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 Albrand, H. mascc-0395 Anttila, A.H.T.I. mascc-0058 Aapro, M. mascc-0160 Alexander, S. mascc-0560 Aogi, K. mascc-0264 Aapro, M. mascc-0161 Alfieri, S. mascc-0251 Aouizerat, B. mascc-0154 Aapro, M. mascc-0158 AlHarbi, K. mascc-0509 Aouizerat, B.E. mascc-0226 Aapro, M. mascc-0367 Alhazmi, N. mascc-0523 Applegate, T.E.R.I. mascc-0064 Aaronson, N.K. mascc-0138 Alibhai, S. mascc-0293 Apte, S.M. mascc-0613 Abasher, S. mascc-0017 Alibhai, S. mascc-0180 Arab, N. mascc-0575 Abbink, F. mascc-0185 Alibhai, S. mascc-0301 Arab, N. mascc-0502 Abdelkhalek, El mascc-0519 Alibhai, S.M.H. mascc-0483 Arabyat, R. mascc-0113 Abdias, A. mascc-0606 Alibhai, S.M.H. mascc-0559 AraújodaSilva, E. mascc-0061 Abe, K. mascc-0378 Alkhalil, A.M.R.A. mascc-0254 Araz, M. mascc-0258 Abernethy, A. mascc-0244 AlKindi, S. mascc-0253 Arcusa-Lanza, M.A. mascc-0549 Abernethy, A.P.mascc-0416 Allam, A. mascc-0245 Arellano, J. mascc-0498 AbisaidBaker, R. mascc-0271 Allam, A. mascc-0253 Arguis, P.mascc-0597 Aboudagga, H. mascc-0420 Allexandre, D. mascc-0033 Arpaci, F. mascc-0110 Aboudi, K. mascc-0254 Alloo, A. mascc-0610 Artru, P.mascc-0272 Abraham, I. mascc-0367 AlmEl-Din, M.A. mascc-0337 Asadilari, M. mascc-0080 Abudari, G. mascc-0526 AlmEl-Din, M.A. mascc-0467 Ashikaga, T. mascc-0304 Aburub, A. mascc-0417 Alrehili, R. mascc-0523 Aslam, I. mascc-0113 AbuZeinah, G. mascc-0253 Alterio, D. mascc-0562 Ata, O. mascc-0372 Acar, H. mascc-0574 Altinok, A. mascc-0574 Ata, O. mascc-0258 Acar, H. mascc-0577 Altinok, A. mascc-0577 Atayee, R.S. mascc-0486 Acar, H. mascc-0576 Altinok, A. mascc-0576 Atayee, R.S. mascc-0151 Acquavella, J. mascc-0512 Altun, M. mascc-0592 Atenafu, E. mascc-0500 Acquavella, JF mascc-0490 AlUstwani, O. mascc-0127 Athanassiadis, I. mascc-0517 Adair, M. mascc-0026 Àlvar, R. mascc-0305 Atherton, P.J. mascc-0450 Adair, M. mascc-0030 Alvarez, I. mascc-0453 Atherton, P.J. mascc-0049 Ades, S. mascc-0304 Alves, B.C. mascc-0011 Attali, P.mascc-0148 Adeyemi, J.D. mascc-0169 Alves, M. mascc-0119 Attali, P.mascc-0150 AdrianaLinsdeMorais, A.L.M. mascc-0551 Amadori, F. mascc-0136 Aubaret, C. mascc-0330 AdrianaLinsdeMorais, A.L.M. mascc-0553 AmaralMendes, R. mascc-0619 Aubaret, C. mascc-0341 Affronti, M.L. mascc-0215 Amin, A. mascc-0125 Audigier-Valette, C. mascc-0272 Agarwal, A. mascc-0465 Aminah, J. mascc-0620 Audigier-Vallet, C. mascc-0269 Agarwal, A. mascc-0231 Amir, E. mascc-0497 August, A. mascc-0560 Agarwal, J. mascc-0172 An, H.J. mascc-0366 Aurer, I. mascc-0265 Aguilar, D. mascc-0591 An, H.J. mascc-0368 AuroDelGiglio, A.D.G. mascc-0054 Ahadian, H. mascc-0050 An, H.J. mascc-0365 AyaladelaPeña, F. mascc-0549 Ahmad, F. mascc-0433 An, X. mascc-0255 Ayora, P.mascc-0575 Ahmad, H.E.B.A. mascc-0287 Anami, S. mascc-0264 Ayora, P.mascc-0502 Ahmad, I. mascc-0521 Ancizar, N. mascc-0453 Azevedo, L.R. mascc-0260 Ahmadi, M. mascc-0080 Andersen, B. mascc-0413 Azzam, B.A. mascc-0374 Ahmadi, M. mascc-0079 Andersen, B.L. mascc-0418 Ahmed, S. mascc-0125 Andersen, O. mascc-0527 B Ahmed, S. mascc-0417 Andersen, O. mascc-0529 Baba, M. mascc-0347 Ahn, J.S. mascc-0008 Anderson, D.M. mascc-0049 Badyal, D. mascc-0403 Aiba, K. mascc-0170 Anderson, K. mascc-0063 Bae, D. mascc-0090 Aina, O.F. mascc-0168 Anderson, K. mascc-0064 Bae, D.S. mascc-0091 Ait-kaci, F. mascc-0214 Anderson, K. mascc-0064 Bae, D.S. mascc-0092 Ajay, G. mascc-0085 Ang, N.K.E. mascc-0241 Bae, S.B. mascc-0401 Ajmera, A.J. mascc-0443 Ang, S.F. mascc-0194 Baek, S. mascc-0351 Aketch, W.mascc-0415 Ang, S.F. mascc-0200 Bafaloukos, D. mascc-0219 Aketch, W.mascc-0380 Angelelli, L. mascc-0083 Bailey, K.G. mascc-0335 AkhavanKarbassi, M.H. mascc-0050 Annunziata, M. mascc-0095 Bain, E. mascc-0153 Akiba, C. mascc-0542 Annunziata, M.A. mascc-0096 Bain, E. mascc-0411 Akman, T. mascc-0331 Annunziata, M.A. mascc-0118 Bajic, J.E. mascc-0238 Akopov, A. mascc-0055 Anstey, S. mascc-0405 Bakhshi, S. mascc-0564 Aktas, A. mascc-0114 AntonioRebollo, M. mascc-0597 Balakumaran, A. mascc-0340 Aktas, A. mascc-0027 AntonioRebollo, M. mascc-0549 Balakumaran, A. mascc-0498 Aktas, A. mascc-0267 Antoniou, F. mascc-0517 Baldini, S. mascc-0265 Aktas, A. mascc-0115 Antonuzzo, A. mascc-0595 Ballard, A. mascc-0614 Aktas, A. mascc-0029 Antonuzzo, A. mascc-0594 Ballatori, E. mascc-0083 Akyurek, S. mascc-0361 Antonuzzo, A. mascc-0593 Baltina, D. mascc-0570 AlAyoubi, H. mascc-0254 Antonuzzo, A. mascc-0600 Bansal, S. mascc-0165 Alberts, D. mascc-0463 Antonuzzo, A. mascc-0252 Barasch, A. mascc-0617 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S3 barasch, A. mascc-0072 Bedard, G. mascc-0441 Blanco, J. mascc-0453 Barashid, A. mascc-0523 Bedard, G. mascc-0411 Blasco, A. mascc-0549 Barata, P.mascc-0583 Bedard, G. mascc-0531 Blayney, D.W.mascc-0335 Barata, P.C. mascc-0119 Bedard, G. mascc-0467 Block, V. mascc-0563 Barbier, E. mascc-0362 Bedard, G. mascc-0075 Blum, D. mascc-0603 Barbosa, A. mascc-0119 Bedard, G. mascc-0179 BlumGrynberg, B. mascc-0621 Barbosa, R.P.mascc-0018 Bedard, G. mascc-0410 Boccadoro, M. mascc-0367 Barbounis, V. mascc-0166 Bedard, G. mascc-0455 Bodnar, M. mascc-0299 Bardellini, E. mascc-0136 Bedard, G. mascc-0473 Bohac, C. mascc-0216 Bardellini, E. mascc-0399 Bedard, G. mascc-0472 Bohac, G.C. mascc-0469 Barnes, E. mascc-0541 Bedard, G. mascc-0481 Boisnic, S. mascc-0148 Barnes, E. mascc-0446 Bedard, G. mascc-0184 Bokemeyer, C. mascc-0367 Barnes, E. mascc-0468 Bedard, G. mascc-0464 Bonan, B. mascc-0420 Barnes, E. mascc-0338 Bedard, G. mascc-0449 Bonfim, E. mascc-0217 Barnes, E. mascc-0441 Bedard, G. mascc-0191 Bonilla, Y. mascc-0549 Barnes, E. mascc-0411 Bedard, G. mascc-0231 Bopp, A. mascc-0167 Barnes, E. mascc-0531 Bedard, P.mascc-0497 Boregowda, L. mascc-0107 Barnes, E. mascc-0410 Bedi, D. mascc-0536 Boregowda, L. mascc-0134 Barnes, E. mascc-0455 Begum, A. mascc-0254 Boregowda, L. mascc-0134 Barnes, E. mascc-0473 Begum, S. mascc-0584 Borget, I. mascc-0341 Barnes, E. mascc-0472 Bekelman, D. mascc-0332 Borget, I. mascc-0385 Barnes, E. mascc-0481 Bektas-Kayhan, K. mascc-0592 Borod, M. mascc-0557 Barnes, E. mascc-0464 Belkaid, M.I. mascc-0269 Borod, M. mascc-0535 Barone, G. mascc-0261 Benchamart, M.S. mascc-0345 Borod, M. mascc-0534 Barone, G. mascc-0263 Benge, S. mascc-0189 Borre, M. mascc-0066 Barone, G. mascc-0204 Benn, M. mascc-0486 Borroni, M.E. mascc-0160 Barrera, C. mascc-0575 Bennani-Baiti, N. mascc-0029 Borroni, M.E. mascc-0162 Barrera, C. mascc-0502 Bennani-Baiti, N. mascc-0028 Borsaru, G. mascc-0265 Barron, R. mascc-0512 Bennett, M. mascc-0405 Borta, T.M. mascc-0018 Barron, R. mascc-0230 Bensadoun, R.J. mascc-0617 Bosani, R. mascc-0428 Barron, RL mascc-0490 Berardi, G. mascc-0605 Boscagli, G. mascc-0261 Bartilol, P.mascc-0062 Berardi, R. mascc-0196 Boscagli, G. mascc-0263 Barton, D.L. mascc-0049 Berardi, R. mascc-0195 Bosi, A. mascc-0265 Bartow, C. mascc-0112 Berbiche, D. mascc-0183 Bossi, P.mascc-0251 Bashir, A. mascc-0253 Berenberg, J.L. mascc-0445 Bossi, P.mascc-0508 Batarda, L. mascc-0583 Bergamini, C. mascc-0251 Bossi, P.mascc-0252 Bateman, E. mascc-0098 Berkane, K. mascc-0291 Bossi, P.*mascc-0562 Bateman, E. mascc-0188 Berry, N.M. mascc-0152 Boterberg, T. mascc-0396 Bateman, E. mascc-0186 Besen, A. mascc-0056 Bottomley, A. mascc-0342 Bearden, J.D. mascc-0049 Besen, A. mascc-0371 Bottomley, A. mascc-0337 Beasley, A. mascc-0240 Bessette, P.mascc-0307 Bottomley, A. mascc-0467 Beato, C. mascc-0597 Betticher, D. mascc-0076 Bottomley, A. mascc-0075 Beato, C. mascc-0549 Beuzeboc, P.mascc-0581 Bottomley, A. mascc-0225 Beaumont, J. mascc-0225 Beyzadeoglu, M. mascc-0110 Bottomley, A. mascc-0274 Beaumont, J. mascc-0179 Bezjak, A. mascc-0500 Bottomley, A. mascc-0179 Beaumont, J.L. mascc-0342 Bezjak, A. mascc-0494 Bottomley, A. mascc-0452 Beaumont, J.L. mascc-0075 Bhandari, R. mascc-0499 Botturi, A. mascc-0588 Beaumont, J.L. mascc-0274 Bhandari, R. mascc-0376 Bouillet, T. mascc-0272 Bedard, G mascc-0147 Bhargava, R. mascc-0104 Bouleuc, C. mascc-0547 Bedard, G. mascc-0192 Bhargava, R. mascc-0444 Bouleuc, C. mascc-0362 Bedard, G. mascc-0317 Bhargava, R. mascc-0429 Boulton, S. mascc-0215 Bedard, G. mascc-0177 Bhargava, R. mascc-0408 Bourbeau, J. mascc-0494 Bedard, G. mascc-0153 Bhattacharyya, M. mascc-0580 Bowen, J. mascc-0339 Bedard, G. mascc-0447 Bias, P.mascc-0544 Bowen, J. mascc-0188 Bedard, G. mascc-0541 Bias, P.mascc-0530 Bowen, J.M. mascc-0302 Bedard, G. mascc-0435 Bin, J. mascc-0307 Bozkurt, B. mascc-0372 Bedard, G. mascc-0327 Biosca, M. mascc-0597 Braakhuis, B.J.M. mascc-0406 Bedard, G. mascc-0446 Biosca, M. mascc-0549 Braakman, A. mascc-0513 Bedard, G. mascc-0468 Birbilaite, S. mascc-0285 Braccia, D. mascc-0437 Bedard, G. mascc-0132 Bisson, G.S. mascc-0217 Braccia, D. mascc-0438 Bedard, G. mascc-0342 Bista, S.R. mascc-0348 Bracke, M. mascc-0396 Bedard, G. mascc-0337 Bista, S.R. mascc-0346 Bracke, M. mascc-0392 Bedard, G. mascc-0338 Blacker, S. mascc-0436 Brady, A. mascc-0133 Bedard, G. mascc-0422 Blacker, S. mascc-0439 Brady, A. mascc-0193 Bedard, G. mascc-0434 Blais, J. mascc-0433 Brakenhoff, R.H. mascc-0406 Bedard, G. mascc-0423 Blais, N. mascc-0315 Brames, M. mascc-0097 S4 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Brandis, S. mascc-0266 Buzgova, R. mascc-0094 Cella, D. mascc-0216 Brandwein, J. mascc-0559 Cella, D. mascc-0342 Brasnu, D. mascc-0330 C Cella, D. mascc-0075 Brasnu, D. mascc-0341 Cadungog, M. mascc-0615 Cella, D. mascc-0225 Braspenning, A.M. mascc-0514 Cagetti, M.G. mascc-0399 Cella, D. mascc-0274 Braun, A. mascc-0340 Caglar, H.B. mascc-0574 Cella, D. mascc-0179 Brauner, E. mascc-0379 Caglar, H.B. mascc-0577 Cerny, T. mascc-0603 Brennan, M.T. mascc-0599 Caglar, H.B. mascc-0576 Cervi, C. mascc-0563 Breuer, J. mascc-0300 Caissie, A. mascc-0545 Ceugnart, L. mascc-0278 Breunis, H. mascc-0301 CakirGokce, S. mascc-0361 Chair, S.Y. mascc-0069 Breunis, H. mascc-0559 Calcoen, C. mascc-0278 Chak, J.Q. mascc-0052 Brinksma, A. mascc-0175 Calderon, C. mascc-0575 Cham, M.T. mascc-0200 Brinksma, A. mascc-0174 Calderon, C. mascc-0502 Cham, M.T. mascc-0139 Brito, G.M. mascc-0018 Calvo-Temprano, D. mascc-0597 Chan, A. mascc-0194 Broder, M. mascc-0227 Campana, F. mascc-0362 Chan, A. mascc-0039 Broder, M. mascc-0228 Campbell, B. mascc-0087 Chan, A. mascc-0040 Brooker, J. mascc-0319 Campbell, B. mascc-0086 Chan, A. mascc-0200 Broom, R. mascc-0189 Campbell, F. mascc-0240 Chan, A. mascc-0139 Bruera, E. mascc-0270 Campus, G. mascc-0399 Chan, A. mascc-0140 Bruera, E. mascc-0606 Caniza, M. mascc-0591 Chan, C. mascc-0241 Bruera, E. mascc-0618 Caniza, M.A. mascc-0470 Chan, C. mascc-0019 Bruera, E. mascc-0164 Caniza, M.A. mascc-0082 Chan, C. mascc-0239 Bruera, E. mascc-0165 Cannavale, K. mascc-0478 Chan, C. mascc-0243 Bruera, E. mascc-0236 Cannavale, K. mascc-0471 Chan, C. mascc-0616 Bruera, E. mascc-0284 Cannavale, K. mascc-0476 Chan, C. mascc-0242 Bruera, E. mascc-0389 CannavaleCA, K. mascc-0479 Chan, C. mascc-0190 Bruera, E. mascc-0282 Cantor, S. mascc-0460 Chan, C.W.mascc-0200 Bruera, E. mascc-0279 Cantoreggi, S. mascc-0188 Chan, C.W.H. mascc-0232 Bruera, E. mascc-0462 Cantoreggi, S. mascc-0186 Chan, C.W.H. mascc-0316 Bruera, E. mascc-0536 Cantu, H. mascc-0282 Chan, C.W.H. mascc-0013 Bruggeman, A. mascc-0538 Capriati, A. mascc-0265 Chan, C.W.H. mascc-0069 Brunet, A. mascc-0565 Carabellese, B. mascc-0605 Chan, H.Y.L. mascc-0316 Brunetti, I.M. mascc-0595 Carafizi, N. mascc-0598 Chan, J.C.Y. mascc-0013 Brunetti, I.M. mascc-0594 Caraiscos, V. mascc-0421 Chan, J.C.Y. mascc-0069 Brunetti, I.M. mascc-0593 Caramanti, M. mascc-0196 Chan, K. mascc-0190 Brunetti, I.M. mascc-0600 Carbonnelle, G. mascc-0214 Chan, K.K.W.mascc-0448 Bu?gová, R. mascc-0093 Cardoso, A. mascc-0119 Chan, N. mascc-0241 Buadi, F.K. mascc-0427 Carles, R. mascc-0305 Chandra, L.A.L. mascc-0522 Buchanan, A. mascc-0060 Carmona, L. mascc-0475 Chang, E. mascc-0227 Buchanan, A. mascc-0129 Carmona-Bayonas, A. mascc-0575 Chang, E. mascc-0228 Buchanan, A. mascc-0068 Carmona-Bayonas, A. mascc-0597 Chang, I. mascc-0091 Buchanan, A. mascc-0422 Carmona-Bayonas, A. mascc-0549 Chang, T. mascc-0126 Buchner, A. mascc-0544 Carola, E. mascc-0220 Chang, Y.C. mascc-0350 Buchner, A. mascc-0530 Caroli-Bosc, F.X. mascc-0272 Chao, C mascc-0478 Budrukkar, A. mascc-0172 CarolinaMariadaSilva, C.M.S. mascc-0551 Chao, C. mascc-0479 Buffart, L.M. mascc-0406 CarolinaMariadaSilva, C.M.S. mascc-0553 Chao, C. mascc-0471 Bugat, M.E. mascc-0336 Caron, H.N. mascc-0185 Chao, C. mascc-0476 Bugat, M.E. mascc-0334 Carr, S. mascc-0133 Chao, J. mascc-0542 Bugat, R. mascc-0336 Carr, S. mascc-0193 Charalambous, A. mascc-0321 Bugat, R. mascc-0334 Carreño, M. mascc-0575 Charalambous, A. mascc-0067 Bugos, K. mascc-0335 Carreño, M. mascc-0502 Charalambous, M. mascc-0067 Bujedo, A. mascc-0453 Carrino, F. mascc-0076 Charette, V. mascc-0377 Bukhari, S. mascc-0523 Carrino, F. mascc-0077 Charpidou, A. mascc-0280 Bulotiene, G. mascc-0285 Carroll, J.D. mascc-0617 Charpidou, A. mascc-0281 Burgerhof, J.G.M. mascc-0174 Carter, S. mascc-0377 Chasen, M. mascc-0104 Burney, S. mascc-0319 Casao, F. mascc-0549 Chasen, M. mascc-0444 Burnod, A. mascc-0547 Cascinu, S. mascc-0196 Chasen, M. mascc-0429 Burnod, A. mascc-0362 Cascinu, S. mascc-0195 Chasen, M. mascc-0407 Burns, A.M. mascc-0408 Case-Eads, S. mascc-0097 Chasen, M. mascc-0408 Burz, C. mascc-0101 Cassel, B. mascc-0320 Chattopadhyay, P.mascc-0528 Bustamante, E.I. mascc-0474 Castagnani, M. mascc-0196 Chattopadhyay, P.mascc-0561 Bustamante, E.I. mascc-0475 Castillo-Deluao, C.M. mascc-0591 chaudhary, S. mascc-0564 Butow, P.mascc-0614 Cauwenbergh, G. mascc-0364 Chay, W.Y. mascc-0194 Butrynski, J. mascc-0610 CavanaghPodesta, M. mascc-0504 Chay, W.Y. mascc-0200 Buxo, E. mascc-0575 Cavanna, L. mascc-0083 Chay, W.Y. mascc-0139 Buxo, E. mascc-0502 CaySenler, F. mascc-0331 Cheah, K.Y. mascc-0237 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S5

Cheah, K.Y. mascc-0235 Chow, E. mascc-0337 Ciutto, L. mascc-0534 Chebolu, S. mascc-0149 Chow, E. mascc-0338 Clance, M. mascc-0493 Chen, C. mascc-0038 Chow, E. mascc-0322 Clemons, J. mascc-0493 Chen, D.R. mascc-0518 Chow, E. mascc-0414 Cmelak, A.J. mascc-0112 Chen, M. mascc-0350 Chow, E. mascc-0422 Cnossen, I.C. mascc-0397 Chen, Z. mascc-0178 Chow, E. mascc-0434 Coburn, N. mascc-0567 Cheng, D.R. mascc-0518 Chow, E. mascc-0423 Cohn, R.J. mascc-0370 Cheng, D.R. mascc-0359 Chow, E. mascc-0441 Cohn, R.J. mascc-0369 Cheng, H. mascc-0616 Chow, E. mascc-0404 Colantonio, I. mascc-0083 Cheng, K. mascc-0241 Chow, E. mascc-0402 Coller, J. mascc-0339 Cheng, K. mascc-0239 Chow, E. mascc-0411 Collins, A.J. mascc-0512 Cheng, K. mascc-0242 Chow, E. mascc-0328 Collins, AJ mascc-0490 Cheng, S.T. mascc-0246 Chow, E. mascc-0465 Conlon, M. mascc-0477 Cheon, P.M. mascc-0317 Chow, E. mascc-0545 Conroy, S. mascc-0035 Cheung, A.M. mascc-0483 Chow, E. mascc-0457 Conti, G. mascc-0399 Cheung, W.mascc-0484 Chow, E. mascc-0456 Cooper, B. mascc-0226 Cheung, Y.T. mascc-0194 Chow, E. mascc-0531 Cooper, B. mascc-0154 Cheung, Y.T. mascc-0200 Chow, E. mascc-0467 Copel, L. mascc-0547 Cheung, Y.T. mascc-0139 Chow, E. mascc-0075 Corey-Lisle, P.mascc-0469 Cheung, Y.T. mascc-0140 Chow, E. mascc-0225 Cotinaut, L. mascc-0220 Chevalier, D. mascc-0278 Chow, E. mascc-0274 Coveney, J. mascc-0152 Chiang, A. mascc-0435 Chow, E. mascc-0179 Covens, A. mascc-0307 Chie, W.mascc-0467 Chow, E. mascc-0325 Cox, D. mascc-0222 Chie, W.C. mascc-0337 Chow, E. mascc-0410 Craddock, K.J. mascc-0454 Chinnabhandar, V. mascc-0458 Chow, E. mascc-0452 Cramarossa, G. mascc-0567 Chiodo, J. mascc-0433 Chow, E. mascc-0455 Cramp, F. mascc-0426 Chisholm, G. mascc-0164 Chow, E. mascc-0473 Cranston, C. mascc-0444 Chisholm, G. mascc-0165 Chow, E. mascc-0472 Crawford, G. mascc-0025 Chisholm, G. mascc-0389 Chow, E. mascc-0481 Crawford, J.C. mascc-0548 Chisholm, G. mascc-0282 Chow, E. mascc-0184 Crawford, J.C. mascc-0546 Chisholm, G. mascc-0279 Chow, E. mascc-0323 Crosthwaite, K. mascc-0413 Chisholm, G. mascc-0462 Chow, E. mascc-0326 Crosthwaite, K. mascc-0418 Chisholm, G.B. mascc-0236 Chow, E. mascc-0454 Cruz, F. mascc-0018 Chiu, L. mascc-0132 Chow, E. mascc-0464 Cruz, F.M. mascc-0011 Chiu, L. mascc-0342 Chow, E. mascc-0449 Crvenkova, S. mascc-0045 Chiu, L. mascc-0337 Chow, E. mascc-0191 Cubero, D. mascc-0061 Chiu, L. mascc-0338 Chow, E. mascc-0231 Cubero, D.I.G. mascc-0011 Chiu, N. mascc-0132 Chow, K.M. mascc-0019 Cuijpers, P.mascc-0393 Chiu, N. mascc-0342 Chow, K.M. mascc-0013 Culleton, S. mascc-0545 Chiu, N. mascc-0337 Chow, T. mascc-0232 Culos-Reed, N. mascc-0559 Chiu, N. mascc-0338 Christensen, J. mascc-0398 Cunningham, D. mascc-0033 Choi, C. mascc-0090 ChristofferJohansen, C.J. mascc-0099 Cure, H. mascc-0272 Choi, D.R. mascc-0401 Christopoulos, A. mascc-0280 Currow, D. mascc-0244 Choi, I. mascc-0333 Chu, D. mascc-0075 Currow, D. mascc-0349 Choi, K.C. mascc-0069 Chu, D. mascc-0225 Custódio, M. mascc-0583 Choi, Y. mascc-0202 Chu, D. mascc-0274 CustodioCabello, S. mascc-0504 Chong, C.J.Y. mascc-0052 Chu, L.L. mascc-0352 Czerwiec, F.C. mascc-0433 Chou, B. mascc-0229 Chu, M. mascc-0190 Chou, HsiuLing mascc-0360 Chui, W.K. mascc-0194 D Chow, E mascc-0147 Chui, W.K. mascc-0139 D’Olimpio, J.T. mascc-0445 Chow, E. mascc-0192 Chung, H. mascc-0567 Dalakou, E. mascc-0283 Chow, E. mascc-0567 Chung, H. mascc-0317 Dalal, S. mascc-0536 Chow, E. mascc-0448 Chung, H. mascc-0177 Dalle, E. mascc-0400 Chow, E. mascc-0317 Chung, K.S. mascc-0128 Dalton, J.T. mascc-0548 Chow, E. mascc-0177 Chung, K.S. mascc-0143 Dalton, J.T. mascc-0546 Chow, E. mascc-0153 Chung, V. mascc-0542 daLuz, R. mascc-0583 Chow, E. mascc-0447 ChungEun, L. mascc-0375 Damaj, L. mascc-0269 Chow, E. mascc-0541 Churruca, C. mascc-0453 D'Amico, F. mascc-0605 Chow, E. mascc-0435 Ciafone, D. mascc-0414 DamilaChristinaTrufelli, D.C.T. mascc-0054 Chow, E. mascc-0327 Ciesielski, P.mascc-0571 Damore-Petingola, D. mascc-0477 Chow, E. mascc-0446 Ciesielski, P.mascc-0586 Damrongrajasak, W.mascc-0084 Chow, E. mascc-0468 Çiftçibasi, E. mascc-0592 Danbolt, L.J. mascc-0218 Chow, E. mascc-0132 Cimpianu, M. mascc-0101 Danchaivijitr, P.mascc-0127 Chow, E. mascc-0117 Ciuffreda, L. mascc-0083 Daniel, C. mascc-0581 Chow, E. mascc-0121 Ciutto, L. mascc-0557 DaniellePatriciaCerqueiraMacedo, Chow, E. mascc-0342 Ciutto, L. mascc-0535 D.P.C.M. mascc-0551 S6 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

DaniellePatriciaCerqueiraMacedo, Demirci, F. mascc-0372 Dodo, M. mascc-0572 D.P.C.M. mascc-0553 Deng, J. mascc-0612 Dodo, M. mascc-0516 Danis, J. mascc-0547 Deng, J. mascc-0602 Dogan, O. mascc-0056 Danis, J. mascc-0362 Deng, J. mascc-0105 Dolai, T.K. mascc-0580 Danjoux, C. mascc-0541 Deng, J. mascc-0112 Dolendo, M. mascc-0591 Danjoux, C. mascc-0446 Deng, J. mascc-0070 Dollman, J. mascc-0152 Danjoux, C. mascc-0468 Denhaerynck, K. mascc-0367 Domen, K. mascc-0012 Danjoux, C. mascc-0441 Denis, J.L. mascc-0176 Domínguez, A. mascc-0597 Danjoux, C. mascc-0411 Dennis, K. mascc-0571 Dominguez, J.A. mascc-0617 Danjoux, C. mascc-0531 Dennis, K. mascc-0317 Donahue, E. mascc-0469 Danjoux, C. mascc-0410 Dennis, K. mascc-0177 Dong, F.D. mascc-0524 Danjoux, C. mascc-0455 Dennis, K. mascc-0586 Donovan, K. mascc-0294 Danjoux, C. mascc-0473 Dennis, K.* mascc-0567 Donovan, K.A. mascc-0613 Danjoux, C. mascc-0472 denpoya, A. mascc-0355 Doolan, E.L. mascc-0370 Danjoux, C. mascc-0481 Dent, R. mascc-0139 Doolan, E.L. mascc-0369 Danjoux, C. mascc-0464 Dent, R. mascc-0140 Doshi, S. mascc-0078 Danklou, J. mascc-0400 Dent, R.A. mascc-0194 Doucet, S. mascc-0315 Dardeno, M. mascc-0391 Dent, R.A. mascc-0200 Dr.Baumann, W.mascc-0578 Darmani, N. mascc-0149 dePaula, L. mascc-0061 Dr.Hermes-Moll, K. mascc-0578 Darviri, C. mascc-0566 Deray, G. mascc-0581 Dranitsaris, G. mascc-0222 DAS, J. mascc-0522 Derbyshire, A. mascc-0059 Drew, D. mascc-0369 Dauchy, S. mascc-0409 DeRyck, T. mascc-0396 Drewa, T.A. mascc-0299 Daudt, H.M.L. mascc-0425 DeRyck, T. mascc-0392 Drodge, C.S. mascc-0308 Daudt, H.M.L. mascc-0424 Desai, H. mascc-0270 Dryden, T. mascc-0319 Daudt, H.M.L. mascc-0431 Desjardins, A. mascc-0215 Dubey, C. mascc-0076 Davies, A. mascc-0060 Desrosiers, M.P.mascc-0469 Dubey, C. mascc-0077 Davies, A. mascc-0129 Desti, C. mascc-0261 Ducrocq, J.L. mascc-0292 Davies, A. mascc-0068 Desti, C. mascc-0263 Dudgeon, D. mascc-0500 Davies, A. mascc-0354 Dev, R. mascc-0164 Dudgeon, D. mascc-0494 Davies, A. mascc-0422 Dev, R. mascc-0165 Duke, S. mascc-0405 Davis, J. mascc-0078 Dev, R. mascc-0536 Dunn, L. mascc-0226 Davis, J. mascc-0398 Devereaux, A. mascc-0537 Dunn, L. mascc-0154 Davis, M. mascc-0240 Devigne, A. mascc-0089 Dupas, G. mascc-0106 Davis, M. mascc-0032 deVries, J. mascc-0048 Duprez, F. mascc-0392 Davis, M. mascc-0033 deWolf-Linder, S. mascc-0603 Dupuis, L.L. mascc-0459 Davis, M. mascc-0034 Dhillon, H. mascc-0614 Dupuis, L.L. mascc-0560 Day, R. mascc-0078 DiCarlo, S. mascc-0379 Durand, J.B. mascc-0271 De, R. mascc-0580 Dickman, A. mascc-0354 Durbano, S. mascc-0559 DeAngelis, C. mascc-0567 DiCristina, C. mascc-0286 Dyck, M. mascc-0288 DeAngelis, C. mascc-0448 DiCristo, C. mascc-0261 Deangelis, C. mascc-0317 DiCristo, C. mascc-0263 E DeAngelis, C. mascc-0177 Didwaniya, N. mascc-0389 Eboras, Y. mascc-0615 DeAngelis, C. mascc-0328 Dieperink, K. mascc-0382 EchavarríaDíaz-Guardamino, I. mascc-0504 DeAngelis, C. mascc-0179 Dietrich, M mascc-0558 Eckhoff, L. mascc-0250 Debiais, F. mascc-0565 Dietrich, M. mascc-0221 Eden, G.L. mascc-0237 deBont, E.S.J.M. mascc-0174 Dietrich, M.S. mascc-0123 Eden, G.L. mascc-0235 deBree, R. mascc-0406 Dietrich, M.S. mascc-0612 Eden, G.L. mascc-0238 deBree, R. mascc-0397 Dietrich, M.S. mascc-0602 Edwards, B. mascc-0113 Defachelles, A.S. mascc-0214 Dietrich, M.S. mascc-0105 Edwards, J. mascc-0189 Dégi, C. mascc-0101 Dietrich, M.S. mascc-0112 Eerenstein, S.E. mascc-0397 Dégi, C. mascc-0100 Dietrich, M.S. mascc-0070 Eicher, M. mascc-0076 delaCruz, M. mascc-0270 DiGiacomo, M. mascc-0318 Eicher, M. mascc-0077 delacruz, M. mascc-0284 DiGiovanni, J. mascc-0075 Einhorn, L. mascc-0097 delacruz, M. mascc-0389 Digiovanni, J. mascc-0225 Elaidi, R. mascc-0420 DeLaCruz, M. mascc-0536 DiGiovanni, J. mascc-0274 ElHada, A mascc-0519 delaHaba, I. mascc-0597 Dijkstra, P.U. mascc-0135 Elklit, A. mascc-0131 delaRosa, A. mascc-0606 Dilhuydy, M.S. mascc-0272 Ellidokuz, H. mascc-0331 Delbarre, M. mascc-0214 Dillaha, L. mascc-0463 elOsta, B. mascc-0057 Delbey, S. mascc-0386 DiMari, A. mascc-0419 elOsta, L. mascc-0057 DelFabbro, E. mascc-0320 Dimitrovska, A. mascc-0045 elOsta, N. mascc-0057 Delgado-Guay, M. mascc-0282 diPalma, M. mascc-0383 El-Safy, E mascc-0519 Delgado-Guay, M. mascc-0279 diTomasso, J. mascc-0557 Elshiekh, A. mascc-0287 DelGiglio, A. mascc-0011 diTomasso, J. mascc-0535 Elting, L.S. mascc-0487 delGiglio, A. mascc-0018 diTomasso, J. mascc-0534 Emara, S. mascc-0526 DelGiglio, A. mascc-0061 Divers, J. mascc-0488 Emmenegger, U. mascc-0328 Demirbas, S. mascc-0110 Dockter, T. mascc-0049 Enami, A. mascc-0264 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S7

