASCC-0034

Symptoms 2

Symptoms 2

NARRATIVES OF PATIENTS LIVING WITH RADIATION-INDUCED XEROSTOMIA: DEMYTHOLOGIZING THE SYMPTOM

DOES HOPE CORRELATE WITH SYMPTOM BURDEN

A. Charalambous1, M. Charalambous2, T. Tsitsi2 1 Nursing, Cyprus University of TEchnology, Limassol, Cyprus; 2Nursing, Cyprus University of Tchnology, Limassol, Cyprus Background and Aims Introduction: Head and neck cancer patients often experience a number of persistent treatment related symptoms, such as xerostomia. The impact of xerostomia can be profound and wearing on the patients, hence negatively influencing their quality of life. Objectives: To explore the in-depth experiences of head and neck cancer patients living with radiation-induced xerostomia. Emphasis is placed on the psychological and social impact of this symptom. Methods: This is a hermeneutic phenomenological study inspired by the Philosophy of Paul Ricoeur. Research data were retrieved with individual narratives from 15 patients diagnosed with head and neck cancer. Interpretation was influenced by the hermeneutic paradigm and Ricoeur’s theory of interpretation. The interpretation proceeded through three phases: naïve reading, structural analysis and comprehensive understanding. Results: Five themes emerged from the narratives reflecting on the patients’ lived experiences. These were “suffering of the body”, “suffering of the person’s world”, “being helpless against xeostomia”, “suffering of the mind” and “being alone”. The comprehensive understanding disclosed new possibilities for being-in-the world in relation to living with xerostomia. Table 1: Examples of hermeneutic phenomenological structural analysis Meaning Unit

Condensation

Sub-Theme

It is an awkward situation, wanting to swallowing and not been able to I had to settle with an important asset of my everyday living…my communication with the outer world Drugs for xerostomia are a joke, they have no effect at all and when they do it only lasts for a while and then the wheel is again set in motion with the same effects I have lost my eagerness to live…living is about doing the things you like and be with the people you love, I think that I have lost both

Inability to swallow

Being strangled Suffering of by xerostomia the (physical) body

Theme

Inability to Being withdrawn Suffering of the person’s world communicate from the others

Lack of effective Feeling despair treatment from the ineffective treatments

Beeing helpless against xerostomia

Feeling despair

Suffering of the mind

Being emotionally drained

Conclusions Conclusions: The precedent consideration of xerostomia mainly as a physical side-effect of radiotherapy was outweighed by the social and psychological effects revealed by this study. These xerostomia’s effects are inflicted on the patients and their families with an obvious reflection on their perceived quality of life. The findings call upon a shift towards acknowledging the severity of xerostomia and the need to care for these patients holistically.

A. Platt1, J. Gross1, M. Davis1, R. Lagman1, F. Fielding1, T. Sanford1, H. Goforth1, C. Patel1 1 Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA Background and Aims The Herth Hope Index (HHI) is a validated and reliable tool that measures hope and emotional wellbeing. Comparing the HHI with Edmonton Symptom Assessment Scale (ESAS) provides a means of comparison between symptom burden and hope. We assessed hope and its relationship to symptom burden in an inpatient palliative medicine unit as a pilot trial. Methods Eligible patients verbally consented, participated in the study. Patients completed or were assisted in completing the HHI and ESAS. Correlation between the HHI and symptom burden will be estimated using a 95 % confidence interval once the study is completed. A correlation of >0.20 or <−0.20 would be considered clinically relevant. One hundred ninetythree patients will be needed to have 80 % power at a 5 % significance level based on pilot data. Results From pilot data of 25 patients, no correlation between hope and symptom burden was observed. Mean ESAS score is 35/90, mean Herth score is 35/ 48. The mean ESAS NRS scores for pain is 4/10, nausea 2/10, and tiredness 5/10. A large study powered to 196 patients for a correlation of <0.2 will be completed January 2014 with final analysis available for presentation. Conclusions Comparison between symptom burden and hope is relevant to patient care. If a high correlation is found, symptom management may improve hope if no or low correlation is found additional services are needed. This ongoing study has potential to influence patient care and service delivery in an inpatient palliative medicine units.

MASCC-0033 Symptoms 2 CORTICOL CORRELATES OF SUNITINIB-INDUCED FATIGUE IN METASTATIC RENAL CELL CARCINOMA

D. Janini1, D. Cunningham1, N. Varnerin1, D. Allexandre1, E. Plow1, M. Davis1, B. Rini1 1 Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA Background and Aims Fatigue is one of the most common adverse effects of sunitinib treatment for renal cell carcinoma (RCC) and may be associated with changes in the motor cortex. Transcranial Magnetic Stimulation (TMS) is a noninvasive method to study cortical maps. The aim of this study was to assess sunitinib-induced fatigue changes in cortical maps of fatiguing muscle. Methods Patients with RCC were tested before and after 4 weeks of sunitinib 50 mg QD. Strength was measured as maximum voluntary contraction (MVC) of a hand muscle. Fatigue was assessed by the Brief Fatigue Inventory (BFI) and duration of a sustain 30 % of MVC. TMS was applied in a 7×5 grid (1 cm resolution) while electromyography was recorded from muscle. Variables included: 1) map area, 2) excitability of map, measured as the sum of electromyographic responses, and 3) location of map. Results Six patients have been analyzed. Average BFI score increased (p=0.043). MVC significantly decreased for 5 who reported greater fatigue on BFI

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(p=0.043). There was no significant change in duration of sustaining 30 % MVC contraction. The area map area decreased (p=0.07) shifted antero-medially (p=0.028), but the excitability did not change. Conclusions Four weeks of sunitinib increases fatigue and reduces muscle strength which parallels reorganization of the muscle’s map in the brain. The map shift suggests spread to higher motor regions in order to maintain muscle drive. An additional 6 patients have been entered, results will be available for the meeting. Future studies should use fMRI image connectivity between brain regions.

MASCC-0077 Symptoms 2 ENHANCING SYMPTOM SELF-MANAGEMENT THROUGH A SMARTPHONE APPLICATION: DEVELOPMENT AND PILOT TESTING

C. Dubey1, C. Hoeppli1, F. Carrino2, E. Mugellini2, M. Kueng3, S. Kropf4, S. Zuercher4, M. Eicher2 1 School of Health Science, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland; 2Technology for Human Wellbeing Institute, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland; 3Oncology and internal medicine, Hopital Fribourgeois, Fribourg, Switzerland; 4Lindenhof Gruppe, Lindenhof Spital, Berne, Switzerland Background and Aims Cancer treatment usually comes with burdensome symptoms. As the majority of multimodal treatments are provided in the ambulatory sector, patients often have to self-manage these symptoms. The World Health Organization recommends symptom management interventions from initial diagnosis and continuing throughout illness trajectory while respecting patient’s autonomy in developing his or her symptom self-management. The aim is to present development and implementation of a smartphone application to support symptom self-management of patients during cancer treatment. Methods In a multidisciplinary approach, we developed a three stage patient support that differentiates between a) Definition of stable symptom experience and related preventive selfmanagement strategies, b) Definition of unpleasant symptom experience and optional selfmanaged interventions, c) Definition of symptom experience that should be monitored/treated by health care professionals. We defined symptom experience and related evidence based selfmanagement strategies for the following 11 symptoms: anxiety, mucositis, neuropathy, hand-foot syndrome, lack of appetite, bleeding, diarrhea, fatigue, hair loss, nausea and vomiting, obstipation. A smartphone application (iOS and Android) was developed to facilitate an easy use of these management strategies. The interface was conceived following user-centered design paradigms (in particular, visibility, accessibility and legibility) aiming at improving usability for aged people. Results The application is currently tested for its applicability. In springtime 2014 pilot testing and qualitative evaluation is planned with a selected sample of patients with different cancer types and stages. Conclusions Results of the pilot testing and qualitative evaluation will be presented at the meeting.

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MASCC-0288 Symptoms 2 VALIDATION OF THE NUMERICAL RATING SCALE VERSIONS (NRS) OF THE EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS) AND ESAS-R AMONG OUTPATIENTS WITH ADVANCED CANCER

B. Hannon 1 , M. Dyck 1 , A. Pope 1 , N. Swami 1 , C. Lo 1 , L. Le 1 , C. Zimmermann1 1 Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada Background and Aims The ESAS is commonly presented as a NRS, but has been only been validated as a visual analogue scale for outpatients with cancer. We aimed to validate the NRS versions of ESAS and ESAS-r, and assess patient preference for either version. Methods Patients with advanced cancer (N=202) attending ambulatory palliative care clinics at the Princess Margaret Cancer Centre, Toronto, between February 2012 and January 2013, completed the ESAS (with an added time window of ‘past 24 h’), and the ESAS-r, (which includes a time window of ‘now’ and symptom definitions). Participants completed the Memorial Symptom Assessment Scale (MSAS) and a patient-rated version of the Eastern Cooperative Oncology Group (ECOG) performance status measure. Physicians rated the ECOG independently. At 24 h, 26 patients completed a test-retest study. Results ESAS and ESAS-r total scores both correlated well with total MSAS scores (Spearman’s rho: 0.62 and 0.64, respectively). Correlations of individual ESAS symptoms with MSAS symptoms and with ECOG are shown in the Table, as are correlations of the overall ESAS scores with physician and patient-rated ECOG. Participants preferred the ESAS-r (42.8 % versus 18.6 %), but preferred the ‘past 24 h’ window (52.8 %) over ‘now’ (21.3 %). The 24 h test-retest evaluation of the ESAS showed good correlation (ICC=0.74). Conclusions The ESAS and ESAS-r NRS are valid and reliable for outpatients with advanced cancer. The 24-h time window was preferred and may best capture fluctuating symptoms in this population. Table – Correlations of ESAS scores/subscores with validations measures Measure Patient ECOG, N (r) Physician ECOG, N (r) MSAS Pain Lack of energy Nausea Sad Nervous Worry Drowsiness Appetite TMSAS Shortness of breath