Enric, J. mascc-0305 Ferrell, B. mascc-0542 Gagliese, L. mascc-0421 Epstein, J.B. mascc-0123 Ferrer, J. mascc-0282 Gagnon, B. mascc-0417 Epstein, J.B. mascc-0617 Ferrini, C. mascc-0196 Galiti, D. mascc-0517 epstein, J.B. mascc-0072 Fetterly, T. mascc-0377 Galiti, D. mascc-0219 Erdem, G. mascc-0110 Fielding, F. mascc-0034 Galitis, E. mascc-0517 Escalante, C. mascc-0426 Filho, G. mascc-0552 Galitis, E. mascc-0166 Escalante, C.P.mascc-0271 Filipe, F. mascc-0583 Gallardo, E. mascc-0549 Espinosa, J. mascc-0549 Filler, K. mascc-0426 Gallego, C. mascc-0575 Estfan, B. mascc-0027 Filova, A. mascc-0094 Gallego, C. mascc-0502 Estfan, B. mascc-0267 Findlay, M. mascc-0189 Gan, Y.X. mascc-0039 Estfan, B. mascc-0029 Fiordoliva, I. mascc-0196 Gan, Y.X. mascc-0040 Eto, K. mascc-0163 Fischer, M. mascc-0115 Gandhi, G. mascc-0522 Ewertz, M. mascc-0250 Fischer, S. mascc-0332 Gandhi, G. mascc-0521 Eziada, S.A.A.D. mascc-0253 Fisher, M. mascc-0230 Ganem, G mascc-0272 Eziada, S.A.A.D. mascc-0254 Fisher, M.D. mascc-0233 Ganguly, B. mascc-0580 Fitch, M. mascc-0293 Ganul, A. mascc-0145 F Fitch, M. mascc-0180 GarmingLegert, K. mascc-0599 Faez, L. mascc-0597 Fitz, A. mascc-0114 Gartshore, K. mascc-0461 Fagerlie, S. mascc-0182 Fitzgerald, P.mascc-0582 Gascón, P.mascc-0367 Fahl, W.mascc-0124 Fizazi, K. mascc-0340 Ge, L. mascc-0242 Fairchild, A. mascc-0337 Flahiff, C. mascc-0215 Geater, S.L. mascc-0432 Fairchild, A. mascc-0308 Flaiban, C. mascc-0095 Gehrke, F.S. mascc-0011 Fairchild, A. mascc-0414 Flank, J. mascc-0560 George, K. mascc-0477 Fairchild, A. mascc-0467 Flank, J.* mascc-0459 George, M. mascc-0487 Fairchild, A.M. mascc-0155 Flannery, M. mascc-0311 George, M. mascc-0271 Falcone, A. mascc-0595 Flannery, M. mascc-0445 Gerasin, A. mascc-0055 Falcone, A. mascc-0594 Fleer, J. mascc-0175 Geuke, M. mascc-0108 Falcone, A. mascc-0593 Fleischer, A.C. mascc-0105 Geursen, A. mascc-0189 Falcone, A. mascc-0600 Flória-Santos, M. mascc-0260 Ghanem, I. mascc-0549 Falcou, M.C. mascc-0362 Flynn, J. mascc-0418 Ghatage, P.mascc-0307 Fallai, C. mascc-0251 Fond, G. mascc-0006 Ghestem, F. mascc-0278 Fallai, C. mascc-0562 Fonfa, A. mascc-0579 GhodratyJabloo, V. mascc-0301 Fan, G. mascc-0194 Fonseca, F. mascc-0061 Ghosh, S. mascc-0308 Fan, G. mascc-0200 Fonseca, L.L.A. mascc-0011 Ghosh, S. mascc-0414 Fan, G. mascc-0139 Font, C. mascc-0575 Ghosh-Laskar, S. mascc-0172 Fan, J. mascc-0284 Font, C. mascc-0502 Ghuman, S. mascc-0065 Fares, B.F. mascc-0374 FontPuig, C. mascc-0597 Giampieri, R. mascc-0195 Fares, F.F. mascc-0374 FontPuig, C. mascc-0549 Gibbons, K. mascc-0348 Faria, C. mascc-0394 Foran, J. mascc-0335 Gibson, R.J. mascc-0302 Faria, C. mascc-0227 Forges, F. mascc-0337 Gilbert, J. mascc-0112 Faria, C. mascc-0228 Forges, F. mascc-0467 Gilbert, L. mascc-0307 Faria, C. mascc-0222 Forman, N. mascc-0463 Gill, P.mascc-0203 Farman, H. mascc-0428 Forman, S. mascc-0542 Gill, P.mascc-0049 Farsi, F. mascc-0623 Foster, N. mascc-0007 GilsaaHansen, D. mascc-0131 Farsi, F. mascc-0409 Fournier, M.A. mascc-0315 Ginocchi, L. mascc-0595 Farsi, F. mascc-0565 Franco, D. mascc-0220 Ginocchi, L. mascc-0594 Farsi, F. mascc-0336 Francoletti, M. mascc-0195 Ginocchi, L. mascc-0593 Farsi, F. mascc-0334 Frau, B. mascc-0083 Ginocchi, L. mascc-0600 Fatigoni, S. mascc-0083 Freeman, M. mascc-0215 Giordano, G. mascc-0605 Fatiregun, O. mascc-0169 Freytes, C.O. mascc-0289 Giotis, A. mascc-0328 Faust, N. mascc-0309 Friedman, H.S. mascc-0215 Gkiozos, I. mascc-0280 Faust, N. mascc-0493 Friend, J. mascc-0244 Gkiozos, I. mascc-0281 Fava, S. mascc-0083 Frisbee-Hume, S. mascc-0282 Glare, P.mascc-0349 Fearon, K. mascc-0244 Frisbee-Hume, S. mascc-0279 Glaser, L.A. mascc-0433 Federico, M. mascc-0265 Fritz, G. mascc-0167 Gleich, L. mascc-0244 Feldstain, A. mascc-0429 Froelund, J.C. mascc-0248 Gligorov, J. mascc-0581 Feldstain, A. mascc-0407 Frydenberg, M. mascc-0319 Glowacka, I. mascc-0306 Feldstain, A. mascc-0408 Fu, J. mascc-0348 Glushko, N.L. mascc-0265 FelipeMeloCruz, F.M.C. mascc-0054 Fu, Q. mascc-0388 Gobert, G. mascc-0278 Fenton, G. mascc-0441 Fullman, L. mascc-0240 Goforth, H. mascc-0034 Feo, B. mascc-0234 Fung, O.W.M. mascc-0069 Goldstein, L. mascc-0542 Fernandes, D. mascc-0539 Furfari, A mascc-0147 Goldstein, R. mascc-0494 Fernandez, G. mascc-0500 Furuhata, T. mascc-0163 Goldwasser, F. mascc-0581 Fernandez-Avilés, F. mascc-0575 Gomes, F. mascc-0583 Fernandez-Avilés, F. mascc-0502 G Gomez, J. mascc-0453 FernándezSuárez, H. mascc-0621 GachigiKamau, P.mascc-0062 Gomez, S. mascc-0082 S8 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Gonçalves, S.S. mascc-0552 Guth, D. mascc-0357 Heo, S.J. mascc-0143 Gonçalves, S.S. mascc-0550 Hera, M. mascc-0208 Gonçalves, S.S. mascc-0569 H Hera, M. mascc-0211 Gonçalves, S.S. mascc-0506 Haas, M. mascc-0182 Heras, P.mascc-0205 Gonçalves, S.S. mascc-0491 Hacini, M. mascc-0269 Heras, P.mascc-0207 Good, P.mascc-0348 Haddad, P.mascc-0245 Heras, P.mascc-0210 Good, P.mascc-0346 Haile, D. mascc-0289 Heras, P.mascc-0209 Gorbach, O. mascc-0145 Hakki, S. mascc-0372 Heras, P.mascc-0212 Gordon, N. mascc-0111 Hall, S. mascc-0137 Heras, P.mascc-0208 Gordon, P.mascc-0032 Hall, S. mascc-0354 Heras, P.mascc-0211 Gornitzka, J. mascc-0181 Hamaguchi, Y. mascc-0264 Heras, P.mascc-0206 Gough, K. mascc-0087 Hammel, J. mascc-0113 Herlong, F. mascc-0113 Gough, K. mascc-0086 Han, H.S. mascc-0401 Hernando, A. mascc-0575 Gralla, R. mascc-0438 Hancock, M.L. mascc-0548 Hernando, A. mascc-0502 Gralla, R. mascc-0162 Hancock, M.L. mascc-0546 Hernando, J. mascc-0549 Gralla, R. mascc-0161 Hannon, B. mascc-0290 HerndonII, J.E. mascc-0215 Gralla, R. mascc-0158 Hannon, B. mascc-0288 Herr, F. mascc-0437 Gralla, R.J. mascc-0548 Hans, S. mascc-0330 Herr, F. mascc-0438 Gralla, R.J. mascc-0159 Hardy, J. mascc-0543 Herve, C. mascc-0303 Gralla, R.J. mascc-0433 Hardy, J. mascc-0349 Herve, C. mascc-0330 Gramling, R.E. mascc-0525 Hardy, J. mascc-0348 Herve, C. mascc-0341 Granata, R. mascc-0251 Hardy, J. mascc-0346 Herve, C. mascc-0336 Grandner, M. mascc-0489 Harti, S. mascc-0364 Herve, C. mascc-0334 Granot, T. mascc-0428 Hartmann, B. mascc-0505 Hesketh, P.J. mascc-0161 Granot, T. mascc-0111 Hartogh, M.D. mascc-0192 Hesketh, P.J. mascc-0158 Graul-Conroy, A. mascc-0124 Hashmi, S. mascc-0427 Hesketh, P.J. mascc-0159 Greco, A. mascc-0562 Hassali, M. mascc-0014 Hettler, D. mascc-0292 Green, S. mascc-0286 Hassan, A. mascc-0245 Hidaka, A. mascc-0264 Greillier, L. mascc-0272 Hassan, A. mascc-0253 Higaki, K. mascc-0264 Gretz, S. mascc-0225 Hassan, A. mascc-0254 Higgins, B. mascc-0307 Grigoriou, K. mascc-0205 Hassan, B. mascc-0014 Hindenburg, H.J. mascc-0358 Grigoriou, K. mascc-0207 Hasséus, B. mascc-0599 Hinder, V. mascc-0189 Grigoriou, K. mascc-0210 Hatanaka, K. mascc-0163 Hira, N. mascc-0314 Grigoriou, K. mascc-0212 Hatoum, H. mascc-0127 hira, N. mascc-0355 Grinevich, Y.U. mascc-0145 Hatzopoulos, A. mascc-0207 Hisham, M. mascc-0287 Groen, W.G. mascc-0138 Hatzopoulos, A. mascc-0212 Ho, H.K. mascc-0194 Gromcakova, L. mascc-0604 Hawley, P.mascc-0352 Ho, H.K. mascc-0200 Gromcakova, L. mascc-0589 Hawryluk, E. mascc-0609 Ho, H.K. mascc-0139 Grosicki, S. mascc-0265 Hawyley, P.mascc-0422 Ho, R. mascc-0190 Gross, J. mascc-0034 Haywood, A. mascc-0348 Ho, S. mascc-0368 Grossman, D. mascc-0436 Haywood, A. mascc-0346 Hobbs, K. mascc-0614 Grossman, D. mascc-0439 Hazenberg, M.D. mascc-0108 Hodgson, S. mascc-0431 Grothey, A. mascc-0450 Healy, P.mascc-0215 Hoeppli, C. mascc-0076 Gu, D.R. mascc-0518 Heavey, S.F. mascc-0538 Hoeppli, C. mascc-0077 Gu, D.R. mascc-0359 Heavey, S.F. mascc-0486 Hoffman, K. mascc-0078 Gu, F. mascc-0010 Heckler, C. mascc-0445 Hoffman, K. mascc-0460 Gu, F.* mascc-0009 Heckler, C.E. mascc-0540 Hogan, W.J. mascc-0427 Guarino, G. mascc-0379 Hedley, M.L. mascc-0387 Holden, L. mascc-0153 Guazzelli, C.A. mascc-0018 Hedley, M.L. mascc-0384 Holden, L. mascc-0541 Guido, V.H. mascc-0065 Hegarty, J. mascc-0081 Holden, L. mascc-0446 Guilhaume, M.N. mascc-0547 Heij, H. mascc-0185 Holden, L. mascc-0468 Guillou, A. mascc-0330 Heike, Y. mascc-0554 Holden, L. mascc-0322 Guillou, A. mascc-0341 Heimgartner, J. mascc-0427 Holden, L. mascc-0441 Gulamhusein, H. mascc-0483 Hein, M. mascc-0542 Holden, L. mascc-0411 Gunn, B. mascc-0562 Heinig, K. mascc-0357 Holden, L. mascc-0545 Guo, Q.G. mascc-0524 Heintz, A. mascc-0182 Holden, L. mascc-0531 Guo, Y. mascc-0462 Henderson, S. mascc-0020 Holden, L. mascc-0410 Gupta, A. mascc-0458 Hennequin, M. mascc-0057 Holden, L. mascc-0455 Gupta, A.K. mascc-0458 Henninger, C. mascc-0167 Holden, L. mascc-0473 Gupta, D. mascc-0016 Henriques-Filho, G.A.T.M. mascc-0569 Holden, L. mascc-0472 Gupta, N. mascc-0127 Henriques-Filho, G.A.T.M. mascc-0568 Holden, L. mascc-0481 Gupta, S. mascc-0144 Henriques-Filho, G.A.T.M. mascc-0506 Holden, L. mascc-0323 Gupta, T. mascc-0172 Henry, D.H. mascc-0340 Holden, L. mascc-0454 Guru, K. mascc-0485 Henry, R.J.W.mascc-0059 Holden, L. mascc-0464 Guru, K. mascc-0496 Henry, S.C. mascc-0059 Holden, L. mascc-0449 Gushiken, F. mascc-0289 Heo, S.J. mascc-0128 Holden, L. mascc-0231 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S9

Holloman, C. mascc-0413 Imai, H. mascc-0329 Johansen, J. mascc-0363 Holloman, C. mascc-0418 Imai, H. mascc-0324 Johansson, P.mascc-0599 Holst, J.J. mascc-0505 Imbimbo, M. mascc-0251 John, L. mascc-0380 Holt, K.A. mascc-0131 Inci, F. mascc-0258 Johnson, D.B. mascc-0049 Hong, Y.S. mascc-0008 Ip, W.Y. mascc-0316 Johnson, K.M. mascc-0470 honma, T. mascc-0355 Iredale, R. mascc-0203 Johnson, K.M. mascc-0082 Hoover-Regan, M.L. mascc-0124 Isaacs, R. mascc-0189 Johnston, M.A. mascc-0548 Hopkinson, J. mascc-0405 Isenring, E. mascc-0037 Johnston, M.A. mascc-0546 Hoque, M. mascc-0065 Isenring, E. mascc-0087 Jones, J.M. mascc-0497 Horaiya, K. mascc-0378 Isenring, E. mascc-0086 Jones, R. mascc-0413 Horn, J. mascc-0240 Ishak, F. mascc-0377 Jones, R. mascc-0418 Hosie, A. mascc-0156 Ishii, T. mascc-0329 Jordan, K. mascc-0265 Hoskin, P.mascc-0447 Ishii, T. mascc-0324 Jordan, K. mascc-0162 Hoskins, P.mascc-0307 Ishitobi, M. mascc-0347 Jordan, K. mascc-0158 Hosokawa, R. mascc-0572 Ismail, R. mascc-0229 José, L. mascc-0305 Hosokawa, R. mascc-0516 Isobe, H. mascc-0163 Jouannaud, C. mascc-0581 Hosokawa, R. mascc-0223 Ito, E. mascc-0572 Jovenin, N. mascc-0292 Hotwani, C. mascc-0172 Ito, E. mascc-0516 Jovenin, N. mascc-0336 Hou, L. mascc-0010 Ito, T. mascc-0347 Jovenin, N. mascc-0334 Hou, L.L. mascc-0009 Iwamoto, M. mascc-0347 Judin, G. mascc-0312 Hou, M. mascc-0467 Iwanaga, I. mascc-0163 Jumnani, D. mascc-0485 Hou, M.F. mascc-0337 Hou, W.K. mascc-0246 J K Houghton, D. mascc-0240 Jackson, L.K. mascc-0123 K.Bouzid, K.B. mascc-0291 Howarth, G.S. mascc-0237 Jackson, L.K. mascc-0112 Kadoya, T. mascc-0264 Howarth, G.S. mascc-0235 Jackson, L.K. mascc-0070 Kadri, M. mascc-0509 Howarth, G.S. mascc-0234 Jacobsen, J. mascc-0527 Kagawa, M. mascc-0264 Howarth, G.S. mascc-0238 Jacobsen., P.B. mascc-0294 Kaida, K. mascc-0012 Howell, D. mascc-0497 Jacquot, J. mascc-0214 Kainis, E. mascc-0283 Howell, D. mascc-0500 Jakkoju, R. mascc-0078 Kallay, E. mascc-0101 Howell, D. mascc-0494 Jakucs, J. mascc-0265 Kalyani, N. mascc-0172 Howell, M. mascc-0180 Jamal, N. mascc-0328 Kamal, N. mascc-0519 Hoy, S. mascc-0240 Jamani, R. mascc-0322 Kamath, J. mascc-0273 Hsu, T. mascc-0542 Jameson, M.B. mascc-0189 Kamen, C. mascc-0311 Huang, I. mascc-0146 Jamshir, S. mascc-0379 Kamen, C. mascc-0445 Hubbard, S. mascc-0469 Jané, E. mascc-0312 Kamen, C.S. mascc-0525 Hubert, K. mascc-0377 Jané, E. mascc-0313 Kamigaki, S. mascc-0264 Hughes, J. mascc-0405 Janelsins, M. mascc-0445 Kamioner, D.S. mascc-0623 Hui, D. mascc-0164 Jang, J.S. mascc-0401 Kamps, W.A. mascc-0175 Hui, D. mascc-0165 Janini, D. mascc-0033 Kanda, T. mascc-0378 Hui, D. mascc-0236 Jansen, F. mascc-0513 Kang, H. mascc-0286 Hui, D. mascc-0536 Jansen, F. mascc-0510 Kang, H. mascc-0202 Hullihen, B. mascc-0267 Jansen, F. mascc-0514 Kang, J.H. mascc-0171 Hung, L.H. mascc-0350 Jansen, F. mascc-0393 Kang, J.H. mascc-0236 Hunter, S. mascc-0216 Janus, N. mascc-0581 Kang, S.S. mascc-0373 Hunter, S. mascc-0469 Jaro?ová, D. mascc-0093 Kang, Y. mascc-0366 Hurria, A. mascc-0542 Jatoi, A. mascc-0007 Kang, Y. mascc-0368 Husain, A. mascc-0500 Javid, J. mascc-0521 Kang, Y.K. mascc-0373 Hussain, A. mascc-0498 Jean-Pierre, P.mascc-0489 Kansra, V. mascc-0398 Husson, O. mascc-0048 Jeffery, M. mascc-0189 Karadurmus, N. mascc-0110 Hutchinson, M.R. mascc-0238 Jegina, K. mascc-0604 Karagoz, G. mascc-0592 Hutchinson, T.E. mascc-0149 Jenkinson, R. mascc-0465 Karakaya, B. mascc-0258 Hutin-Brissot, A. mascc-0563 Jensen, B. mascc-0066 Karanes, C. mascc-0542 Hwang, K. mascc-0333 Jensen, J.B. mascc-0066 Karapetis, C. mascc-0339 Hyatt, A. mascc-0319 Jensen, M.B. mascc-0250 Karatsu, F. mascc-0314 HyeMyung, J. mascc-0375 Jensen, P.T. mascc-0131 KarinB.Dieperink, K.B.D mascc-0099 Jeong, J.H. mascc-0373 Karthaus, M. mascc-0160 I Jesus-Garcia, R. mascc-0337 Kasera, C. mascc-0415 Iacono, M. mascc-0419 Jesus-Garcia, R. mascc-0467 Kasera, C. mascc-0380 Ibrahim, E mascc-0519 Ji, Y. mascc-0304 Kasperova, S. mascc-0573 Iemmolo, S. mascc-0419 Jimenez, R. mascc-0414 Kataoka, T. mascc-0482 Ihenacho, I. mascc-0536 Jiménez-Fonseca, P.mascc-0597 Kato, T. mascc-0572 Iijima, W. mascc-0516 Jiménez-Fonseca, P.mascc-0549 Kato, T. mascc-0516 Iire, L. mascc-0088 Jin, J.Y. mascc-0171 Kazakov, N. mascc-0055 Ikegame, K. mascc-0012 Jingjie, X. mascc-0548 Kearsley, J. mascc-0156 Ilozumba, O. mascc-0294 Joerger, M. mascc-0603 Keaveney, S.K. mascc-0089 S10 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Kee, Y.C. mascc-0194 Kim, T.W.mascc-0008 Kritikos, K. mascc-0212 Keech, J. mascc-0445 Kim, Y. mascc-0366 Krommidas, G. mascc-0281 Keefe, D. mascc-0098 Kim, Y. mascc-0366 Kropf, S. mascc-0077 Keefe, D. mascc-0189 Kim, Y. mascc-0202 Krull, K. mascc-0146 Keefe, D. mascc-0188 Kimura, M. mascc-0329 Krzyzanowska, M. mascc-0293 Keefe, D. mascc-0186 Kimura, M. mascc-0324 Krzyzanowska, M. mascc-0180 Kellett, U. mascc-0020 Kingsley, P.mascc-0403 Kucuk, N. mascc-0574 Kenmotsu, H. mascc-0329 Kishor, K. mascc-0499 Kucuk, N. mascc-0577 Kenmotsu, H. mascc-0324 Kiss, N. mascc-0087 Kucuk, N. mascc-0576 Kerschgens, C. mascc-0266 Kiss, N. mascc-0086 Kucukmorkoc, E. mascc-0574 Kerschgens, C. mascc-0120 Kissow, H. mascc-0505 Kucukmorkoc, E. mascc-0577 Kevork, N. mascc-0436 Kitely, C. mascc-0494 Kucukmorkoc, E. mascc-0576 Kevork, N. mascc-0439 KjerholtMette, M. mascc-0015 Kudo, M. mascc-0163 Kfoury, M. mascc-0330 KlausK.Andersen, K.K.A. mascc-0099 Kueng, M. mascc-0077 Kfoury, M. mascc-0341 Klein, G. mascc-0098 Kuijpers, W.mascc-0138 Khalid, I. mascc-0509 Kloskowski, T. mascc-0299 Kumar, A. mascc-0458 Khan, I. mascc-0528 Knoop, A.S. mascc-0250 Kumar, A. mascc-0467 Khan, I. mascc-0561 Knoth, R. mascc-0394 Kumar, D. mascc-0412 Khan, L. mascc-0435 Knoth, R. mascc-0227 kumar, L. mascc-0564 Khan, L. mascc-0410 Knoth, R. mascc-0228 Kumar, S. mascc-0304 Khan, S. mascc-0534 Ko, E. mascc-0333 KumarV, S. mascc-0539 Khan, S. mascc-0421 Ko, Y.H. mascc-0171 Kuniyoshi, R.K. mascc-0011 Khranovska, N. mascc-0145 Kobayashi, N. mascc-0170 Kurihara, M. mascc-0378 Khurana, N.I.T.A. mascc-0522 Kobayashi, T. mascc-0378 Kurtz, J.E. mascc-0395 Kiagia, M. mascc-0280 Kober, K. mascc-0154 Kust, D. mascc-0353 Kiagia, M. mascc-0283 Kober, K.M. mascc-0226 Kutuk, T. mascc-0361 Kiagia, M. mascc-0281 Köck-Hódi, S. mascc-0298 Kuznecova, G. mascc-0589 Kikuchi, Y. mascc-0520 Köck-Hódi, S. mascc-0295 Kuznecova, G. mascc-0589 Kikuchi, Y. mascc-0554 Koczwara, B. mascc-0152 Kuznecovs, I. mascc-0604 Kilgour, R.D. mascc-0557 Koczywas, M. mascc-0542 Kuznecovs, I. mascc-0570 Kilgour, R.D. mascc-0535 Kodama, N. mascc-0012 Kuznecovs, I. mascc-0589 Kilgour, R.D. mascc-0534 Koh, C. mascc-0242 Kuznecovs, S. mascc-0604 Kim, B. mascc-0090 Koh, S.J. mascc-0501 kuznecovs, S. mascc-0570 Kim, B.G. mascc-0091 Koh, S.J. mascc-0503 Kuznecovs, S. mascc-0589 Kim, B.G. mascc-0092 Koh, S.J. mascc-0401 Kvigne, K.J. mascc-0218 Kim, C. mascc-0365 Koller, M. mascc-0295 Kwan, T. mascc-0190 Kim, G.M. mascc-0365 Komatsu, Y. mascc-0163 Kwatra, G. mascc-0403 Kim, H. mascc-0366 Komurcu, S. mascc-0110 Kwon, K. mascc-0202 Kim, H. mascc-0368 Komurcu, S. mascc-0331 Kwong, K. mascc-0019 Kim, H. mascc-0365 Kondo, K. mascc-0170 Kim, H.J. mascc-0401 Kong, B. mascc-0368 L Kim, H.J. mascc-0401 Kong, B.H. mascc-0366 Lacaze, M. mascc-0383 Kim, H.K. mascc-0171 Kose, F. mascc-0056 Lacey, J. mascc-0157 Kim, H.S. mascc-0366 Kose, F. mascc-0371 Lacey, J. mascc-0156 Kim, I. mascc-0368 Kose, K. mascc-0361 Ladjroud, A.L. mascc-0291 Kim, J. mascc-0078 Koseki, T. mascc-0572 Lagman, R. mascc-0034 Kim, J. mascc-0333 Koseki, T. mascc-0516 Lahoti, A. mascc-0271 Kim, J. mascc-0008 Kostadinova, L. mascc-0045 Lai, Y.H. mascc-0622 Kim, J. mascc-0624 Koumarianou, A. mascc-0566 Laia, G. mascc-0305 Kim, J. mascc-0390 Koutinos, G. mascc-0517 Lakiss, S. mascc-0057 Kim, J.H. mascc-0401 Koutsoukis, E. mascc-0377 Lam, C.G. mascc-0470 Kim, J.S. mascc-0501 Koutsoukos, K. mascc-0166 Lam, H. mascc-0192 Kim, J.S. mascc-0503 Koyama, T. mascc-0378 Lam, H. mascc-0448 Kim, K. mascc-0333 Krakowski, I. mascc-0336 Lam, H. mascc-0447 Kim, K. mascc-0202 Krakowski, I. mascc-0334 Lam, H. mascc-0132 Kim, K.P.mascc-0008 Kreder, H.J. mascc-0465 Lam, H. mascc-0342 Kim, M. mascc-0090 Kreilgaard, M. mascc-0527 Lam, H. mascc-0337 Kim, M. mascc-0092 Kreit, P.mascc-0292 Lam, H. mascc-0338 Kim, M.K. mascc-0091 Kremer, L.C.M. mascc-0492 Lam, H. mascc-0434 Kim, S. mascc-0501 Kriegel, I. mascc-0623 Lam, H. mascc-0465 Kim, S. mascc-0503 Krishnasamy, M. mascc-0087 Lam, H. mascc-0075 Kim, S. mascc-0333 Krishnasamy, M. mascc-0086 Lam, H. mascc-0225 Kim, S. mascc-0624 Krissensen, G. mascc-0189 Lam, H. mascc-0274 Kim, S. mascc-0390 Kristensen, C.A. mascc-0527 Lam, H. mascc-0179 Kim, S.H. mascc-0164 Kristensen, C.A. mascc-0529 Lam, H. mascc-0449 Kim, S.Y. mascc-0351 Kritikos, K. mascc-0207 Lam, K. mascc-0467 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S11

Lampton, L.L. mascc-0237 Lee, J.A. mascc-0139 Lim, E. mascc-0242 Lampton, L.L. mascc-0235 Lee, J.E. mascc-0368 Lim, H.G. mascc-0201 Lampton, L.L. mascc-0238 Lee, J.E. mascc-0373 Lima, R. mascc-0217 Lane, K. mascc-0431 Lee, J.J. mascc-0351 Lima, R. mascc-0102 Langeberg, W.mascc-0230 Lee, J.L. mascc-0008 Lima, R.A.G. mascc-0106 Langede, J. mascc-0108 Lee, J.L. mascc-0401 Lima, T.A.S. mascc-0260 Lao, N. mascc-0177 Lee, J.Y. mascc-0008 Lima-Neto, R.G. mascc-0552 Lao, N. mascc-0117 Lee, J.Y. mascc-0091 Lima-Neto, R.G. mascc-0550 Lao, N. mascc-0121 Lee, J.Y. mascc-0092 Lima-Neto, R.G. mascc-0569 Lao, N. mascc-0179 Lee, K.H. mascc-0401 Lima-Neto, R.G. mascc-0568 Laplaige, P.mascc-0272 Lee, L. mascc-0090 Lima-Neto, R.G. mascc-0555 Laresn, S.L. mascc-0374 Lee, M. mascc-0294 Lima-Neto, R.G. mascc-0556 Larionova, V. mascc-0073 Lee, N.R. mascc-0401 Lima-Neto, R.G. mascc-0506 Larkin, D. mascc-0426 Lee, S. mascc-0142 Lima-Neto, R.G. mascc-0491 Larocque, G. mascc-0310 Lee, S. mascc-0143 Lin, M.K.Y. mascc-0316 Latter, S. mascc-0405 Lee, S. mascc-0365 Linardou, E. mascc-0219 Lau, K.M. mascc-0246 Lee, S.H. mascc-0128 Linder, S. mascc-0460 Launay-Vacher, V. mascc-0581 Lee, Y.L. mascc-0350 Lindkær-Jensen, S.L.J. mascc-0374 Laustsen, S. mascc-0066 Leemans, C.R. mascc-0406 Lindsay, S. mascc-0443 Lauzon, N. mascc-0541 Leemans, C.R. mascc-0397 Ling, W.M. mascc-0069 Lauzon, N. mascc-0322 Leemans, C.R. mascc-0510 Lipp, E. mascc-0215 Lauzon, N. mascc-0411 Leemans, C.R. mascc-0514 Lipton, A. mascc-0340 Lauzon, N. mascc-0410 Leemans, C.R. mascc-0393 Liru, M. mascc-0415 Lauzon, N. mascc-0323 Lefebvre, D. mascc-0400 Liru, M. mascc-0380 Lauzon, N. mascc-0454 Lefebvre, G. mascc-0278 Lis, C. mascc-0016 Lauzon, N. mascc-0449 Lefebvre, G. mascc-0386 LisbethRosenbekMinet, L.R.M. mascc-0099 Lavoratore, S. mascc-0459 Lefebvre, G. mascc-0400 Lisi, G. mascc-0071 Lawlor, P.G. mascc-0119 LeGallou, K. mascc-0563 Liska, C. mascc-0310 Lawsin, C. mascc-0614 Leighl, N. mascc-0293 LisWagner, L.W.mascc-0099 Lawson, D.M. mascc-0452 Leighl, N. mascc-0180 Litton, J. mascc-0536 Le, L. mascc-0290 Leino-Kilpi, H. mascc-0088 Liu, D. mascc-0270 Le, L. mascc-0288 Leitz, L. mascc-0424 Liu, D. mascc-0284 Leach, C. mascc-0294 Lemarchand, C. mascc-0148 Liu, D.R. mascc-0518 LeandroLuongodeMatos, L.L.M. mascc-0054 Lemarchand, C. mascc-0150 Liu, J mascc-0490 Lebel, S. mascc-0407 Lemonde, M. mascc-0596 Liu, J. mascc-0512 Leblanc, E. mascc-0400 Lera, A.T. mascc-0018 Liu, J.W.mascc-0364 LeBlanc, T.W.mascc-0416 Lerner, T. mascc-0018 Lizeaga, G. mascc-0453 LeBoeuf, N. mascc-0611 Leroux, N. mascc-0400 Lo, C. mascc-0288 LeBoeuf, N.R. mascc-0610 Leroy, P.mascc-0303 Lo, S.K. mascc-0194 LeBoeuf, N.R. mascc-0609 Leroy, P.mascc-0330 Lo, S.K. mascc-0139 Lechner, B. mascc-0192 Leroy, P.mascc-0341 Lobb, L. mascc-0156 Lechner, B. mascc-0153 Leroy, P.mascc-0336 Lobchuk, M.M. mascc-0537 Lechner, B. mascc-0327 Leroy, P.mascc-0334 Loblaw, A. mascc-0435 Lechner, B. mascc-0441 Lervat, C. mascc-0214 LobodeMena, M. mascc-0504 Lechner, B. mascc-0411 Lester, J. mascc-0413 Locati, L.D. mascc-0251 Lechner, B. mascc-0328 Lester, J. mascc-0418 Lochray, F. mascc-0435 Lechner, B. mascc-0457 Letarte, N. mascc-0315 Locke, S.C. mascc-0416 Lechner, B. mascc-0456 Leung, A. mascc-0545 Loeffen, E.A.H. mascc-0492 Lechner, B. mascc-0225 Leung, D.Y.P.mascc-0232 Loftus, S. mascc-0286 Lechner, B. mascc-0325 Leung, D.Y.P.mascc-0316 Logan, R. mascc-0339 Lechner, B. mascc-0410 Lewis, J. mascc-0318 Logan, R.M. mascc-0302 Lechner, B. mascc-0323 Li, M. mascc-0582 Logie, N. mascc-0414 Lechner, B. mascc-0326 Li, S mascc-0490 Loiselle, C. mascc-0109 Lechner, B. mascc-0454 Li, S. mascc-0512 Loiselle, C.G. mascc-0533 Lechner, B. mascc-0449 Li, X. mascc-0394 Longo, C. mascc-0497 Lechner, B. mascc-0231 Li, X. mascc-0230 Lopes-Júnior, L.C. mascc-0217 Lee, B. mascc-0059 Li, Z. mascc-0146 Lopes-Júnior, L.C. mascc-0102 Lee, C. mascc-0343 Liao, S. mascc-0126 Lopez, J. mascc-0312 Lee, C. mascc-0344 Liauw, W.mascc-0156 Lopez, J. mascc-0313 Lee, D. mascc-0184 Licitra, L. mascc-0251 Loprinzi, C.L. mascc-0049 Lee, D.J. mascc-0423 Liede, A. mascc-0498 Lorhan, S. mascc-0425 Lee, D.T.F. mascc-0232 Lien, K. mascc-0545 Lorhan, S. mascc-0424 Lee, H. mascc-0202 Lieverst, J. mascc-0185 Lorhan, S. mascc-0431 Lee, J. mascc-0343 Lim, D. mascc-0542 Loscalzo, M. mascc-0542 Lee, J. mascc-0344 Lim, D. mascc-0039 Low, X.H. mascc-0039 Lee, J.A. mascc-0200 Lim, D. mascc-0040 Low, X.H. mascc-0040 S12 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Lowson, E. mascc-0405 Manoor, U. mascc-0496 McDonald, R. mascc-0423 Lu, M. mascc-0271 Manzano, J.G. mascc-0487 McDonald, R. mascc-0441 Luan, Y.H. mascc-0461 Manzyuk, L. mascc-0073 McDonald, R. mascc-0411 Lubberding, S. mascc-0393 MárciadeMeloRodrigues, McDonald, R. mascc-0531 Lucarelli, A. mascc-0195 M.M.R. mascc-0551 McDonald, R. mascc-0455 Lucchesi, M. mascc-0595 MárciadeMeloRodrigues, McDonald, R. mascc-0473 Lucchesi, M. mascc-0594 M.M.R. mascc-0553 McDonald, R. mascc-0472 Lucchesi, M. mascc-0593 Marcucci, F. mascc-0195 McDonald, R. mascc-0481 Lucchesi, M. mascc-0600 Margolies, L. mascc-0311 McDonald, R. mascc-0184 lucchiari, C. mascc-0588 Marioli, A. mascc-0283 McDonald, R. mascc-0464 Ludwig, H. mascc-0367 Marliot, G. mascc-0386 McDonald, R. mascc-0191 Lukacs, I. mascc-0101 Marliot, G. mascc-0400 McDonald, R. mascc-0231 Luo, R. mascc-0487 Márquez-Rodas, I. mascc-0504 McGarvey, N. mascc-0469 Luporsi, E. mascc-0395 Marre, A. mascc-0272 mcGowan, C. mascc-0240 Luther, A.N.I.L. mascc-0376 Marszalek, A. mascc-0299 McKavanagh, D. mascc-0037 Luthra, R. mascc-0230 Martell, R. mascc-0398 McLoone, J.K. mascc-0369 Lutrino, S.E. mascc-0083 Martell, R. mascc-0387 McPherson, C.J. mascc-0537 Lymn, K.A. mascc-0237 Martell, R. mascc-0384 McSherry, F. mascc-0215 Lymn, K.A. mascc-0235 Martell, R. mascc-0391 Mead, K. mascc-0339 Lymn, K.A. mascc-0234 Martin, M. mascc-0340 Meisenberg, B. mascc-0309 Lyng, G. mascc-0150 Martin, P.mascc-0349 Meisenberg, B. mascc-0493 Martínez, J. mascc-0549 Mellado, B. mascc-0575 M MartínezdeCastro, E. mascc-0549 Mellado, B. mascc-0502 Ma, B. mascc-0337 Martinez-Puig, D. mascc-0234 Mellemgaard, A. mascc-0363 Ma, J.D. mascc-0538 MartínJiménez, M. mascc-0504 Mello, T.B. mascc-0106 Ma, J.D. mascc-0486 Martins, S. mascc-0061 MeloCruz, F. mascc-0061 Ma, J.D. mascc-0151 Marx, W.mascc-0037 Mertsoylu, H. mascc-0056 Maccaroni, E. mascc-0195 Mashtoub, S. mascc-0237 Merx, M. mascc-0167 MacDonald, K. mascc-0367 Mashtoub, S. mascc-0235 Messier, C. mascc-0315 Macêdo, D. mascc-0569 Mashtoub, S. mascc-0234 Miaskowski, C. mascc-0226 Macêdo, D.* mascc-0568 Mashtoub, S. mascc-0238 Miaskowski, C. mascc-0154 Macêdo, D.P.C. mascc-0552 Masroor, M. mascc-0521 Michallet, M. mascc-0395 Macêdo, D.P.C. mascc-0550 Massey, D. mascc-0432 Michiels, E.M. mascc-0185 Macêdo, D.P.C. mascc-0555 Masuda, N. mascc-0264 Mickeviciene, V. mascc-0285 Macêdo, D.P.C. mascc-0556 Masuda, N. mascc-0347 Migliorati, C. mascc-0166 Macêdo, D.P.C. mascc-0506 Masuda, Y. mascc-0329 Migliorati, C.A. mascc-0123 Macêdo, D.P.C. mascc-0491 Masuda, Y. mascc-0324 Mikkelsen, T. mascc-0382 Mackenzie, C. mascc-0152 Masuko, H. mascc-0163 Milakovic, M. mascc-0192 MacKintosh, D. mascc-0133 Masuoka, K. mascc-0378 Milakovic, M. mascc-0448 MacKintosh, D. mascc-0193 Mathias, S.D. mascc-0233 Milakovic, M. mascc-0465 MacKintosh, J. mascc-0133 Matsunami, N. mascc-0264 Milakovic, M. mascc-0191 Madhukumar, P.mascc-0194 Matsuoka, J. mascc-0130 Milito, G. mascc-0071 Madhukumar, P.mascc-0200 Matzka, M. mascc-0295 Miller, E. mascc-0215 Madridano, O. mascc-0597 Maunsell, E. mascc-0183 Miller, M. mascc-0152 Maessen, D. mascc-0356 May, C. mascc-0405 min, D.O.N.G. mascc-0178 Maggi, C.A. mascc-0265 Mayer, C. mascc-0477 Minami, S. mascc-0163 Mahovlich, S. mascc-0424 Mayer, H. mascc-0224 Minchew, J. mascc-0215 Mais, K. mascc-0240 Mayer, H. mascc-0173 Minden, M. mascc-0421 Maiya, A. mascc-0539 Mayer, H. mascc-0300 Minn, H. mascc-0088 Majdan, M. mascc-0307 Mayer, H. mascc-0298 Mir, A. mascc-0521 Majorana, A. mascc-0136 Mayer, H. mascc-0295 Mir, O. mascc-0581 Majorana, A. mascc-0399 Mayer, J. mascc-0265 Mir, R. mascc-0522 Mak, S.S.S. mascc-0069 Mayo, B. mascc-0188 Mirabile, A. mascc-0083 Malgouzou, M. mascc-0220 Mayo, B. mascc-0186 Mirabile, A. mascc-0562 Malila, N.E.A. mascc-0058 Mayo, N. mascc-0417 Miralda, B. mascc-0335 Mallinson, P.mascc-0352 Mayo, S. mascc-0494 Miranda, D.O. mascc-0260 Maloney, A.M. mascc-0459 McCarthy, A. mascc-0037 Mirjalili, N. mascc-0050 Mamzer-Bruneel, M.F. mascc-0303 McCarthy, D. mascc-0125 Mischitelle, A. mascc-0421 Mandal, S. mascc-0580 McCullough, R. mascc-0187 Mitchell, W.M. mascc-0151 Mandrelle, K. mascc-0376 McDonald, R mascc-0147 Mitsuda, M. mascc-0329 Mangenot, M. mascc-0214 McDonald, R. mascc-0153 Mitsuda, M. mascc-0324 Mani, P.mascc-0528 McDonald, R. mascc-0327 Miyagishima, T. mascc-0163 Mani, P.mascc-0561 McDonald, R. mascc-0446 Mizuochi, K. mascc-0378 Mank, A.P.mascc-0108 McDonald, R. mascc-0468 Modiano, M. mascc-0384 mannion, K. mascc-0612 McDonald, R. mascc-0422 Mogensen, O. mascc-0131 Mannion, K. mascc-0112 McDonald, R. mascc-0434 Mogensen, S. mascc-0527 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S13

Mogensen, S. mascc-0529 Munk, P.mascc-0352 Ng, R. mascc-0200 Mohammad, A. mascc-0529 MuñozMartín, A. mascc-0504 Ng, R. mascc-0139 Mohan, M.P.mascc-0607 Murakami, H. mascc-0329 Ng, R. mascc-0140 Mohan, M.P.mascc-0608 Murakami, H. mascc-0324 Ng, S.M. mascc-0246 Mohile, S. mascc-0445 Murphy, B. mascc-0221 Ng, T. mascc-0139 Mohile, S.G. mascc-0525 Murphy, B. mascc-0558 Ng, T. mascc-0140 Mohsen, H. mascc-0245 Murphy, B.A. mascc-0123 Ng, T.R.D. mascc-0194 Mok, T. mascc-0432 Murphy, B.A. mascc-0612 Ng, T.R.D. mascc-0200 Molani, P.mascc-0261 Murphy, B.A. mascc-0602 Ng, W.T. mascc-0069 Molani, P.mascc-0263 Murphy, B.A. mascc-0105 Ngan, H. mascc-0190 Molasiotis, A. mascc-0321 Murphy, B.A. mascc-0112 Ngo, A. mascc-0462 Molassiotis, A mascc-0200 Murphy, B.A. mascc-0070 Nguyen, E. mascc-0571 Molassiotis, A. mascc-0500 Murphy, D. mascc-0319 Nguyen, E. mascc-0586 Molony, J. mascc-0512 Murphy, G. mascc-0610 Nguyen, H. mascc-0197 Molony, JT mascc-0490 Murray-Brown, F. mascc-0213 Nguyen, J. mascc-0545 Mols, F. mascc-0048 Murthy, V. mascc-0172 Nguyen, J. mascc-0075 Mondéjar, R. mascc-0549 Musa, I. mascc-0035 Nguyen, J. mascc-0225 Monette, J. mascc-0180 Musch, R. mascc-0356 Nguyen, J. mascc-0274 Moraes, V.L.L. mascc-0550 Mustian, K. mascc-0426 Nguyen, P.mascc-0007 Moraes, V.L.L. mascc-0555 Mustian, K. mascc-0311 Nguyen, P.mascc-0292 Moraes, V.L.L. mascc-0556 Mustian, K. mascc-0445 Niarou, V. mascc-0205 Morag, A. mascc-0428 Muzzatti, B. mascc-0096 Niarou, V. mascc-0210 Morais, J.A. mascc-0557 Muzzatti, B. mascc-0095 Niarou, V. mascc-0208 Morais, J.A. mascc-0535 Muzzatti, B. mascc-0118 Nicholas, L. mascc-0404 Morais, J.A. mascc-0534 Nicholas, L. mascc-0402 Morais, V.L.L. mascc-0491 N Nickolich, M.S. mascc-0416 Morash, R. mascc-0310 Na, I. mascc-0202 Nicolatou-Galitis, O. mascc-0517 Moreira, A.C. mascc-0619 Nademanee, A. mascc-0542 Nicolatou-Galitis, O. mascc-0219 Moreno, C. mascc-0575 Nagasaki, E. mascc-0170 Nicolatou-Galitis, O. mascc-0166 Moreno, C. mascc-0502 Nagy, Z. mascc-0265 Nicolussi, A.C. mascc-0256 Moreno, H. mascc-0279 Nair, R.G. mascc-0617 Nicolussi, A.C. mascc-0257 Morere, J.F. mascc-0581 Naito, T. mascc-0329 Nicolussi, A.C. mascc-0275 Morgado, M. mascc-0165 Naito, T. mascc-0324 Nielsen, T. mascc-0015 Morgese, F. mascc-0196 Nakajima, J. mascc-0163 Nielson, D. mascc-0560 Mori, K. mascc-0329 Nakamura, M. mascc-0163 Niermann, K. mascc-0221 Mori, K. mascc-0324 Nakayama, T. mascc-0347 Niermann, K. mascc-0112 Mori, M. mascc-0304 Namer, M. mascc-0336 Niharika, D. mascc-0585 Mori, T. mascc-0223 Namer, M. mascc-0334 Nikolaidi, A. mascc-0166 Morimoto, M. mascc-0347 Narducci, F. mascc-0400 Nikulina, V. mascc-0145 Morimoto, T. mascc-0264 Narui, H. mascc-0314 Nishimura, S. mascc-0264 Morishita, S. mascc-0012 narui, H. mascc-0355 Nolte, T. mascc-0309 Morita, E. mascc-0329 Nascimento, L.C. mascc-0217 Nomura, M. mascc-0347 Morita, E. mascc-0324 Nascimento, L.C. mascc-0106 Noonan, B. mascc-0081 Morita, S. mascc-0347 Nathan, P.mascc-0459 Norris, R. mascc-0346 Morrow, G. mascc-0311 Nathwani, N. mascc-0542 North, R. mascc-0189 Morrow, G.R. mascc-0445 Natsis, V. mascc-0205 Nosov, D. mascc-0073 Morrow, G.R. mascc-0540 Natsis, V. mascc-0207 Noujeim, M.E. mascc-0123 Morrow, P.mascc-0230 Natsis, V. mascc-0210 Nousiainen, M.T. mascc-0465 Morrow, P.K. mascc-0512 Natsis, V. mascc-0209 Novotny, P.mascc-0450 Morrow, P.K. mascc-0229 Natsis, V. mascc-0212 Nowacka, K. mascc-0306 Morrow, PK mascc-0490 Natsis, V. mascc-0208 Nowacki, A. mascc-0029 MoyaOrtega, B. mascc-0504 Natsis, V. mascc-0211 Nowacki, M. mascc-0306 Muallaoglu, S. mascc-0056 Natsis, V. mascc-0206 Nowacki, M.S. mascc-0299 Mudireddy, M. mascc-0271 Navari, R. mascc-0387 Nunes, M.D.R. mascc-0217 Mueller, U. mascc-0544 Negmeldin, R. mascc-0254 Nygaard, A. mascc-0529 Mueller, U. mascc-0530 Nematollahi, M. mascc-0596 Muenzberg, M. mascc-0367 Ness, J. mascc-0493 O MufidM.ElMistiri, M. mascc-0254 Neves, R. mascc-0556 Oba, K. mascc-0163 Mugellini, E. mascc-0076 Neves, R.P.mascc-0552 Oberholzer, R. mascc-0603 Mugellini, E. mascc-0077 Neves, R.P.mascc-0550 O'Brien, D. mascc-0432 Mukhopadhyay, S. mascc-0584 Neves, R.P.mascc-0569 Obuya, S. mascc-0415 Mukhopadhyay, S. mascc-0403 Neves, R.P.mascc-0568 Obuya, S.A. mascc-0380 Mukkada, S. mascc-0591 Neves, R.P.mascc-0555 O'Byrne, K.J. mascc-0432 Mulder, R.L. mascc-0492 Neves, R.P.mascc-0506 O'Callaghan, C. mascc-0319 Mullins, C.D. mascc-0498 Neves, R.P.mascc-0491 Ochoa, J. mascc-0282 Munhoz, B.A. mascc-0011 Ng, R. mascc-0194 Ogasawara, Y. mascc-0170 S14 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Ogawa, H. mascc-0012 Ozyilkan, O. mascc-0056 Paul, S. mascc-0226 Ogawa, T. mascc-0554 Ozyilkan, O. mascc-0371 Paul, S. mascc-0154 Oguda, J. mascc-0415 Ozyilkan, O. mascc-0331 Paula, J.M. mascc-0256 Ogunti, R. mascc-0536 Paula, J.M. mascc-0257 Ogur, R. mascc-0110 P Paula, J.M. mascc-0275 Oguzkurt, L. mascc-0371 P,J. mascc-0412 Pearce, A. mascc-0377 Oh, J. mascc-0078 Page, J. mascc-0230 Pedersen, J. mascc-0505 Oh, P.mascc-0559 Page, J.H. mascc-0478 PedroJoséRolimNeto, P.J.R.N. mascc-0551 Oh, S. mascc-0142 Page, J.H. mascc-0479 PedroJoséRolimNeto, P.J.R.N. mascc-0553 Oh, S. mascc-0401 Page, J.H. mascc-0471 Pena, E. mascc-0606 Ohashi, T. mascc-0329 Page, J.H. mascc-0476 Penel, N. mascc-0214 Ohashi, T. mascc-0324 Page, J.H. mascc-0512 Peoples, A. mascc-0311 Ohlig, J. mascc-0167 Paisan, A. mascc-0453 Peoples, A.R. mascc-0540 Ohno, S. mascc-0264 Pakpour, A.H. mascc-0452 Peppone, L. mascc-0445 Ojha, R.P.mascc-0470 Pal, S. mascc-0542 Peppone, L.J. mascc-0540 Ojha, R.P.mascc-0082 Palesh, O. mascc-0426 Perazzo, F. mascc-0061 Okamura, H. mascc-0482 Palma, C.G.L. mascc-0018 Pereira, J. mascc-0429 Okayama, T. mascc-0329 Palmano, K. mascc-0189 Perez, D. mascc-0189 Okayama, T. mascc-0324 Palmas, M. mascc-0160 PérezRamírez, S. mascc-0504 Okino, L. mascc-0256 Palmas, M. mascc-0161 Peria, F.M. mascc-0260 Okishiro, M. mascc-0347 Palmas, M. mascc-0158 Perry, S. mascc-0111 Okuyama, S. mascc-0332 Palmas, M. mascc-0159 Pesevska, M. mascc-0045 Olagunju, A. mascc-0169 Panagiotarakou, M. mascc-0283 Pessi, M.A. mascc-0261 Olagunju, A.T. mascc-0168 Pang, C.K. mascc-0243 Pessi, M.A. mascc-0263 Olagunju, T.O. mascc-0168 Pang, C.K. mascc-0069 Pessi, M.A. mascc-0204 Oldenburg, H.S.A. mascc-0138 Panmeesub, B. mascc-0084 Peters, K. mascc-0215 OlfredHansen, O.H. mascc-0099 Pant, M.C. mascc-0412 Petersen, J. mascc-0527 Oliveira, M.M. mascc-0018 Paolucci, V. mascc-0196 Petersen, J. mascc-0529 Oliveira, S. mascc-0583 Papadopoulos, A. mascc-0210 Petrcich, W.mascc-0537 Olsen, K. mascc-0497 Papadopoulou, E. mascc-0219 Petree, J. mascc-0335 Olson, K. mascc-0426 Papasotiriou, I. mascc-0219 Petsersen, A.K. mascc-0066 Olver, I. mascc-0198 Papoila, A.L. mascc-0119 Phelip, J.M. mascc-0272 O'Mahony, M. mascc-0081 Parahym, A. mascc-0551 Philip, J. mascc-0349 Omaña, C.J. mascc-0313 Parahym, A. mascc-0553 Piana, G. mascc-0399 Omar, K. mascc-0305 Parahym, A.M.R.C. mascc-0552 Pierantoni, C. mascc-0195 Ong, P.S. mascc-0052 Parahym, A.M.R.C. mascc-0550 Pietkun, K. mascc-0306 Ong, Y.Y. mascc-0200 Parahym, A.M.R.C. mascc-0569 Pietkun, K. mascc-0299 Ono, A. mascc-0329 Parahym, A.M.R.C. mascc-0568 Pietra, C. mascc-0188 Ono, A. mascc-0324 Parahym, A.M.R.C. mascc-0555 Pietra, C. mascc-0186 Ono, M. mascc-0572 Parahym, A.M.R.C. mascc-0556 Pili, R. mascc-0127 Onofri, A. mascc-0196 Parahym, A.M.R.C. mascc-0506 Pinkerton, A. mascc-0543 Onofri, A. mascc-0195 Parahym, A.M.R.C. mascc-0491 Piyabandidgool, P.mascc-0084 Onukwugha, E. mascc-0498 Parent, D. mascc-0292 Plasencia, J. mascc-0597 Ooi, W.S. mascc-0194 Park, E. mascc-0365 Plate, S. mascc-0573 Ooi, W.S. mascc-0200 Park, I. mascc-0236 Platt, A. mascc-0034 Ooi, W.S. mascc-0139 Park, J. mascc-0333 Plews, E. mascc-0098 Orel, V. mascc-0145 Park, J. mascc-0202 Plews, E. mascc-0186 Orlandi, E. mascc-0251 Park, K. mascc-0201 Plow, E. mascc-0033 Orlandi, E. mascc-0562 Park, S. mascc-0624 Pokrywczynska, M. mascc-0299 Ortner, P.mascc-0357 Park, S. mascc-0390 Polimeni, A. mascc-0399 Osburg, S. mascc-0578 Park, S.J. mascc-0008 Pollard, S. mascc-0189 Oshima, K. mascc-0347 Park, W.S. mascc-0142 Polsoni, S. mascc-0136 Otero-Candelera, R. mascc-0597 Park, Y. mascc-0343 Poma, A. mascc-0398 Othman, S. mascc-0014 Park, Y. mascc-0344 Poma, A. mascc-0387 Oudard, S. mascc-0581 Park, Y.J. mascc-0368 Poma, A. mascc-0384 Oudard, S. mascc-0330 Park, Y.S. mascc-0171 Poma, A. mascc-0391 Oudard, S. mascc-0341 Park, Y.S. mascc-0008 Pompa, G. mascc-0379 Oudard, S. mascc-0420 ParmarCalislar, M. mascc-0461 Poon, M. mascc-0192 Overgaard, B. mascc-0248 Parot-Monpetit, A. mascc-0563 Poon, M. mascc-0567 Overman, M. mascc-0271 Pasdera, A. mascc-0595 Poon, M. mascc-0448 Owens, G.O. mascc-0524 Paszat, L. mascc-0483 Poon, M. mascc-0317 Oyakawa, T. mascc-0329 Patel, C. mascc-0034 Poon, M. mascc-0177 Oyakawa, T. mascc-0324 Patel, K. mascc-0016 Poon, M. mascc-0447 Ozaydin, S. mascc-0110 Patel, S. mascc-0354 Poon, M. mascc-0132 Özbek, C. mascc-0592 Paul, C. mascc-0305 Poon, M. mascc-0342 Ozturk, M. mascc-0110 Paul, D. mascc-0437 Poon, M. mascc-0338 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S15

Poon, M. mascc-0404 Pulenzas, N. mascc-0448 Ravagnani, F. mascc-0263 Poon, M. mascc-0402 Pulenzas, N. mascc-0177 Ray, P.C. mascc-0521 Poon, M. mascc-0184 Pulenzas, N. mascc-0153 Ray-Coquard, I. mascc-0581 Pope, A. mascc-0290 Pulenzas, N. mascc-0447 Razis, E. mascc-0166 Pope, A. mascc-0288 Pulenzas, N. mascc-0327 Reddy, A. mascc-0270 Popovic, M mascc-0147 Pulenzas, N. mascc-0117 Reddy, A. mascc-0389 Popovic, M. mascc-0192 Pulenzas, N. mascc-0121 Reddy, S. mascc-0270 Popovic, M. mascc-0448 Pulenzas, N. mascc-0414 ReginaldoGonçalvesdeLimaNeto, Popovic, M. mascc-0317 Pulenzas, N. mascc-0441 R.G.L.N. mascc-0551 Popovic, M. mascc-0177 Pulenzas, N. mascc-0411 ReginaldoGonçalvesdeLimaNeto, Popovic, M. mascc-0153 Pulenzas, N. mascc-0328 R.G.L.N. mascc-0553 Popovic, M. mascc-0446 Pulenzas, N. mascc-0457 Rego, E.M. mascc-0265 Popovic, M. mascc-0468 Pulenzas, N. mascc-0456 Reguart, N. mascc-0575 Popovic, M. mascc-0132 Pulenzas, N. mascc-0075 Reguart, N. mascc-0502 Popovic, M. mascc-0117 Pulenzas, N. mascc-0225 Reich, M. mascc-0409 Popovic, M. mascc-0121 Pulenzas, N. mascc-0274 Reid, K. mascc-0037 Popovic, M. mascc-0342 Pulenzas, N. mascc-0179 Reiner, M. mascc-0230 Popovic, M. mascc-0338 Pulenzas, N. mascc-0325 RejanePereiraNeves, R.P.N. mascc-0551 Popovic, M. mascc-0422 Pulenzas, N. mascc-0410 RejanePereiraNeves, R.P.N. mascc-0553 Popovic, M. mascc-0434 Pulenzas, N. mascc-0323 Renault-Tessier, E. mascc-0547 Popovic, M. mascc-0423 Pulenzas, N. mascc-0326 Resteghini, C. mascc-0251 Popovic, M. mascc-0441 Pulenzas, N. mascc-0454 Revta, C. mascc-0486 Popovic, M. mascc-0404 Pulenzas, N. mascc-0449 Rey, J.B. mascc-0581 Popovic, M. mascc-0402 Pulenzas, N. mascc-0231 Rey, J.B. mascc-0292 Popovic, M. mascc-0465 Pumo, V. mascc-0419 Rezk, J. mascc-0123 Popovic, M. mascc-0531 Puts, M. mascc-0596 Rha, S. mascc-0343 Popovic, M. mascc-0075 Puts, M. mascc-0293 Rha, S. mascc-0344 Popovic, M. mascc-0225 Puts, M. mascc-0180 Rhondali, W.mascc-0282 Popovic, M. mascc-0274 Puts, M. mascc-0301 Rhoten, B. mascc-0026 Popovic, M. mascc-0179 Puzzo, E. mascc-0419 Rhoten, B. mascc-0030 Popovic, M. mascc-0452 Ribeiro, C. mascc-0583 Popovic, M. mascc-0455 Q Ribera, J.M. mascc-0265 Popovic, M. mascc-0277 Qian, Y. mascc-0498 Ribi, K. mascc-0076 Popovic, M. mascc-0276 qu, L. mascc-0178 Ricci, S. mascc-0595 Popovic, M. mascc-0473 Quinn, B. mascc-0259 Ricci, S. mascc-0594 Popovic, M. mascc-0472 Quinn, B. mascc-0240 Ricci, S. mascc-0593 Popovic, M. mascc-0481 Quittet, P.mascc-0269 Ricci, S. mascc-0600 Popovic, M. mascc-0184 Quittet, P.mascc-0272 Richards, A. mascc-0339 Popovic, M. mascc-0464 Qushmaq, I.A. mascc-0509 Richardson, A. mascc-0405 Popovic, M. mascc-0191 Richardson, M.N. mascc-0271 Popovic, M. mascc-0231 R Ridner, S. mascc-0221 Popovic, M.P.mascc-0268 R.Feghir, R.F. mascc-0291 Ridner, S. mascc-0026 Porta, F. mascc-0136 Raber-Durlacher, J.B. mascc-0072 Ridner, S. mascc-0030 Portman, D.G. mascc-0613 Raber-Durlacher, J.E. mascc-0617 Ridner, S.H. mascc-0612 Porwit, A. mascc-0454 Raber-Durlacher, J.E. mascc-0108 Ridner, S.H. mascc-0602 Pose, K. mascc-0335 Radhakrishnan, N. mascc-0458 Ridner, S.H. mascc-0105 Pouliot, J.F. mascc-0307 Radina, E. mascc-0026 Ridner, S.H. mascc-0112 Powers, A. mascc-0394 Radina, E. mascc-0030 Ridner, S.H. mascc-0070 Powers, A. mascc-0227 Rafaqat, R. mascc-0023 Rieber, A. mascc-0282 Powers, A. mascc-0228 Rafaqat, R. mascc-0022 Riley, E. mascc-0240 Prabha, S. mascc-0107 Rafaqat, R. mascc-0021 Rimedio, A. mascc-0562 Prabhu, K.R. mascc-0485 Raina, V. mascc-0564 Rinaldi, S. mascc-0195 Prado, C.M. mascc-0548 Raisch, D. mascc-0113 Rini, B. mascc-0033 Prashant, S. mascc-0032 Ramchandani, A. mascc-0549 Ripamonti, C. mascc-0251 Pravettoni, G. mascc-0588 RamettaGiuliano, S. mascc-0419 Ripamonti, C. mascc-0508 Preetha, M. mascc-0139 Rana, F.N. mascc-0049 Ripamonti, C. mascc-0252 Pristupa, A.S. mascc-0265 Randazzo, D.M. mascc-0215 Ripamonti, C.I. mascc-0261 Probyn, L. mascc-0322 Ranjan, T. mascc-0215 Ripamonti, C.I. mascc-0263 Probyn, L. mascc-0323 Rao, J. mascc-0388 Ripamonti, C.I. mascc-0204 Proctor, J. mascc-0189 Raphael, M.F. mascc-0185 Ristic, D. mascc-0265 Provencher, D. mascc-0307 Raphaelis, S. mascc-0173 Rizel, S. mascc-0111 PS, H. mascc-0607 Rapoport, B. mascc-0387 Rizk, N.R. mascc-0089 PS, Satheeshkumar mascc-0607 Rashi, C. mascc-0109 Rizzi, G. mascc-0160 PS, Satheeshkumar. mascc-0608 Rasmussen, A. mascc-0374 Rizzi, G. mascc-0162 Puerta, A. mascc-0597 Rathod, S. mascc-0172 Rizzi, G. mascc-0161 Pulenzas, N. mascc-0192 Rauck, R. mascc-0463 Rizzi, G. mascc-0158 S16 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Rizzi, G. mascc-0159 Rybicki, L. mascc-0032 Schep, G. mascc-0048 Roberge, D. mascc-0183 Rydall, A. mascc-0421 Schilling, J. mascc-0358 Roberge, D. mascc-0176 Ryoo, B.Y. mascc-0373 Schilling, J. mascc-0357 RobertPartyka, RP mascc-0249 Ryu, M.H. mascc-0373 Schimmer, A. mascc-0421 Roccaro, S. mascc-0419 Schnadig, I. mascc-0384 Rodin, G. mascc-0421 S Schofield, P.mascc-0319 Rodin, G. mascc-0582 S, V. mascc-0412 Schoot, R.A. mascc-0185 Rodri´guez, A. mascc-0417 S, Y.O.O.N. mascc-0008 Schuler, M.H. mascc-0432 Rodrigues, I. mascc-0386 S.Aziez, S.A. mascc-0291 Schuren, N. mascc-0618 Rodrigues, M.M. mascc-0556 S.Sami, S.S. mascc-0291 Schuurhuis, J.M. mascc-0135 Rodriguez, R. mascc-0478 Sachdev, J. mascc-0376 Schwartzberg, L. mascc-0384 Rodriguez, R. mascc-0479 Sachdeva, A. mascc-0458 Schwartzberg, L. mascc-0160 Rodriguez, R. mascc-0471 Saeedi, A.A. mascc-0509 Schwartzberg, L. mascc-0161 Rodriguez, R. mascc-0476 Saevarsson, C.W.mascc-0181 Scott, J. mascc-0189 Rodriguez, R. mascc-0313 Sagara, Y. mascc-0264 Scotte, F mascc-0272 Roeland, E.J. mascc-0538 Sagawa, T. mascc-0163 Scotte, F. mascc-0303 Roeland, E.J. mascc-0486 Sahgal, A. mascc-0541 Scotté, F. mascc-0581 Roeland, E.J. mascc-0151 Sahgal, A. mascc-0435 Scotté, F. mascc-0330 Rohn, R. mascc-0400 Saito, M. mascc-0130 Scotté, F. mascc-0341 Roila, F. mascc-0083 Saji, S. mascc-0264 Scotté, F. mascc-0385 Roila, F. mascc-0252 Sakji, I. mascc-0386 Scotté, F. mascc-0336 Rolim-Neto, P.J. mascc-0552 Sakji, I. mascc-0400 Scotté, F. mascc-0334 Rolim-Neto, P.J. mascc-0550 Sala, M. mascc-0562 Scotté, F. mascc-0420 Rolim-Neto, P.J. mascc-0569 Saleh, S. mascc-0287 Seccareccia, D. mascc-0436 Rolim-Neto, P.J. mascc-0568 Sali, A. mascc-0037 Seccareccia, D. mascc-0439 Rolim-Neto, P.J. mascc-0555 Saligan, L. mascc-0426 Sedef, A. mascc-0056 Rolim-Neto, P.J. mascc-0556 Samim, P.mascc-0599 Segal, R. mascc-0310 Rolim-Neto, P.J. mascc-0506 Samsa, G.P.mascc-0416 Selle, F. mascc-0581 Rolim-Neto, P.J. mascc-0491 Samson, B. mascc-0176 Senn, B. mascc-0173 Romero, M. mascc-0508 Samuel, S. mascc-0539 Seo, B. mascc-0202 Ronald, C. mascc-0179 Sanad, R mascc-0519 Seo, S.H. mascc-0373 Roodbol, P.F. mascc-0175 Sanderman, R. mascc-0175 Sequist, L.V. mascc-0432 Roodbol, P.F. mascc-0174 Sanderman, R. mascc-0174 Seymour, J. mascc-0035 Roquemore, J. mascc-0164 Sandoval, N. mascc-0474 Sezer, A. mascc-0056 Ros, C. mascc-0312 Sanford, T. mascc-0034 Sgouros, J. mascc-0166 Roscoe, J. mascc-0445 SangHee, K. mascc-0375 Shankar, A. mascc-0499 Roscoe, J.A. mascc-0540 SanMiguel-Arregui, M. mascc-0389 Shankar, A. mascc-0376 Rosello, A. mascc-0312 Sansom-Daly, U.M. mascc-0370 Shapiro, C. mascc-0413 Rosello, A. mascc-0313 Santi, P.mascc-0061 Sharka, R. mascc-0523 Rosello, J. mascc-0312 Santini, D. mascc-0195 Sharma, A. mascc-0564 Rosello, J. mascc-0313 Santos, M.F. mascc-0217 Sharples, K.J. mascc-0189 Rosenthal, D. mascc-0562 Santos-Oliveira, R. mascc-0074 Shayne, M. mascc-0540 Rosenthall, L. mascc-0557 Santos-Silva, A.R. mascc-0123 Shebl, A mascc-0519 Rosenthall, L. mascc-0535 Saraykar, S. mascc-0460 Sheehan, P.mascc-0153 Rossi, G. mascc-0160 Saraykar, S. mascc-0113 Sheehan, P.mascc-0411 Rossi, G. mascc-0162 Sarimiye, F.O. mascc-0168 Sheehan, P.mascc-0328 Rossi, G. mascc-0161 Sarkar, D. mascc-0528 Sheehan, P.mascc-0410 Rossi, G. mascc-0158 Sarkar, D. mascc-0561 Sheehan, P.mascc-0231 Rossi, G. mascc-0159 Sasaki, E. mascc-0378 Shenkman, E. mascc-0146 Rotich, J. mascc-0062 Sasaki, K. mascc-0163 Sherief, L. mascc-0287 Rouby, P.mascc-0272 Sasaki, T. mascc-0163 Sherief, L. mascc-0519 Rouleau, T. mascc-0377 Satoh, T. mascc-0337 Sheu, J. mascc-0611 Roulet, V. mascc-0150 Saunders, D. mascc-0377 Sheu, J. mascc-0610 Rouley, V. mascc-0148 Sauvajot, C. mascc-0330 Sheu, J. mascc-0609 Rovinelli, F. mascc-0196 Sauvajot, C. mascc-0341 Shibuta, K. mascc-0264 Roy, S. mascc-0499 Savinelli, F. mascc-0269 Shibuya, H. mascc-0163 Ruggeri, B. mascc-0083 Savini, A. mascc-0196 Shih, H. mascc-0414 Rugo, H. mascc-0160 Sawada, N. mascc-0256 Shim, B.Y. mascc-0401 RupérezBlanco, A.B.. mascc-0504 Sawada, N. mascc-0257 Shimada, T. mascc-0170 Rusanov, A. mascc-0055 Sawada, N. mascc-0275 Shin, D. mascc-0202 Rushing, C.N. mascc-0416 Sawada, N.O. mascc-0587 Shin, D.B. mascc-0008 Rushton, M. mascc-0310 Saxena, A. mascc-0522 Shin, S. mascc-0236 Russi, E. mascc-0562 Saxena, A. mascc-0521 Shin, S. mascc-0284 Rybicki, L. mascc-0114 Scachkova, O. mascc-0145 Shin, S. mascc-0389 Rybicki, L. mascc-0027 Scartoni, S. mascc-0265 Shin, S.W.mascc-0401 Rybicki, L. mascc-0115 Schechter, T. mascc-0560 Shinde, S. mascc-0032 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S17