ESAS score/subscore ESAS ESAS-r EDS 193 (0.40) 192 (0.33) EDS 173 (0.35) 172 (0.24) * Tiredness * Depression Anxiety Anxiety * * Wellbeing *

0.68 0.58 0.72 0.66 0.57 0.64 0.66 0.63 0.45 0.80

0.66 0.52 0.64 0.64 0.59 0.65 0.61 0.73 0.46 0.74

*same item name for ESAS; EDS; ESAS distress score; TMSAS, Total MSAS score

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MASCC-0112 Symptoms 2 INTERNAL LYMPHEDEMA CORRELATES WITH SUBJECTIVE AND OBJECTIVE MEASURES OF DYSPHAGIA IN HEAD AND NECK CANCER

L.K. Jackson1, S.H. Ridner2, J. Deng2, C. Bartow3, K. Mannion4, K. Niermann5, J. Gilbert1, M.S. Dietrich6, A.J. Cmelak5, B.A. Murphy1 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; 2School of Nursing, Vanderbilt University Medical Center, Nashville, USA; 3Department of Speech and Hearing Sciences, Vanderbilt University Medical Center, Nashville, USA; 4Department of Surgery, Vanderbilt University Medical Center, Nashville, USA; 5Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, USA; 6Department of Biostatistics Schools of Medicine and Nursing, Vanderbilt University Medical Center, Nashville, USA Background and Aims Tumor/treatment-related external (EL) and/or internal lymphedema (IL) are associated with functional deficits and increased symptom burden in head and neck cancer (HNC) patients. We noted associations between EL/ IL and patient-reported dysphagia using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0. Consequently, we studied the relationship between EL/IL with subjective and objective measures of swallow function. Methods Eighty-one HNC patients completed: 1) VHNSS version 2.0: including 13 swallowing/nutrition-related questions grouped into 3 clusters: swallow solids (ss), swallow liquids (sl), nutrition(nt); 2) physical assessment of EL using Foldi scale; 3) endoscopic assessment of IL using Patterson scale (n=56); and 4) modified-barium videofluoroscopy (MBSS) rated by Dysphagia Outcome and Severity Scale (DOSS) and in conjunction with a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied timepoints to assess the lymphedema spectrum, from baseline (n=15, 18.1 %) to 18 months post-therapy (n=20, 24.1 %). Results VHNSS swallow/nutrition items scores correlated with NOMS and DOSS ratings. Highest correlation was with NOMS: ss (−0.73; p<0.001); sl (−0.61; p<0.001); nt (−0.56; p<0.001). VHNSS swallow/ nutrition scores correlated with maximum grade of swelling for any single structure on Patterson scale: ss (0.43; p=0.001); sl (.38; p=0.004); nt (0.41; p=0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis and pyriform sinus were most strongly correlated with VHNSS and NOMS ratings. There were no meaningful correlations with VHNSS swallow/nutrition items or NOMS/DOSS ratings and EL. Conclusions IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.

MASCC-0070 Symptoms 2 PRELIMINARY TESTING OF A PATIENT REPORTED OUTCOME MEASURE FOR RECURRENT OR METASTATIC HEAD AND NECK CANCER

L.K. Jackson1, J. Deng2, S.H. Ridner2, M.S. Dietrich3, B.A. Murphy1 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; 2School of Nursing, Vanderbilt University Medical Center, Nashville, USA; 3Dept of Biostatistics Schools of Medicine and Nursing, Vanderbilt University Medical Center, Nashville, USA

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Background and Aims There are no patient reported outcome measures developed and tested in recurrent-metastatic head and neck cancer (RMHNC) patients. Available tools focus on acute/late effects of primary therapy and are hypothesized to lack content specific to RMHNC. Consequently, we undertook development of the Vanderbilt Head & Neck Symptom Survey - Recurrent/Metastatic (VHNSS-RM) to assess tumor-related symptoms, residual toxicity from prior therapy and side effects from current therapy. The tool contains 35 physical symptoms and 12 psychosocial issues scored from 0 (none) to 10 (severe) (ASTRO abstract 46, 2014). We report preliminary testing of the tool. Methods A pilot trial with 39 patients was completed 6/2013–1/2014. Inclusion criteria: non-curable recurrent/metastatic HNC. The tool was administered to patients online during clinic. Results No barriers to online tool completion were noted. Patients found the tool acceptable, with high feasibility and readability. Completion time was ≤15 min for 92.4 % of patients. 46/47 questions had a full range of scores. VHNSS-RM includes 12 novel symptom questions and 7 novel psychosocial issues. Overall, symptom burden was high with moderate-to-severe symptoms (VHNSS-RM ≥5) identified in >30 % of patients for 33/47 questions (70.2 %), of those 48.5 % had severe symptoms (VHNSS-RM ≥7). Conclusions The VHNSS-RM is feasible and can be completed in a timely manner. RMHNC symptoms are often different than at initial presentation and during primary treatment. The 19 novel questions could aid in improved palliation to these patients. There are plans to validate the VHNSS-RM and analyze its role in assessment of treatment response and impact on overall symptom burden.

MASCC-0190 Symptoms 2 SYMPTOM DISTRESS IN HONG KONG CHINESE GYNAECOLOGIC CANCER SURVIVORS

T. Kwan1, K. Chan2, M. Chu2, R. Ho3, C. Chan3, H. Ngan2 1 Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong China; 2Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong China; 3 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, Hong Kong China Background and Aims Cancer survivors may experience distressing symptoms long after the completion of curative treatment. This study aimed to assess the prevalence and associated factors of physical symptoms in Chinese gynaecologic cancer survivors. Methods Consecutive disease-free gynaecologic cancer patients (n=24, mean age=50 years) who were treated by hysterectomy only (median time since surgery=23 months) were individually interviewed in an oncology outpatient clinic of a public hospital in Hong Kong. A control group comprising women with benign gynaecologic diseases (n=26, mean age=51 years) who had hysterectomy ≥6 months before were also interviewed. The physical symptom distress subscale of the Rotterdam Symptom Checklist was used for data collection. Results The cancer and control groups were demographically similar except for marital status. Nearly all of the cancer group (96 %) and 31 % of the control group had hysterectomy with removal of ovaries. The three most common symptoms were vaginal dryness (12/14, 86 %), tiredness (17/24, 71 %) and dyspareunia (8/14, 57 %) for the cancer group; tiredness (20/26, 77 %), lack of energy (19/26, 73 %) and numbness of hands/feet (15/26, 58 %) for the control group. The two groups did not differ in their mean physical distress

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scores by Mann–Whitney test (p=0.251). Hysterectomy with ovarian conservation was significantly correlated with higher symptom distress (p= 0.013). No associations were found between symptom distress and time since surgery, age, income, education, marital status or work status. Conclusions The overall symptom distress of women treated for gynaecologic cancer by hysterectomy only was not different from those of women surgically treated for benign gynaecologic disease.

MASCC-0295 Symptoms 2 SYMPTOM-DISTRESS AND PSYCHOSOCIAL RESOURCES OF PATIENTS WITH ADVANCED COLON CANCER – A CROSS-SECTIONAL DESCRIPTIVE STUDY

S. Köck-Hódi1, M. Matzka1, M. Wallner1, M. Koller1, H. Mayer1 1 Department of Nursing Science, University of Vienna, Vienna, Austria Background and Aims Individual and adequate symptom management programs for patients with advanced colon cancer in the course of chemotherapeutic treatment require specific knowledge about symptom-distress and influencing factors, as well as knowledge about the impact of psychosocial resources. This study aimed to explore the type and the extent of symptom-distress and its relation to resilience, general or treatment-specific optimism, social support, and socio-demographic factors. Methods The study employed a cross-sectional descriptive design. Five different standardized and tested instruments were used to identify the distress resulting from physical and mental symptoms, QOL, psychosocial resources, and influencing factors. Data analysis was performed using current methods of descriptive and exploratory statistics. 54 patients with advanced colon cancer currently undergoing chemotherapeutic treatment in a day-unit at a general hospital in Vienna were assessed between January and September of 2013. Results Fatigue, peripheral neuropathy, altered sense of taste, nausea, depressiveness, and anxiety were identified as the symptoms causing the highest levels of distress. Symptom-distress had a significant impact on QOL, especially for women and elders. A high correlation exists between resilience, general optimism, and social support. Furthermore, significant differences were identified between patients receiving different types of therapy (infusion, oral, or antibody). Conclusions For high-quality cancer care and individual symptom management programs for patients with advanced colon cancer, assessing the impact of psychosocial resources and other influencing factors, such as gender, age, or type of therapy on symptom-distress is crucial, especially for the development of nursing management interventions.

MASCC-0298 Symptoms 2 THE COMPLEX SITUATION OF PATIENTS WITH ADVANCED COLON CANCER – THE EXPERIENCE OF COPING WITH DISEASE AND THERAPY

H. Mayer1, S. Köck-Hódi1, C. Wollank1 1 Department of Nursing Science, University of Vienna, Vienna, Austria Background and Aims Developing specific symptom management programs for patients with advanced colon cancer is challenging for nursing, because of the great

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extent of subjectivity in the illness experience, which appears to be inconsistent to standardization. The aim of this study was to gain insight in the situation and the experiences of patients with advanced colon cancer currently undergoing chemotherapeutic treatment, and to identify relevant phenomena that influence their situation. This knowledge should help to develop an individualized and adequate symptom management program. Methods Thirteen in-depth interviews were conducted with patients suffering from advanced colon cancer and currently undergoing chemotherapeutic treatment. The interviews were analyzed using thematic content analysis and type-building procedures. Results The interviews showed a broad range in experiences of disease and therapy, as well as different coping strategies. However, within these individual experiences, essential phenomena, resources, and destabilizing factors could be identified, that applied across individuals. Based on these findings, three ‘types’ were identified: the ‘persister’, the ‘cooperator’, and the ‘fighter’. Due to the type-specific phenomena, resources and destabilizing factors are experienced in different ways and therefore result in different behaviors and coping strategies. Furthermore, they are vulnerable to different ‘critical incidents’ that may lead to destabilization of their situation. Conclusions While in clinical practice caution should be exercised with categorizing, ‘types’ may help to understand different kinds of experiences and individual strategies in coping with illness situations. For developing adequate symptom management programs, it is important to be responsive to these different types, their perceptions, and coping strategies.