Shinde, S. mascc-0620 Smith, M.R. mascc-0340 Sudour-Bonnange, H. mascc-0214 Shintaku, W.H. mascc-0123 Smith, P.mascc-0405 Sue, K. mascc-0375 Shiota, K. mascc-0264 Smith-Stoner, M. mascc-0311 Suenaga, H. mascc-0572 Shklovskiy-Kordi, N. mascc-0590 Snegovoy, A. mascc-0073 Sugazaki, M. mascc-0572 Shore, N. mascc-0340 So, W.mascc-0019 Sugimori, N. mascc-0378 Shrotriya, S. mascc-0027 So, W.mascc-0616 Sulkers, E. mascc-0175 Shrotriya, S. mascc-0267 So, W.K.W.mascc-0069 Sulkers, E. mascc-0174 Shrotriya, S. mascc-0029 Soga, Y. mascc-0223 Suman, S. mascc-0078 Shrotriya, S. mascc-0028 Sohn, J.H. mascc-0128 Summers, Y. mascc-0321 Shun, S. mascc-0622 Soliman, H. mascc-0435 SUN, D.S. mascc-0171 Shuster, L.T. mascc-0049 Somarriba, M.M. mascc-0470 Sung, L. mascc-0560 Shwe, M. mascc-0194 Son, C. mascc-0414 Sung, M.K. mascc-0373 Shwe, M. mascc-0039 Søndergaard, I. mascc-0066 Supe, S. mascc-0496 Shwe, M. mascc-0040 Song, J. mascc-0271 Suppasun, K. mascc-0084 Shwe, M. mascc-0200 Song, S. mascc-0343 Surbone, A. mascc-0096 Shwe, M. mascc-0139 Song, S. mascc-0344 Surbone, A. mascc-0419 Sicard, J. mascc-0292 Sonis, S. mascc-0150 Surbone, A. mascc-0095 Sidani, S. mascc-0500 Sonobe, H.M. mascc-0257 Surbone, S. mascc-0118 Sidani, S. mascc-0494 Soohyeon, L. mascc-0375 Sut, P.mascc-0574 Siddiqi, T. mascc-0542 Sørensen, B. mascc-0382 Sut, P.mascc-0577 Sigaard, L. mascc-0181 Sørlie, V.M. mascc-0218 Sut, P.mascc-0576 Sikorova, L. mascc-0094 Soror, M. mascc-0526 Sutradhar, R. mascc-0483 Sikorová, L. mascc-0093 Sosa, R mascc-0490 Suwannapong, K. mascc-0511 Sills, E. mascc-0354 Sosa, R. mascc-0512 Suzuki, K. mascc-0170 Silva, C. mascc-0506 Soubeyran, P.mascc-0395 Sveindottier, K. mascc-0527 Silva, C. mascc-0491 Soupos, N. mascc-0166 Sveindottier, K. mascc-0529 Silva, C.M. mascc-0552 Sovenko, V. mascc-0145 Svergun, N. mascc-0145 Silva, C.M. mascc-0550 Spanjaard, L. mascc-0185 Svetec, B. mascc-0353 Silva, C.M. mascc-0569 Spano, J.P.mascc-0581 Svintsytskiy, V. mascc-0145 Silva, C.M. mascc-0568 Spielmann, M. mascc-0269 Swami, N. mascc-0290 Silva, C.M. mascc-0555 Spijkervet, F.K.L. mascc-0135 Swami, N. mascc-0288 Silva, C.M. mascc-0556 Spina, M. mascc-0265 Sweeney, M.P.mascc-0354 Silva, M.C.M. mascc-0217 Springall, E. mascc-0180 Sym, S.J. mascc-0008 Silva, M.C.M. mascc-0102 Stamataki, Z. mascc-0321 Syrigos, K. mascc-0280 Silva, O.B. mascc-0506 Steca, P.mascc-0562 Syrigos, K. mascc-0283 SilvaBisson, G. mascc-0260 Stein, A. mascc-0542 Syrigos, K. mascc-0281 Sim, J.H. mascc-0401 Stein, K. mascc-0294 Syrigos, K. mascc-0566 Siminska, J. mascc-0306 SteinbjørnHansen, S.H. mascc-0099 Szeto, C. mascc-0377 Simonelli, C. mascc-0265 Steiner, M.S. mascc-0548 Szumacher, E. mascc-0441 Simpson, A. mascc-0189 Steiner, M.S. mascc-0546 Sinclair, V. mascc-0026 Steinmetz, A. mascc-0571 T Sinclair, V. mascc-0030 Stella, P.J. mascc-0049 Taira, T. mascc-0329 Singh, C. mascc-0144 Stemmer, S.M. mascc-0428 Taira, T. mascc-0324 Singh, D. mascc-0058 Stemmer, S.M. mascc-0111 Takahashi, M. mascc-0264 Singh, S. mascc-0412 Stephenson, J.J. mascc-0233 Takahashi, T. mascc-0329 Sinha, S. mascc-0528 Stern, Y. mascc-0428 Takahashi, T. mascc-0324 Sinha, S. mascc-0561 Stevens, J. mascc-0420 Takakura, Y. mascc-0378 Sirbilantze, T. mascc-0205 Stevens, K. mascc-0612 Takanen, S. mascc-0562 Sirbilantze, T. mascc-0207 Stewart, R.E. mascc-0175 Tamahara, T. mascc-0572 Sirbilantze, T. mascc-0210 Stijnen, T. mascc-0185 Tamahara, T. mascc-0516 Sirbilantze, T. mascc-0209 Stinson, J. mascc-0567 Tan, L.T.M. mascc-0239 Sirbilantze, T. mascc-0212 Stinson, J. mascc-0317 Tan, S.W.O. mascc-0051 Sirbilantze, T. mascc-0208 Stinson, J. mascc-0177 Tan, S.Y. mascc-0139 Sirbilantze, T. mascc-0211 St-Jean, L.A. mascc-0315 Ta n, Y.P.mascc-0200 Sirbilantze, T. mascc-0206 Stokman, M.A. mascc-0135 Ta n, Y.P.mascc-0139 Sit, J. mascc-0019 Stopeck, A. mascc-0340 Tanaka, I. mascc-0314 Sit, J. mascc-0616 Stout, R. mascc-0413 Tanco, K. mascc-0284 Skilton, R. mascc-0203 Stout, R. mascc-0418 Tanco, K. mascc-0389 Skoro, N. mascc-0320 Strasser, F. mascc-0603 Tanda, N. mascc-0516 Sloan, J.A. mascc-0450 Stringer, A. mascc-0188 Tanriverdi, O. mascc-0331 Sloan, J.A. mascc-0049 Stringer, A. mascc-0186 Tantoy, I. mascc-0154 Small, S.G. mascc-0548 Strohmenger, L. mascc-0399 Tanuma, A. mascc-0329 Small, S.G. mascc-0546 Stryker, S. mascc-0512 Tanuma, A. mascc-0324 Smit, J.H. mascc-0406 Stryker, WS mascc-0490 Tapscott, B. mascc-0180 Smith, C. mascc-0221 Su, C. mascc-0466 Tapuni, A. mascc-0346 Smith, D. mascc-0542 Suarez-Almazor, M.E. mascc-0487 Tarangini, D. mascc-0458 S18 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Tateyama, M. mascc-0163 Touati, N. mascc-0176 U Tavakoli-Ardakani, M. mascc-0507 Tougeron, D. mascc-0563 Ueno, K. mascc-0482 Tawa, M. mascc-0611 Tourangeau, A. mascc-0293 Ulas, M. mascc-0371 Taylor, A. mascc-0286 Tourani, J.M. mascc-0336 Ünür, M. mascc-0592 Taylor, P.mascc-0321 Tourani, J.M. mascc-0334 Uomori, T. mascc-0130 Taylor, R.P.mascc-0548 Tournigand, C. mascc-0336 Urban, L. mascc-0391 Taylor, R.P.mascc-0546 Tournigand, C. mascc-0334 urita, G. mascc-0355 Taylor, S. mascc-0078 Toussaint, S. mascc-0563 Uyterlinde, W.mascc-0038 Taylor,T.mascc-0459 Trager, S. mascc-0220 Tejani, M. mascc-0525 Trakoolngamden, B. mascc-0345 V Tejani, M. mascc-0311 Tralongo, P. mascc-0419 Vaartio-Rajalin, H. mascc-0088 Telli, M.L. mascc-0335 Treldal, C. mascc-0527 Vadhan-Raj, S. mascc-0340 Temel, J. mascc-0244 Treldal, C. mascc-0529 Vainchtock, A. mascc-0385 Tenge, C. mascc-0380 Treleaven, J. mascc-0240 Valentine, B. mascc-0064 Teramoto, M. mascc-0615 Tremblay, D. mascc-0183 vandePoll-Franse, L. mascc-0048 TerezinhaSalles, T.J.M.S. mascc-0551 Tremblay, D. mascc-0176 vanderWesthuizen, M. mascc-0425 Terstreip, S. mascc-0049 Tresch, E. mascc-0278 vandeWetering, M. mascc-0185 Terzyk, A.P.mascc-0299 Tresch, E. mascc-0386 vandeWetering, M.D. mascc-0492 Thackray, J. mascc-0560 Trindade, A. mascc-0119 VandeWiele, T. mascc-0396 ThaianaAragãoSantana, T.A.S. mascc-0054 Trindade, A. mascc-0583 VandeWiele, T. mascc-0392 Thakkar, D. mascc-0458 Tripault, L. mascc-0330 vanHarten, W.H. mascc-0138 Thanarajasingam, G. mascc-0450 Tripault, L. mascc-0341 Vanhoecke, B. mascc-0396 Thanasilp, S. mascc-0511 Trochon-Joseph, V. mascc-0148 Vanhoecke, B. mascc-0392 Thanasilp, S. mascc-0197 Trochon-Joseph, V. mascc-0150 Vanlancker, E. mascc-0396 Thavarajah, N. mascc-0322 Trufelli, D. mascc-0061 Vanlemmens, L. mascc-0565 Thavarajah, N. mascc-0411 Tsagkouli, S. mascc-0280 Vanlemmens, L. mascc-0272 Thavarajah, N. mascc-0457 Tsagkouli, S. mascc-0281 vanNieuwenhuizen, A.J. mascc-0406 Thavarajah, N. mascc-0456 Tsai, K. mascc-0126 vanOmmen, C.H. mascc-0185 Thavarajah, N. mascc-0325 Tsang, A. mascc-0571 vanUden-Kraan, C.F. mascc-0513 Thavarajah, N. mascc-0410 Tsang, A. mascc-0586 vanUden-Kraan, C.F. mascc-0397 Thavarajah, N. mascc-0323 Tsao, M. mascc-0448 vanUden-Kraan, C.F. mascc-0510 Thavarajah, N. mascc-0326 Tsao, M. mascc-0447 vanUden-Kraan, C.F. mascc-0514 Thavarajah, N. mascc-0454 Tsao, M. mascc-0541 vanUden-Kraan, C.F. mascc-0393 Thavarajah, N. mascc-0449 Tsao, M. mascc-0446 vanZwieten, V. mascc-0510 Thery, J.C. mascc-0581 Tsao, M. mascc-0468 Varnerin, N. mascc-0033 Thibault, C. mascc-0420 Tsao, M. mascc-0441 Vasile, E. mascc-0595 Thibault, I. mascc-0435 Tsao, M. mascc-0411 Vasile, E. mascc-0594 Thielen, J. mascc-0049 Tsao, M. mascc-0328 Vasile, E. mascc-0593 Thirlwell, S. mascc-0613 Tsao, M. mascc-0465 Vasile, E. mascc-0600 Thomas, S. mascc-0267 Tsao, M. mascc-0531 Va s s i l i o u , V. mascc-0337 Thomas, S. mascc-0028 Tsao, M. mascc-0410 Va s s i l i o u , V. mascc-0467 Thompson, M. mascc-0240 Tsao, M. mascc-0455 Vassos, D. mascc-0283 Thong, M. mascc-0048 Tsao, M. mascc-0473 VeraLúciaLinsdeMorais, V.L.L.M. mascc-0553 Tiberi, M. mascc-0196 Tsao, M. mascc-0472 Verdonck-deLeeuw, I.M. mascc-0513 Tilak, T. mascc-0564 Tsao, M. mascc-0481 Verdonck-deLeeuw, I.M. mascc-0406 Timilshina, N. mascc-0559 Tsao, M. mascc-0464 Verdonck-deLeeuw, I.M. mascc-0397 Tissing, W.E. mascc-0175 Tseng, L. mascc-0467 Verdonck-deLeeuw, I.M. mascc-0510 Tissing, W.J. mascc-0185 Tseng, L.M. mascc-0337 Verdonck-deLeeuw, I.M. mascc-0514 Tissing, W.J.E. mascc-0492 Tsimafeyeu, I. mascc-0073 Verdonck-deLeeuw, I.M. mascc-0393 Tissing, W.J.E. mascc-0174 Tsimicalis, A. mascc-0533 Verma, S. mascc-0307 Tjulandin, S. mascc-0073 Tsimpoukis, S. mascc-0166 Vicente, M.A. mascc-0597 Tkaczuk, K. mascc-0498 Tsitsi, T. mascc-0067 Victoria, S. mascc-0273 Toftdal-SørensenOle, O.T.S. mascc-0015 Tsovou, Z. mascc-0566 Vidal, M. mascc-0536 Toh, M.R. mascc-0140 Tsubota, M. mascc-0347 Vieillard, M. mascc-0565 Tokunaga, S. mascc-0347 Tsuji, T. mascc-0378 Vigano, A. mascc-0557 Tomlinson, G. mascc-0559 Tsurutani, J. mascc-0347 Vigano, A. mascc-0535 Toneti, B.F. mascc-0256 Tsyp, N. mascc-0145 Vigano, A. mascc-0534 Toneti, B.F. mascc-0257 Tual, V. mascc-0420 Vimalathithan, V. mascc-0107 Toneti, B.F. mascc-0275 Tuca, A. mascc-0575 Vincenzi, B. mascc-0195 Tonini, G. mascc-0195 Vinod, R. mascc-0085 Tuca, A. mascc-0502 Torniai, M. mascc-0196 Virella, D. mascc-0119 Tuke, S. mascc-0339 Tornoe, K.A. mascc-0218 Virizuela, J. mascc-0549 Toro, J.J. mascc-0289 Turcotte, A. mascc-0176 Vissink, A. mascc-0135 TorresPérez-Solero, G. mascc-0504 Turner, M. mascc-0367 Vitetta, L. mascc-0037 Torres-Vigil, I. mascc-0606 Twardowski, P.mascc-0542 Vlahovic, G. mascc-0215 Touati, N. mascc-0183 Tzaninis, D. mascc-0517 Vol, H. mascc-0459 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S19

Volk, R. mascc-0460 White, I. mascc-0186 Wong, W.mascc-0414 Volovat, C. mascc-0544 White, L. mascc-0156 Wong, W.H. mascc-0242 Volovat, C. mascc-0530 Whitford, H. mascc-0198 Wongsa, O. mascc-0084 vonBultzingslowen, I. mascc-0599 Whittaker, A.L. mascc-0234 Woo, I.S. mascc-0171 VonHoff, D. mascc-0463 Wierick, E. mascc-0357 Woodman, R.J. mascc-0152 Vorobyova, L. mascc-0145 Wignall, A. mascc-0098 Woodring, S. mascc-0215 Vriens, J. mascc-0060 Wignall, A. mascc-0186 Wootten, A. mascc-0319 Vriens, J. mascc-0129 Williams,J.mascc-0389 Workentin, K. mascc-0436 Vruwink, J. mascc-0427 Williams,J.mascc-0282 Workentin, K. mascc-0439 Vulpe, H. mascc-0447 Williams,J.mascc-0279 Wouters, M.W.J.M. mascc-0138 Vvedenskaia, E. mascc-0297 Williams, J.L. mascc-0236 Wozniak, B. mascc-0098 Williams, L. mascc-0216 Wozniak, B. mascc-0186 W Williams, P.M. mascc-0599 Wu, J. mascc-0270 Wade, J.L. mascc-0445 Williams, S. mascc-0319 Wu, J. mascc-0284 Waghorn, M. mascc-0060 Williamson, C. mascc-0335 Wu, Q.S. mascc-0388 Waghorn, M. mascc-0129 Winn, S. mascc-0613 Wu, W.Y. mascc-0350 Waghorn, M. mascc-0068 Wirth, A. mascc-0087 Wu, X. mascc-0277 Wakasugi, T. mascc-0012 Wirth, A. mascc-0086 WU, X. mascc-0276 Wakeda, T. mascc-0554 Wisniewski, M. mascc-0299 WU, X.W. mascc-0268 Wakefield, C.E. mascc-0370 Witte, B.I. mascc-0513 Wu, Y.L. mascc-0432 Wakefield, C.E. mascc-0369 Witte, B.I. mascc-0510 Walker,P.mascc-0618 Witte, B.I. mascc-0514 X Wallner, M. mascc-0224 Wittman, T. mascc-0109 xiangyuan, W.U. mascc-0178 Wallner, M. mascc-0295 Wollank, C. mascc-0298 xiaokun, M. mascc-0178 Walsh, D. mascc-0114 Wong, C.S. mascc-0567 Xu, H. mascc-0478 Walsh, D. mascc-0027 Wong, D. mascc-0437 Xu, H. mascc-0479 Walsh, D. mascc-0267 Wong, D. mascc-0438 Xu, H. mascc-0471 Walsh, D. mascc-0115 Wong, E mascc-0147 Xu, H. mascc-0476 Walsh, D. mascc-0029 Wong, E. mascc-0153 Xu, L. mascc-0478 Walsh, D. mascc-0028 Wong, E. mascc-0447 Xu, L. mascc-0479 Walton, S. mascc-0431 Wong, E. mascc-0541 Xu, L. mascc-0471 Wan, R.W.M. mascc-0069 Wong, E. mascc-0435 Xu, L. mascc-0476 Wan-Chow-Wah, D. mascc-0180 Wong, E. mascc-0327 XY, L.I. mascc-0178 Wang, J.B. mascc-0255 Wong, E. mascc-0446 Wang, K. mascc-0127 Wong, E. mascc-0468 Y Wa n g , Y. mascc-0484 Wong, E. mascc-0132 Yadav, P.mascc-0522 Wanger, T. mascc-0007 Wong, E. mascc-0342 Yadav, P.mascc-0521 Wangnum, K. mascc-0084 Wong, E. mascc-0338 Yadav, S.P.mascc-0458 Warde, P.mascc-0483 Wong, E. mascc-0322 Ya h a g i , Y. mascc-0170 Wardill, H.R. mascc-0302 Wong, E. mascc-0414 Yamaguchi, M. mascc-0347 Warr, D. mascc-0307 Wong, E. mascc-0422 Yamanaka, T. mascc-0264 Warr, D.G. mascc-0448 Wong, E. mascc-0434 Yamauchi, S. mascc-0012 Wartlick, F. mascc-0167 Wong, E. mascc-0423 Yamazaki, S. mascc-0572 Watson, A. mascc-0610 Wong, E. mascc-0441 Yanagisawa, T. mascc-0347 Wazneh, L. mascc-0533 Wong, E. mascc-0411 Yang, H.S. mascc-0350 Weaver, E. mascc-0098 Wong, E. mascc-0465 Yang, J.C.H. mascc-0432 Webber, K. mascc-0129 Wong, E. mascc-0531 Yang, S. mascc-0202 Weikel, D. mascc-0443 Wong, E. mascc-0467 Yano, S. mascc-0170 Wells, N. mascc-0558 Wong, E. mascc-0452 Yao, K.G. mascc-0350 Wells, N. mascc-0602 Wong, E. mascc-0455 Yap, K. mascc-0052 Wells, N. mascc-0105 Wong, E. mascc-0473 Yap, K. mascc-0039 Weluchio, B. mascc-0380 Wong, E. mascc-0472 Yap, K. mascc-0040 Wen, S. mascc-0078 Wong, E. mascc-0481 Ya p , K . Y. mascc-0051 Wentlandt, K. mascc-0436 Wong, E. mascc-0184 Ya p , Y.S. mascc-0194 Wentlandt, K. mascc-0439 Wong, E. mascc-0464 Ya p , Y.S. mascc-0139 Were, A.P.mascc-0380 Wong, E. mascc-0449 Yates, P.mascc-0349 Were, P. mascc-0415 Wong, E. mascc-0191 Yavas, C. mascc-0372 Werengowska-Ciecwierz, K. mascc-0299 Wong, E. mascc-0231 Yavas, G. mascc-0372 Weru, J. mascc-0047 Wong, E.M.L. mascc-0232 Yavuzsen, T. mascc-0331 West, D. mascc-0113 Wong, K. mascc-0541 Yazicioglu, O. mascc-0592 Wettlin, J. mascc-0474 Wong, M. mascc-0194 Yeh, L. mascc-0020 Wettlin, J. mascc-0475 Wong, M. mascc-0200 Yellowlees, A. mascc-0437 Wheeler, G. mascc-0087 Wong, M. mascc-0139 Yennu, S. mascc-0426 Wheeler, G. mascc-0086 Wong, P. mascc-0585 Yennu, S. mascc-0284 White, A. mascc-0319 Wong, S. mascc-0317 Yennurajalingam, S. mascc-0270 White, I. mascc-0339 Wong, S. mascc-0177 Yeung, S. mascc-0536 S20 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Ye u n g , Y. mascc-0582 Z Zhang, L. mascc-0337 Yim, Y.M. mascc-0233 Zakaria, K. mascc-0528 Zhang, L. mascc-0411 Yip, C. mascc-0448 Zakaria, K. mascc-0561 Zhang, L. mascc-0465 Yip, C. mascc-0117 Zaki, N. mascc-0125 Zhang, L. mascc-0531 Yip, C. mascc-0121 Zakin, L. mascc-0148 Zhang, L. mascc-0467 Zakin, L. mascc-0150 Zhang, L. mascc-0410 Yip, C. mascc-0404 Zalpour, A. mascc-0271 Zhang, L. mascc-0455 Yip, C. mascc-0402 Zambrano, S. mascc-0025 Zhang, L. mascc-0473 Yip, C. mascc-0465 Zandonai, A.P.mascc-0587 Zhang, L. mascc-0472 Yokoyama, R. mascc-0163 Zatarain, L. mascc-0221 Zhang, L. mascc-0481 Yonemoto, N. mascc-0130 Zazulina, V. mascc-0432 Zhang, L. mascc-0464 Yong, C. mascc-0498 Zegarski, W.mascc-0306 Zhang, X. mascc-0268 Yong, W.S. mascc-0194 Zelunka, E. mascc-0459 Zheng, R.Z. mascc-0524 Yong, W.S. mascc-0200 Zeng, L. mascc-0567 Zhong, W.mascc-0149 Yong, W.S. mascc-0139 Zeng, L. mascc-0447 Zhou, K. mascc-0340 Yool, A.J. mascc-0237 Zeng, L. mascc-0541 Zhou, W.mascc-0433 Yoon, D. mascc-0624 Zeng, L. mascc-0342 Zidan, A.M.A.L. mascc-0287 Yoon, D. mascc-0390 Zeng, L. mascc-0322 Zimmermann, C. mascc-0421 Yo o n , S . Y. mascc-0401 Zeng, L. mascc-0545 Zimmermann, C. mascc-0290 Yoshida, E. mascc-0572 Zerilli, F. mascc-0083 Zimmermann, C. mascc-0436 Yoshidome, K. mascc-0347 Zhang, D.R. mascc-0518 Zimmermann, C. mascc-0439 Yu, B.W.L. mascc-0069 Zhang, L. mascc-0192 Zimmermann, C. mascc-0288 Yu , S . Y. mascc-0388 Zhang, L. mascc-0448 Zingerman, B.V. mascc-0590 Yuen, D. mascc-0421 Zhang, L. mascc-0317 Zontanos, M. mascc-0280 Yuki, S. mascc-0163 Zhang, L. mascc-0177 Zuberi, M. mascc-0521 Yun, H.J. mascc-0401 Zhang, L. mascc-0541 Zuercher, S. mascc-0077 Yun, L. mascc-0483 Zhang, L. mascc-0435 Zvirbule, Z. mascc-0573 Yurikusa, T. mascc-0223 Zhang, L. mascc-0446 Zwaan, C.M. mascc-0286 Yusoff, Z. mascc-0014 Zhang, L. mascc-0468 Zwaan, C.M. mascc-0185 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S21

MASCC-0014 induce renal anemia, is also highly prevalent in solid-tumour pa- Anemia tients. 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 ANEMIA AND THROMBOCYTOPENIA IN SOLID CANCER prevalence. PAT I E N T S Methods B. Hassan1, Z. Yusoff1,M.Hassali2, S. Othman1 Anemia was defined as Hb <10 g/dL. Patients were classified according 1clinical pharmacy, Universiti Sains Malaysia, pinang, Malaysia; to the ESMO definition. CKD was defined according to the KDIGO and 2Discipline of Social and Administrative Pharmacy, Universiti the glomerular filtration rate estimated with the MDRD formula, as Sains Malaysia, pinang, Malaysia recommended. Results Background and Aims 10’753 patients were included in total. Mean/median age was 58.8/ Introduction: Anemia and thrombocytopenia are two of the major det- 59.0 years. Female: 63.9 %. Main cancers were breast (4’123), rimental side effects of the malignant disease itself and/or the chemother- colorectal (1’520), lung (1’013), ovarian (649), and prostate (525). apy, leading to impairment of function in all tissues and organs of cancer 12.2 % of the patients had a Hb<10 g/dL and 11.6 % had CKD patients and associated with serious stress and both have a great negative (MDRD<60). The mean Hb was slightly but significantly lower in effect on cancer patients quality of life (QOL). CKD patients: 11.5 vs 12.0 g/dL, p=0.0001) and the prevalence of Objectives: This present study works on to evaluate the effectiveness of Hb<10 was nearly twice and significantly higher in CKD patients: treatment guidelines used for anemia and thrombocytopenia and to de- 21.3 % vs 11.1 %, p=0.0001. termine the association between anemia and thrombocytopenia onset and severity with different chemotherapeutics regimens and doses used in the treatment of several solid cancers. Prevalence MDRD≥60 MDRD<60 Methods: This is a retrospective observational study was conducted on 10≤Hb<12 36.4 % 34.8 % 875 solid cancer patients who were admitted to a government (Penang 8≤Hb<10 9.8 % 17.6 % Hospital/Malaysia) in the period between 2003 and 2009. Results Hb<8 1.3 % 3.7 % Effectiveness of standard anemia and thrombocytopenia treatment guidelines were not sufficient because correction of anemia and Conclusions thrombocytopenia was just temporary. Moreover, FEC, 5-FU+5- The prevalence of anemia in our patients was higher in cancer patients FU, FOLFOX, Docetaxel and Cisplatin+ 5-FU regimens have strong with CKD, suggesting that renal anemia may be present in addition to association and correlation with both anemia and thrombocytopenia other cancer-related causes. This observation is of importance since, onset and severity. However the associations and correlations with although the treatments are the same (IV iron and erythropoiesis- both anemia and thrombocytopenia severity were stronger than stimulating agents), the doses and schedules may vary between CIA those with the onset. Different doses of 5-FU, cyclophosphamide, and renal anemia. docetaxel and cisplatin play a critical role in anemia and thrombo- cytopenia onset and severity. Conclusion: Monitoring and determination of hemoglobin and platelets levels for cancer patients who will treat with FEC, 5-FU+5-FU, MASCC-0476 FOLFOX, Docetaxel, Cisplatin+5-FU specifically with high doses must Anemia be emphasized and focused. Moreover, thrombocytopenia and erythro- poietin must be used as a cornerstone treatment. TREATMENT PATTERNS FOR ANEMIA AMONG BREAST CANCER PATIENTS TREATED WITH CHEMOTHERAPY IN 2000–2013 MASCC-0581 H. Xu1,L.Xu2, J.H. Page1, K. Cannavale3,R.Rodriguez4, C. Chao3 1 Anemia Center for Observational Research, Amgen Inc, Los Angeles, USA; 2Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 3Department of research PREVALENCE OFANEMIA AND CHRONIC KIDNEY DISEASE and evaluation, Kaiser Permanente Southern California, Los (CKD) IN CANCER PATIENTS, AND POTENTIAL Angeles, USA; 4Department of Hematology Oncology, Kaiser INTER-RELATIONSHIPS Permanente Southern California, Los Angeles, USA 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. Background and Aims Rey7, C. Jouannaud8, J.F.Morere9,S.Oudard10,G.Deray11 ,F.Scotté10 It is unclear how management of chemotherapy induced anemia 1Service ICAR, GH Pitié-Salpêtrière, Paris, France; 2Medical Oncology, Centre (CIA) has evolved over time given the changes in the US prescrib- Léon Bérard, Lyon, France; 3Medical Oncology, Institut Curie, Paris, France; ing information, reimbursements, and the implementation of a risk 4Medical Oncology, Hôpital Tenon, Paris, France; 5Medical Oncology, Hôpital evaluation and mitigation strategy (REMS) for the use of Cochin, Paris, France; 6Medical Oncology, GH Pitié-Salpêtrière, Paris, erythropoiesis-stimulating agents (ESAs). We therefore conducted France; 7Clinical Pharmacy, Institut Jean Godinot, Reims, France; 8Medical this study to describe treatment trends and current treatment patterns Oncology, Institut Jean Godinot, Reims, France; 9Medical Oncology, Hôpital for CIA in 2000–2013. Avicenne, Bobigny, France; 10Medical Oncology, Hôpital Européen Georges Methods Pompidou, Paris, France; 11 Nephrology, GH Pitié-Salpêtrière, Paris, France Incident breast cancer patients (n=3374) who developed grade II-IV CIA (hemoglobin (Hb) <10 g/dL) were identified from Kaiser Background and Aims Permanente Southern California Health Plan. We estimated the pro- Anemia in cancer patients is often, if not only, considered as portions of anemia episodes with ESA use and red blood cell (RBC) chemotherapy-induced anemia (CIA). However, CKD which may transfusion and the hemoglobin concentrations within 7 days prior S22 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 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 trans- fusion 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 1Center for Observational Research, Amgen Inc, Los Angeles, USA; 2Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 3Department of Hematolo- gy Oncology, Kaiser Permanente Southern California, Los Angeles, Figure 1. Incidence proportion of chemotherapy induced anemia by USA chemotherapy regimen and cycle Conclusions The risk of CIA (Hb <10 g/dL) is high in breast cancer patients. Careful Background and Aims attention to anemia management is needed when planning chemotherapy. Chemotherapy induced anemia (CIA) is a common chemotherapy complication that can cause clinically important symptoms, lead- ing to reduced quality of life. Yet, little data exist on the burden MASCC-0479 of CIA in current oncology practice. We estimated the incidence Anemia and severity of CIA in breast cancer patients receiving chemotherapy. TREATMENT PATTERNS FOR ANEMIA AMONG PATIENTS Methods WITH NON-HODGKIN LYMPHOMA (NHL) TREATED WITH Incident breast cancer patients who received chemotherapy were CHEMOTHERAPY IN 2000–2013 identified from Kaiser Permanente Southern California Health Plan (2010–2012). Patients who had anemia before chemotherapy C. Chao1,L.Xu1,J.H.Page2,K.CannavaleCA1, R. Rodriguez3,H.Xu2 (i.e., diagnosis of inherited anemia or hemoglobin measurement 1Department of research and evaluation, Kaiser Permanente Southern <10 g/dl within 3 months of chemotherapy) were excluded. All California, Los Angeles, USA; 2Center for Observational Research, clinical data were collected from health plan’s electronic medical Amgen Inc, Los Angeles, USA; 3Department of Hematology Oncology, records. Incidence proportions of patients developing CIA were Kaiser Permanente Southern California, Los Angeles, USA calculated for overall and by CIA severity and morphological type, as well as by stage at cancer diagnosis, chemotherapy Background and Aims regimen and cycle. It is unclear how management of chemotherapy induced anemia (CIA) has Results evolved over time given the changes in the US prescribing information, Of 2,374 breast patients included, 2,048 (86 %) patients developed reimbursements, and implementation of a risk evaluation and mitigation strategy anemia during the course of chemotherapy (61 % grade I, 33 % (REMS) for the use of erythropoiesis-stimulating agents (ESAs). We described grade II, 5 % grade III and <1 % grade IV, normocytic 89 %, treatment trends and current treatment patterns for CIA in 2000 to 2013. macrocytic 7 %, microcytic 4 %). The risk of grade II–IV CIA Methods (Hb <10 g/dL) increased from 33 % in stage 1 to 52 % in stage 4 Incident NHL patients (pts) who developed grade II–IV CIA (hemoglobin. breast cancer. CIA incidence proportion increased over cycles, and Results declined after cycle 5 or 6 for the most common regimens (TC, The observed anemia episodes were 313 (213 pts) in P1, 144 (102 pts) in AC->T, and TCH). (Figure 1) P2, and 140 (106 pts) in P3. Proportion of anemia episodes with ESA use Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S23 decreased from 2006 to 2013 (P1: 34 %; P2: 22 %; and P3: 6 %). elaboration of a score-card to evaluate oncological services; 4) Communica- Increased trend of transfusion use was observed (P1:12 %; P2: 22 %; tion and; 5) Identification of guidelines to implement integral care. and P3:27 %), with the most evident changes observed in grade IV (Hb). Conclusions Conclusions Nevertheless a national health policy aligned with a national research Our study indicates that along with the decreased utilization of ESA, policy for cancer must be implemented trying to follow the scheme (figure utilization of RBC transfusion has increased significantly over time. 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 TANSHINONE IIA COULD INHIBIT HUMAN GASTRIC CARCINOMA AGS CELLS THROUGH DECREASING BCL-XL, C. Chao1,L.Xu1,K.Cannavale1, J.H. Page2, R. Rodriguez1,H.Xu2 TCPC AND MCL-1 BUT INCREASING BAX EXPRESSIONS 1Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, USA; 2Center for Observational Research, C. Su1 Amgen Inc, Los Angeles, USA 1Surgery, Changhua Christian Hospital, Changhua, Taiwan

Background and Aims Background and Aims Chemotherapy induced anemia (CIA) is a common chemotherapy com- Tanshinone IIA (Tan-IIA; C19H18O3), a phenanthrenequinone derivative plication that can cause clinically important symptoms, leading to re- extracted from Danshen, Salviae Miltiorrhizae Radix, possesses anti-tumor duced quality of life. Changes in the US prescription information have led activity in many cancer cells. It was well documented that Tan-IIA exerted to decreased utilization of erythropoiesis-stimulating agents. Yet, little powerful inhibitory effects in gastric cancer cells SGC7901 with time- and data exist on the burden of CIA in current oncology practice. Wetherefore dose-dependent. These reports suggest that Tanshinone IIA may serve as an conducted this study to estimate the incidence and severity of CIA among effective adjunctive reagent in the treatment of gastric cancer. However, the non-Hodgkin lymphoma (NHL) patients . molecular mechanisms that cause Tan-IIA to induce apoptosis in gastric Methods cancer have not been clarified. In our previous studies showed that Tan-IIA Incident NHL cases who received chemotherapy were identified from can inhibit the growth of pancreatic cancer BxPC 3 cells by decreasing Kaiser Permanente Southern California Health Plan (2010–2012). Pa- protein expression of TCTP, MCL 1 and Bcl xL. In the present study, we tients who had anemia before chemotherapy (i.e., inherited anemia or investigated the effects of Tan-IIA in human gastric cancer AGS cells. hemoglobin measurement. Methods Conclusions In the present study we evaluated the cytotoxicity of Tan-IIA in human Absence of VEGF within the gastric carcinoma tissue despite its high-level gastric carcinoma AGS cells by MTT assay. The protein expression of expression can suggest that either VEGF protein is somehow quickly TCTP,MCL 1 and Bcl xL, TNF-α, Caspase-8, Caspase-3, Bax and beta- eliminated into the blood stream, or other pathomechanisms are involved. actin in AGS cells was measured by Western blotting. The protein Lack of VEGF protein in gastric cancer tissue and high plasma concentra- expression of Caspase-3 was detected by immunocytochemical (I.C.C) tions of that protein presumes the VEGF transfer from cancer tissue to blood. 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, MASCC-0074 Caspase-8, Caspae-3 and Bax were increased, but Bcl-xl, TCPC and Mcl- Basic Research 1 were decreased in AGS cells were treated with Tan-IIA. Conclusions CANCER IN BRAZIL: POLICIES AND DATA These finding indicate that Tan-IIA can inhibit the proliferation of AGS 1 cells through inducing apoptosis in vitro. The chemotherapeutic potential R. Santos-Oliveira of Tan-IIA for human gastric cancer warrants further study. 1Faculty of Pharmacy, Zona Oeste Estadual University, Rio de Janeiro, Brazil MASCC-0521 Background and Aims Basic Research 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, EPIGENETIC SIGNATURES OF RASSF1 AND PTEN GENES AS as a plague, the number just increase each day. In this study we discussed the POTENTIAL CANDIDATES FOR TARGETING EPITHELIAL Brazilian policy for cancer. Also, we gave some data about cancer in Brazil. OVARIAN CANCER Methods A review of the literature using some criteria of Systematic Review was M. Zuberi1, I. Ahmad1,A.Mir1,J.Javid1,P. Yadav1,M.Masroor1,G. conducted. The legislation of Brazil related to Cancer was systematically Gandhi1,P.C. Ray1,A.Saxena1 studied and summarized. 1Biochemistry, Maulana Azad Medical College and LN Hospital, Delhi, India Results To achieve good resultshas been proposed five points to control cancer: 1) Background and Aims Partnership integration: development of a portal dedicated to integral care; 2) Ovarian cancer is a fatal gynaecological cancer and a major cause of Diagnosis quality: elaboration of guidelines to help diagnosis; 3) Care quality: cancer-related mortality worldwide. Tumour suppressor genes (TSGs) are S24 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 wild-type alleles of genes which play primary regulatory roles in diverse MASCC-0383 cellular activities, and whose loss of function contributes to the develop- Bone Health ment of cancer. The present study aimed to investigate the methylation status in promoter SAFETY OF HOME SETTING ADMINISTRATION region of RASSF1 gene and differential DNA methylation pattern of OF ZOLEDRONATE IN CANCER PATIENTS PTEN gene in Epithelial ovarian cancer patients in North India. Methods M. di Palma1,M.Lacaze1 Fifty patients and 20 healthy controls were recruited in the study.Isolation 1ambulatory department, Institute Gustave Roussy, villejuif, France of genomic DNA from peripheral blood and methylation -specific PCR (MSP) were applied. Background and Aims Results Zoledronate is an IV bisphosphonate, indicated for the prevention of Seventeen out of 50 patients (34.0 %) were found to be methylated for skeletal related events in cancer patients with bone metastases. RASSF1 gene, while methylation of the PTEN gene occurred in 8 of 50 Initially used in day hospital, zoledronate was authorized in France cases (16.0 %). A statistically significant result was obtained (p=0.01) for in home care. At this time some cases of renal insufficiency were RASSF1 gene that correlated with the patients clinico pathological fea- reported, because home care health professionals were not used to tures. However, no association could be established with the PTEN gene it. Therefore we decided to implement a specific protocol for these and the patients’ clinical history. patients. Conclusions Methods Hypermethylation of RASSF1 gene in blood DNA from ovarian cancer Patients who had to receive zoledronate at home were seen in con- patients might offer an exposition for early diagnosis of the malignancy. sultation by a nurse of the Coordination for Home Care. This is a This study might be extrapolated further for possible epigenetic therapies service in our institution aimed to organize complex home treatments targeting epigenetically dysregulated genes in ovarian cancer. A better in collaboration with home care professionals (ie chemotherapy). understanding of the epigenetic changes in ovarian cancer will contribute Each patient had the day before zoledronate perfusion a blood test to the improvement of patient outcomes. (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 MASCC-0291 (mean 61); 71 % had significant pain, mean delay between diagno- Bone Health sis of bone metastases and zoledronate initiation was 12 months. Patients received 1 to 64 injections (mean 26); in 90 % of patients EFFICACY OF ZOLEDRONIC ACID FOR ALGERIAN initial dose was 4 mg, 12 % required further dose reduction. Jaw PATIENTS WITH BONE METASTASES FROM BREAST bone necrosis occurred in 4 patients, after 11, 17, 26 and 43 cycles. CANCER 2 patients experienced grade 2 renal toxicity, one related to chemo- therapy, the other possibly to zoledronate. K. Berkane1,R.F. R. Feghir1,S.A.S.Aziez1, A.L. A. Ladjroud1,S.S.S. Conclusions Sami1, K.B. K. Bouzid1 Home based use of zoledronate is safe. As the knowledge of this 1Medical Oncology, Pierre & Mary Curie Center,Algiers, Algeria drug by home care health professionals has increased, this protocol is restricted to patients at higher risk of toxicity (age over 75, renal Background and Aims impairment). 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 MASCC-0557 of renal toxicity, pain control and health quality of life on Algerian Bone Health patients with bone metastases from breast cancer. Methods THE RELATIONSHIPS BETWEEN BONE MINERAL DENSITY One hundred sixty-two Patients>18 years of age with radiological evi- AND CLINICAL CORRELATES OF CANCER CACHEXIA dence of bone metastases stratified according to positive estrogen recep- tor (ER) progesterone receptor (PR), HER2 status were included and who J. di Tomasso1,L.Ciutto2, L. Rosenthall3, R.D. Kilgour4, J.A. Morais5,M. assigned for zoledronic acid (4 mg every 4 weeks via 15 min intravenous Borod6, A. Vigano7 infusion). 1Clinical Nutrition, McGill University Health Centre, montreal, Canada; Results 2Clinical Nutrition, Centre Hospitalier Universitaire Vaudois, Lausanne, Results were expressed as median values and correlation of pathologic Switzerland; 3Radiology, McGill University Health Centre, Montreal, parameters were performed using analysis of variants. Any p value<0,05 Canada; 4Concordia University Exercise Science, McGill Nutrition and was considered significant. Patients are ranged in age 18 to 79 years. The Performance Laboratory, Montreal, Canada; 5Geriatric Medicine Mc- most frequently involved area was the spine followed by ribs end pelvic Gill University Health Centre, McGill Nutrition and Performance Labo- bone. Significant correlation between location of bone pain and evidence ratory, Montreal, Canada; 6Palliative and Supportive Care, McGill Uni- metastases was observed . We evaluate the effects of zoledronic acid on versity Health Centre, Montreal, Canada; 7Palliative and Supportive renal function (creatininemia, serum ions fluctuations including hypocal- Care McGill University Health Centre, McGill Nutrition and Perfor- cemia). Significant clinically relevant analgesic effect of treatment reduce mance Laboratory, Montreal, Canada bone pain in 72 % patients. Conclusions Background and Aims This study confirm the high quality of life and safety of zoledronic acid in Introduction: Autoimmune, digestive, and gastrointestinal disorders algerian women with bone metastases receiving zoledronic acid. with elevated inflammatory responses are associated with Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S25 osteoporosis. To date, no human studies have documented the rela- MASCC-0535 tionships between bone mineral density (BMD) and biomarkers of Bone Health cancer cachexia. Objectives: Todetermine if BMD is associated with clinical correlates of RELATIONSHIPS BETWEEN BONE MINERAL DENSITYAND cachexia in advanced cancer patients. CLINICAL CORRELATES OF CANCER CACHEXIA Methods: Whole body BMD and total fat mass were measured using dual energy x-ray absorptiometry (DXA). Appendicular J. di Tomasso1,L.Ciutto2, L. Rosenthall3, R.D. Kilgour4, J.A. Morais5,M. skeletal muscle index (ASMI) was calculated according to Kilgour Borod6, A. Vigano7 et al. (2010). Handgrip strength (HGS) was measured by 1Clinical Nutrition, McGill University Health Centre, Montreal, Canada; dynamometry. 2Centre Hospitalier Universitaire Vaudois, McGill Nutrition and Perfor- Results: One hundred and twenty five patients with advanced can- mance Laboratory, Lausanne, Switzerland; 3Radiology, McGill Univer- cer, mostly with gastrointestinal and pulmonary tumors were includ- sity Health Centre, Montreal, Canada; 4Concordia University Exercise ed in the analysis (Table 1). Significant correlations (Spearman’s Science, McGill Nutrition and Performance Laboratory, Montreal, p<0.05) were found between BMD and CRP, ASMI, total fat mass Canada; 5Geriatric Medicine McGill University Health Centre, McGill and HGS (Table 2). Nutrition and Performance Laboratory, Montreal, Canada; 6Palliative and Supportive Care, McGill University Health Centre, Montreal, Canada; 7Palliative and Supportive Care McGill University Health Cen- tre, McGill Nutrition and Performance Laboratory, Montreal, Canada Table 1. Demographic information Introduction Autoimmune, digestive, and gastrointestinal disorders with elevated in- N=125 Mean ± SD flammatory responses are associated with osteoporosis. To date, no hu- Age (years) 62.4±12.2 man studies have documented the relationships between bone mineral BMI (kg/m2) 23.5±5.2 density (BMD) and biomarkers of cancer cachexia. n%Objectives To determine if BMD is associated with clinical correlates of cachexia in Gender Males 75 60 advanced cancer patients. Females 50 40 Methods Diagnosis GI 85 68 Whole body BMD and total fat mass were measured using dual energy x- ray absorptiometry (DXA). Appendicular skeletal muscle index (ASMI) NSCLC 24 19 was calculated according to Kilgour et al. (2010). Handgrip strength Others 16 13 (HGS) was measured by dynamometry. CCS NC 31 25 Results PC 33 26 One hundred and twenty five patients with advanced cancer, mostly with gastrointestinal and pulmonary tumors were included in the analysis C4738 (Table 1). Significant correlations (Spearman’s p<0.05) were found be- RC 14 11 tween BMD and CRP,ASMI, total fat mass and HGS (Table 2).

GI gastrointestinal; NSCLC non-smaill cell lung cancer; CCS cancer cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; Table 1. Demographic information C cachectic patients; RC refractory cachectic patients; BMI body mass index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; N=125 Mean ± SD HGS hand grip strength Age (years) 62.4±12.2 BMI (kg/m2) 23.5±5.2 n% Table 2. Correlations with bone mineral density Gender Males 75 60 Females 50 40 Diagnosis GI 85 68 p value Spearman NSCLC 24 19 CRP 0.038 0.204 Others 16 13 ASMI 0.004 0.253 CCS NC 31 25 Fat mass 0.001 0.387 PC 33 26 HGS 0.001 0.551 C4738 BMI body mass index; CRP C-reactive protein; ASMI appendicular RC 14 11 skeletal muscle index; HGS hand grip strength GI gastrointestinal; NSCLC non-small cell lung cancer; CCS cancer Conclusions cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; Decreased BMD is associated with clinical correlates of cancer cachexia. C cachectic patients; RC refractory cachectic patients; BMI body mass Effective anti-cancer-cachexia therapies may help maintain BMD and index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; reduce complications of osteoporosis. HGS hand grip strength S26 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Table 2. Correlations with bone mineral density Benefit of Denosumab Versus ZA on Time to First On-study SRE

p value Spearman Baseline characteristic HR (95 % CI) P-value CRP 0.038 0.204 Axial bone metastases (n=1,422) 0.83 (0.70,1.00) 0.046 ASMI 0.004 0.253 Appendicular bone metastases (n=753) 0.78 (0.61,0.99) 0.042 Fat mass 0.001 0.387 Axial & appendicular bone metastases 0.83 (0.71,0.97) 0.022 HGS 0.001 0.551 (n=1,695) ≥2bonemetastases(n=2,234) 0.81 (0.71,0.93) 0.003 BMI body mass index; CRP C-reactive protein; ASMI appendicular <2 bone metastases (n=3,489) 0.84 (0.74,0.94) 0.003 skeletal muscle index; HGS hand grip strength Visceral metastases (n=2,341) 0.80 (0.69,0.93) 0.003 No visceral metastases (n=3,382) 0.84 (0.75,0.94) 0.002 Conclusions uNTx ≥43.5 nmol/mmol (n=2,553) 0.86 (0.76,0.98) 0.028 Decreased BMD is associated with clinical correlates of cancer cachexia. uNTx <43.5 nmol/mmol (n=2,553) 0.75 (0.65,0.86) <0.001 Effective anti-cachectic therapies may help maintain BMD and reduce complications of osteoporosis. Effective anti-cachectic treatments, which can also improve BMD, could Conclusions: Denosumab significantly delayed SREs versus ZA regard- potentially reduce the risk of complications secondary to osteoporosis in less of patients’ baseline characteristics. advanced cancer patients.

MASCC-0219 Bone Health MASCC-0340 Bone Health MARKERS OFANGIOGENESIS AND INFLAMMATION IN PATIENTS WITH SOLID TUMORS RECEIVING TARGETED BENEFIT OF DENOSUMAB VERSUS ZOLEDRONIC ACID THERAPYAND/OR ZOLEDRONIC ACID FOR PREVENTION OF SKELETAL-RELATED EVENTS D. Galiti1, E. Papadopoulou2, O. Nicolatou-Galitis2, I. Papasotiriou3,E. IN SUBGROUPS OF PATIENTS WITH METASTATIC BONE Linardou4, D. Bafaloukos4 DISEASE 1Oral Diagnosis, University of Athens, Athens, Greece; 2Hospital Den- A. Lipton1, K. Fizazi2,A.Stopeck3, D.H. Henry4,M.R.Smith5,N.Shore6, tistry, University of Athens, Athens, Greece; 3Biochemistry Department, M. Martin7, S. Vadhan-Raj8,K.Zhou9, A. Balakumaran9,A.Braun9 ‘Paidon-Agia Sofia’ Hospital, Athens, Greece; 41st Oncology Depart- 1Milton S. Hershey Medical Center, Pennsylvania State University, ment, ‘Metropolitan’ Hospital, Athens, Greece Hershey, USA; 2Institut Gustave Roussy, University of Paris Sud, Villejuif, France; 3Arizona Cancer Center, University of Arizona, Tucson, USA; Background and Aims 4Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, Introduction: Antiangiogenesis inhibition and inflammation through targets, USA; 5, Massachusetts General Hospital Cancer Center, Boston, USA; such as VEGF and IL-17 is thought to be associated with jaw osteonecrosis. 6, Carolina Urologic Research Center, Myrtle Beach, USA; 7, Hospital Objectives: We evaluate VEGF and IL-17 in serum and crevicular fluid Universitario San Carlos, Madrid, Spain; 8, The University of Texas MD in patients, who received targeted therapies and/or zoledronic acid. Anderson Cancer Center,Houston, USA; 9, Amgen Inc., Thousand Oaks, Methods: Twenty-five solid cancer patients were studied. Fifteen re- USA ceived bevacizumab alone (9) or combined with zoledronic acid (6) or temsirolimus (1). Ten patients received zoledronic acid alone (9) or Background and Aims: There is an interest in identifying patients combined with everolimus (1). VEGF and IL-17 were investigated in who may benefit most from receiving bone-targeted agents (BTAs). the baseline examination and 6 months later.Serum was collected from 21 Previous analyses showed denosumab was superior to zoledronic patients and crevicular fluid from 23 in the first point and from 6 patients acid (ZA) for preventing SREs (pathologic fracture, radiation or (serum) and 5 patients (crevicular fluid) in the 2nd point. VEGF and IL- surgery to bone, spinal cord compression) regardless of pain symp- 17 were measured by quantitative ELISA kits. toms or SRE status at baseline. We evaluated additional baseline Results: At baseline patients had good oral hygiene; one had ONJ characteristics to identify specific patient subgroups that could ben- stage I; no osteonecrosis was observed during the study period. efit from BTAs. Serum VEGF was similar in patients with bevacizumab alone or Methods: Randomized (1:1) patients with metastatic bone disease combined with zoledronic acid, while it was significantly lower received SC denosumab 120 mg and IV placebo (n=2,862) or IV (P=0.003) when compared to zoledronic acid alone or combined ZA 4 mg (adjusted for CrCl) and SC placebo Q4W (n=2,861) in with everolimus. VEGF was not detected in the crevicular fluid. IL- three double-blinded phase 3 studies. Time to first SRE and time 17 remained unchanged in all groups and study points, either in to first-and-subsequent SREs were evaluated by baseline variables serum or crevicular fluid. including location and number of bone metastases, presence of Conclusions: The stronger VEGF inhibition in bevacizumab versus visceral metastases, and uNTx levels above or below the median zoledronic acid, without additive inhibition effect and without (43.5 nmol/mmol). increased risk of osteonecrosis, may denote that antiangiogenesis Results: Denosumab significantly delayed time to first SRE versus ZA in plays little role in osteonecrosis. The good oral health of patients all subgroups. Similar results were observed for time to first-and- may have resulted to the stable values of IL-17. More patients are subsequent SREs. needed to confirm these results. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S27

General Oncology Hospital of Kifissia “Agioi Anargyroi”, Athens, MASCC-0517 7 Bone Health Greece; 2nd Internal Medicine-Oncology Unit, General Oncology Hos- pital of Kifissia “Agioi Anargyroi”, Athens, Greece; 8Oncology depart- ment, Mitera Hospital-Hygeia, Athens, Greece; 93rd Oncology Depart- DENTAL EXTRACTIONS AS PART OF THE MANAGEMENT ment, Metropolitan Hospital, Athens, Greece; 109. Department of Diag- STRATEGY IN PATIENTS WITH SOLID CANCERS nostic Sciences and Oral Medicine, University of Tennessee Health Sci- AND PRE-EXISTING OSTEONECROSIS OF THE JAWSTAGE 2 ence Center College of Dentistry, Tennessee, USA I. Athanassiadis1, E. Galitis2, D. Galiti3,F. Antoniou4, G. Koutinos5,D. Tzaninis6, O. Nicolatou-Galitis7 Introduction. Local tissue infection or localized periodontitis are considered 1Oncology Department, Mitera Hospital-Hygiea, Athens, Greece; 2Clinic risk factors for osteonecrosis of the jaw (ONJ) in patients on targeted therapies of Orofacial Pain Dental School, University of Athens, Athens, Greece; and/or antiresorptives. However, evidence of this association is lacking. 3Clinic of Oral Diagnosis and Radiology Dental School, University of Objective. Wepresent the clinical data of possible association of gingival and Athens, Athens, Greece; 4Oncology Department, Elenas Venizelou Hos- periodontal toxicity and ONJ in 8 patients with solid tumors, who received pital, Athens, Greece; 5Oncology Department, Aghios Savvas Hospital, targeted therapies, as monotherapy or in combinations with zoledronic acid. Athens, Greece; 6Oncology Department, Hygeia Hospital, Athens, Report of cases. Eight patients with solid tumors (mean age 46.5) Greece; 7Clinic of Hospital Dentistry Dental School, University of Ath- presented with gingival pain, bleeding, gingival necrosis, and/or localized ens, Athens, Greece periodontitis, and/or exposed periodontal bone. Two patients received bevacizumab alone, one bevacizumab and zoledronic acid, one Introduction. Dental extractions and poor oral health have been associ- bevacizumab and temsirolimus, one bevacizumab, temsirolimus and ated with increased risk of osteonecrosis of the jaw (ONJ). zoledronic acid, and 3 everolimus and zoledronic acid. The duration of Objective. Weevaluated the clinical course of 28 extractions of teeth with symptoms was 1–2 weeks (6 patients) and 8 and 11 weeks (2 patients). poor periodontal health in cancer patients and pre-existing ONJ stage 2. Results: Diagnosis was consistent with necrotizing ulcerative gingivitis Report of cases. Four women with breast (3) and thyroid cancer (1) (1 patient) and ONJ stage 0 (5 patients). ONJ stage 0 and 2 (two sites) and presented, between June 2013 to November 2014, with severe pain, ONJ stage 2 were diagnosed in two patients with long-term symptoms. numbness and ONJ stage 2. Pain, swelling and tooth mobility, followed Antibiotics and/or dental extractions led to healing (5 patients with by dental extraction or tooth exfoliation had preceded the development of symptoms of short duration) or symptom alleviation (2 patients). One ONJ. Radiolucency with densities characterized the ONJ lesions as seen patient with ONJ 0 progressed to stage 2, following tooth self-exfoliation. with panoramic radiographs and Cone Beam Computed Tomography, Conclusions. Gingival and periodontitis-like toxicity may represent early while periodontal ligament widening of the teeth near or within the clinical stages of ONJ. Early recognition can lead to successful treatment ONJ lesions was observed. All patients had received zoledronic acid and prevent progression to advanced ONJ stages. Awareness among (6 – 36 injections) alone (2) or combined with bevacizumab (1) or health care professionals working in oncology is important for the early sunitininb (1). Three patients had received standard chemotherapy. recognition and management of this toxicity.Further research is needed to Results confirm this hypothesis. Twenty-eight dental extractions were performed under antibiotics, com- bined 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 MASCC-0192 remained in one socket after 2 months of follow up. Pre-existing ONJ Bone Health regressed to stage 1. Conclusion. The high healing rate of dental extractions (27/28), in INTERNATIONAL PATTERNS OF PRACTICE FOR THE patients with pre-exisitng ONJ stage 2, does not support the causal TREATMENT OF PAINFUL BONE METASTASES WITH relationship of dental extractions with ONJ. Dental extractions of teeth PALLIATIVE RADIOTHERAPY FROM 1993 TO 2013 with poor periodontal health, near or within ONJ areas, may be a good M. Popovic1, M.D. Hartogh2,L.Zhang1,M.Poon1,H.Lam1, G. Bedard1, management strategy in such patients to control local infection and ONJ. N. Pulenzas1,B.Lechner1, M. Milakovic1, E. Chow1 1Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, MASCC-0166 Canada; 2Department of Radiotherapy, University Medical Center Bone Health Utrecht Utrecht University, Utrecht, Netherlands

Background and Aims GINGIVAL AND PERIODONTALTOXICITY Past randomized controlled trials and meta-analyses have affirmed that AND OSTEONECROSIS IN PATIENTS RECEIVING TARGETED single and multiple fraction radiotherapy provide an equally efficacious THERAPIES ALONE OR COMBINED WITH ZOLEDRONIC response in the palliation of painful uncomplicated bone metastases ACID: A CASE-SERIES AND CLINICAL IMPLICATIONS (UBM). However, historical patterns show a preference for multiple O. Nicolatou-Galitis1,E.Razis2,E.Galitis3,S.Tsimpoukis4,K. fractions. Globally, we aimed to determine the current patterns of practice Koutsoukos5, J. Sgouros6, N. Soupos7, A. Nikolaidi8,V. Barbounis9,C. in this setting. Migliorati10 Methods 1Dental School, University of Athens, Athens, Greece; 23rd Oncology A literature search was conducted on Ovid MEDLINE and Ovid Department, Hygeia Hospital, Athens, Greece; 3Department of Orofacial EMBASE. Studies were included if they disclosed patterns of practice Pain, Dental School University of Athens, Athens, Greece; 4Department either through hypothetical cases or patient data and were published of Internal Medicine, 3. Oncology Unit 3rd Sotiria Hospital, Athens, between 1993 and 2013. Weighted analysis of variance was conducted Greece; 5Department of Clinical Therapeutics, Alexandra Hospital Med- for binary predictors while weighted linear regression analysis was per- ical School, Athens, Greece; 63rd Department of Medical Oncology, formed for continuous parameters. S28 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results demographic and clinical factors and an SRE was examined using Cox Nine hypothetical case studies and 13 actual patterns of practice articles proportional hazards model, accounting for death as a competing risk. were included from 301 search results. Radiation oncologists prescribed Results dose fractionations ranging from 3Gy×1 to 2Gy×30, with a median of Of 7,278 older women with metastatic BC (median age: 77), 3,729 3Gy×10, for the palliation of UBM. Actual data demonstrated a weak, (51 %) developed any SRE during a mean follow-up of 637 days. The non-significant, negative linear relationship between the use of single proportions of patients who had RAD, FRAC, BS, and SCC were: 35 %, fraction radiotherapy and the year of treatment (Figure 1). Geographical 30 %, 9 %, and 4 %. The mean (median) time from diagnosis to first SRE location, anatomical site, type of practice and presence of oligometastases was 214 (63) days. Of the 3,729 women with at least 1 SRE, 2,627 (70 %) were key predictors of prescription patterns. experienced a subsequent SRE. Potential SRE risk factors included baseline estrogen receptor/progesterone receptor positive status, non- Hispanic 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 subse- quent SREs.

MASCC-0244 Cachexia

ANAMORELIN PHASE III CLINICALTRIAL Conclusions PROGRAM (ROMANA) FOR THE TREATMENT There was an overall global reluctance to practice evidence-based med- OFANOREXIA-CACHEXIA IN NON-SMALL CELL LUNG icine by employing single fractions in the treatment of painful UBM. CANCER (NSCLC) PATIENTS: BASELINE Prescription patterns have not changed considerably in the last two CHARACTERISTICS decades and are influenced by factors related to the radiation oncologist, 1 2 3 4 5 6 patient, radiotherapy centre, published evidence and personal beliefs. D. Currow ,A.Abernethy,K.Fearon, L. Gleich , J. Friend ,J.Temel 1Palliative and Supportive Services, Flinders University, Adelaide, Australia; 2Department of Medicine, Duke University, Durham, USA; 3Surgical Oncology, Western General Hospital, Edinburgh, United MASCC-0498 Kingdom; 4Medical Affairs, Medpace Inc., Cincinnati, USA; 5R&D, 6 Bone Health Helsinn Therapeutics Inc., Bridgewater,USA; Department of Medicine, Massachussets General Hospital, Boston, USA PREVALENCE OFAND FACTORS ASSOCIATED Background and Aims WITH SKELETAL-RELATED EVENTS IN OLDER UNITED Cancer anorexia-cachexia, a frequent multifactorial syndrome involving STATES WOMEN DIAGNOSED WITH METASTATIC BREAST altered metabolism and loss of lean body mass (LBM), is associated with CANCER increased morbidity and mortality. Anamorelin HCl (ANAM) is a new, A. Hussain1,C.Yong2,K.Tkaczuk1,Y.Qian3,J.Arellano3,A. oral, selective ghrelin receptor agonist. ROMANA 1 and ROMANA 2 are Balakumaran4, A. Liede5,C.D.Mullins2, E. Onukwugha2 double-blind, placebo-controlled, randomized (2:1 ANAM vs. placebo) 1Department of Medicine, University of Maryland School of Medicine, phase III trials assessing ANAM safety/efficacy in Stage III/IV NSCLC Baltimore MD, USA; 2Pharmaceutical Health Services Research, Uni- patients with cachexia (≥5 % weight loss within prior 6 months or BMI< versity of Maryland School of Pharmacy, Baltimore MD, USA; 3Global 20 kg/m2). ROMANA 3 is their safety extension study. Health Economics, Amgen Inc., Thousand Oaks CA, USA; 4Medical, Methods Amgen Inc., Thousand Oaks CA, USA; 5Center for Observational Re- In ROMANA 1 and 2, patients receive 100 mg ANAM or placebo once search, Amgen Inc., Thousand Oaks CA, USA daily for 12 weeks. Co-primary endpoints are the change from baseline in LBM (measured by DXA) and in muscle strength (measured by handgrip Background and Aims strength [HGS]). Secondary endpoints include change in body weight, One in two women with metastatic breast cancer (BC) experience overall survival, and quality of life (FACIT-F,FAACT). ROMANA 1 only skeletal-related events (SREs); however, there is limited data regarding additionally assesses population pharmacokinetics. Patients who com- baseline risk factors associated with an SRE. Weestimated the prevalence plete ROMANA 1 or 2 with ECOG≤2 are eligible for additional 12-week of SREs and identified factors associated with SREs among older women treatment in ROMANA 3. with metastatic BC. Results Methods ROMANA 1 and ROMANA 2 enrolled 484 and 495 patients, respec- Using the linked SEER (Surveillance, Epidemiology, and End Results) tively. These are mainly Stage IV NSCLC patients (76.1 %; 70.5 %) with and Medicare data, we identified women aged 66+ with incident meta- ECOG=1 (69.8 %; 66.5 %), weight loss ≤10 % (61.8 %; 52.3 %), static BC diagnosed during 2000–2009. Post-diagnosis SREs identified baseline LBM and HGS lower than values commonly observed in healthy included radiation therapy (RAD), fractures (FRAC), bone surgery (BS), adults or patients without weight loss. As of January 2014, ROMANA 3 and spinal cord compression (SCC). The association between patient enrolled 510 patients mainly with ECOG=1 (71.9 %). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S29

Conclusions Table 1. Demographic information 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. N=125 Mean ± SD Age (years) 62.4±12.2 BMI (kg/m2) 23.5±5.2 n% MASCC-0534 Gender Males 75 60 Cachexia Females 50 40 Diagnosis GI 85 68 CANCER CACHEXIA STAGING: FROM THEORY TO NSCLC 24 19 CLINICAL PRACTICE Others 16 13 1 2 3 4 5 L. Ciutto , J. di Tomasso ,R.D.Kilgour,S.Khan,J.A.Morais,M. CCS NC 31 25 Borod6, A. Vigano7 PC 33 26 1Clinical Nutrition, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 2Clinical Nutrition, McGill University Health Centre, mon- C4738 treal, Canada; 3Concordia University Exercise Science, McGill Nutrition RC 14 11 and Performance Laboratory, Montreal, Canada; 4McGill Nutrition and Performance Laboratory, McGill Nutrition and Performance Laboratory, GI gastrointestinal; NSCLC non-small cell lung cancer; CCS cancer Montreal, Canada; 5Geriatric Medicine McGill University Health Cen- cachexia stages; NC non-cachectic patients; PC pre-cachectic patients; tre, McGill Nutrition and Performance Laboratory, Montreal, Canada; C cachectic patients; RC refractory cachectic patients; BMI body mass 6Palliative and Supportive Care, McGill University Health Centre, Mon- index; CRP C-reactive protein; ASMI appendicular skeletal muscle index; treal, Canada; 7Palliative and Supportive Care McGill University Health HGS hand grip strength Centre, McGill Nutrition and Performance Laboratory, Montreal, Canada

Background and Aims Figure 2. Kaplan Meier survival curves for the different cancer Based upon specific criteria, cancer cachexia stages (CCS) including non- cachexia stages cachexia (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(Table1). Results

Figure 1 Sets of classification criteria and methods for CCS

Two-hundred and seventy five patients were included in the anal- ysis. 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 aPG- SGA for profiling nutritional and functional characteristics in advanced cancer patients. S30 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0320 Methods Cachexia 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 PREVALENCE OF CACHEXIA AMONG PATIENTS WITH placebo or enobosarm (3 mg/day) at initiation of first-line standard SOLID AND HEMATOLOGICAL MALIGNANCIES ATA platinum doublet chemotherapy (Power1= platinum+taxane or Power2= NATIONAL CANCER INSTITUTE (NCI) DESIGNATED platinum+non-taxane) and continued through day-147. SM change is CANCER CENTER DURING THE 12 MONTHS PRECEDING reported from baseline to day-84 and day-147. DEATH Results E. Del Fabbro1,N.Skoro2,B.Cassel3 Enobosarm was associated with significant SM (whole body basis) gains. 1HematologyOncology and Palliative Care, Virginia Commonwealth In Power1, the median change in SM from baseline to day-84 differed University, Richmond, USA; 2Massey Cancer Center,Virginia Common- (p<0.0001) between enobosarm (+0.5 kg, n=103) and placebo patients wealth University, Richmond, USA; 3Hematology Oncology and Pallia- (-0.3 kg, n=107) and was more pronounced at day-147 (+0.1 kg and tive Care, Virginia Commonwealth University, Richmond, USA −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) Background and Aims and placebo patients (−0.2 kg, n=99) and was again more pronounced at day- A consensus definition characterizes cancer cachexia as a multifactorial 147 (+0.5 kg and −0.3 kg; p=0.003). SM gain ≥1kgatday-84wasassociated syndrome with loss of lean body mass and progressive functional impair- with longer median survival in the enobosarm arm (+2.6 months, p=0.04). ment. The core criterion for diagnosis is weight loss >5 %; or a Body Mass Conclusions Index (BMI) <20 with weight loss >2 %. Because obesity is common in Enobosarm promoted SM gain, and SM gain was associated with the general population, cancer cachexia may be under-recognized. prolonged survival. CT analysis can be used as an opportunistic tool to Objectives: To determine the prevalence of cachexia among solid (SC) assess body composition in clinical trials. and hematological cancer (HC) decedents using weight loss and BMI criteria, at a NCI center. Methods MASCC-0546 Retrospective review of 1,891 adult cancer decedents with ≥2 weight measures Cachexia during the 12 months before death. Height, weight, body mass index, albumin were analyzed relative to death. Descriptive statistics and odds ratios calculated. ENOBOSARM, A SELECTIVE ANDROGEN RECEPTOR Results MODULATOR (SARM), INCREASES LEAN BODY MASS (LBM) Eight months prior to death, 52 % n=289 were overweight or obese by IN ADVANCED NSCLC PATIENTS; UPDATED RESULTSOF BMI. 41 % n=42 of patients with HC had >5 % weight loss compared to TWO PIVOTAL, INTERNATIONAL PHASE 3 TRIALS 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=192with J.C. Crawford1, M.A. Johnston2, M.L. Hancock2, S.G. Small2,R.P. SC and 40 % n=46 with HC had weight loss consistent with cachexia. In Ta y l o r 2,J.T.Dalton2, M.S. Steiner2 the final month of life, HC were less likely to have experienced weight 1Division of Medical Oncology, Duke University Medical Center, Dur- loss (OR 0.65, CI 0.48–0.89) than SC, and more SC had an underweight ham, USA; 2Medical Affairs, GTx Inc., Memphis, USA – BMI (17 %, n=142 vs 6 %, n=12, OR 3.23, CI 1.76 5.95). Background and Aims Conclusions Cancer-induced muscle wasting is a progressive disease related symptom ’ More than half the decedents had overweight or obese BMI s 8 months that is a consequence of a reduced rate of anabolic activity and increased prior to death. catabolic activity. Enobosarm is a first-in-class nonsteroidal oral SARM. Depending on the interval to death, the prevalence of weight loss consis- Wereport top line results for two Phase 3 clinical trials conducted for the tent with cachexia varies between HC and SC patients. prevention/treatment of muscle wasting in patients with NSCLC. Methods Six hundred forty-one patients (Stage III/IV NSCLC) were randomized at MASCC-0548 initiation of first-line chemotherapy; platinum + taxane {POWER1, n= Cachexia 321} or platinum + non-taxane {POWER2, n=320} plus add on, consisting of either enobosarm 3 mg or placebo for 5 months. Patients INCREASE IN SKELETAL MUSCLE AS MEASURED BY were males and postmenopausal females ≥30 y, and ECOG ≤1. Coprimary COMPUTERIZED TOMOGRAPHY IN NON-SMALL CELL endpoints (Day 84) are physical function response assessed by stair climb LUNG CANCER PATIENTS RECEIVING ENOBOSARM power (SCP) and lean body mass (LBM) as measured by DXA. Results 1 1 2 3 4 C.M. Prado ,X.Jingjie,M.L.Hancock,J.C.Crawford, R.J. Gralla , Mixed model repeated measures (MMRM) slope analysis of coprimary 2 2 2 2 2 M.A. Johnston ,S.G.Small,R.P. Taylor , J.T. Dalton ,M.S.Steiner endpoints: 1Department of Nutrition Food and Exercise Sciences, Florida State University, Tallahassee, USA; 2Medical Affairs, GTx Inc., Memphis, MMRM Slopes – POWER1 MMRM Slopes – POWER2 USA; 3George Barth Geller Professor for Research in Cancer, Duke Placebo Enobosarm p-value Placebo Enobosarm p-value University Medical Center,Durham, USA; 4Jacobi Medical Center,Albert (n=161) (n=160) (n=161) (n=159) Einstein College of Medicine, Bronx, USA SCP (Day 84) −0.0773 +0.0443 0.0147 −0.0245 −0.0305 0.8877 %/day − − Background and Aims LBM (Day 84) 0.011 +0.0049 0.0002 0.0044 +0.0056 0.0111 kg/day Computerized tomography (CT) is a state-of-the-art technique providing SCP (Day 147) −0.0794 −0.0191 0.0492 −0.0094 +0.0052 0.6138 direct assessment of skeletal muscle (SM), a critical component of lean body %/day mass (as measured by other techniques such as DXA). SM loss observed LBM (Day 147) −0.0104 +0.0014 <0.0001 −0.0038 +0.0031 0.0028 among patients with non-small cell lung cancer (NSCLC) is associated with kg/day poorer prognostic outcomes. Here, we investigate the efficacy of an anabolic agent in promoting SM gain in patients with stage III or IV NSCLC. Adverse events were similar between enobosarm/placebo subjects in both trials. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S31