MASCC-0191 Symptoms 2 METASTATIC LUNG CANCER TO SPINE, LIVER AND ADRENAL GLAND IN A 27 YEAR OLD FEMALE: A CASE REPORT

M. Milakovic1, M. Popovic1, E. Wong1, G. Bedard1, R. McDonald1, E. Chow1 1 Rapid Response Radiotherapy Program, Odette Cancer Center, Toronto, Canada Background and Aims Lung cancer accounts for 14 % of new cancer cases in Canada and has a 17 % 5 year survival rate. The incidence of lung cancer in patients 20– 29 years of age in Canada is reported to be only 20 out of 25,500 cases per year. This report discusses the implications of a rare case of a young woman who was initially suspected of having either pneumonia or lymphoma, and was later diagnosed with metastatic lung cancer to the liver, adrenal gland and bone. Methods A 27 year old woman was referred to the Scarborough Hospital in December 2013 for assessment of recurrent hemoptysis. Results A chest x-ray upon admission demonstrated right hilar and right upper lobe opacity, suggesting pneumonia, but not ruling out lung cancer. An urgent CTscan showed soft tissue to the right of the trachea to the thoracic inlet, paratracheal adenopathy, a compression fracture of the T9 vertebra, and soft tissue extending into the spinal cord. A CT scan of the abdomen and pelvis showed 3 liver lesions, a lytic lesion on the L3 vertebra, and a left adrenal gland lesion. Due to the patient’s age, lymphoma was possible. However, a lung biopsy demonstrated malignant cells consistent with a lung adenocarcinoma.

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Conclusions This case demonstrates the importance of screening all patients who exhibit symptoms consistent with lung cancer, regardless of age.

MASCC-0197 Symptoms 2 SYMPTOM CLUSTER: RECONCEPTUALIZED FOR CANCER NURSING PRACTICE

H. Nguyen1, S. Thanasilp2 1 Department of Nursing, Thang Long University, Hanoi, Vietnam; 2 Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand Background and Aims Despite numerous studies have been conducting to examine symptom clusters in cancer, the concept of symptom cluster appears not to be different from its first introduction. Many limitations in conceptualization and empirical approaches to this concept are hindering its application in real practice. This paper aims to re-conceptualize symptom cluster to promote the usefulness of this concept in nursing practice. Methods Literature review Results Symptom cluster should not be seen merely as a group of concurrent symptoms. Symptom members of a cluster should either be interactive (directly or indirectly) or share the same etiology. A cluster is claimed as stable if it remains its ‘quality’ or ‘nature’ rather than to remain certain number of members. Moreover, a symptom cluster should have sentinel symptom(s). For the purpose of either symptom assessment or symptom management, sentinel symptom could be the predictive symptom of the cluster or could be the one, which interacts significantly with other members. It may be helpful to find symptom clusters, which are highly common or highly generalizable. However, for the better understanding towards such clusters, they should be examined in specific population. Most importantly, there is an urgent call for a framework to examine clinical relevancy of symptom cluster. This could be the key point to enhance the state of science related to this concept. Conclusions The nature of associations among symptom members, stability, sentinel symptom, commonality, and clinical relevancy would be critical characteristics of symptom cluster. Further theoretical and empirical works on these attributes are recommended.

MASCC-0231 Symptoms 2 RAPID ONSETS OF PAIN FLARE AND PAIN RELIEF FOLLOWING PALLIATIVE RADIOTHERAPY IN A PATIENT WITH BONE METASTASES

M. Popovic1, A. Agarwal1, B. Lechner1, N. Pulenzas1, P. Sheehan1, L. Holden1, G. Bedard1, E. Wong1, R. McDonald1, E. Chow1 1 Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada Background and Aims Pain is a common accompanying symptom in patients with bone metastases. Palliative radiotherapy is well-established for symptomatic bone metastases, with pain relief onset varying from several days to 4 weeks and lasting between 3 and 6 months. Pain flare, or temporary worsening

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of pain at metastatic sites following radiotherapy, typically occurs within the first 5 days post-treatment. We aimed to discuss the implications of a case involving a rapid onset of pain flare and pain relief following radiotherapy in a metastatic colorectal cancer patient. Methods A 70-year-old man, diagnosed with metastatic colorectal carcinoma, presented to the Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre with right-sided chest pain. Computed tomography revealed progression of a destructive right anterior sixth rib metastasis with surrounding soft tissue mass, and pain was reported in the associated area. The patient was treated with radiotherapy and given a single dose of 8 Gy. Results The patient experienced rapid onset of pain flare approximately half a day following treatment. He also experienced a rapid onset of complete pain relief the following morning at 1 day post-therapy, an uncharacteristically short duration relative to previously reported cases. Conclusions This case supports that pain flare is indicative of a positive response to radiotherapy as has been previously proposed. Our findings also suggest the potential subjectivity of the timing and severity of pain flare onset across bone metastases patients, which warrants therapy and follow-up tailored on a case-by-case basis.

MASCC-0058 Symptoms 2 ASSOCIATION OF BREAST CANCER SYMPTOMS AND CANCER IN POPULATION-BASED SCREENING IN FINLAND

D. Singh1, N.E.A. Malila2, A.H.T.I. Anttila2 1 health Sciences, University of Tampere, Tampere, Finland; 2mass screening, finnish Cancer Registry, helsinki, Finland Background and Aims In Finland, organized national screening program for breast cancer is based on mammography and clinical examination of possible symptoms. The purpose of the study was to assess the association of symptoms at screening visits with the detection of breast cancer. Methods A cross-sectional study was performed among women aged 50 to 69 years who had breast cancer screening during the period 2006–2010. A total of 1.2 million screening visits were made and symptoms (lump, retraction, scar, secretion and mole) were reported either by women or radiographer. 6445 women were diagnosed with breast cancer. Breast cancer risk was calculated for each symptom using the odds ratios (OR) at 95 % confidence intervals (CI) using logistic regression models. Results Out of 1,198,410 screening visits symptoms was reported in 298,220 (25 %) visits, of which breast cancer was detected in 2,323 (0.78 %) women. Women reporting lump had an increased odd of breast cancer (OR 6.47, CI 5.89–7.09) than retraction (OR 2.19, CI 1.90–2.49) and other symptoms. The sensitivity of symptoms in detecting breast cancer was 35.5 % however individual sensitivity of symptoms ranged from 0.66 to 14.7 %. The 1857 (36 %) out of 5,165 invasive tumors were reported as symptom/s. Conclusions Our findings reinforce the importance of fully evaluating the symptoms as a predictor of breast cancer. This study was done in a setting where the size of breast tumors is usually rather small. Still, the findings may have relevance also for such countries, which plan to develop CBE as an alternative to mammography screening in breast cancer control.

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MASCC-0230

MASCC-0365

Symptoms 2

Toxicities

COMORBIDITIES AMONG PATIENTS WITH BREAST CANCER (BC) OR NON-HODGKINS LYMPHOMA (NHL) WHO DO AND DO NOT DEVELOP FEBRILE NEUTROPENIA (FN) DURING THEIR FIRST CHEMOTHERAPY CYCLE

DOCETAXEL-INDUCED NAILTOXICITYAND ITS PREVENTION WITH ICE-WATER FINGER DIPPING

X. Li1, R. Luthra2, P. Morrow3, M. Fisher2, M. Reiner4, J. Page5, R. Barron1, W. Langeberg5 1 Global Health Economics, Amgen Inc., Thousand Oaks, USA; 2Health Economics and Outcomes Research, HealthCore Inc., Wilmington, USA; 3 Global Development, Amgen Inc., Thousand Oaks, USA; 4Global Biostatistical Sciences, Amgen Inc., Thousand Oaks, USA; 5Center for Observational Research, Amgen Inc., Thousand Oaks, USA Background and Aims Some comorbidities can increase FN risk among patients receiving chemotherapy. Few studies have comprehensively examined possible FN-related comorbidities across cancers. This study compared comorbidity prevalence among BC and NHL patients with and without FN. Methods Using claims from managed care plans assembled by HealthCore, this case–control study selected the first chemotherapy cycle of adult BC or NHL patients from 2007 to 2011. Each patient who developed FN (case) was matched with up to 4 patients without FN (controls) by cancer type, metastasis, chemotherapy regimen (eg, CHOP-based for NHL, TC for BC), age (18–44, 45–54, 55–64, 65–74, 75+), and sex. Comorbidities were identified by diagnosis codes in the year before chemotherapy. Adjusted odds ratios (aORs) and 95 % CIs for FN were calculated comparing the risk of each comorbidity among cases relative to controls using conditional logistic regression, adjusting for potential confounding factors (granulocyte colony-stimulating factor prophylaxis and previous hospitalization, surgery, and healthcare expenditure). Results Numerous comorbidities were more prevalent in FN cases than controls (Table).