Conclusions Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA; 4- Overall, enobosarm was safe and well tolerated. Declines in LBM and SCP Department of Oncology, Mayo Clinic, Rochester,USA were observed in the placebo group of both trials. In POWER1 statistically and clinically meaningful differences between enobosarm and placebo were Background and Aims observed for SCP and LBM. In POWER2, statistically and clinically mean- Fewer than 5 % of cancer patients participate in clinical research. Al- ingful differences between enobosarm and placebo were observed for LBM. though this paltry rate has led to extensive research on this topic, previous studies have not sought verbatim comments in a real-time, comprehen- sive manner to understand why patients decline. Our aim was to identify MASCC-0603 and better understand issues related to lack of participation in low risk, Cachexia non-interventional cancer research. Methods LENALIDOMIDE (L) IN INFLAMMATORY CANCER This study used a low-risk, non-interventional parent study that focused on CACHEXIA (CC): A RANDOMIZED, DOUBLE-BLIND, cancer-associated weight loss to understand patients’ reasons for declining PLACEBO-CONTROLLED PROOF-OF-CONCEPT STUDY research participation. A research assistant wrote down the name and verba- timreasonofallpatientswhodeclinedtoparticipate.Thesecommentswith R. Oberholzer1, D. Blum1,M.Joerger2, S. de Wolf-Linder3,T.Cerny2,F. accompanying patient demographic data are the subject of this research. Strasser1 Results 1Oncological Palliative Medicine Oncology Dept. Int. Med. & Palliative Of 334 patients, 51 (15 %) declined parent study enrollment; 3 comment- Care Cntr Dept. Int. Med. Disc., Cantonal Hospital, St.Gallen, related themes emerged: 1) a repelling sense of too much institutional Switzerland; 2Clinic Oncology/Hematology Dept. Int. Med., Cantonal research; 2) overwhelming personal health issues; and 3) a low likelihood Hospital, St.Gallen, Switzerland; 3Oncological Palliative Medicine On- of returning to the institution. In univariate and multivariate analyses, cology Dept. Int. Med., Cantonal Hospital, St.Gallen, Switzerland only age (older) and gender (female) were associated with non- enrollment. Interestingly, 41 patients with fatigue scores of 7 or worse Background and Aims and 26 with pain scores of 7 or worse enrolled. CC impacts physical function, survival, quality-of-life and anticancer Conclusions treatment. Inflammation is an important mediator of CC. To investigate Although many factors were associated with declining to participate in re- if Lenalidomide has promising activity in patients with CC and systemic search, symptom severity was not. Up front education might help cancer inflammation. patients better prioritize their participation in research, particularly as some Methods patients felt overwhelmed by too much research in the institution; and for now, Patients (pts) with advanced solid malignancies, weight loss (≥5 %/6mts), investigators should continue to keep asking patients for their participation. 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 bi- weekly dose adaption in a 1:2:2 randomization. Responders were defined as 32 % increase of lean body mass [CT-scan L4/5], and 34kgincreaseof MASCC-0221 hand-grip strength [Jamar®]. Secondary endpoints included adverse Cachexia events, CRP,nutritional intake, symptoms and physical functioning. Results A LONGITUDINAL STUDY OF BODY COMPOSITION IN Of 24 eligible pts 16 (12M, 4F) were included (5 mesothelioma, 2 NSCLC, HEAD AND NECK CANCER PATIENTS UNDERGOING 2 renal-cell carcinoma, 2 neuroendocrine tumors, 5 other). Nine pts com- RADIATION-BASED THERAPY UTILIZING DEXA AND CT pleted 8 weeks of treatment, mean survival was 43 days. No responder was IMAGING identified. CRP-guiding did not result in lower doses. Decrease of muscle L. Zatarain1,C.Smith2,B.Murphy1, M. Dietrich3,S.Ridner4,K. mass was 1,141 cm2 (P) and 23 cm2 (L), of muscle strength 5,5 kg and Niermann2 2,25 kg, increase of nutritional intake 32 kcal/d and 249 kcal/d and change 1Division of Hematology & Oncology, Vanderbilt University School of of CRP +17 mg/dl and −35 mg/dl, respectively. Intervention-related Medicine, Nashville, USA; 2Radiation Oncology, Vanderbilt University, adverse-events were mainly haematological toxicity and fatigue. Nashville, USA; 3Nursing Psychiatry and Biostatistics, Vanderbilt Uni- Conclusions versity, Nashville, USA; 4Nursing, Vanderbilt University, Nashville, USA Treatment with Lenalidomide was feasible with close monitoring. No re- sponder on muscle mass and strength was observed, but trends towards Background and Aims slower decrease. Present treatment with other anticancer drugs hampered Radiation in head and neck cancer (HNC) patients results in severe accrual. Lenalidomid has limited potential to improve cachexia in this setting. unintentional weight loss with lean body mass (LBM) wasting ac- Study support: Celgene (free study treatments [P, L], unrestricted grant); counting for 70 % of total losses. Slice-O-Matic is computer software Hospital St.Gallen (grant CTU-11-006; EKSG-09/040) which utilizes routine CT imaging to assess body composition. CT imaging would be an invaluable tool in body composition analysis if: MASCC-0007 1) LBM measurements using this software correlate with gold stan- Cachexia dard measures such as DEXA, and 2) feasible for use in head and neck region. Methods WHY DO CANCER PATIENTS DECLINE PARTICIPATION We conducted a secondary analysis of 31 HNC patients undergoing IN A LOW RISK, NON-INTERVENTIONAL XRT. DEXA measured LBM and fat mass at baseline and 3 months CANCER-ASSOCIATED WEIGHT LOSS STUDY? CAPTURING post-XRT. Routine CT images of the neck acquired at the same time VERBATIM, REAL-TIME COMMENTS TO INFORM points were analyzed with Slice-O-Matic software to generate esti- INVESTIGATORS mates of total LBM. We calculated cross-sectional areas (cm2)ofthe T. Wa n g e r 1, N. Foster2,P.Nguyen3, A. Jatoi4 posterior paraspinal muscles at levels C6 and C7. LBM and skeletal 1Cancer Education Program, Mayo Clinic, Rochester,USA; 2Biomedical muscle surface area were normalized for stature to define skeletal Statistics and Informatics, Mayo Clinic, Rochester,USA; 3Department of muscle indices (SMI). S32 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Background and Aims At baseline, statistically significant direct correlations were observed between Introduction: Patients knowledge about their disease is highly important; DEXALBMandbothSMIC6andC7values(r=0.57 and 0.59 respectively, it has been related with treatment adherence and satisfaction level. 44,761 p=0.001). At 3-months post-XRT,these correlations reduced to 0.39 (C6, p= consultations were given at INCan in 2012 and 44 % of them by breast 0.034) and 0.14 (C7, p=0.464). Similarly, statistically significant direct cancer service. We suggest that this busy schedule is associated with correlations were observed between DEXA fat mass and C6 adiposity at shorter time consultations, patient information deficit, lower satisfaction baseline (C6, r=0.59, p=0.001) and 3 months (C6, r=0.55, p=0.002). and low quality medical care. Objectives: To identify the association Conclusions between patient knowledge and the perception of medical attention. Also Although the correlations of C6 and C7 posterior paraspinal musculature we evaluate our service’s quality. with whole LBM in this HNC sample were statistically significant, they Methods were not sufficiently strong to recommend use of the Slice-o-Matic Self-response survey was done in breast cancer patients. Demographic software in this setting. variables such as age, scholarship, marital status were asked in combina- tion with diagnosis, prognosis and treatment comprehension level. Vari- ables related with our service’s quality, global care support and waiting time before consultations were asked too. Finally, we questioned about MASCC-0366 explanations given by doctors about daily activities, diet and workout. Communication Results Two hundred fifty-nine patients were surveyed. Median age was 50 years old HIGHER RATE OF RECEIVING PALLIATIVE SEDATION IN (17–88); 18 % achieved university degree and 28.7 % had less than elemen- WHOM COMPLETED ADVANCE DIRECTIVES tary education. Education level was significantly associated with diagnosis (77 vs. 88 %, p=0.032), prognosis (47 vs. 61 %, p=0.043) and treatment (58 H.J. An1,H.S.Kim1,B.H.Kong1,Y.Kim1,Y.Kim1,Y.Kang1,H.Kim1 vs. 73 % p=0.019) understanding. Although 70 % of the patients are 1Department of Medical Oncology & Hospice Center, Catholic Univer- satisfied with the medical attention, 30 % of them did not receive information sity, Suwon, Korea about integral support given at INCan and 43 % referrers that doctors did not give enough information related to treatment care and daily activities. Introduction: Advance directives (ADs) has been recently issued and Conclusions gradually accepted in Korea. Palliative sedation (PS) is used in terminal Efforts to improve medical care attention have to focus in doctor-patient cancer patients suffering from refractory symptoms. The decision for PS communication and patient knowledge to reach a greater proportion of is usually made not by patients but by family. Since October 2012, we satisfaction and better medical attention. 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. MASCC-0351 Results: Seventy-six patients (35.5 %) completing ADs, but ADs were not Communication completed in patients with poor performance or family’s disagreement. Sixty- eight (31.8 %) agreed PS. The PS was actually performed in 37 (17.4 %) of 214 INFLUENCE OF PSYCHOSOCIAL CONSULTATION WITH patients; 20/138 patients without ADs (14.5 %), 17/68 patients who agreed PS COMPREHENSIVE PSYCHOSOCIAL ASSESSMENT (CPA) ON (25.0 %), none (0/8, 0 %) patients who did not agree PS on ADs. Higher trend INDENTIFYING THEIR DIFFICULTIES IN CANCER PATIENTS of performing PS in patients who completed ADs comparing to patients who S. Baek1,J.J.Lee1,S.Y.Kim1 did not (25.0 % vs. 14.5 %, P=0.057). The decision at the time of performing 1Internal Medicine, Kyung Hee University Medical Center,Seoul, Korea 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 Background and Aims ADs, the decision of PS was made by same proxy written in ADs (82.4 %). We evaluated the contributory factors to investigate the psychosocial diffi- Conclusions: Most patients completing AD agreed PS, and they showed culties and to determine the referral to the social worker in cancer patients. higher rates of receiving PS comparing to patients without ADs. Com- Methods pleting ADs in advance might influence the decision making of PS for From February to December 2009 we prospectively conducted the study family members in a positive way. 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 MASCC-0451 problem, psychological problem, and rehabilitation problem and their Communication overall need of consultation. Results A total of 95 patients were enrolled. The median age was 58 years and MEDICAL CARE ATTENTION AND SATISFACTION male was 65 %. The common diseases were lung cancer and gastrointes- EVALUATION IN THE BREAST CANCER SERVICE AT tinal cancer. Two thirds was stage IVand in the course of chemotherapy. NATIONAL CANCER INSTITUTE, MEXICO CITY (INCAN) The most common needs were to know the social system (90 %), to solve C. Arce-Salinas1, L. Mendoza-Galindo1, M. Navarro2,R.Caba-Tinoco3, the financial (74 %), and personal care problem (70 %) according to A. Alvarado-Miranda1, G. Calderillo-Ruiz4, J.L. Aguilar-Ponce5 patients but the social system (96 %), financial (65 %), and psychological 1Breast Cancer,Nacional Cancer Institute Mexico City (INCan), Mexico problem (47 %) according to physician. The agreement of the financial City, Mexico; 2Integral Attention Support Center (CAAI), Nacional Can- problem was highest (Kappa coefficient, 0.212, p=0.035) between pa- cer Institute Mexico City (INCan), Mexico City, Mexico; 3Clinical Re- tients and physician. 2 or more of total count was significantly correlated search, Nacional Cancer Institute Mexico City (INCan), Mexico City, with their overall need (R=0.434, p<0.0001). With the referral, 26 %, Mexico; 4Medical Oncology, Nacional Cancer Institute Mexico City 37 % and 34 % of patients benefit from support, interview or intervention (INCan), Mexico City, Mexico; 5Internal Medicine, Nacional Cancer in terms of financial problem, the benefit of social system and psychoso- Institute Mexico City (INCan), Mexico City, Mexico cial problem, respectively. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S33

Conclusions circumstances where practitioners may feel pressured from advocates With the comprehensive psychosocial assessment, more than a third and litigants from whom they are briefed and receive remuneration. An patient benefited. The assessment of the psychosocial difficulty would alternate process is currently being trialled in some Australian jurisdic- be considered as the sixth vital sign and be evaluated to identify the tions and international counterparts. Concurrent medical evidence (“hot contributory factors in cancer patients for improving the quality of life. 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. MASCC-0285 The aim of this study was to conduct a review of “hot tubbing” as it has Communication been used to date, to examine its feasibility. Methods COMMUNICATION SKILLS TRAINING IN ONCOLOGY:A An extensive search of legal websites (eg LexisNexus, Westlaw) was NEW PROJECT IN LITHUANIA conducted. Local and international experts were contacted to determine their views. G. Bulotiene1, S. Birbilaite2,V. Mickeviciene3 Results 1Department of Physical Medicine and Rehabilitation, Vilnius University The concurrent model seems popular amongst many medical professionals Institute of Oncology, Vilnius, Lithuania; 2Institute of Psychology, who value the bipartisan professional dialogue the method facilitates. Mykolas Romeris University, Vilnius, Lithuania; 3Cancer Control and Some doctors have felt restricted and intimidated by the traditional “hired Prevention Center, Vilnius University Institute of Oncology, Vilnius, gun” adversarial process. Conversely, some legal practitioners are reluctant Lithuania 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. Background and Aims Conclusions Lithuania has not yet developed any communication skills training (CST) If endorsed by the legal profession, “hot tubbing” may become the standard program for health care professionals working with cancer patients. practice. Much depends on feedback from the medical profession. 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. MASCC-0266 Methods Communication CST needs evaluation questionnaires based on cancer research data and survey from oncologists, oncology nurses and cancer patients were pre- REHABILITATION OF LIMITED GERMAN PROFICIENT pared. 70 health-care professionals from the oncology units and 60 cancer PATIENTS IN AN OUT-PATIENT SETTING IN BERLIN patients have completed questionnaires. Sixteen hour CST program was C. Kerschgens1,S.Brandis1 developed based on CST needs evaluation results. The program offers a 1Oncology, Vivantes Rehabilitation, Berlin, Germany variety of theoretical models with special focus on handling emotions and breaking bad news in oncology. It integrates a lot of interactive methods Background and Aims such as self-reflection, video analysis, exercises and role-plays. Rehabilitation serves to regain function and self-empowerment after Results cancer. This includes educational programs. In Patients with native lan- Seventy-six percent of nurses and 53 % of doctors admitted a lack of adequate guages other than German this might be a problem. training in communication skills. At project start CST based on Swiss Methods experience was provided for 6 trainers. In 2013–2014 we provided intensive In 2008 all patients in our department were given a home language 16 workshops for ten groups of personnel, involving 164 participants. assessment. Patients with native languages other than German were Conclusions assessed concerning their language proficiency. This was classified as The new CST module is an effective tool for teaching communication ‘very good’ when the level was equivalent to that of native speakers and skills. Future research is required to assess the impact of the CST on ‘good’ when the patient was able to understand the information given and doctor-patient’s relationship in order to support the implementation of the respond to questions. It was said to be ‘poor’, when the patient was able to CST in the national system of cancer care. understand information concerning the organisation and ‘none’ when the patient was not able to understand basic information. Results MASCC-0543 In 2008, 517 patients were treated. 15,3 % spoke languages other than Communication 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. CONCURRENT MEDICAL EVIDENCE (“HOT TUBBING”) In the assessment of language proficiency 45,6 % were assessed ‘very A. Pinkerton1, J. Hardy2 good’,21,5%‘good’,12,7%‘poor’,20,3%‘none’. 1TC Beirne Law School, University of Queensland, Brisbane, Australia; Combining the groups of ‘very good’ and ‘good’, this accounts for 12 2Palliative and Supportive Care, Mater Research Institute-The University patients with Turkish (out of 26), 11 Patients with languages of former of Queensland, Brisbane, Australia 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 Background and Aims Patients of former Yugoslavia and 4 of Russia/Ukraine. It is current practice in many civil trials involving medico-legal disputes Conclusions for multiple expert witnesses to give evidence. Traditionally, witnesses In our department in 2008 15,3 % of patients had languages other than have given evidence separately. Their assessments of disability and/or German as their native language. Nevertheless during rehabilitation sup- degree of permanent impairment have often been conflicting, creating a port has to be organized to ensure that needed information can be widely disparate process. There is also the potential for bias in delivered. S34 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0503 communication model for EOL care planning compatible with clinical Communication 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 COMMUNICATION FOR END-OF-LIFE CARE PLANNING hospice care facility from distinct provinces of Korea participated in this AMONG PATIENTS WITH TERMINAL CANCER: A study. CONTEXT-ORIENTED MODEL Results: Five themes emerged regarding EOL care planning that S.J. Koh1,S.Kim2,J.S.Kim3 included right time, a responsible professional, preparedness for 1Department of Hematology and Oncology, Ulsan University Hospital, breaking bad news, content of EOL care discussion, and imple- Ulsan, Korea; 2Department of Nursing, Changwon National University, mentation of EOL care decisions. These themes were based for the Changwon, Korea; 3Department of Nursing, Sunchon National Univer- development of a communication algorithm for EOL discussion sity, Sunchon, Korea among patients with terminal cancer (Figure 1), in which a struc- tural communication steps for delivering a terminal prognosis was Introduction: Terminally ill patients or those with terminal cancer are specified at the phase of preparedness beginning with determina- often excluded in the loop of end-of-life (EOL) discussion in Korea. tion of a patient decision-making capability, followed by a patient Further, healthcare professionals have difficulty engaging in such com- perception of his/her condition, a patient’s wish to know, family munication in a variety of healthcare contexts. A communication model decision-making dynamics, and a patient’s and/or family’s readi- for EOL care planning is demanding in Korea. ness for EOL discussion. Objectives: To solicit professional opinions on communication with Conclusion: It is suggested that the proposed context-oriented commu- terminal cancer patients and their family caregivers and to develop a nication algorithm be communication supporting guidelines for EOL communication model for EOL care planning compatible with clinical discussion and accordingly, facilitate meaningful improvements in EOL environment in Korea. care in clinical practice. 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 MASCC-0368 included right time, a responsible professional, preparedness for Communication breaking bad news, content of EOL care discussion, and implemen- tation of EOL care decisions. These themes were based for the ONLYONE THIRD OF TERMINAL CANCER PATIENTS development of a communication algorithm for EOL discussion COMPLETED ADVANCE DIRECTIVES IN ST. VINCENT’S among patients with terminal cancer (Figure 1), in which a struc- HOSPITAL HOSPICE CENTER tural communication steps for delivering a terminal prognosis was 1 1 1 1 1 1 1 specified at the phase of preparedness beginning with determination B. Kong ,I.Kim,J.E.Lee,S.Ho, Y.J. Park ,Y.Kang,H.J.An,H. Kim1 of a patient decision-making capability, followed by a patient per- 1 ception of his/her condition, a patient’swishtoknow,family Department of Medical Oncology & Hospice center,The Catholic Uni- ’ decision-making dynamics, and a patient’s and/or family’s readiness versity of Korea St. Vincents Hospital, Suwon, Korea for EOL discussion. Conclusion: It is suggested that the proposed context-oriented commu- Background and Aims nication algorithm be communication supporting guidelines for EOL Introduction: To protect cancer patient’s autonomy when confronting discussion and accordingly, facilitate meaningful improvements in EOL death, the importance of advance directives (ADs) has been recently care in clinical practice. 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 MASCC-0501 patient’s preference for end-of life care and proxy. Communication 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 COMMUNICATION FOR END-OF-LIFE CARE PLANNING (90.9 %) patients completed ADs with their caregivers, while the rest AMONG KOREAN PATIENTS WITH TERMINAL CANCER: A singed ADs alone. Most patients did not want to receive cardiopul- CONTEXT-ORIENTED MODEL monary resuscitation except one (1.3 %), and refuse dialysis except S.J. Koh1,S.Kim2,J.S.Kim3 four (5.2 %) patients. Seventeen (22.1 %) patients wanted artificial 1Department of Hematology and Oncology, Ulsan University Hospital, nutritional supports. Sixty eight (89.5 %) agreed palliative sedation. Ulsan, Korea; 2Department of Nursing, Changwon National University, As a proxy, patients preferred their spouses in 55.8 %, and son/ Changwon, Korea; 3Department of Nursing, Sunchon National Univer- daughters in 28.6 %. The reason for not completing ADs was the sity, Sunchon, Korea poor performance of patients (59.4 %), and caregiver’s or patient’s refusal was the next. The median timing of ADs after admission was Introduction: Terminally ill patients or those with terminal cancer are 3(0–90) days, and duration of survival since ADs was 22 (1–340) often excluded in the loop of end-of-life (EOL) discussion in Korea. days. Further, healthcare professionals have difficulty engaging in such com- Conclusions: Most patients did not want life-sustaining treatments, munication in a variety of healthcare contexts. A communication model but some wanted artificial nutritional support. Palliative sedation for EOL care planning is demanding in Korea. was easily accepted. Considering that patient’s poor condition was Objectives: To solicit professional opinions on communication with the main reason of not completing ADs, earlier discussion about terminal cancer patients and their family caregivers and to develop a ADs is necessary. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S35

MASCC-0303 Results Communication 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. EQUAL SHARING OF INFORMATION IN THE CONTEXT OF Conclusions PERSONALIZED MEDICINE IN ONCOLOGY The EC and HCA are distinct roles. EC information is gathered by non-clinical P. Leroy1,M.F. Mamzer-Bruneel2,C.Herve2,F. Scotte3 clerical personnel without the training to explain the distinction. Some patients 1Supportive Care in Cancer Unit, Hôpital Européen Georges-Pompidou, describe EC as the person to call for transportation problems; others as the person Paris, France; 2Departement of medical ethics, Paris Descartes Univer- to call for clinical deterioration but not necessarily as a spokesperson or decision sity, Paris, France; 3Supportive Care in Cancer Unit, Hôpital Européen maker. Further, it is not part of routine nursing practice to review this information. Georges Pompidou, Paris, France Hospital processes should be amended to include explicit questioning about HCA, in addition to EC, in order to facilitate goals of care discussions. Background and Aims The development of personalized medicine in oncology requires not only a better understanding of the mechanisms of carcinogenesis, but also MASCC-0585 identification of prognostic biomarkers and targeted therapies in order to Communication more accurately assess the management of patients. This includes an equal sharing of knowledge among clinicians, research programs and patients. Methods USE OF CHECKLIST TO IMPROVE COMMUNICATION IN We attempted to identify the key participants in the care management of MULTIDISCIPLINARY CARE OF CANCER PATIENTS personalized medicine so that an equal sharing of information could be D. Niharika1,P. Wong2 made between patients and caregivers. The objective was to guide action 1Medicine, University of California San Francisco, San Francisco, USA; and development in the field of research and clinical practice. 2Nursing, University of California San Francisco, San Francisco, USA Results In the Cancer Research for Personalized Medicine (CARPEM) organiza- Background and Aims tion, two distinct multidisciplinary committees were created: the patient Cancer patients who are admitted for chemotherapy are cared for by committee and the interface committee. Personalized medicine enabled multidisciplinary teams. This creates confusion and leads to miscommu- these two committees to establish a feedback exchange, first with a more nication or no communication between many providers. We sought to citizen ethics approach and second a medical ethics approach. create a solution that will allow us to delineate expectations, encourage We also evaluated the care pathway which involved various oncology experts. communication and improve education. Once the care pathway was established, we assessed the experts who routinely Methods participate in the interface group, i.e. radiologists, pathologists, biologists etc. Wecreated a checklist to be filled out by providers at each point in patient Conclusions care to ensure care of the patients and reducing adverse outcomes. The results of our study showed that there were many ethical problems The checklist is divided in to three separate parts. The first part is filled linked with the emergence of personalized medicine and patient informa- out by the primary outpatient oncology provider who is expected to fill in tion. The equal sharing of patient-caregiver information would improve the details of treatment during admission. The second part is filled out by the quality of cancer patient care management . 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 MASCC-0309 time of discharge. This includes any complications, prophylaxis, anti Communication nausea medications and outstanding laboratory or imaging results. Results WHO SPEAKS FOR THE PATIENT? MISMATCH BETWEEN We rolled out the checklist as we had two adverse events related to poor ‘EMERGENCY CONTACTS’ AND ‘HEALTH CARE AGENTS’ communication. Over the last 4 months we have 12 completed checklists. IN THE MEDICAL RECORD Wehave not noted any adverse events. There was also higher satisfaction among the medicine and family practice residents. N. Faust1,T.Nolte1, B. Meisenberg1 1 Conclusions DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, USA 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 Background and Aims in patients receiving chemotherapy and may reduce adverse outcomes. 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. MASCC-0525 When patients cannot speak for themselves, crucial conversations need to Communication be held with Health care agents (HCAs). Wesought to determine if the electronic medical record (EMR) accurately COPING WITH UNCERTAINTY:A QUALITATIVE STUDY OF defined the authorized health care agent HCA) or desired spokesperson. 36 PALLIATIVE CARE CONSULTATIONS AMONG PATIENTS Methods WITH ADVANCED CANCER Forty-two randomly selected oncology inpatients were asked who they would choose to be their HCA or spokesperson in case of a M. Tejani1, C.S. Kamen2, S.G. Mohile1,R.E.Gramling3 medical crisis. Queries were made only in private when no family 1Hematology/Oncology, University of Rochester Medical Center, Roch- members or friends were present. We then reviewed the EMR ‘emer- ester, USA; 2Cancer Control, University of Rochester Medical Center, gency contacts’ to see if the desired HCA or spokesperson was also Rochester,USA; 3Palliative Care, University of Rochester Medical Center, the emergency contact (EC). Rochester,USA S36 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims Conclusions Palliative care consultation can reduce emotional distress and improve quality Depression and anxiety may not be higher in cancer survivor patients than of life (QOL) for cancer patients. Uncertainty about the future can lead to normal population, but self-esteem is generally lower in cancer survivor distress, loss of sense of control and lower QOL for patients. Little is known patients than normal population related to consequence of cancer surgery about how palliative care providers help cancer patients manage uncertainty. that impact on physical appearance. 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 MASCC-0157 by line to code direct and indirect expressions of uncertainty. Excerpted Communication 2 segments dealing with uncertainty about the future were analyzed by an experienced qualitative research working group. RECOGNISING GRIEF IN ONCOLOGY PATIENTS AND THEIR Results CAREGIVERS. VIEWPOINT: THE ROLE OF THE DOCTOR Thirty-six consultations were analyzed: 53 % men, median age 62. Mul- J. Lacey1 tiple expressions of uncertainty were identified – 121 by patients/families 1Oncology and Supportive Care, St George Private Hospital, Sydney, and 66 by providers. Sixty-two percent were centered on uncertainty in Australia predicting an individual patient’s trajectory. Palliative care providers coped with this type of uncertainty in three main ways: (a) reiteration of what was Background and Aims certain at time of consultation (e.g. ‘we will not let you suffer’); (b) utilizing As people live longer with a diagnosis of incurable cancer and all its uncertainty to promote hope and faith (e.g. ‘nobody knows how long you uncertainty, researchers remind us to consider anticipatory grief. Both are going to survive ’) and (c) reassurance of providing consensus at next patient and family can be grieving — a process that may begin at any time visit (eg. ‘we will put our heads together and come up with exact options.’) from the moment of a cancer diagnosis. Recognizing and addressing the Conclusions psychological distress of patients and their families often falls to the Uncertainty is prevalent during consultations with cancer patients. Palli- oncologist or palliative care physician. When it comes to patient grief, ative care providers use distinct methods to help patients to manage what how do we diagnose this and differentiate it from other complaints? is inherently uncertain about their future. Communication skills training Which patients are more susceptible? How do we identify the family for providers could build on these strategies. 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 MASCC-0258 Supportive Oncology in 2011 . This presentation looks at the impact of Communication 2 the study by Kacel, Gao, and Prigerson, and other studies of anticipatory grief and how, as physicians, the doctor-patient and doctor care-giver ASSESSMENT OF DEPRESSION, ANXIETY,AND relationship is crucial to well being and reducing suffering. SELF-ESTEEM IN FEMALE PATIENTS WHO UNDERWENT Results SURGERY DUE TO BREAST, THYROID, COLORECTAL OR Raising awareness around anticipatory grief has the potential to reduce OVARIAN CANCER long term morbidity. Conclusions O. Ata1, B. Karakaya2,M.Araz1,F. Inci1 Clinicians have the opportunity to aid in reducing post loss and poten- 1Medical Oncology, Selcuk University, Konya, Turkey; 2Internal Medi- tially pre-loss suffering. We need to identify those patients and family cine, Selcuk University, Konya, Turkey members who are at risk of developing PGD, think about the possibility of anticipatory grief, refer those requiring intervention, and refer early to Background and Aims palliative care (hospice) as it improves bereavement outcome. Weneed to A wide variety of emotional and behavioral reactions occur in a cancer be aware of the significant positive impact good patient–doctor, parent– patients starting from the diagnosis through all treatment stages and doctor, and family–doctor communication can have on reducing PGD and afterwards. An individual’s psychologic response to cancer is influenced long-term morbidity. 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 MASCC-0232 female patients who are in remission after completed primary surgery and Communication 2 adjuvant treatment of different cancer types Methods CHINESE ELDERS NEED SUPPORT IN SEEKING AND SCAN In this study, anxiety, depression and self-esteem were assessed using the NING BEHAVIORS OF INFORMATION REGARDING Hospital Anxiety and Depression Scale and Rosenberg Self-Esteem Scale COLORECTAL CANCER SCREENING TESTS 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. D.Y.P.Leung1,T.Chow1, E.M.L. Wong1, C.W.H. Chan1,D.T.F.Lee1 Results 1The Nethersole School of Nursing, The Chinese University of Hong While no statistically significant difference was found between the de- Kong, Hong Kong, Hong Kong China pression and anxiety scales of the patients and the control group, self- esteem was seen to markedly decrease in the patients. When anxiety, Introduction depression and self-esteem were compared by cancer types, no statisti- Colorectal cancer (CRC) is one of the most common types of cancer in cally significant difference was found in terms of depression, but there both men and women in Hong Kong. Cancer-related information acqui- was a difference between the diseases in terms of anxiety and self-esteem. sition can happen via active and purposeful seeking, but may also happen Anxiety and depression was low but self-esteem was high in the patients less purposively via routine use of media and interactions with other with papillary thyroid cancer. people (scanning). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S37

Objectives MASCC-0265 To examine levels of seeking and scanning behaviors regarding informa- Complications tion for CRC screening and associated demographic factors in Chinese elders in Hong Kong. FEBUXOSTAT HEAD TO HEAD VERSUS ALLOPURINOL Methods ACHIEVES A HIGHER SERUM URIC ACID (SUA) CONTROL A convenience sample of 260 community-dwelling adults aged≥60 and IN TUMOR LYSIS SYNDROME (TLS) PREVENTION: RESULTS cognitively intact was recruited. Information seeking and scanning be- OF FLORENCE PIVOTAL STUDY haviors of CRC screening behaviors in the past 12 months via six sources were measured by self-reports. Bivariate analyses identified their demo- K. Jordan1,M.Spina2,Z.Nagy3, J.M. Ribera4,M.Federico5,I.Aurer6, graphic associated factors. G. Borsaru7, A.S. Pristupa8, A. Bosi9,S.Grosicki10,N.L.Glushko11 ,D. Results Ristic12,J.Jakucs13, J. Mayer14,E.M.Rego15, S. Baldini16, S. Scartoni16, The mean age of the respondents was 77.2±8.01 years, 59.2 % were C. Simonelli16,A.Capriati16, C.A. Maggi16 female, and 67.3 % had no formal/primary education. Both the levels of 1Department of Oncology and Hematology, Martin Luther University seeking (0.09±0.47) and scanning (0.49±0.97) behaviors for CRC Halle-Wittenberg, Halle, Germany; 2Divisione di Oncologia Medica A, screening tests were low. Scanning behaviors was associated significantly National Cancer Institute, Aviano, Italy; 31.st Department of Medicine, and positively with education (r=0.193,p=0.002) and household income Semmelweis University Medical School, Budapest, Hungary; (r=0.185, p=0.003) and negatively with age (r=−0.344, p<0.001) while 4Department of Hematology, ICO-Hospital Germans Trias i Pujol Jose seeking behaviors was associated positively with education (r=0.221, Carreras Research Institute UAB, Badalona, Spain; 5Department of p<0.001) and negatively with age (r=−0.152, p=0.017). Diagnostic Clinical and Public Health Medicine, University of Modena Conclusions and Reggio Emilia, Modena, Italy; 6Division of Hematology, University The low levels of both scanning and seeking behaviors for CRC Hospital Centre Zagreb and Medical School University of Zagreb, Za- screening tests information in this elderly sample suggests a need greb, Croatia; 7Hematology Department, “Coltea” Clinical Hospital, to provide professional support to further promote effective health Bucharest, Romania; 8Hematology Department, Ryazan regional Clini- communication in this group. Healthcare professionals could focus cal Hospital, Ryazan, Russia; 9Hematology Unit, Azienda Ospedaliero their support on CRC screening tests to elders who very old and Universitaria Careggi University of Firenze, Firenze, Italy; 10Oddzial had low educational level. Hematologiczny, ZSM, Chorzow, Poland; 11 Hematology Department, Ivano- Frankivsk Regional Clinical Hospital, Ivano- Frankivsk, Ukraine; 12Department of Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; 13Department of Hematology, Pandy Kalman 14 MASCC-0259 Megyei Korhaz, Gyula, Hungary; Department of Internal Medicine- Communication 2 Hematooncology, University Hospital Brno, Brno, Czech Republic; 15Department of Internal Medicine Division of Hematology/Oncology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, THE ROLE OF STORYTELLING IN PERSON CENTRED CARE Ribeirão Preto, Brazil; 16Clinical Research, Menarini Ricerche, Firenze, B. Quinn1 Italy 1Cancer,Chelsea and Westminster NHS Foundation Trust, London, Unit- ed Kingdom Background and Aims TLS and renal events risk increases with sUA level, thus sUA control Background and Aims improvement is a key element in TLS prevention. Amidst the advances being made in medicine and medical tech- Objectives: To determine whether Febuxostat achieves a higher sUA nology, previous studies reveal that people facing illness need the control than Allopurinol while preserving renal function in patients with practitioner to engage with and to be sensitive to their humanity. hematologic malignancies at intermediate to high TLS risk. This study was based on the premise that a central component of Methods being human is the ability to engage with one’s story and to make In this phase III study 346 patients stratified for TLS risk grade and sense of that reality. It is this ability to create and make sense of baseline sUAwere 1:1 randomized to Febuxostat or Allopurinol starting story that makes humanity unique. from 2 days prior chemotherapy (CT) for 7–9 consecutive days. Treat- Methods ment was blinded, dose level was upon investigator’s choice among low/ This study explored people’s perceptions of living with cancer by inviting standard/high daily doses containing Allopurinol 200/300/600 mg or them to engage with telling their story through in depth interviews. fixed Febuxostat 120 mg. Primary endpoints: sUA area under curve Through the medium of storytelling and their own search for meaning, (AUC sUA 1−8), serum creatinine change from baseline to Day 8. Sec- each participant was asked to recall their experiences, including for some, ondary endpoints: response rate (sUA≤7.5 mg/dL from CTonset to Day the reality of moving towards their death. 8), laboratory and clinical TLS incidence and safety. Results Results Participants spoke of many profound life issues that had influenced their Study population (82.1 % of patients at intermediate TLS risk; 87.6 % experience of living and dealing with cancer, the treatments they had to baseline sUA≤7.5 mg/dl) was allocated to standard dose in 82.7 % of undergo and the care they received. All of the participants were able to patients. Mean AUC sUA1−8 for Febuxostat and Allopurinol was 514.0± describe times when those caring for them had not always heard their 225.71 and 708.0±234.42 mgxh/dl (p<0.0001). Mean serum creatinine concerns. A key finding from the study was the recognition that attending change for Febuxostat and Allopurinol was −0.83±26.98 % and −4.92± to storytelling in clinical practice is sometimes overlooked and yet it can 16.70 % (p=0.0903). No differences among secondary efficacy end- act as a doorway into understanding the needs of the person living with points. Adverse events at least possibly drug-related occurred in 6.4 % cancer. of patients in each arm. Conclusions Conclusions The study suggests that educating and supporting the clinical team to In the largest adult trial performed in TLS prevention, Febuxostat engage with and be attentive to the story of those they care for, has a achieved a significant superior sUA control with one fixed dose in central role to play in showing compassion and delivering person centred comparison to Allopurinol with comparable renal function preservation care. and safety profile. S38 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0196 The onset of hyponatremia (serum sodium <135 mEq/l) during the treat- Complications ment 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) 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 1Clinica 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 The occurence of hyponatremia during first line chemotherapy (cut-off Patients characteristics are summarized in table 1. 135 and 130 mEq/l) was significantly associated to a shorter median PFS Table 1. Patients characteristics. (p=0.0214). Results were also similar in subgroup receiving a second line treatment. At multivariate analysis, including haemoglobin and sodium level at the Characteristics Number of patients (%) beginning of first line chemotherapy, age, gender, smoking habit, job exposure and performance status, only hyponatremia resulted an inde- Total number=62 (100 %) pendent factor (p=0.029). Hyponatremia also resulted a predictive factor Age both in first-line chemotherapy, being related to poorer response to =60 14 (22.6 %) pemetrexed-based chemotherapy (p=0.047) and in second-line chemo- >60 48 (77.4 %) therapy (p=0.044). Conclusions Sex To our knowledge this is the first in study to evaluate the association of male 49 (79 %) hyponatremia on outcome of malignant pleural mesothelioma patients. female 13 (21 %) Early detection, close monitoring and management of hyponatremia are ’ Smoking recommended since they might improve the patient s prognosis. yes 37 (59.7) no 25 (40.3 %) Asbestos exposure MASCC-0339 Complications yes 41 (66.1 %) no 21 (33.9 %) IMMUNE GENETIC VARIABILITY IS ASSOCIATED WITH PS at diagnosis (ECOG) RISK OF SEVERE GASTROINTESTINALTOXICITY IN 033(53.2%)PATIENTS TREATED WITH FLUOROURACIL 124(38.7%)J. Bowen1, I. White2, S. Tuke3, R. Logan4, A. Richards5,K.Mead5,C. 2 4 (6.5 %) Karapetis6,J.Coller1 1 3 1 (1.6 %) Medical Sciences, University of Adelaide, Adelaide, Australia; 2Medicine, University of Adelaide, Adelaide, Australia; 3Mathematical Staging 4 Sciences, University of Adelaide, Adelaide, Australia; Dentistry, Univer- locally advanced 51 (82.3 %) sity of Adelaide, Adelaide, Australia; 5Medical Oncology, Flinders Med- metastatic 11 (17.7 %) ical Centre, Adelaide, Australia; 6Medicine, Flinders University, Ade- Histology laide, Australia epithelioid 42 (67.7 %) Background and Aims sarcomatoid 9 (14.5 %) The incidence of severe gastrointestinal toxicity (GIT) following fluoroura- desmoplastic 1 (1.6 %) cil 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 biphasic 5 (8.1 %) inflammation in GIT development, we conducted an immune-pathway unknown 5 (8.1 %) targeted approach to uncover genetic variation associated with toxicity. Objectives: Uncover associations between genetic variability in innate All patients received a first line Pemetrexed-based chemotherapy. A immune signaling, specifically Toll/Interleukin-1 receptor (TIR), on the second-line chemotherapy was administered to 31 patients. severity of GIT in patients treated with fluorouracil. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S39

Methods MASCC-0601 Adults treated with 5-fluorouracil or capecitabine were invited to Complications participate in the study. GIT data was collected from case note review. Genomic DNA was isolated from saliva and analysed for CLINICAL DETERIORATION IN THE AMBULATORY 21 TIR pathway alleles using a customised Sequenom MassArray SETTING – WHEN IS IT TIME TO ACT? assay. A general linear model of toxicity was created that included logistic regression with stepwise addition of factors including A. Fitzgerald1, J. Manning1, J. Campbell1 SNPs and patient characteristics. Receiver operator characteristic 1Clinical Services, Icon Cancer Care, Brisbane, Australia curves (ROC) determined the performance of the model in predicting GIT. Background and Aims Results Clinical deterioration is not selective and occurs across the cancer trajec- Thirty four patients participated in the study, of which 10 had tory. Recognising and promptly responding to its occurrence can be the severe GIT (Grade≥3 NCI CTCAE or necessitating a dose reduc- difference between life or death for the patients in our care. Icon Cancer tion). The model that included genetic variability in TLR2 Care is Australia’s largest private provider of haematology and oncology (rs1800629) and TNF (rs3804100) (individual variant P=0.049 day services in the outpatient ambulatory care setting with 6 day hospitals and 0.33, respectively) and cancer type was best related to severe located in two states across Australia. In an acute ambulatory setting GIT, such that the ROC % area under the curve from this model monitoring a patients progress is vital in ensuring any clinical deteriora- was 87.3 %. tion is recognised early and treated appropriately. Conclusions Methods Conclusions: This pilot study has shown that TLR2 with TNF variant Following a coordinated national consultation, Icon Cancer Care has genotype is predictive of severe GIT. This study is ongoing in a larger developed a unique advanced track and trigger nursing observation chart patient population and will be validated in a prospective trial. 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. MASCC-0045 Results Complications Track and trigger nursing observation chart developed for specific use in the acute ambulatory cancer care setting. Conclusions MANAGEMENT OF COMPLICATIONS IN MULTIPLE This paper will explore the initial research undertaken and discuss the MYELOMA (MM) difficulties in the development and trial process of this track and trigger A. Dimitrovska1,S.Crvenkova1,M.Pesevska1,L.Kostadinova1 nursing observation chart within an acute ambulatory cancer care setting. 1Limphoma and sarcoma, Institute of Radiotherapy and Oncology, Skop- je, Macedonia

Background and Aims MASCC-0412 The aim of the work is to examine the impact of supportive therapy Complications on the performance status and treatment outcome of pts suffering from MM. STUDY TO RETROSPECTIVELYANALYSE THE EFFECT OF Methods PRE-RADIOTHERAPY COUNSELLING IN HEAD AND NECK Histories of 124 pts with symptomatic MM were retrospectively CANCER PATIENTS GIVEN RADIOTHERAPY reviewed. Clinical signs, radiological and laboratory findings and the kind of supportive therapy were analyzed. D. Kumar1, M.C. Pant2,S.Singh2,J.P1,V.S1 Results 1radiotherapy, jipmer, pondicherry, India; 2radiotherapy, kgmc, lucknow, India The pain was the most dominant clinical sign in 84 % of pts. It was successfully managed by anti-tumor therapy, radiotherapy (RT) plus Background and Aims corticosteroids and only 15 (14 %) pts continued to take analgetics Introduction- Toxicities are an unwanted side effects of the radiation after completing the chemotherapy (CT). Osteolytic bone destruc- treatment and measures taken to reduce them forms an integral part of tions were treated with bisphosphonates and 78 % responded well. supportive care for the patients undergoing radiation therapy. The most prominent complication of bone disease was vertebral Objective-To analyse the effect of pre-RT counselling on radiotherapy collapse secondary to osteolytic lesions found in 78 (63 %) pts. induced toxicities (skin, mucosal, upper GI) and weight changes, if any in RT and/or surgery ensured good palliation and relieved the pain in patients who undergo radiotherapy. 85 % of pts. Hypercalcemia was present in 45 (36 %) pts and was Methods normalized with prompt rehydration, corticosteroids and i.v. Material and methods-110 Head and neck cancer patients who had re- bisphosphonates. Renal impairment, seen in 37 % of pts at presen- ceived radiotherapy were analysed for the radiation induced skin, oral tation was reversible in 75 % (34/46) after administration of i.v. mucosa and upper gastrointestinal reactions and weight changes developed fluids and CT. Only 3 patients were sent for dialysis at the time of during radiotherapy. RTOG toxicity criteria was used for documenting the diagnosis. Anemia was present in 65 % (81/124) and hemoglobin toxicities and weight changes during treatment were categorised into mild was less than 8 g/dl in 7 % of patients. After a 3–6 months eryth- (<5 % wt. loss of baseline), moderate (5–10 %) and severe as (>10 %). ropoietin treatment a response rate of 77 % (62/81) was achieved. Results were analysed statistically using chi square test for trend. 10 % of MM pts required antibiotics due to repeated bacterial Results infections. Results-80 (72.72 %) patients had received counselling prior to start of Conclusions radiotherapy and 30 (27.27 %) patients had skipped the pre-RTcounselling Our results confirmed that efficient management of disease and therapy- due to unknown causes.7 patients defaulted during treatment (2 from induced complications in MM improve patients’ well being and probably counselled and 5 from non counselled patients). Thus 78 counselled and prolong the survival rate. 25 not counselled were analysed. The counselled patients had developed less S40 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 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 OFANASTOMOTIC LEAKS G. Milito1, G. Lisi1 1General Surgery, Policlinico TorVergata 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. Conclusions Methods The Endosponge seems an effective minimally invasive procedure to treat Between January 2005 and December 2013, 12 patients with anastomotic extraperitoneal anastomotic leakage without reintervention reducing mor- leakage following low anterior resection and neoadjuvant radiochemother- bidity and mortality. apy 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 MASCC-0512 was performed in every patients. The diagnosis of anastomotic leakage was Complications 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× CO-MORBIDITIES IN ELDERLYBREAST CANCER AND 55 mm and 85×50 respectively. The median duration of therapy was LUNG CANCER PATIENTS WHO RECEIVE 35 days (range 16–51), with a 8–15 sponge exchanges for patient. Median CHEMOTHERAPY OF NCCN DEFINED INTERMEDIATE – healing time was 59 days (range 32–65). No intraoperative complications (10 20 %) RISK OF FEBRILE NEUTROPENIA were recorded. 5 cases of mild anal pain successfully treated medically J.H. Page1,S.Li2, J. Molony2, R. Sosa3, R. Barron4,P.K. Morrow5,S. Stryker6,J.Liu2,A.J.Collins2, J. Acquavella7 1Center for Observational Research, Amgen Inc., Thousand Oaks, USA; 2Chronic Disease Research Group, University of Minnesota, Minneapo- lis, 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 Re- search, Amgen, Thousand Oaks, USA

Background and Aims Introduction: Febrile neutropenia/hospitalizations for infections (FN) are serious potential complications of myelosuppressive chemotherapy treat- ment in cancer patients. Previous research suggests that certain comor- bidities are associated with higher risk of FN. Little is known about the comorbidity burden in elderly patients taking NCCN defined FN inter- mediate 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. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S41

Results Background and Aims During the first course, 1686 (9.6 %) patients with BC (total 17512) and Chemotherapy-induced febrile neutropenia (CIFN) is a major complica- 10 961 (43.1 %) patients with LC (total 25422) used an IR regimen. Of tion of chemotherapy. the comorbidities investigated, diabetes, thyroid disease and anemia were To describe the use of a G-CSF (Tevagrastim) in primary (PP) and the most common among BC patients on IR regimens (table). The most secondary prophylaxis (SP) of CIFN in routine medical practice. common among LC patients were chronic obstructive pulmonary disease, Methods atherosclerotic heart disease, and diabetes. Prospective, observational, French cohort study of patients>18 years Table. Distribution of Comorbidities in Breast Cancer or Lung Cancer with hematologic malignancy (HM) or solid organ tumor (SOT). patients on Chemotherapy regimens associated with intermediate risk of Results FN in Medicare. One hundred seventy-eight investigators (58 % oncologists, 28 % hema- tologists, 12 % pulmonologists) included 882 patients: mean age: 63.5 years (50 % over 65), ECOG 0 or 1: 87 %, distant metastases: Breast Cancer Lung Cancer 48.3 %, HM 239, lung cancer 190, other SOT: 452. The risk of CIFN Characteristics n (%) n (%) was>20 % and 10–20 % in 19.5 % and 46 % of cases respectively. To t a l N u m b e r 1,686 10,961 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 Demographics (Table 1) but differed between HM and SOT patients (Table 2). Age, years Tevagrastim was self-injected by 12.6 % of patients at the end of the 65–69 434 (25.7) 2,734 (24.9) study. 70–74 475 (28.2) 3,426 (31.3) Ta bl e 1 : 75–79 388 (23.0) 2,700 (24.6) 80+ 389 (23.1) 3,409 (31.1) 1st cycle 2d cycle 3rd cycle 4th cycle 5th cycle Female sex 1,666 (98.8) 5,089 (46.4) Time between 4.2±2.6 4.3±2.5 4.2±2.6 4.1±2.6 4.1±2.7 Co-existing comorbidities CTand Atherosclerotic heart disease 211 (12.5) 2,948 (26.9) tevragrastim Anemia 246 (14.6) 1,900 (17.3) (days) Cardiac Arrhythmia 212 (12.6) 2,076 (18.9) Duration of 5.4±2.1 5.4±2.0 5.3±1.9 5.2±1.7 5.2±2.8 tevagrastim Cerebrovascular disease 61 (3.6) 698 (6.4) (days) Chronic obstructive lung disease 213 (12.6) 5,677 (51.8) Congestive heart failure 118 (7.0) 974 (8.9) Diabetes 389 (23.1) 2,375 (21.7) Ta bl e 2 : Liver disease 14 (0.8) 99 (0.9) Osteoarthritis 192 (11.4) 1,036 (9.5) HM SOT p Peptic ulcer disease 12 (0.7) 112 (1.0) Time to tevagrastim administration (days) 6.1±3.3 3.9±3.2 <0.0001 Peripheral vascular disease 124 (7.4) 1,604 (14.6) Duration of treatment (days) 5.7±2.6 5.3±1.8 0.031 Other cancer 108 (6.4) 774 (7.1) PP 87.0 % 75.4 % 0.0002 Chronic renal disease 111 (6.6) 978 (8.9) G-CSF from first cycle 89.5 % 70.3 % <0.0001 Rheumatoid arthritis 38 (2.3) 242 (2.2) Conclusions Thyroid disorder 258 (15.3) 1,174 (10.7) Tevagrastim was prescribed mostly in PP, 4.2 days after chemotherapy, with a mean duration of 5.3 days. Conclusions Over 20 % of elderly patients with BC or LC treated with an IR regimen have a clinically important comorbidity, previously shown to be associ- ated with increased risk of FN. MASCC-0565 Decision-Making

MASCC-0269 ANTICANCER DRUGS-INDUCED ARTHRALGIA: WHAT Complications MANAGEMENT ? L. Vanlemmens1,F. Debiais2,F. Farsi3,A.Brunet3,M.Vieillard4 USE OFA GCSF BIOSIMILAR UNDER REAL-LIFE 1Disspo, Centre Oscar Lambret, Lille, France; 2Rhumatologie, chu Poi- CONDITIONS IN PRIMARY OR SECONDARY PROPHYLAXIS tiers, Poitiers, France; 3Résau Espace Santé Cancer Rhône-Alpes, Résau OF CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA: Espace Santé Cancer Rhône-Alpes, Lyon, France; 4Centre Oscar RESULTS OF THE ESTIM STUDY Lambret, Centre Oscar Lambret, Lille, France M. Spielmann1,M.Hacini2, C. Audigier-Vallet3,P. Quittet4, L. Damaj5, M.I. Belkaid6,F. Savinelli7 Background and Aims 1Oncology, Institut Gustave Roussy, villejuif, France; 2Oncology, Centre The musculo skeletal disorders induced by anticancer drugs are often hospitalier, Chambéry, France; 3Oncology, Hôpital Ste Musse, Toulon, underestimated by clinicians. Yet, they can sustainably alter quality of life France; 4Oncology, Hôpital St Eloi, Montpellier, France; 5Oncology, of patients. Hôpital Sud, Amiens, France; 6Oncology, Hôpital Louis Pasteur,Colmar, The majority of available literature data concerning arthralgia related to France; 7Oncology, Hôpital St Joseph, Paris, France treatment with aromatase inhibitors and taxanes. S42 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

We found useful to work on this issue that require multidisciplinary care development and pooling of guidelines for clinical practice. AFSOS and support throughout the care pathway in order to elaborate recom- collaborates with the French Society of Psycho-Oncology for topics mendations for management of musculo skeletal disorders in the context regarding Psycho-Oncology. of cancer. Professionals are encouraged to form interregional workgroups Methods which benefit from logistical framework of Regional Cancer The Francophone Association of Supportive Care in Oncology networks. (AFSOS) encourages collaboration between regional cancer net- The development of a consensus involves several steps: works for development of reference document for clinical practice 1. Literature review; identification of existing tools and pooling them. 2. Meetings of the Workgroup: development of a plan, complete the Professionals are encouraged to form interregional workgroups content, formatting. which benefit from logistical framework of Regional Cancer 3. networks. Presentation in workshops during days dedicated to sharing support- The development of a consensus involves several steps: ive care guidelines (J2R) 4. 1. Literature review Validation during plenary meeting. 2. Meetings of the Workgroup: Development of a plan, complete the Results content, formatting. Guidelines, recalling : – ’ 3. Presentation of the referential in workshops during days dedicated to the impact of psychotic disorders on patient s adjustment sharing supportive care guidelines (J2R). – the main clinical diagnosis 4. Validation during plenary meeting. – the differential diagnosis Results – Some legal aspects: informed consent, legal protection… & A pragmatic guideline, which distinguishes the different clinical – Practical recommendations for symptom management and coordi- syndromes: joint, tendon, tunnel… nation of care & Approach by molecule/incidence – Pharmacological considerations for the use of neuroleptics and & Presentation of symptoms: clinical presentation, duration, risk fac- antipsychotics in oncology tors, predisposing factors Conclusions & proposal of symptoms management : These guidelines will be made available through the AFSOS and the – SFPO website, and useable for training of both the oncological and Assessment of the severity of the symptoms psychiatric teams. – Interest of biology and imaging – Therapeutic approach: Global approach, medicamentous approach, non-medicamentous approach. Conclusions These guidelines will be made available through the AFSOS MASCC-0623 (www.afsos.fr) and the SFPO (www.sfpo.fr) website, and useable for Decision-Making training of both the oncological and psychiatric teams. LONG-TERM VENOUS ACCESS: AFSOS GUIDELINES D.S. Kamioner1,I.Kriegel2,F. Farsi3 1Onco hématologie, Hôpital Privé de l’Ouest Parisien, Trappes, France; MASCC-0409 2Anesthésie, Institut Curie, Paris, France; 3Réseau Espace Santé Cancer Decision-Making Rhône-Alpes, Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France

IMPROVEMENT OF COMPREHENSIVE CANCER CARE FOR PATIENTS WITH PSYCHOTIC DISORDERS Background and Aims M. Reich1, S. Dauchy2,F.Farsi3 Repeated venipuncture is often aggressive, painful and sometimes dan- 1psychooncologie, Centre Oscar Lambret, Lille, France; gerous, especially with the risk of severe extravasation during the admin- 2psychooncologie, Institut Gustave Roussy, Villejuif, France; 3Réseau istration of anticancer chemotherapy. Espace santé Cancer Rhône-Alpes, Réseau Espace santé Cancer Externalized central catheters (ECC) are less frequently used and Rhône-Alpes, Lyon, France currently reserved for special situations: such as short chemothera- py treatment (< 3 cycles), terminal palliative care and intensive Background and Aims care. Internal CC can be used for chemotherapy, infusions, trans- Psychoses are a group of psychiatric conditions that are accompanied by a fusions, blood samples and administration of various medications significant psychosocial disability that may interfere with cancer care and or parenteral nutrition requiring repeated access to the venous patient’s adjustment. system. Cancer mortality in psychotic patients is higher than in general popula- Instructions for the device must be observed according to the rules tion, due notably to delays in diagnosis, cumulation of cancer risk factors defined by tracing items (Code of Public Health). and difficulties in access to somatic care. To treat cancer patients with Methods psychotic disorders is a challenge both for the oncological teams and the In accordance with AFSOS’ methodology, an inter-regional multidis- psychiatric teams. Common guidelines are necessary to improve carers ciplinary group composed of physicians and caregivers has been set- formation and strengthen multidisciplinary care. up. This latter conducted a review of the literature, defined the Methods methodological approach and developed a work plan. As a result of The Francophone Association of Supportive Care in cancer (AFSOS) this collective effort, recommendations are identified and presented encourages collaboration between regional cancer networks for during during days dedicated to sharing supportive care guidelines Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S43

(J2R). These recommendations are discussed in workshop and ap- MASCC-0178 proved in plenary session. Decision-Making Results Pragmatic guidelines to manage long-term venous devices. IDENTIFICATION OF PROGNOSTIC VALUE OF Conclusions NEUTROPHIL-TO-LYMPHOCYTE RATIO(NLR) IN PATIENTS The use of implanted catheters with subcutaneous chamber has grown WITH ADVANCED HEPATOCELLULAR CARCINOMA(HCC) considerably and it is important to prevent the trivialization of these techniques so as to avoid complications that can sometimes be very Z. Chen1,L.I.XY1,D.O.N.G.min1,L.qu1,M.xiaokun1,W.U.xiangyuan1 severe (Fig. 1). 1Onclogy Department, The third affiliated Hospital of Sun Yat-Sen Uni- versity, Canton, China

Introduction: Neutrophil-to-lymphocyte ratio (NLR) was considered to be an independent predictor of survival after hepatectomy in MASCC-0563 patients with HCC. No study had focused on its role in advanced Decision-Making HCC patients. Objectives: To assess NLR’s prognostic value and its related factors in MANAGEMENT OF MALIGNANT BOWEL OBSTRUCTION IN advanced HCC patients. DIGESTIVE CANCERS: GUIDELINES OF THE FRENCH Methods: From September 2008 to June 2010, a total of 219 patients SUPPORTIVE CARE ASSOCIATION with advanced HCC without fever or signs of infections were analyzed. S. Toussaint1, D. Tougeron2, C. Cervi3, A. Hutin-Brissot4, A. Parot- Clinicopathological parameters, including NLR, were evaluated to iden- Monpetit4, K. Le Gallou5,V.Block6 tify predictors of overall survival. Univariate and multivariate analyses 1Office d’hygiène sociale, Office d’hygiène sociale, Nancy, France; were performed, using the Cox proportional hazards model. The best 2Gastro entérologie, chu Poitiers, Poitiers, France; 3Chirurgie digestive, cutoff was determined with time-dependent receiver operating character- Ch Camille Gérin, Châtellerault, France; 4Centre Eugène Marquis, istic curve. Centre Eugène Marquis, Rennes, France; 5Hôpital privé Océane, Hôpital Results: Univariate and multivariate analyses showed that NLR was an privé Océane, Vannes, France; 6Réseau oncolor,Réseau oncolor,Nancy, independent prognostic factor in overall survival in patients with ad- France vanced HCC. The best cutoff point of NLR was 2.58. NLR>2.58 pre- dicted poorer overall survival (OS) compared with NLR10*10e9/L, AFP>400 ng/ml,KPS 50, without portal vein thrombus, distant metasta- Background and Aims sis and tumor size lesser than half of the liver. Malignant bowel obstruction (MBO) is a relatively common com- Conclusion: NLR is an independent prognostic factor of advanced HCC plication in advanced cancer patients with abdominal or pelvic patients. Higher Baseline NLR levels indicates poorer prognosis. 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 MASCC-0035 goals: Decision-Making – optimize patient comfort ’ – ASURVEYOFOLDERPEOPLES ATTITUDES TOWARDS improve the management. ADVANCE CARE PLANNING Methods 1 2 3 These guidelines were based on a review of previous and recent I. Musa , S. Conroy ,J.Seymour 1 literature and expert opinion. As an example, recent studies, which Geriatrics, University Hospitals of Leicester NHS trust, Leicester,United 2 confirmed the efficacy of somatostatin analogues, were included in Kingdom; Geriatrics, University of Leicester,Leicester,United Kingdom; 3 the study. Palliative Care, University of Nottingham, Nottingham, United Kingdom Results – Diagnosis of occlusion due to peritoneal cancer is difficult, and Background and Aims should be based on CT-scan. ’ – Advance care planning (ACP) is a process to establish individual sneeds, As there is no longer strong level of evidence on therapy preferences and goals of care but few UK studies have been conducted to used, we clarified the use and combination of therapeutics ascertain public perspectives. The aim of this study was to assess the such as : glucocorticoids, antiemetic agents, analgesic and attitudes of people aged ≥65 in a large mixed urban and rural area of the antisecretory agents (anticholinergic drugs, somatostatin ana- UK through the development and application of a validated survey. logues) by referring at the story of the disease: pathology Methods ’ ’ stage, WHO or Karnofsky s grading, geriatric s evaluation, Focus groups generated the domains of questioning, building on a previ- comorbidities, nutritional status (BMI), specific therapeutic ously validated US survey and refining using key stakeholders. The ’ project, and patient swishes. adapted survey was then sent out to older people in Leicestershire and – Nasogastric tube feeding is no longer used routinely and its use Nottinghamshire. should be discussed on a case-by-case basis. Results Conclusions The response rate was 34 %. The median age was 73 years and 59 % were This proposition was carried out as a global multidisciplinary approach women. Most were functionally independent, Caucasian and of Christian between teams of oncologic supportive cares and palliative cares. Guide- faith. lines have been proposed by the French supportive care association for a Thirteen percent of respondents had prepared an ACP document with 4 % successful management of malignant bowel obstruction in digestive completing an Advance Decision to Refuse Treatment (ADRT). 5 % of cancers. respondent’s stated that they had been offered an opportunity to talk about S44 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

ACP. Predictors of completing an ACP document included: being MASCC-0078 offered the opportunity to discuss ACP, older age, better physical Decision-Making function and male gender. Eighty five percent preferred to just have a discussion rather than write anything down. Levels of trust were SIGNIFICANCE OFAGE AND COMORBIDITY IN THE higher for families than for professionals with 35 % of respondents MANAGEMENT DECISION-MAKING IN EARLYSTAGE being worried that doctors would stop treatment too soon if they had PROSTATE CANCER an ACP. Only 33 % would be interested in talking about ACP if sessions were available. J. Oh1,J.Davis2, K. Hoffman3,S.Wen4, S. Taylor5,S.Doshi1,R.Jakkoju1, Conclusions S. Suman1,R.Day6,J.Kim7 Although most respondents were in favour of Advance Care 1Dept. of General Internal Medicine, UT MD Anderson Cancer Center, Planning, a relative minority had actively engaged. Preferences Houston, USA; 2Dept. of Urology, UT MD Anderson Cancer Center, were for informal discussions with family and friends rather than Houston, USA; 3Dept. of Radiation Oncology, UT MD Anderson Cancer professionals. 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 MASCC-0306 Oncology, UT MD Anderson Cancer Center,Houston, USA Decision-Making Background and Aims PALLIATIVE SURGERY IN ADVANCED COLORECTAL Comorbidities, associated with all-cause mortality,should be an important CANCER. WHAT WE SHOULD KNOWABOUT DECISION factor in prostate cancer (PC) management decision making. This study MAKING? aimed to describe the relationship between the severity of comorbidities and management decision-making of clinically localized prostate cancer. M. Nowacki1,K.Pietkun2, K. Nowacka2, J. Siminska2, I. Glowacka3,W. Methods Zegarski3 Twohundred twenty-six patients with clinically localized Prostate Cancer 1Tissue Engineering Department, Ludwik Rydygier Collegium Medicum (PC), enrolled in a prospective cohort study of Active Surveillance (AS) in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, between 2/1/2006-12/31/2008, were compared to 592 PC patients, iden- Poland; 2Rehabilitation Clinic Department of Health Sciences, Ludwik tified by chart review, who received active treatment (AT), matched by Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus Uni- clinical stage (T1/T2), prostate-specific antigen (PSA) level (<10 ng/mL), versity in Torun, Bydgoszcz, Poland; 3Surgical Oncology Department, Gleason score (7 [3+4] or less), and inclusion of AS option during Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus management discussion. Severity of comorbidities was scored using University in Torun, Bydgoszcz, Poland Adult Comorbidity Evaluation 27 index. Multivariate logistic regression was used. Background and Aims Results The number of yearly performed colorectal cancer surgeries with Moderate/severe comorbidities were present in 52 (23.0 %) in AS group non-curative character is still growing. But as it has been mentioned and128(21.6%)inATgroup(p=0.74). Older age was the only covariate by many authors the term paliative is very often used subjectively. associated with AS (p<0.001). Higher clinical stage and Gleason score 7 The decision-making procedure is still very controversional and not (p <0.0001), white race (p 0.008), family history of PC in first-degree fully described. The aim of our work was the systemic collection of relative (p 0.015), and higher baseline PSA (p 0.029) were associated current published opinions and recommendations related to the with higher likelihood of receiving AT. decision-making process of palliative surgery in patients with ad- Conclusions vanced stage of colorectal cancer. In previous studies comorbidities has been associated with mortality in Methods prostate cancer patients. However, in this study,the decision for AS versus In our study we have systemically and critically analyzed scientific ATwas associated to clinicopathologic risk features and family history of data published in the last 10 years, fully relating to the subject of PC, while severity of comorbidities was not a significant factor. Despite potential palliative surgery interventions which could be performed our study limitations, findings underscore the need for real-time measure- in patients with the end stage colorectal cancer. In this study we have ment of comorbidities and the importance of better integration of comor- especially analyzed the detailed indications, surgical procedures bidities in management decision making in patients with prostate cancer. types, their potential effects and benefits or their side effects and complications. Results There are now some clear guidelines relating to the palliative surgery MASCC-0460 procedures including interventional management of patients with ad- Decision-Making vanced colorectal cancer. But their use is still problematic and not so popular, especially in non-specialized colorectal cancer units. In our work “JUST BEAR WITH IT”:MEN’S EXPERIENCES WITH SIDE we have presented the proper specific indicators of conduct and observa- EFFECTS OF SHORT-TERM ANDROGEN DEPRIVATION tion times. THERAPY FOR INTERMEDIATE-RISK PROSTATE CANCER Conclusions The term palliative surgery should be used only when the performed R. Volk1,S.Cantor2,S.Linder1,S.Saraykar1, K. Hoffman3 procedure is based onto the latest and currently existing recommendations 1General Internal Medicine, The University of Texas MD Anderson and schemes created by the relevant and representativesurgical oncology Cancer Center,Houston, USA; 2Health Services Research, The University associations and societies. Paliative surgery interventions should be al- of Texas MD Anderson Cancer Center,Houston, USA; 3Radiation Oncol- ways undertaken only in very specific cases when there are clinical ogy Department, The University of Texas MD Anderson Cancer Center, indications. Houston, USA Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S45

Background and Aims cancer and their family before any intervention could be undertaken. Optimal management of men who receive external beam radiation ther- It was clear from the data that parents and their sick adolescent first apy for intermediate-risk prostate cancer remains uncertain. The addition needed to make decisions in complicated situations, such as choos- of short-term androgen deprivation therapy (ADT) to dose-escalated ing a hospital, living in a paediatric ward, treatment strategies and radiation therapy has been suggested, but men are often reluctant to schooling. It is noteworthy that the sick adolescent and their family accept ADT because of its impact on quality of life. As an initial step needed support from different sources as a way of confronting the toward developing decision support interventions for men with broken chain of family life. intermediate-risk prostate cancer, we explored men’s experiences with Conclusions short-term ADT. This goal supports families to regain harmony when life threatens Methods family life balance. The findings have implications for Taiwanese Semi-structured interviews were conducted with 11 patients 54–72 years families in perceiving, adjusting to and fulfilling the altered rela- of age nearing completion of a 6-month course of ADT at a large tionships associated with caring for an adolescent with cancer at comprehensive cancer center. The interviews addressed six treatment- home. related 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 MASCC-0619 lower energy and needing more sleep. Some men used the treatment Dental Care period as time to increase their physical fitness. Overall men did not differentiate loss of libido from erectile dysfunction. Others described the ORAL MANIFESTATIONS FOLLOWING TREATMENT OF mechanical nature of manipulating an erection or taking medications for CANCER OF THE GI TRACT- A RETROSPECTIVE erectile dysfunction as unpleasant, while expressing concerns that they OBSERVATIONAL STUDYAT THE HOSPITAL OF S. ‘use it or lose it.’ Men who were sexually active before treatment TEOTÓNIO expressed a hope-filled expectation that functioning would return after 1 2 treatment was completed. A.C. Moreira , R. Amaral Mendes 1Institute of Health Sciences - Department of Oral Medicine and Oral Conclusions 2 The side effects of ADT, while bothersome, appear to be manage- Oncology,The Catholic University of Portugal, Viseu, Portugal; Institute able. For sexually active men, loss of libido and erectile dysfunction of Health Sciences - Department of Oral Medicine and Oral Oncology, are distressing and they expect function will fully return after The Catholic University of Portugal and University of Michigan, Viseu, treatment. Portugal Background and Aims The overall incidence of cancer has increased substantially over the last MASCC-0020 decades. The oral cavity is one of the locations where side effects usually Decision-Making occur, namely mucositis, changes in salivary glands, rampant caries, bleeding caused by blood dyscrasias, osteoradionecrosis and osteochemonecrosis. MAKING DECISIONS IN COMPLICATED SITUATIONS FOR Purpose: To assess the main oral manifestations of cancer treatment. ADOLESCENTS WITH CANCER AND THEIR FAMILIES Methods L. Yeh1,S.Henderson2,U.Kellett2 A retrospective observational study was performed. Records from 1Nursing, Kang Ning Junior College of Medical care and Management, patients undergoing chemotherapy in the Hospital of S.Teotónio, Taipei City, Taiwan; 2Nursing, Griffith UNiversity, Bribsane, Australia Viseu, were retrieved from the Hospital files and reviewed. Patients were observed and questionnaires were applied. Tumor type, stage, Introduction therapeutic regimens, and oral manifestations were determined. Sta- The adolescent with cancer and their family had to confront long tistical analysis was performed using SPSS 18.0. Fisher’s exact test term life-threatening therapy and follow-up procedures. While the and the correlation matrix were used to check the existence of sick adolescent was moving in and out of the hospital, waiting correlation between the variables. Data were considered statistically and receiving diagnosis and undergoing treatment periods, the significant if p<0.05. parents and family members needed to make decisions to maintain Results sick adolescent’s safety and progress through the course of the A sample of 30 patients was assessed. Half of them (n=15) were diag- treatment. nosed with stage IV cancer. The most common tumor was colorectal, Aims affecting 63.3 % (n=19). The most frequent treatment protocols were This study explores the processes undertaken by family members in Folfox (40 %, n=12) and Folfiri (20 %, n=6), both administered for making decisions for adolescents with cancer within the Taiwanese colorectal tumor. On average, each patient presented 1.87 (± 1.22) oral society. manifestations, with xerostomia being the most common, followed by Methods oral mucositis. From the study sample, 30 % (n=9) underwent oral Seven families (27 participants) were recruited from a medical monitorization although only 4 patients (13.3 %) have been advised to hospital in Taiwan. Data were collected by qualitative interviews visit their dentist. and analysed following Strauss and Corbin’s Grounded theory Conclusions methodology. Assessment and subsequent monitorization of the oral status before, Results during and after cancer treatment is of utmost importance in order to Making decisions in complicated situations was instigated to reduce the side effects and improve overall quality of life of cancer confront the broken chain of family life of the adolescent with patients. S46 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0592 them were within 2 month after surgery and two of them spent more than Dental Care 1 year after surgery. We measured the distance between upper and lower incisors and evaluated the efficiency after 6 month opening training. Results DENTAL SCREENING OVERVIEW OF 187 HEAD-NECK Patients with in 2 month showed improvement of mouth opening. The ONCOLOGY PATIENTS; A RETROSPECTIVE STUDY mean of improvement was 20.3 mm in this group after 6 month. The other K. Bektas-Kayhan1, G. Karagoz1,C.Özbek1, O. Yazicioglu2,E. group did not indicated improvement. Çiftçibasi2,M.Altun3,M.Ünür1 1Oral 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– Decem- ber 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)ofthe 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)and2.7% (n=5) respectively. Conclusions The anectodal statement that head neck oncology patients had poor oral Conclusions health at the time of oncologic diagnosis was assessed in this retrospective The device we used in this report could be useful for the patients just after review and found to reflect facts for this study population. The long term surgery. However, it could not work for long-term patients. follow up after appropriate pretherapy dental management is required to prevent risk of osteonecrosis for this group of patients.