FN cases Controls Comorbidity* Chronic obstructive pulmonary disease Coronary artery disease Diabetes Dyslipidemia Hypertension Liver disease Renal disease Osteoarthritis Osteoporosis Thyroid disease *Comorbidities with ≥20 FN cases shown

BC 308

H.J. An1, C. Kim2, G.M. Kim3, S. Lee4, E. Park4, H. Kim1 1 Medical Oncology, Catholic University, Suwon, Korea; 2Pulmonology, Catholic University, Suwon, Korea; 3Dermatology, Catholic University, Suwon, Korea; 4Hospice center, Catholic University, Suwon, Korea Background and Aims Introduction: Docetaxel-induced nail toxicity is reported in 10–50 %. Risk factors include cumulative dose and weakly administration. Severe nail toxicity impairs patient’s quality of life which leads to treatment discontinuation. Ice-mitten is used to decrease peripheral circulation to nail, but but hard to get. Objectives: We observed serial changes of nails in patients receiving docetaxel for lung cancer and tried to prevent nail toxicity with ice-water finger dipping. Methods Methods: Patients received weekly docetaxel at a dose of 20 mg/m2, 1 h intravenous infusion, on days 1, 8 and 15, every 4 weeks. In two patients, natural nail changes were observed, and later, another two patients did ice-water finger dipping while intravenous infusion of docetaxel. Results Results: In two patients without intervention, painful subungal hemorrhage and nail ridge (cumulative dose: 140–160 mg/?,) followed by hemopurulent subungal hematomas, longitudinal ridges, onycholysis and paronychias developed. The whole finger nail became hyperpigmented and onycholysis resulted in nail extraction. After then, regeneration from proximal nail areas (dose over 300 mg/m2) happened with onychodystrophy, subungal hyperkeratosis, trachyonychia at the distal areas. Nail change of toes was somewhat delayed and less severe than hands. In two patients who did ice-water finger dipping, any of nail changes developed but in toes and patients were tolerable to ice-water. Four patients showed more than stable disease with chemotherapy. Conclusions Conclusions: Finger nail changes in patients receiving weakly docetaxel were subungal hemorrhage, purulent change, onycholysis, and then regeneration. Ice-water finger dipping was effective to prevent nail toxicity.

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1,232 690 aOR (95 % CI) 1.1 (0.6,1.8) 1.5 (0.9,2.4) NA 0.9 (0.5,1.6) 1.2 (0.8,2.0) 1.1 (0.7,1.8) 1.0 (0.7,1.4) 1.4 (0.9,2.0) 1.2 (0.9,1.7) 1.2 (0.8,1.8) NA 1.6 (0.9,2.8) NA 2.3 (1.2,4.1) 1.8 (1.1,3.2) NA NA 1.6 (0.9,2.9) 1.2 (0.8,1.7) 1.4 (0.8,2.4)

Conclusions Certain comorbidities (eg, osteoarthritis in BC, renal disease in NHL) should be further evaluated and considered in FN risk assessment.

MASCC-0400 Toxicities MORBIDITY OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY: A REPORT OF 21 CASES IN A CANCER CENTER

J. Danklou1, G. Lefebvre1, E. Dalle1, G. Marliot2, I. Sakji2, N. Leroux3, D. Lefebvre3, R. Rohn3, F. Narducci4, E. Leblanc4 1 Oncology supportive care department, Centre Oscar Lambret, Lille, France; 2Clinical pharmacy department, Centre Oscar Lambret, Lille, France; 3Anesthesy department, Centre Oscar Lambret, Lille, France; 4 Surgery department, Centre Oscar Lambret, Lille, France Background and Aims Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery are a therapeutic alternative in peritoneal carcinomatosis, colorectal cancer and in evaluation for ovarian carcinomatosis. However HIPEC is frequently associated with significant morbidity. The aim of this study was to investigate morbidity according to the Clavien-Dindo classification, in 21 patients treated by HIPEC.

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Methods This is a review of all patients treated for peritoneal disease by HIPEC between 2006 and 2013. They had laparotomy with or without cytoreductive surgery and heated fluid with chemotherapy irrigated with a temperature of 41–43°. Results One man and 20 female were included. The median age was 60 years [37–71]. 57 % were obese (BMI>30) and 5 % were morbidly obese (BMI>40). The PS was 0 (n=17), 1 (n=3) and unknown for one person. 52 % had preoperative albumin<30 g/l. 38 % had first recurrence of ovarian carcinomatosis, 62 % had peritoneal mesothelioma or pseudomyxoma. 43 % had received a first line chemotherapy before HIPEC. Drug

Dose

Route of admistration

Hystologic type or organ

Number of patients

Cisplatin

80 mg/m2 400 mg/m2 300 mg/m2

Ovarian carcinomatosis Pseudomyxoma Mesothelioma

8

5 Fluorouracil Oxaliplatin

Intraperitoneal for 30 mn Intravenous Intraperitoneal for 30 mn

Irinotecan

200 mg/m2

Results Five patients who received ponatinib for either treatment-refractory CML or metastatic gastrointestinal stromal tumors, developed prominent hyperkeratotic folliculocentric eruptions involving the scalp, face, trunk and extremities resembling pityriasis rubra pilaris or inflammatory keratosis pilaris; these eruptions began 2–4 weeks into therapy. Multiple patients also exhibited marked xerosis, asteatosis and striking areas of ichthyosiform scale, particularly on the lower extremities. Conclusions While the mechanism for these eruptions remains undefined, we suspect that ponatinib, and other tyrosine kinase inhibitors, result in dysregulation of downstream inflammatory pathways with resultant aberrant epidermal growth. While classification of the eruptions allows for more effective management in these patients, these observations may also provide critical insight into mechanisms for the pathogenesis of pityriasis rubra pilaris and other follicular and ichthyosiform disorders.

13

Intraperitoneal for 30 mn

Severe outcomes were reported: digestive hemorrhage grade III 10 %, anemia grade II 10 %, pneumonia grade II 30 %, febrile aplasia grade II 10 %, thrombocytopenia grade II 10 %, septic shock grade IV 10 %, renal failure grade II 30 %, renal failure grade IV 10 % . There is no statistically significant difference in overall complications according to the type of chemotherapy used (p>0.05). Conclusions Although some complications may be related to the surgery, this study has identified high toxicity due to HIPEC including febrile aplasia, severe renal failure and thrombocytopenia.

MASCC-0610 Toxicities PONATINIB-INDUCED FOLLICULOCENTRIC, ICHTH YOSIFORM AND PITYRIASIFORM ERUPTIONS

A. Alloo1, J. Sheu1, A. Watson1, J. Butrynski2, G. Murphy3, N.R. LeBoeuf1 1 Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA; 2Medical Oncology/ Program in Sarcoma, Dana-Farber Cancer Institute, Boston, USA; 3 Pathology, Brigham and Women’s Hospital, Boston, USA Background and Aims Ponatinib, a potent third-generation tyrosine kinase inhibitor active against mutated and wild-type BCR-ABL, has demonstrated significant efficacy in CML and Philadelphia-chromosome positive ALL. It is also currently being explored in various other solid organ-tumor trials. Recently published trial data suggests that dermatologic toxicity, in the form of a non-specific ‘rash,’ or ‘dry skin,’ is the most common side effect associated with the use of ponatinib. Methods We describe five patients treated with ponatinib who experienced dermatologic side-effects, review the management of these eruptions and hypothesize on pathophysiologic mechanisms that may result in these effects.

MASCC-0609 Toxicities PAPULOPUSTULAR (ACNEIFORM) SKIN ERUPTIONS RESULTING FROM HER2 INHIBITION WITH TRAS TUZUMAB

J. Sheu1, E. Hawryluk2, N.R. LeBoeuf1 1 Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA; 2Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, USA Background and Aims The epidermal growth factor cell surface receptors (HER1/EGFR, HER2, HER3, HER4) are common oncologic targets. It is welldescribed that HER1/EGFR inhibitors frequently cause a papulopustular eruption. However, reports of these eruptions in patients treated with HER2 inhibitors are rare. A single case of acneiform dermatitis associated with trastuzumab has been reported, despite the increasing use of HER2 inhibitors for breast cancer. With use of HER inhibitors in a broader range of malignancies, recognition and management of this toxicity is critical to prevent treatment interruption and impairment of patient quality of life. Methods We describe the acneiform/papulopustular eruption from trastuzumab, discuss its management and review the pathophysiology of the epidermal growth factor receptors in skin keratinocytes. Results Four patients undergoing treatment of breast cancer with trastuzumab developed an acneiform eruption 7 to 22 days following initiation of therapy. In one case, the eruption prompted dose interruption. All patients’ eruptions resolved with treatment. No patients experienced eruption recurrence and all patients continued or completed the trastuzumab course. All are alive today, two still undergoing treatment, with no evidence of breast carcinoma. Conclusions Compared with HER1/EGFR homodimers, the predominant dimerization form of these cell surface receptors in skin keratinocytes, HER2 homodimers and HER1/HER2 heterodimers are thought to be expressed at very low levels. HER2 inhibition is significant enough to also cause a papulopustular reaction, although less frequently. Prompt recognition and appropriate treatment of this papulopustular reaction in patients treated with HER2 inhibitors prevent chemotherapy treatment interruptions and may also improve patient quality of life.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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MASCC-0432 Toxicities EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) -MEDIATED ADVERSE EVENTS (AES) IN PATIENTS WITH EGFR-MUTATION POSITIVE (EGFR M+) NON-SMALL CELL LUNG CANCER (NSCLC) TREATED WITH AFATINIB

J.C.H. Yang1, L.V. Sequist2, K.J. O’Byrne3, M.H. Schuler4, T. Mok5, S.L. Geater6, D. Massey7, D. O’Brien8, V. Zazulina9, Y.L. Wu10 1 Oncology, National Taiwan University Hospital, Taipei, Taiwan; 2 Medicine, Massachusetts General Hospital Cancer Center, Boston MA, USA; 3Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia; 4Medical Oncology, West German Cancer Center University Duisburg-Essen, Essen, Germany; 5Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong China; 6Internal Medicine, Prince of Songkla University, Songkhla, Thailand; 7Biometrics and Data Management, Boehringer Ingelheim Limited, Bracknell, United Kingdom; 8Global Pharmacovigilance, Boehringer Ingelheim Pharmaceuticals, Ridgefield CT, USA; 9Clinical Development & Medical Affairs, Boehringer Ingelheim Limited, Bracknell, United Kingdom; 10Vice President, Guangdong General Hospital, Guangzhou, China Background and Aims Afatinib, an oral, irreversible ErbB family blocker, showed superior efficacy to chemotherapy in EGFR M+ patients in the LUX-Lung 3 (LL3) and LUX-Lung 6 (LL6) first-line trials. Here, we present data on common EGFR-mediated AEs from both phase III trials. Methods 345 (LL3) and 364 (LL6) EGFR M+ patients were randomized (2:1) to afatinib (40 mg) or chemotherapy. On-treatment AEs were summarized by preferred and grouped terms. No AE diaries were supplied; patients recalled AE start/stop dates during clinic visit. AEs were graded using NCI-CTCAE version 3.0. Results Two hundred twenty-nine and 239 EGFR M+ patients were treated with afatinib in LL3 and LL6, respectively, and reported ≥1 AE. The commonly observed EGFR-mediated AEs are included in the Table (n=468).

Conclusions The most common AEs observed with afatinib were characteristic of EGFRinhibiting agents. Grade ≥3 AEs were short-lived and responded to dose interruptions/reductions. Treatment discontinuation due to EGFR-related AEs was low, indicating that afatinib has a manageable safety profile and is suitable for the long-term treatment of EGFR M+ NSCLC patients.

MASCC-0453 Toxicities NEUTROPENIC ENTEROCOLITIS DUE TO TREATMENT WITH DOCETAXEL-BASED ADJUVANT CHEMOTHERAPY IN PATIENTS WITH BREAST CANCER

A. Paisan1, A. Bujedo1, C. Churruca1, N. Ancizar1, J. Blanco1, J. Gomez1, G. Lizeaga2, I. Alvarez1 1 Medical Oncology Unit, Hospital Universitario Donostia, San Sebastian, Spain; 2Pharmacology Unit, Hospital Universitario Donostia, San Sebastian, Spain Background and Aims Neutropenic enterocolitis (NE) or typhlitis is a life-threatening complication of chemotherapy. Typhlitis is more often associated with hematologic malignancies but it has also been reported in solid tumors, especially in those treated with taxane-containing chemotherapy. Methods Retrospective analysis of breast cancer patients treated with adjuvant docetaxel containing polychemotherapy that presented NE as adverse event. Patients were treated between March 2007 and January 2013, at Hospital Universitario Donostia. The schemes used were TAC (docetaxel-adriamycincyclophosphamide) plus GCSF or TC (docetaxel-cyclophosphamide). Results Four hundred sixty-three cases were evaluated: 331 (TAC) and 132 (TC). NE occurred in 17 patients (3.67 %), 12 TAC and 5 TC, with a mean age of 52.7 (28.5–69.9). In 15 patients (88.24 %) typhlitis appeared in first cycle and mean interval debut after chemotherapy was 8.2 days (5–18). Thirteen cases (76.47 %) suffered enterocolitis grade 3, and 2 grade 4 and grade 5. Fourteen patients (82.35 %) were treated medically and 3 (17.65 %) needed surgical approach. 4 cases (23.53 %) required admission in intensive care unit. Mean hospital stay was 12.4 days (1–42). NE was resolved without sequelae in 13 cases (76.47 %). 3 patients (17.65 %) died (1 TC and 2 TAC). Chemotherapy was halted in 6 patients (35.29 %). One (5.88 %) resumed the same treatment, 8 (47.06 %) reduced dose, and 2 (11.76 %) changed to other scheme without docetaxel. No new episodes of NE appeared. Conclusions NE as adverse event of docetaxel-containing adjuvant chemotherapy for breast cancer is uncommon, but is a life-threatening complication, and intensive supportive care should be started immediately.

Most common Diarrhea EGFR-mediated AEs* All grades, n (%) 434 (92.7) Grade ≥3, n (%) 48 (10.3) Onset of Grade ≥3 event, n (%)

Rash/acne#

Stomatitis/mucositis#

Paronychia

399 (85.3) 72 (15.4)

293 (62.6) 33 (7.1)†

208 (44.4) 26 (5.6)

Before Week 6 After Week 6 Median duration of an episode with ≥1 day pf Grade ≥3 event (days)± Event led to dose reduction, n (%) Grade 3 recurred after dose reduction, n (%) Event led to treatment discontinuation, n (%) Serious AE, n (%)

32 (6.8) 16 (3.4) 5.0

16 (3.4) 56 (12.0)† 10.0

23 (4.9)† 10 (2.1) 8.0

1 (0.2) 25 (5.3) 14.0

64 (13.7)

78 (16.7)

32 (6.8)

32 (6.8)

6 (1.3)

8 (1.7)

2 (0.4)

3 (0.6)

3 (0.6)

5 (1.1)

1 (0.2)

2 (0.4)

MASCC-0573

17 (3.6)

4 (0.9)

3 (0.6)

0

Toxicities

*

All events regardless of relationship to study treatment. Grouped term. † Includes 1 patient with a Grade 4 event. ± Based on patient recollection. No Grade 5 events were observed. The majority of patients experienced 1 or 2 episodes of diarrhea (69.2 %) and rash/acne (78.8 %). Other drug-related EGFR-mediated AEs included cheilitis (7.7 %), conjunctivitis (4.7 %), and dry eyes (3.2 %). Related interstitial lung disease-like events occurred in 4 (0.9 %) patients (Grade 1, Grade 3, Grade 4, Grade 5). #

THE ROLE OF PEGFILGRASTIM IN THE TREATMENT OF NEUTROPENIA - DATA FROM LATVIAN ONCOLOGY CENTER

S. Plate1, Z. Zvirbule1, S. Kasperova1 1 chemotherapy, Riga East University Hospital Latvia Oncology center, Riga, Latvia Background and Aims Hematologic toxicity, especially neutropenia, from chemotherapy is the most prevalent serious side effect.

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Neutropenia can lead to complications such as fever, patient hospitalization and schedule delays. Several hematopoietic growth factors have been identified. Filgrastim and pegfilgrastim are in reimbursement in Latvia. The study has been conducted to clear up the impact of efficacy of pegfilgrastim. Methods The clinical data of patients who recieved pegfilgrastim in the Latvian Oncology center from September 2009 until December 2012 were reviewed. We analyzed efficacy of pegfilgrastim and adverse events. The rate of neutropenia after pegfilgrastim, hospitalizations and cycle delay was evaluated. Results There were 1,680 patients in the study. Median age was 61 years (19–85). The inspected patients consist of 763 patients with breast cancer, 446 with ovarian cancer, 121 with colorectal cancer, 86 with lung cancer and 264 with other cancer types. All patients start therapy with pegfilgrastim after at least one episode of IV grade neutropenia (as in reinbursement regulations). After starting pegfilgrastim 104 (6.1 %) patients have neutropenia grade I and II, but without fever and hospitalization. Fifty-two (3.09 %) patients were hospitalized due to trombocitopenia, anemia, ileus and prolapsus of colostomia. All 1,680 patients were evaluable for adverse events. The major problem was bone and muscular pain, observed in 568 (33.8 %) cases but only in 219 (13 %) cases a heavy pain and decrease of QoL was reported. All of the patients recieved analgetics. Conclusions Pegfilgrastim is a highly active growth factor treatment for patients with neutropenia after chemotherapy with a tolerable and manageable toxicity.

and expression of tumor suppressor genes increased significantly. BP-C2 stimulated the innate immune system. The effect is properly mediated via several cytokines (TNF-α, INF-γ, GM-CSF, IL-1β, IL-6, Il-25) and apoptotic genes. Conclusions BP-C2 is potential for clinical use protecting and treating radiation induced skin injuries. Fig1: 5 weeks after irridatiation

Fig 2: Histologic of full-thickness skin biopsy 5 weeks after exposure to 30 GY.

MASCC-0420 Toxicities

MASCC-0374 Toxicities BP-C2, A NEWANTI-RADIATION COMPLEX PREVENT AND CURE RADIOTHERAPY INDUCED SKIN INJURIES IN MICE

A PRACTICAL APPROACH TO IMPROVE SAFETYAND MANAGEMENT IN AMBULATORY CHEMOTHERAPY UNITS BASED ON A CHEMOTHERAPY NETWORK MONITORING PROGRAM

A. Rasmussen , F.F. Fares , B.A. Azzam , B.F. Fares , S.L. Laresn , S.L.J. Lindkær-Jensen2 1 Clinical Oncology, Meabco A/S, Copenhagen, Denmark; 2Dep. of Molecular Biology, Carmel Medical Center University of Haifa, Haifa, Israel; 3Controlled Clinical Trials and Biostatistics, University Oslo, Oslo, Norway

F. Scotté1, H. Aboudagga2, R. Elaidi3, C. Thibault3, B. Bonan4, J. Stevens3, V. Tual3, S. Oudard3 1 Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France; 2Pharmacy Department, Georges Pompidou European Hospital, Paris, France; 3Medical Oncology, Georges Pompidou European Hospital, Paris, France; 4Pharmacy Department, Foch Hospital, Suresnes, France

Background and Aims BP-C2 is a topical radio-protective drug based on a benzene-polycarboxylic acid complex with molybdenum having detoxifying properties and BP-Cx-1, a globular polydentant ligand known for its free radical scavenging, anti-oxidant and detoxifying activity. BP-C2 results in highly significant survival in animals receiving either lethal or sub-lethal doses of gamma irradiation; LD50/30 at 6.56 GY. In vitro studies demonstrated no toxicity (LDH release) after administering BP-C2. Methods This study included a prophylactic treatment group (PTG), a post treatment group (PoTG), and a control group (CG) (n=8 each) of mice irradiated with 30 GY at the one hind leg. The PTG was sprayed with BP-C2 dose 0.75 mg/ml on the day of irradiation and 3 times a week for 5 weeks. The PoTG was treated with BP-C2 similarly after occurrence of skin injuries. The effects were investigated by H&E histopathology, cytokine and gene expression by immunohistochemistry. Results No skin injury was observed in the PTG. All mice in the CG and PoTG developed severe skin injuries with ulcerations (Fig1). In the PoTG all mice were cured after 5 weeks of BP-C2. Histological evaluation of the skin demonstration protection (fig2). Oncogenes expression decreased

Background and Aims 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. This program is evaluated on a 4 years period. Methods This prospective study compared the program Data from patients entered in the PROCHE program with 513 control patients. Results Between Oct 2008 and Feb 2014, 2,040 patients participated in the program, representing 21,920 scheduled chemotherapy. Main adverse events (AE) were collected on an ongoing basis (percentages are rounded to nearest integer, m=mild, M=moderate, S=severe, LT=life threatening). Fatigue was the most incident: 25 % (m), 35 % (M), 16 % (S) and 3 % (LT). Pain: 11 % (m), 14 % (M), 5 % (S) and 1 % (LT). At least one episode of infection was present in 5 % of patients. Nausea: 12 % (m), 6 % (M) and 1 % (S) and vomiting : 3 % (m), 1 % (M), <1 % (S) and <1 % (LT). Weight loss: 6 % (m), <1 % (M) and <1 % (S).

1

2

2

2

3

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Mucositis: 6 % (m), 2 % (M) and <1 % (S). Diarrhea: 6 %(m), <1 %(M) and <1 %(S). Constipation: 12 %(m), 1 %(M), <1 %(S) and <1 %(LT). Neuropathy: 22 % (m), 6 % (M), 2 % (S) and <1 % (LT). Results demonstrated significant reductions in mean hospital stay i.e. decreased it by 53 min allowing 95 % of patients satisfied with the care. Conclusions The PROCHE initiative resulted in improved patient quality of care and improved hospital as well as pharmacy efficacy.

MASCC-0519 Toxicities NEUROCOGNITIVE OUTCOME IN CHILDREN WITH ACUTE LYMPHOBLASSTIC LEUKEMIA FOLLOWING HIGH-DOSE METHOTREXATE

L. Sherief1, E. Abdel khalek1, A. Shebl2, R. Sanad2, A. El Hada3, N. Kamal4, E. El-Safy5, E. Ibrahim6 1 Pediatric Oncology, Zagazig university, Zagazig, Egypt; 2Pediatric, Beha university, Beha, Egypt; 3Pediatric Oncology, Cairo university, Cairo, Egypt; 4pediatric, Cairo university, Cairo, Egypt; 5Psychiatry, Zagazig university, Zagazig, Egypt; 6Pediatric, Benha university, Beha, Egypt Background and Aims To investigate neurocognitive function in children treated for acute lymphoblastic leukaemia (ALL) with high dose methotrexate (HDMXT) and to identify treatment-related risk factors that can lead to impairment. Methods In this multi-centres study, 102 survivors with ALL and 5o healthy control were included. All patients and controls were subjected to test the Cognitive function through the Wechsler Intelligence Scale. Results There is impairment in full scale in ALL survivors than the control except for coding. The impact of HDMXT was dependent on young age at diagnosis for intelligence, academic, and memory functions but not in picture completion and object assembly. Conclusions HDMXT appears to have effects on neurocognitive functions. We hope that this new study will help us for early identification for preventive behavioral or educational intervention.

MASCC-0583 Toxicities EFFICIENCYAND TOXICITY STUDY OF SUNITINIB IN RENAL CELL CARCINOMA – EXPERIENCE OF A LARGE LISBON’S HOSPITAL CENTER

A. Trindade1, P. Barata1, S. Oliveira1, F. Gomes1, C. Ribeiro1, F. Filipe1, M. Custódio1, R. da Luz1, L. Batarda1 1 Oncology, Centro hospitalar Lisboa Central, Lisboa, Portugal Background and Aims Introduction: Sunitinib is the current standard of care in the first-line treatment of advanced RCC. As incidence of side effects with Sunitinib varies between clinical studies, clinical information from different populations is very useful to help physicians to maximize efficacy and to optimize supportive care for patients treated with this drug. Objectives: To evaluate the response to treatment with Sunitinib in metastatic RCC and related toxicity.

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Methods Methods: Between January 2010 and February 2014, data from patients with metastatic RCC good/intermediate risk and treated with Sunitinib were collected. Response to treatment was assessed by RECIST criteria (v1.1) and toxicities were graded according to NCI-CTC (v4.0). Results Results: A total of 19 patients, median age of 63 (46–88) years, 95 % men, were included. The most frequent symptom leading to diagnosis was bone pain (21 %). At diagnosis ten patients (53 %) were stage 4 with lung and bone the most frequent metastatic sites. Sixteen patients (84 %) experienced side effects of any grade, more frequently: gastrointestinal (47 %), hematological (32 %) and hypertension (26 %). Those were responsible for a treatment delay/dose reduction/ suspension in 53 %, 32 % and 26 % of the cases, respectively. Median progression-free survival (PFS) was 14.17 months (10.9–17.4) and overall survival (OS) was 27.5 months (11.7–43.3). Conclusions Conclusions: Despite similar toxicity profile compared with other studies, there is still room to optimize supportive care, as a significant number of changes to treatment plan was obtained.

MASCC-0530 Toxicities EFFICACY OF LIPEGFILGRASTIM VERSUS PEGFILGRAS TIM IN PATIENTS WITH BREAST CANCER: SUBGROUP ANALYSIS BASED ON AGE, WEIGHT, AND TYPE OF TREATMENT

C. Volovat1, A. Buchner2, P. Bias2, U. Mueller3 1 medical oncology, Centrul de Oncologie Medicala, Iasi, Romania; 2 Clinical, Teva Rathiopharm, Ulm, Germany; 3Clinical, Teva Pharmaceuticals Inc., Ulm, Germany Background and Aims Background and Aims: Lipegfilgrastim is a long-acting, fixed-dose, glycopegylated recombinant granulocyte colony-stimulating factor developed to reduce the duration of severe neutropenia and the incidence of febrile neutropenia (FN) in adults receiving myelosuppressive chemotherapy with a ≥20 % risk of FN. This analysis evaluated the effects of age, weight, and treatment type (adjuvant vs metastatic disease) on the efficacy of lipegfilgrastim vs pegfilgrastim using data from 2 studies (1 phase II, 1 phase III) in breast cancer patients receiving chemotherapy. Methods Both studies randomized patients to subcutaneous lipegfilgrastim (3, 4.5, or 6 mg, phase II; 6 mg, phase III) or pegfilgrastim (6 mg) ≈ 24 h after chemotherapy (60 mg/m2 doxorubicin/75 mg/m2 docetaxel) for 4 21-day cycles. Blood samples for absolute neutrophil counts (ANC) were obtained 24 h before chemotherapy (cycle 1), daily until day 15, and during cycles 2, 3, and 4. This post hoc analysis, pooled data from the lipegfilgrastim and pegfilgrastim 6mg groups from both studies. Study endpoints included duration of severe neutropenia; time to ANC recovery; depth of ANC nadir; and incidence of grade 4 neutropenia stratified by age, weight, and type of treatment. Results Data for stratified efficacy endpoints are summarized in the Table. Conclusions Treatment with lipegfilgrastim limits the extent of neutropenia regardless of patient age, weight, or type of treatment. This post hoc analysis demonstrates a trend for a lower rate of grade 4 neutropenia with lipegfilgrastim treatment that is consistent across all subgroups evaluated.

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MASCC-0361 Toxicities 2 IS THERE A ROLE OF A PRONE POSITION WITH A BELLY BOARD AND IMRT FOR MAXIMAL SMALL BOWEL SPARING IN ADJUVANT RADIOTHERAPY OF ENDOMETRIAL CANCER

S. Akyurek1, T. Kutuk1, K. Kose2, S. Cakir Gokce1 1 Radiation Oncology, Ankara Üniversity Faculty of Medicine, Ankara, Turkey; 2Biostatistic, Ankara Üniversity Faculty of Medicine, Ankara, Turkey Background and Aims Small bowel dose is major dose limiting factor for adjuvant radiotherapy of endometrial cancer. In this study we aimed to determine whether the combination of a prone position with belly board device (BBD) and intensity-modulated radiotherapy (IMRT) would further reduce the radiation dose to the small bowel compared with IMRT in supine position. Methods Ten endometrial cancer patients scheduled for pelvic postoperative adjuvant external beam radiotherapy were selected. Patients were immobilized with BBD in prone position or in supine position for CT simulation. Oral gastrograffin was used as small-bowel contrast. Clinical and Planning target volumes (CTV and PTV) as well as organ at risk (OAR) (small bowel, bladder, rectum) were delineated in both studies. A comparison of DVH parameters for PTV, small bowel, bladder, and rectum were performed. Results The percentage of volume receiving 10, 20, 30, 40, 45 and 50 Gy (V10– V50) for small bowel was 42.6 %, 28.5 %, 12.6 %, 4.7 %, 2 %, and 0.5 % in the prone group and 44 %, 34 %, 18 %, 7 %, 4 %, and 0.7 % in the supine group. These difference were significant for V30 and V40, p=0.005 and p=0.009, respectively. Similarly, the dose-volume histograms for bladder and rectum were obtained, there were not any significant difference. The comparison showed a similar PTV coverage of 95 % of the prescribed dose and for target conformity in IMRT plans (prone vs supine). Conclusions We found that, the combination of a prone position with BBD and IMRT can spare small bowel volumes of 30Gy and 40Gy dose levels.

MASCC-0195 Toxicities 2 LOCAL COMPLICATIONS OF CENTRALVENOUS CATHETERS IN THE TARGET THERAPY ERA

R. Berardi1, S. Rinaldi1, D. Santini2, B. Vincenzi2, R. Giampieri1, E. Maccaroni1, F. Marcucci1, M. Francoletti1, A. Onofri1, A. Lucarelli1, C. Pierantoni1, G. Tonini2, S. Cascinu1 1 Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; 2Oncologia Medica, Campus Biomedico, Roma, Italy Background and Aims Totally implantable central venous accesses (port-à-cath) are often used for chemotherapy administration or prolonged intravenous infusions in cancer patients. Despite the technique has been well described, some complications may occur. Among the others, thrombosis and infections are well known. The aim of the study is to investigate complications with the new target therapies. Methods Over a 2 year period 459 devices were placed in two Academic Italian Institutions. Patients characteristics, catheter-related complications and correlation with target therapy administration were analyzed.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Patients characteristics are summarized in table 1. Table 1. Patients’ characteristics Parameters Number of patient Sex Male Female Age Median

N 30/459 (7 %) 16 (53 %) 14 (47 %) 58

Range Primary tumor Colorectal cancer Breast cancer Gastrointestinal (not colorectal) cancer Lung cancer Other Performance Status 0 1 2 Histology Adenocarcinoma Invasive ductal carcinoma Other Anti-tumoral treatment Antiangiogenic drug (Bevacizumab of others) Cetuximab/Panitumum ab-based therapy Herceptin

30–80 15 (50 %) 5 (17 %) 5 (17 %) 2 (6 %) 3 (10 %) 22 6 2 21 (70 %) 5 (17 %) 4 (13 %) 12 (40 %) 5 (17 %) 1 (3 %)

Standard chemotherapy (Platinum-based) Stage of disease M0 M1

12 (40 %) 8 (27 %) 22 (73 %)

Catheter-related complications occurred in 30 out of the 459 analysed cancer patients (7 %): 5 of them were receiving chemotherapy (17 % of the patients developing complications and 1 % of all the treated patients) while the remaining 25 were receiving biological drugs (83 % of the patients with complications and 5 % of all the treated patients). Forty per cent of the patients were receiving an antiangiogenic drug, 43 % were receiving an anti-EGFR. Treatment with a biological drug has been shown to be the only one related to the central venous catheter complications (p=0.02). (Table 2) Table 2. Complications’ Treatment Type of therapy

Outcome

Antibiotic therapy

Resolution

New suture

Resolution

Removal Removal

Dehiscence

Infection Biological drugs 2 (6 %)

3 (10 %)

5 (17 %)

2 (6 %)

1 (2 %)

1 (3 %)

3 (10 %)

6 (20 %) 1 (3 %)

Chemotherapy

Dislodgement

Chemotherapy

Biological drugs

Chemotherapy Biological drugs

1 (3 %) 5 (17 %)

No differences between anti-angiogenic drugs and anti-EGFR have been shown.

Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Our results showed that targeted therapy may influence the occurrence of biological complications (i.e. infection and dehiscence) and that the onset of these complications occurs earlier in patients receiving biological drugs (and in particular during bevacizumab vs. anti-EGFR therapy) than in those undergoing traditional chemotherapy. Further studies are required in order to establish how to manage complications due to new target therapies.

MASCC-0252 Toxicities 2 AN ITALIAN ASSOCIATION FOR SUPPORTIVE CARE IN CANCER: THE CASE OF NICSO (NETWORK ITALIANO DI CURE DI SUPPORTO IN ONCOLOGIA)

F. Roila1, C. Ripamonti2, A. Antonuzzo3, P. Bossi4 1 Medical Oncology, S Maria Hospital, Terni, Italy; 2Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Supportive Care in Cancer Unit, Polo Oncologico, Pisa, Italy; 4 Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

Background and Aims In the oncological setting, there is an increased need of a comprehensive assessment and treatment of cancer and/or treatment related symptoms, toxicities and/or complications from diagnosis to treatment and followup. Methods On 14th December 2013 a new Italian Association (NICSO) was born with these aims, requiring to be recognized by MASCC. Results The Association does not have political or confessional characteristics, it is non-profit and has the exclusive scopes of the promotion of knowledge, clinical practice and research in the field of Supportive Care in Cancer. To provide the social objective, the Association will also perform the following activities: 1. Design, development and implementation of epidemiological studies; 2. Design, development and implementation of biomedical research; 3. Acquisition and use of the technical means required to carry out the research and studies described above; 4. Design and development of educational programs to release to all professional medical and nursing personnel, patients and their associations and volunteers; 5. Assistance and support for the growth and scientific culture of young people by support to meetings and awards, also through other collaborating institutions; 6. Assistance and support for development of communication skills, particularly for medical-scientific congress organization, video releases, informative books, brochures and further related literature relating to patients or health professionals; 7. Participation in medical-scientific congresses 8. Publication of articles or independent reviews; 9. Creation of a dedicated website Conclusions In May 12th, will be held in Rome the first NICSO meeting, with aim to define the social membership’s duties and to discuss scientific protocols.

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MASCC-0202 Toxicities 2 SAFETY OF RENAL FUNCTION IN EAST ASIAN OUTPATIENTS TREATED WITH A SHORT HYDRATION FOR CISPLATIN COMBINATION CHEMOTHERAPY

Y. Choi1, K. Kim1, D. Shin2, H. Kang2, Y. Kim1, J. Park1, H. Lee1, K. Kwon1, B. Seo1, I. Na2, S. Yang2 1 Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea; 2Internal Medicine, Korea Cancer Center Hospital Korea Institute of Radiological and Medical Sciences, Seoul, Korea Background and Aims Cisplatin presents an important chemotherapeutic agent for many solid tumors. However, renal toxicity, which limits its use, requires a 24 h hydration schedule in an inpatient regimen to ensure safe administration. In this study, we studied the safety of short hydration in outpatient for intermediate to high dose of cisplatin administration. Methods Outpatient data was examined retrospectively for patients treated with cisplatin (> or=60 mg/m2/cycle) from January 2010 to December 2012. They were given a short hydration regimen, which included 2000 ml of fluids with control of diuresis. Serum creatinine and creatinine clearance levels were monitored. Results A total of 185 outpatients (median age 62 years, range:31–77) were consecutively enrolled including 101 lung cancer (54.6 %) and 32 gastric cancer (17.3 %). One patient was withdrawn from chemotherapy because of renal toxicity. For the other 184 patients, the maximum median percentage change in creatinine from baseline during the cycles of chemotherapy was 0 % ranging from −30 to 40 % (95 % CI=−20–30). There was no difference in serum creatinine and creatinine clearance between the groups with co-morbid conditions (hypertension, diabetes, heart disease) during treatment (P=0.36). Conclusions A short hydration regimen, which included 2,000 ml of fluids, for the outpatient administration of cisplatin at≥60 mg/m2 was feasible.

MASCC-0222 Toxicities 2 A COMPARISON OF TOXICITYAND SUPPORTIVE CARE USE BETWEEN FOUR CYTOTOXIC AGENTS USED IN PATIENTS WITH TRIPLE NEGATIVE METASTATIC BREAST CANCER (TN-MBC)

C. Faria1, G. Dranitsaris2, D. Cox3 1 Outcomes Research, Eisai Inc, Woodcliff Lake, USA; 2Outcomes Research, Augmentium Pharma Consulting, Toronto, Canada; 3Outcomes Research, Eisai Inc., Woodcliff Lake, USA Background and Aims Eribulin (E), Capecitabine (C), gemcitabine (G) and vinorelbine (V) are commonly used as single agents in patients with TN-MBC. In this study, toxicity and supportive care use was compared between the four agents in a sample of TN-MBC patients. Methods The study identified 225 TN-MBC patients treated with single agent E (n=47), C (n=69), G (n=56) or V (n=53) in 19 community oncology clinics across the U.S. Data collection included patient and disease characteristics, prior therapies, supportive care drugs, the occurrence of dose limiting toxicities and their impact on health care resource use.

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Results The median lines of therapy with C, G, Vand E were 2nd, 3rd, 3rd and 4th respectively. The most common toxicities for patients who received C, G and V were diarrhea (29.4 %), anemia (32.1 %) and neutropenia (45.3 %) respectively. The most common toxicities for E were anemia (32 %) and neutropenia (31 %). Blood transfusions were most prevalent with G (12 %) and E (19 %). In contrast, unplanned clinic visits were most common with C (7 %). Erythropoietin stimulating agents (ESAs) use was highest with V (26 %) relative to E (15 %), G (18 %) and C (16 %) respectively. Toxicity was the cause of treatment discontinuations (D/Cs) in more patients receiving C (12 %) compared to 7 %, 6 % and 2 % of G, Vand E patients respectively. Conclusions More patients receiving vinorelbine required support with high cost ESAs. Capecitabine had less neutropenia and anemia, but more D/Cs due to toxicity. In contrast, fewer patients receiving eribulin required treatment D/Cs because of toxicity.

MASCC-0250 Toxicities 2 DOCETAXEL-INDUCED NEUROPATHY IN EARLY-STAGE BREAST CANCER

L. Eckhoff1, A.S. Knoop2, M.B. Jensen3, M. Ewertz4 1 Department of Oncology, Odense University Hospital Institute of Clinical Research University of Southern Denmark, Odense, Denmark; 2 Department of Oncology, Rigshospitalet Copenhagen University Hospital Denmark, Copenhagen, Denmark; 3Danish Breast Cancer Cooperative Group, RigshospitaletCopenhagen University Hospital, Copenhagen, Denmark; 4Department of Oncology, Odense University Hospital Denmark Institute of Clinical Research University of Southern Denmark, Odense, Denmark Background and Aims Adjuvant chemotherapy with taxanes plays a key role in reducing the risk of recurrence and death from early-stage breast cancer but has side-effects such as peripheral neuropathy (PN). We evaluated occurrence, persistence, and consequences of PN in two adjuvant docetaxel-containing regimens, and the impact of PN on health related quality of life (HRQOL). Methods The study included 1,725 patients with early-stage breast cancer who were randomly assigned to three cycles epirubicin and cyclophosphamide followed by three cycles docetaxel (D100) or six cycles cyclophosphamide and docetaxel (D75). Among these, 1,031 patients completed NCI CTC-like scores, EORTC QLQ-C30 and EORTC CIPN20 1 to 3 years after randomization. All patients received at least one cycle of docetaxel and provided patient-reported outcomes including PN. Results Overall 597 patients (35 %) reported PN, grades 2–4. The risk of PN after the first cycle of docetaxel was significantly 3-fold increased for the D100 regimen. Patients with PN received significantly lower cumulative doses of docetaxel than patients with no PN. Occurrence of PN was significantly reduced if patients wore frozen gloves and socks during treatment. One to 3 years after completion of docetaxel, 157 patients (15 %) reported PN, grades 2–4. Persistent PN had a significant negative correlation with HRQOL, functional scales and symptoms scales. Conclusions Patients developing PN after the first cycle are less likely to receive docetaxel at the planned dose intensity and usage of frozen gloves and socks may modify the risk. Persistent PN has a significant negative impact of HRQOL.

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MASCC-0113 Toxicities 2 HEPATOTOXICITY REPORTED IN ASSOCIATION WITH VISMODEGIB: A RESEARCH ON ADVERSE DRUG EVENTS AND REPORTS (RADAR) PROJECT

B. Edwards1, D. Raisch2, S. Saraykar1, R. Arabyat3, J. Hammel4, I. Aslam4, F. Herlong5, D. West4 1 General Internal Medicine, UT MD Anderson Cancer Center, Houston, USA; 2Pharmacy Practice & Administrative Sciences, University of New Mexico, Albuquerque, USA; 3Pharmacy Practice & Administrative Sciences, University of New Mexico, Albquerque, USA; 4Dermatology, Northwestern University, Chicago, USA; 5Gastroenterology and Hepatology, UT MD Anderson Cancer Center, Houston, USA Background and Aims Post-marketing surveillance often ascertains Adverse Events (AEs) not seen in clinical trials. On Jan 30, 2012 the FDA approved vismodegib for use in locally advanced basal cell cancer patients, who are not candidates for surgery or radiation and for patients with metastatic disease. The aim of this study is to evaluate the FDA adverse event reporting system (FAERS) for adverse events with visdmodegib. Methods FAERS was searched using terms such as hedgehog pathway, vismodegib, liver, jaundice, hepatitis, and hepatic dysfunction. Disproportionality analyses of proportional reporting ratio (PRR) and Empirical Bayes Geometric Mean (EBGM) were conducted. Results Thirteen reports of AEs were identified in FAERS, of which 7 were severe (SAE) resulting in 3 hospitalizations, 1 life threatening event, and 3 deaths. Hepatotoxicity was more common in females (8:5). Disproportionality analysis results were: PRR=6.9 (95 % C.I. 4.2– 11.2), EBGM=6.3 (95 % C.I. 3.3–10.4), chi-square 61.8, p=0.001. Although, a review of data for 18 vismodegib cases at two NCI Comprehensive Cancer Centers revealed no reported liver toxicity, FAERS data represents a larger exposed population. To date, no safety notifications have been issued by the FDA related to hepatotoxicity nor does the FDA labeling require liver function monitoring. Conclusions Thirteen reports of liver toxicity associated with vismodegib produced a safety signal in FAERS. Further proactive pharmacovigilance related to vismodegib and hepatotoxicity is warranted.

MASCC-0271 Toxicities 2 BEVACIZUMAB-INDUCED HYPERTENSION, PROTEINURIA AND ACUTE KIDNEY INJURY IN CANCER PATIENTS

C.P. Escalante1, A. Lahoti1, J. Song1, M. Lu1, A. Zalpour1, R. Abisaid Baker1, M.N. Richardson1, M. Mudireddy1, M. Overman1, M. George1, J.B. Durand1 1 General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA Background and Aims Introduction: Vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab (BV) can result in hypertension (HTN), proteinuria (PU) and acute kidney injury (AKI). Objectives: To assess frequency of PU and AKI; evaluate BV dose changes from PU and AKI; and define time to first resolution post-BV treatment (TX) for HTN, PU and AKI.

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Methods Methods: We reviewed charts of 98 cancer patients on BV TX with≤ 6 months follow-up from 1/1/2009 to 9/30/2011. This included demographic, clinical and outcome parameters, using descriptive statistics. Results Results: 49 (50 %) were males and median age 58 years (19–84). 17 (17 %) had lung cancer and 15 (15 %) colorectal. 91 (93 %) had metastatic disease and were on BV with other agents. At entry, 47 (48 %) had HTN, 14 (14 %) diabetes and 7 (7 %) chronic kidney disease. 59 (60 %) had PU and 27 (28 %) AKI at least once. None had BV dose reduction due to PU or AKI. 1 (1 %) and 1 (1 %) patient had BV TX delay due to PU and AKI, respectively. 4 (4 %) and 1 (1 %) had BV withdrawal due to PU and AKI, respectively. Of the 28 (29 %) who had BV-induced HTN, 11 (11 %) had a first decrease of HTN med at median 26 (7–162) days after last BV TX. The median days to resolve first PU and AKI was 22 (1–193) and 14 (0–34), respectively. Conclusions Conclusions: This first report of the time post-BV TX for HTN, PU and AKI will impact monitoring practices and suggests limited end organ dysfunction due to BV.

MASCC-0363 Toxicities 2 CISPLATIN OR CARBOPLATIN AS PALLIATIVE TREATMENT FOR ADVANCED LUNG CANCER

A. Mellemgaard1, J. Johansen1 1 Oncology, Herlev Hospital, Copenhagen, Denmark Background and Aims Cisplatin has been shown to be more effective in terms of survival than carboplatin, but cisplatin use is limited due to more side effects. Furthermore, infusion time is much longer for cisplatin. In this study we addressed the two main limitations of cisplatin use: infusion time and QOL in patients receiving chemotherapy for advanced lung cancer. Methods Study A (n = 20) was a prospective single arm study of short infusion time for cisplatin (3½ h). Glomerular filtration rate (GFR) measurements done for every series of cisplatin based chemotherapy. Study B (N=43) was a prospective observational study where QOL was measured by self-administered questionnaires (EORTC QLQ C30). Questionnaires were filled out for every cycle up to 6. Results Study A: 20 patients received 4 series of cisplatin combination treatment with a short infusion time. GFR before first and after last treatment was 50–120 ml and 64–111 ml respectively. No significant change in GFR was observed. In study B, 14 and 29 patient was treated with cisplatin or carboplatin combinations respectively. Generally QOL remained unchanged throughout the treatment period. However, a small number of patients in both groups experienced some degree of toxicity and decrease in QOL. Conclusions No sign of kidney toxicity was observed with a shortened infusion time of 3½h for cisplatin combinations. QOL of life remained unchanged in both patients receiving cisplatin and carboplatin combination treatment. With effective antiemetic supportive care, cisplatin combinations can be used with little excess in toxicity for the patient.

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MASCC-0357 Toxicities 2 REAL LIFE EXPERIENCE WITH A NIACINAMID-CONTAINING BODY BALM FOR THE PREVENTION OF CHEMOTHERAPY-INDUCED SKIN REACTIONS AND IMPROVEMENT OF QUALITY OF LIFE IN BREAST CANCER PATIENTS

J. Schilling1, K. Heinig2, D. Guth3, E. Wierick4, P. Ortner5 1 BNGO e.V., BNGO e.V., Neuenhagen b. Berlin, Germany; 2Practice of Gyneco-Oncology, Practice of Gyneco-Oncology, Spremberg, Germany; 3 Practice of Gyneco-Oncology, Practice of Gyneco-Oncology, Plauen, Germany; 4Practice of Gyneco-Oncology, Practice of Gyneco-Oncology, Lohsa, Germany; 5Pomme-med, Pomme-med, München, Germany Background and Aims Chemotherapy-induced skin reactions such as dry or sore skin and itching can impair the quality of life of cancer patients. A 4 % niacinamid body balm reduced symptoms and improved quality of life of breast cancer patients receiving (neo)adjuvant anthracyclineor taxane-containing chemotherapy in a German prospective randomised multicentre study. To verify the results of this study and to evaluate the quality of life of breast cancer patients receiving chemotherapy and 4 % niacinamid body balm under real life conditions in German practices of Gyneco-Oncology. Methods Between May 2013 and Feb 2014, data of 122 breast cancer patients receiving chemotherapy were recorded by the ODM Quasi® GYN system, the online documentation system of the BNGO. Data were collected at start of chemotherapy, 6 weeks after 1st course of chemotherapy and 18 weeks after study enrolment. The documentation is ongoing. Results Median patient age was 54 years. 77,9 % of pts received anthracyclines, 74,5 % taxanes. 66 % of taxane-containing regimens were sequential with T given after the A courses. As per 2 February 2014, 122 patients filled in questionnaire 1, 110 questionnaire 1+2, 56 questionnaire 1, 2+3: No skin problems during the past 7 days: questionnaire 1: 69 %, questionnaire 2: 64,5 %, questionnaire 3: 62,5 %. Skin improved by body balm: questionnaire 1: 20 %, questionnaire 2: 34,5 %, questionnaire 3: 37,4 %. Influence of supportive care with body balm on quality of life: questionnaire 1: 25 %, questionnaire 2: 58 %, questionnaire 3: 75 %. Conclusions Patients benefit from prophylactic and concomitant supportive skin care with niacinamid containing body balm.

MASCC-0038 Toxicities 2 VERTEBRAL FRACTURES IN LOCALLYADVANCED NSCLC PATIENTS TREATED WITH RADICAL IMRT

W. Uyterlinde1, C. Chen1 1 Thoracic Oncology, NKI-AVL, Amsterdam, Netherlands

Background and Aims Little is known about late toxicity of radical radiotherapy (RT) for locally advanced non-small cell lung cancer (NSCLC). Since survival is slowly increasing however, we learn more about this phenomena. One of the late toxicities identified in our patient cohort is the vertebral fracture, leading to symptoms and impaired health related quality of life.

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Objectives To report on the incidence of vertebral fractures and its association with the RT dose to the vertebrae. Methods Planning and follow-up CTor MRI scans of 524 patients were retrospectively utilized to identify vertebral collapses. Clinical and dosimetric parameters were retrospectively collected. The RT dose effect relationship was analyzed using the maximum (Dmax) and mean (Dmean) dose to each vertebra. Dose–response was modeled using Cox model with patient as random effect. Results Three hundred sixty-six patients were eligible for analysis. The median follow-up was 24 months. Twenty-eight (8 %) patients had

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vertebral fractures. All fractures were located from the 6th to 8th thoracic vertebra. The median onset time for the fracture was 7 months (range 2–26). The median Dmax was 40 Gy (range 0–83) and 72 Gy (range 42–83) for non-fractured and fractured vertebrae, respectively. The median Dmean was 12 Gy (range 0–65) and 51 Gy (range 18–71) for non-fractured and fractured vertebras, respectively. Both Dmax and Dmean were significantly (p<0.001) associated with vertebral fractures. Conclusions Vertebral fractures were identified in 8 % of the patients. Both Dmax and Dmean of the vertebra were associated with fractures. Before reduction of the RT dose can be considered, a case–control study is in progress to analyze the dose–response relationship in the entire population.