MASCC-0607 Dental Care MASCC-0572 Dental Care REFLECTORY TRISMUS IN HEAD AND NECK CANCER AND MOUTH OPENING TRAINING DEVICE FORTRISMUS AFTER PRECANCEROUS PATIENTS SURGERY OF HEAD AND NECK CANCER S. PS1,M.P. Mohan1,H.PS2 E. Yoshida1, R. Hosokawa1,M.Dodo1, H. Suenaga1, M. Sugazaki1,T. 1Oral Medicine, Mar Baselios Dental College, Cochin, India; 2Oral Kato1, T. Tamahara1,M.Ono2,E.Ito1, S. Yamazaki2,T.Koseki1 Medicine, Government Dental College, Calicut, India 1Graduate School of Dentistry, Tohoku University, Sendai, Japan; 2University Hospital, Tohoku University, Sendai, Japan Background and Aims Objective: To assess the restricted mouth opening in patients undergoing Background and Aims treatment for head and neck cancers and precancers Trismus is one of severe side effects after surgery in head and neck region. BACKGROUND: cancers of the retromolar area, buccal mucosa, and Patients after cancer therapy complain many problems related to trismus posterior oral cavity would trigger the reflexes for the restricted mouth such as eating, drinking, talking, and keeping oral hygiene. Therefore opening. Patients with oral pre cancer and cancer can develop restricted mouth trismus make Quality of Life of patient deteriorated substantially. Mouth opening because of the lesion present and due to biological cancer treatment. opening training is critical for prevent trismus. Thus several Jaw-opening Methods devices have been developing. These deices basically develop hinge Patients diagnosed as precancers and cancers clinically and histopatho- movement of mandible. logically were assessed for the maximal mouth opening and restricted Aim of this report is to evaluate new device, which can induce complex mouth opening. These patients had undergone assessment at regular movements of mandible. intervals for the next 6 months when undergoing treatment. Assessed Methods together with risk factors including quality of life for the prediction of The opening device we used is Kaikun (Tokyo Shizai, Tokyo, Japan). trismus after treatment in patients with cancer of the head and neck. It was This device develops complex movements because of two shell shapes a longitudinal study of 90 patients accepted for primary treatment who (Figure). We applied this device for five patients after surgery. Three of attended the Oral medicine clinic of a tertiary referral centre. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S47

Results 1Department of Medicine, Vanderbilt University Medical Center, Nash- In precancers and cancers of the posterior oral cavity had a significant ville, USA; 2Oral Medicine Services Otolaryngology and Head and Neck restricted mouth opening at baseline, these subset of patients were more Surgery, City of Hope National Medical Center Samuel Oschin Compre- prone to post treatment restricted mouth opening. In every patient, mouth hensive Cancer Institute Cedars-Sinai Medical Center,Los Angeles, USA; opening decreased after treatment. Tumor location, tumor size, and alco- 3College of Dentistry Dept of Diagnostic Sciences and Oral Medicine, hol consumption had independent effects on mouth opening. University of Tennessee Health Sciences Center, Memphis, USA; Conclusions 4Division of Dentistry Dept of Oral and Maxillofacial Surgery, Vanderbilt Cancers and precancers of the retromolar area, buccal mucosa, and University Medical Center,Nashville, USA; 5Dept of Oral and Maxillo- posterior oral cavity would trigger the reflexes present in the maxillofacial facial Radiology, University of Texas Health Science Center San Antonio, area, which resulted in restricted mouth opening at baseline. And post San Antonio, USA; 6Dept of Oral Diagnosis, University of Campinas operative radiotherapy of maxillary and mandibular tumor involvement is (UNICAMP) Piracicaba Dental School, Piracicaba, Brazil; 7Dept of the highest contributing risk factors in such patients. Biostatistics Schools of Medicine and Nursing, Vanderbilt University Medical Center,Nashville, USA

Background and Aims MASCC-0305 Data pertaining to the prevalence, severity and optimal management of Dental Care 2 oral health complications from Head and Neck Cancer (HNC) and its treatment is critical but lacking. This is partly due to lack of standardized PROSTHETIC OBTURATOR AS ALTERNATIVE TREATMENT: tools that capture key oral health outcomes (OHO) pertinent to the HNC ACASEREPORT population. Methods R. Carles1,R.Àlvar1, K. Omar1, G. Laia1,C.Paul1,J.Enric1, L. José1 Based on a literature review and panel of experts, we undertook devel- 1Dentistry, University of Barcelona, Barcelona, Spain opment of an Oral Health Evaluation Tool (OHET) and Panoramic Radiograph Evaluation Tool (PRET) for use in clinical trials, clinical Background and Aims databases and routine dental care. The tools were tested in a pilot trial The head and neck cancer represents 5 % of the total tumor pathologies of 50 HNC patients treated with chemoradiotherapy.All patients received and the most frequent cause is tobacco and alcohol abuse. The most an oral health assessment by the study dentist, salivary flow, inter-incisal common is oral squamous cell carcinoma (90 %). These tumors tend to be opening measurements and a panoramic radiograph. Data was collected aggressive and with a high growth potential in areas where surgery leaves using OHETand PRET. large consequences, both functionally and aesthetically and psychologi- Results cally, that if not solved, quality of life of patients will decrease. The dentist found both tools easy to use. Upon data review by the A rewarding solution for rehabilitation in patients with maxillary defects expert panel, minor modifications were made to the OHET to ensure are prosthetic obturators. clarity and consistency of captured data. PRET underwent significant Most tumors requieres either a partial or radical maxillectomy. The modifications following preliminary testing by two dental oncolo- amount of soft palate included in ressections is variable and depends on gists and two dental radiologists. Of the 20 original PRET questions, the site and extension of the tumor. 13 had high concordance (>97 % agreement) and were retained in Postsurgical maxillary defects predispose the patients to hypernasal unmodified format. Two items were deleted, one item added and five speech, fluid leakage into the nasal cavity, impaired masticatory function, items modified. and, in some patients, various degrees of cosmetic deformity. Conclusions The oral disabilities, are minimized or eliminated almost immediately The combined use of OHET and PRET provides a comprehensive, with obturation. reproducible, inexpensive and easy tool to capture data on oral health The maxillary resection prostheses also reduces the cosmetic deformity by status. Further testing in a larger patient population is ongoing. These suppling the missing teeth and by properly supporting the upper lip and cheek. tools have the potential to reduce subjectivity, increase sensitivity, and Methods improve monitoring for adverse OHOs. 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 resec- MASCC-0142 tion, the patient has a defect in the soft palate and pharyngeal wall Dental Care 2 lateroposterior issue making a prosthetic obturator. Conclusions PALLIATIVE DENTAL CARE FOR METASTATIC BREAST If there are teeth or alveolar ridge after the resection that provides support, CANCER PATIENTS DURING ACTIVE ANTICANCER stability and retention, for the obturator prostheses, then, surgical recon- TREATMENT struction should be reconsidered. S. Oh1, W.S. Park1,S.Lee2 1Advanced general dentistry, Yonsei University College of Dentistry, Seoul, Korea; 2Internal Medicine, Yonsei University College of Medicine, MASCC-0123 Seoul, Korea Dental Care 2 Background and Aims To investigate the dental status of MBC patients during anticancer ther- DEVELOPMENT OF TOOLS FOR THE ORAL HEALTH AND apy, the palliative dental procedures, demographic and clinical data as PANORAMIC RADIOGRAPH EVALUATION OF HEAD AND potential risk factors for development of dental problems. NECK CANCER PATIENTS: A METHODOLOGIC STUDY Methods L.K. Jackson1, J.B. Epstein2, C.A. Migliorati3,J.Rezk4,W.H.Shintaku3, A total of 67 MBC patients underwent dental examination during active M.E. Noujeim5, A.R. Santos-Silva6, M.S. Dietrich7, B.A. Murphy1 anticancer treatment from Mar 2012 to Decr 2013. Through critical S48 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 pathway, MBC patients were treated by palliative dental procedures MASCC-0312 considering their disease control status and anticancer treatment schedule. Dental Care 2 Results The median age was 54 years and the time between MBC diagnosis AUTOFLUORESCENCE AND DIAGNOSTIC ACCURACY OF to dental consultation was 65 months. Fifty-four patients (79.4 %) LESIONS OF ORAL MUCOSA. A PILOT STUDY had bone metastasis and 48 (70.6 %) had received at least one infusion of bisphosphonate therapy. Although well controlled status A. Rosello1, J. Rosello1, G. Judin1,C.Ros1,E.Jané1,J.Lopez1 in HR positive and HER2 positive subtype, TNBC patients showed 1Oral Medicine, University of Barcelona, Barcelona, Spain disease progressive status at the time of dental consultation. The frequent dental problems were periodontitis (N=46, 68.7 %) and Background and Aims dental caries (N=35, 52.2 %), root rest (N=17, 25.4 %) and The purpose of this study was to determine if the use of autofluorescence pericoronitis (N=7, 10.4 %), respectively. A total of 19 patients techniques for the diagnosis of lesions of the oral mucosa are effective and couldn’t have any dental procedure due to poor medical condition, will enhance the ability to make the diagnosis early. 6 patients had palliative coronectomy and 1 patient had received Methods temporary denture for symptom control and could continue their Wecarries out a pilot study in 60 patients. A control group consisting of anticancer treatment schedule. 30 patients without mucosal pathology and a study group comprising 30 Conclusions patients with known clinical history for mucosal pathology. In order to meet the need for dental care in MBC patients, early dental Both groups were examined by a specialist in oral medicine and by a general intervention is most important to maximize efficacy and minimize cost. dental clinician who used direct visualization through Velscope® system. We consider the characteristics of breast cancer subtype when the dental Results treatment strategy was set up. The effective consultation system between The general dental clinician did an over-diagnostic on two different medical oncologist and dentist is encouraged to improve quality care for occasions, confirming the error with the use of Velscope®. He also MBC patients. 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 MASCC-0136 use of Velscope® obtaining a sensitivity of 0,49 (95 % CI: 0.406 to 0.773) Dental Care 2 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. HANDBOOK FOR THE MANAGEMENT OF ORAL Conclusions COMPLICATIONS IN PEDIATRIC CANCER PATIENTS No clinical benefits were obtained using this Velscope® device. A. Majorana1, E. Bardellini1,F.Amadori1, S. Polsoni2,F. Porta3 1oral pathology, University of Brescia, Brescia, Italy; 2oral Hygiene, University of Brescia, Brescia, Italy; 3Pediatrics, Spedali Civili di Bre- MASCC-0135 scia, Brescia, Italy Dental Care 2

Background and Aims EVIDENCE FOR PRE-RADIATION ELIMINATION OF ORAL INTRODUCTION: While early diagnosis and advances in cancer FOCI IN HEAD AND NECK CANCER PATIENTS TO PREVENT therapy for children continue to improve resulting in higher survival ORAL SEQUELAE: A SYSTEMATIC REVIEW rate, oral complications remain a significant cause of morbidity and potential mortality. Cancer therapy-related oral complications are J.M. Schuurhuis1, M.A. Stokman1,P.U. Dijkstra1, A. Vissink1,F.K.L. common consequences in paediatric patients undergoing chemother- Spijkervet1 apy, myeloablative chemotherapy prior hematopoietic stem cells 1Oral and Maxillofacial Surgery, University Medical Center Groningen transplantations, or radiation therapy for head and neck cancers or (UMCG), Groningen, Netherlands solid tumours. OBJECTIVES: The aim of this study is to create a handbook for man- Background and Aims agement of the common oral complications and simple guide lines useful Pre-radiotherapy oral screening of head-neck cancer (HNC) patients is for pediatric cancer patients and caregiver during hospitalization. aimed at identifying oral foci in order to prevent post-radiation sequelae, Methods such as osteoradionecrosis. The evidence for its effectiveness is not clear. METHODS: A pool of specialists (dentists, oral hygienists, paediatrics, This systematic review aims to determine available evidence for the nurses, psychologists) have collected data available in Literature about efficacy of pre-radiation elimination or maintenance of oral foci in oral complications in children and have created a simple guide which, preventing oral sequelae. through short phrases and colourful pictures and drawings, can explain to Methods children the management of oral complication, during and after therapy. A broad search was conducted in MEDLINE and EMBASE for papers The handbook has been translated in four different languages (English, published up to October 2013. No language filters were applied. Papers Spanish, Russian and Arabic). on HNC patients subjected to pre-radiotherapy oral screening, (chemo) Results radiation and dental follow-up were included. RESULTS: The Authors show the English and Spanish version of the Results handbook distributed to children and caregivers in the Paediatric Oncol- Nineteen studies, predominantly retrospective studies (n=16), with a ogy Department of Spedali Civili di Brescia, (Italy). great heterogeneity in patient groups, oral screening techniques, and Conclusions definitions of oral foci and eliminations techniques were found. Most CONCLUSIONS: The distribution of media, like a colourful hand- papers lack details on how dental screening was performed and what was book, to pediatric cancer patients can help them to deal with the considered as an oral focus. The included articles were not conclusive on therapy and to better bear the hospitalization, increasing the pa- the efficacy of elimination or maintenance of oral foci with regard to the tient’s quality of life. occurrence of oral sequelae post-radiotherapy. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S49

Conclusions Background and Aims After systematically reviewing the literature, it is still unclear what the Head and neck cancer (HNC) in Saudi Arabia is the fifth efficacy is of pre-radiation elimination of oral foci, and whether pre- commonest cancer in males and the sixth among females (year radiation elimination of foci is mandatory and what to consider as an oral 2002). These cancers are more common in men over the age of focus. 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 tobac- MASCC-0561 co, alcohol intake, viral etiology, exposure to UV light, and dietary Drug Interactions factors. Methods RECOMBINANT IMMUNO- VIROSOME DIRECTED TARGET : A pretested questionnaire was administered to a convenient random CELL SPECIFIC PRO-DRUG ACTIVAT I N G G E N E S U I C I D E sample of patients attending Government hospitals. The questionnaire APPROACH TO COMBAT CANCER assessed knowledge and perception of oral cancer as well as habits known to be risk factors. I. Khan1,K.Zakaria1,P. Mani1,D.Sarkar2,P. Chattopadhyay3,S.Sinha4 Results 1Biochemistry, All India Institute of Medical Science, Delhi, India; 68.3 % have heard of “oral cancer” but feel they don’t know enough 2Biochemistry, University of Delhi South Campus, Delhi, India; about it or nothing at all (43.6 % and 50.8 % respectively). 78 % did 3Biochemistry, University of Delhi South Campus, Delhi, India; not feel oral ulcers are early signs of HNC although 50.2 % feel that 4Biochemistry, National Brain Research Centre Manesar,Gurgaon, India 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 Background and Aims than schools or family doctor. 90.2 % said their dentist informed Developing a therapeutic modality that specifically targets the neoplastic them about oral cancer but only 71.4 % actually carried out an oral cells has long been an elusive goal in cancer therapeutics. This necessi- examination. tates the need for the development of therapeutic modality which specif- Conclusions ically targets tumour cells. Accumulating evidence shows that the public is poorly informed about Aim: To develop a novel tumour targeting therapeutic approach based on HNC. Lack of public awareness is considered a potent barrier for early recombinant Sendai Immuno-virosomes detection. In a country where tobacco use is rampant, this poses a very Methods serious health concern. 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 MASCC-0272 deaminase and thereby activate the inactive pro-drug 5-FC specifically Education inside tumour cells. Tumour specific activation to active cytotoxic agent 5-FU addressed one level of non-specificity, which was improved further RESULTS OF THE FRENCH NATIONAL PANACH SURVEY by using PLAP scFv based engineered Sendai virosomes as vehicular COMPARING PATIENTS’ VS. ONCOLOGISTS’ PERCEPTION system for cell specific delivery of the cargo. OF SUPPORTIVE CARE IN CANCER Results T. Bouillet1,P. Artru2, C. Audigier-Valette3,F.X. Caroli-Bosc4,H.Cure5, Gene suiciding inducing therapeutic constructs packaged & delivered by M.S. Dilhuydy6,G.Ganem7,L.Greillier8,P.Laplaige9,A.Marre10,J.M. chimeric virosomal mediated vehicular traffic were able to induce effi- Phelip11 ,P.Quittet12,P.Rouby13, L. Vanlemmens14,F. Scotte15 cient cytotoxicity specifically inside the PLAP positive in vitro models 1oncology, hôpital avicenne, bobigny, France; 2onco-gastroenterolo- and not in non-PLAP cell lines. This demonstrates both the cell specific gy, Hopital Privé Jean Mermoz, lyon, France; 3pneumology, CHITS delivery as well as tumour specific expression of such therapeutic mo- Toulon, toulon, France; 4gastro-enterology, chu, angers, France; dalities. These therapeutic constructs specifically activated the apoptotic 5oncology, Institut Jean Godinot, reims, France; 6hematology, pathways in PLAP expressing cell lines and not in non-PLAP cells as Groupe hospitalier Sud Hôpital Haut-Lévêque, bordeaux, France; demonstrated by caspase assay and expression signatures of various pro 7oncology, Centre Jean Bernard, le mans, France; 8oncology, CHU and anti-apoptotic genes. Hopital Nord, marseille, France; 9oncology, Polyclinique, blois, Conclusions France; 10oncology, ch, rodez, France; 11 gastroenterology, chu, Recombinant Sendai virosomal vehicular traffic combined with tumour saint-etienne, France; 12hematology, chu, montpellier, France; activated expression can pave the way for combating wide range of 13psycho-oncology, Institut Gustave Roussy, villejuif, France; aggressive tumours. 14oncology, Centre Oscar Lambret, lille, France; 15oncology, Hôpital Européen Georges Pompidou, paris, France

MASCC-0523 Background and Aims Education 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 pa- ASSESSMENT OF KNOWLEDGE, ATTITUDE AND BEHAVIOR tients’ vs. oncologists’ perception of supportive care, fatigue, de- ABOUT HEAD AND NECK CANCER (HNC) IN ADULT pression and other disorders associated with cancer and its JEDDAH POPULATION, AND EVALUATION OF treatments. EFFECTIVENESS OF EDUCATIONAL INTERVENTION Methods (PILOT STUDY) A 43-item self-completion questionnaire was sent by postal mail to 2,632 R. Alrehili1,R.Sharka1, A. Barashid1, N. Alhazmi1, S. Bukhari1 French oncologists. Simultaneously,a 29-item ‘mirror’ questionnaire was 1Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia sent to patients undergoing cancer treatment. S50 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results MASCC-0057 Education

Physician- Patient- %ofpatients estimated reported with symptom BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE frequency frequency who mention it JAW: AWARENESS AND LEVEL OF KNOWLEDGE OF to their oncologist LEBANESE PHYSICIANS Fatigue 73 % 86 % 87 % L. el Osta1,B.elOsta2,S.Lakiss3, M. Hennequin4, N. el Osta5 Sleep disturbances NA 81 % 37 % 1Public Health, Faculty of Medicine Saint-Joseph University, Beyrouth, Anxiety/depression 39 % 37 % 51 % Lebanon; 2Hematology-Oncology, Georgia Regents University, GA, 3 Affective disorders/ 55 % NA 38 % USA; Faculty of Medicine, Faculty of Medicine Saint-Joseph University, marital-relationship issues Beyrouth, Lebanon; 4Equipe d’Accueil (EA4847) - Centre de Recherche en Odontologie Clinique (CROC), School of Dentistry Auvergne Univer- sity, Clermont-Ferrand, France; 5Prosthodontics, School of Dentistry Four hundred fourteen oncologists (16 %) and 118 patients completed a ques- Saint-Joseph University, Beyrouth, Lebanon tionnaire from September to December 2013. While 42 % of the patients think that adverse effects of treatments are unavoidable, and even demonstrate their Background and Aims efficacy (18 %), 50 % think that they can be reduced by supportive treatments. Bisphosphonate-induced osteonecrosis of the jaw (ONJ) is a potentially Eighty four percent of the oncologists give equal importance to supportive care destructive complication, particularly encountered in oncology. It is sup- and cancer treatment. Oncologists reckon that cancer-related disorders are frequent posed that awareness and good knowledge of this disease by physicians in patients. However, few patients spontaneously mention them to their physician. are important factors of its early detection, effective management and Conclusions prevention. Though fatigue is rather well managed with supportive care, other symp- This study aims to evaluate the level of knowledge among a sample of toms (depression, sleep disturbances, affective disorders) should be fur- Lebanese physicians with regard to this complication. ther investigated by oncologists to enable their patients to speak out and Methods ask for the management of such symptoms. 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 MASCC-0025 190 eligible physicians in the departments involved in prescribing Education bisphosphonates and in managing the ONJ. Results A total of 136 valid responses were obtained (response rate:71.6 %). LONG-TERM INFLUENCES OF UNDERGRADUATE More than half of the participants (63.2 %) were treating patients with TRAINING IN PALLIATIVE CARE: A QUALITATIVE STUDY bisphosphonates: the most prescribed form being the weekly oral ON THE PERSPECTIVE OF JUNIOR DOCTORS bisphosphonates for osteoporosis followed by the zoledronate several G. Crawford1, S. Zambrano1 times yearly for oncologic bone disorders. 1Palliative Care/Mary Potter Hospice, University of Adelaide, North Almost one-third of the participants (37.5 %) were unaware of Adelaide, Australia bisphosphonate-related ONJ. Furthermore, the level of knowledge was relatively poor: the mean score of all participants was 12.42±10.08; while Background and Aims 56.6 % had a global score more than 16 over 30. There were statistically There is a growing need for medical practitioners to have basic knowl- significant associations between the level of knowledge and physician’s edge and skills in palliative care. Palliative care attachments during specialty (−p-value<0.0001), bisphosphonates prescription (−p-value= undergraduate medical education are aimed at preparing students to deal 0.039), form of bisphosphonate prescribed (−p-value=0.050), examining with end of life issues. The value and effectiveness of these undergraduate patients already on bisphosphonate (−p-value=0.047), having observed attachments in the long-term have remained understudied. (−p-value=0.004) and treated (−p-value=0.002) exposed necrotic bone This qualitative study explored the long-term impact of undergraduate of the jaw among patients. palliative care attachments from the perspective of junior doctors. The Conclusions study aimed to understand how the attachments prepared them to face the Our study showed a deficient knowledge regarding this uncommon challenges of dealing with death and dying. complication. Thus, training strategies to increase the awareness among Methods physicians are required. 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 MASCC-0428 Three main themes were identified: 1) a contrasting experience with death, 2) Education from apprehension to gaining a sense of control, and 3) gaining perspective in the practice of medicine. The first theme describes the differences that partic- DEVELOPING AND IMPLEMENTING GUIDELINES FOR ipants found between palliative care and the acute care context. The second TREATING PATIENTS WITH ORALLY-ADMINISTERED theme relates to the skills and knowledge acquired during the attachments. ANTI-CANCER DRUGS IN THE HOME-CARE SETTING: Finally, the third theme highlights how the skills gained had an impact beyond EXPERIENCE OFA LARGE CANCER CENTER the palliative care setting and their importance in general medical practice. Conclusions T.Granot1,Y.Stern2, H. Farman3, R. Bosani4,S.M.Stemmer5, A. Morag6 Working with patients at the end of life is part of the professional lives of 1Breast Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; all medical practitioners and appropriate preparation is essential. In the 2G.I.Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; 3Head transition to junior doctors, undergraduate palliative care attachments offer and Neck Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; invaluable skills that become relevant early in the junior doctors’ career. 4Urooncology Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S51

5Deputy of Oncology Institute, Davidoff Cancer Institute, Petah-Tikva, Increases in knowledge and competence were as follows: Israel; 6Head Nurse of Davidoff Cancer Institute, Davidoff Cancer Institute, Petah-Tikva, Israel Educational Objective % Correct %Correct Background and Aims Pre-Education Post-Education The ongoing trend of using orally-administered instead of intravenously- Identify patient- and 57 % 88 % administered anti-cancer drugs improves patients’ quality-of-life and treatment-specific reduces costs. However, as this trend facilitates transition of patients to parameters that enable the home-care setting, issues such as compliance, patient monitoring, and personalized therapy addressing adverse events (AEs), become more challenging. Thus, this decisions trend requires remodeling patient care and the communication between Incorporate guideline- 41 % 61 % the ambulatory care staff and the patients. Aim: to describe the develop- based approaches for ment and implementation of guidelines related to the treatment of cancer the prevention and patients with orally-administered drugs in a large cancer center. management of CINV Methods Design optimal prevention 54 % 79 % Guideline development included several steps such as identifying safety and management strategies issues, performing a literature review, evaluating the number of patients for treatment-related CINV treated with orally-administered drugs, developing patient capabilities as- Increase awareness of agents 10 % 69 % Data from sessment tool, and creating relevant documents (eg, information and con- in development for the 6-week responses tacts orders for each treatment and checklists/follow up sheets for the staff). treatment and/or will be presented. Results prevention of CINV Guidelines were developed and implemented among 2013–2014. At present, the ambulatory care nurses proactively monitor the treatment of Data on practice pattern assessment and 6-week responses will be presented. approximately 50 patients (per week), who are being treated at home. The Conclusions monitoring is performed by phone/email and includes confirming appro- The data suggest educating healthcare professionals on clinical trial priate drug handling and administration (eg, issues related to storage, results along with discussion of translation of this information into patient dosage, drug-drug interactions, and drug-food interactions), follow-up on care increases knowledge and competence in CINV management. 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 MASCC-0065 Developing and implementing guidelines for managing patients treated Education with orally-administered anti-cancer drugs was associated with improved patient care and represents the commitment of the oncology staff to CERVICAL CANCER SCREENING AMONG UNIVERSITY patients’ quality-of-life and safety. STUDENTS IN SOUTH AFRICA: ATHEORY BASED STUDY M. Hoque1, S. Ghuman2,V.H. Guido3 1Graduate School of Business and Leadership, University of KwaZulu- MASCC-0182 Natal, Durban, South Africa; 2Department of Community Health Studies, 3 Education Durban University of Technology, Durban, South Africa; Medical Soci- ology and Health Policy, University of Antwerp, Antwerp, Belgium INFLUENCE OF CERTIFIED CONTINUING EDUCATION ON Background: Cervical cancer is a serious public health problem in South PHYSICIAN, NURSE, AND PHARMACIST KNOWLEDGE AND Africa. Even though the screening is free in health facilities in South COMPETENCE IN CHEMOTHERAPY-INDUCED NAUSEA Africa, the Pap smear uptake is very low. AND VOMITING (CINV) Aims: The purpose of the study is to investigate the knowledge and M. Haas1,A.Heintz1,S.Fagerlie1 beliefs of university female students in South Africa. 1Certified Medical Education, Educational Concepts Group, Atlanta, USA Methods: A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, Background and Aims and screening history. Despite significant progress in the prevention and treatment of CINV, Results: The average age of 440 students was 20.39 years (SD= results remain suboptimal. An estimated 70–80 % of patients undergoing 1.71 years). About two-thirds (63 %) of the students had sexual intercourse chemotherapy experience CINV. Review of clinical trial results and before. Regarding cervical cancer, 55.2 % (n=243) ever heard about it. discussion regarding appropriate incorporation into therapeutic decision Results indicated that only 15 % (22/147) of the students who ever had sex making is necessary to provide the highest quality patient care. and heard about cervical cancer had done the Pap test. Pearson correlation Methods analysis showed that cervical cancer knowledge had a significantly nega- Forty independent continuing education activities were held within med- tive relationship with barriers to cervical cancer screening. Susceptibility ical communities across the USA. During each activity, participants were and seriousness score were significantly moderately correlated with ben- asked a series of case-based questions to assess baseline knowledge, efit and motivation score as well as barrier score. Self-efficacy score had competence, and identify practice patterns. Assessments were repeated also a moderate correlation with benefit and motivation score. Students after each activity to determine change. Documented changes and barriers having had a Pap test had significantly lower score in barriers to be to implementation were captured via a 6-week electronic survey. screened compared to students who did not have a Pap test. Results Conclusion: This study showed that educated women in South Africa A total of 332 oncology physicians, nurses, and pharmacists participated lack complete information on cervical cancer and its risk factors. Students in the program. The number of patients cared for each month ranged from having had a Pap test had significantly lower barriers to cervical cancer 1 to 10 to>40 %; representing a potential impact of 11,000 patient lives. screening than those students who had not have had a Pap test. S52 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0596 Background and Aims Education 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 DOES THE USE OF MASCC ORAL AGENT TEACHING TOOL Group to increase expertise in Supportive Care and to produce Russian (MOATT) IN OLDER ADULTSWITH CANCER IMPROVE Supportive Care Recommendations. MEDICATION SELF-EFFICACYAND ADHERENCE? To report on the first 2 years of the RUSSCO Supportive Care Group. M. Lemonde1,M.Puts2, M. Nematollahi3 Methods 1Faculty of Health Sciences, University of Ontario Institute of Technology, Training has been carried out via web seminars, touring visits and via Toronto, Canada; 2Lawrence S. Bloomberg Faculty of Nursing, Univer- sessions at major Russian Oncology meetings. Recommendations have sity of Toronto, Toronto, Canada; 3Medical Oncology, Stronach Regional been tailored to the Russian situation with expert advice and collaboration Cancer Centre, New Market, Canada with MASCC and ASCO experts. Results There is an increased level of Supportive Care knowledge among Background and Aims Russian Oncologists, and a corresponding increase in implementa- Adherence is crucial to obtain optimal treatment outcomes. Non- tion of that knowledge in clinical practice. Russian Recommenda- adherence to oral chemotherapy and/or hormonal therapy has been shown tions have been created for: Anaemia, Emesis, Bone Metastases, to negatively affect cancer outcomes, such as higher recurrence rates and Febrile Neutropenia, Hepatitis reactivation, Hepatotoxicity, Cardio- shorter survival. vascular toxicity, Skin toxicity from EGFRi, nutrition, organ failure, The purpose of this study is to contribute to available evidence-based thromboembolic complications, and extravasation. Annual updates interventions to promote adherence to oral cancer agents in older adults of these guidelines are planned, as well as expansion to include new diagnosedwithcancer. topics. The study aims are: Conclusions 1) To evaluate the feasibility of using the MOATT in face-to-face Ongoing collaboration with MASCC and other Societies is seen education with in older cancer patients to support patient’sself- highly desirable. Tailoring Recommendations or Guidelines to local reported medication adherence and self-reported medication under- needs is vital. Education is key to implementation. Once a critical standing and use self-efficacy scale. mass is achieved it can serve as a platform for expansion and for clinical trial development. 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) Toevaluate the feasibility of the Medication Understanding and Use MASCC-0378 Self-Efficacy Scale in the context of patient education for older Education adults with cancer. Methods An exploratory phase II quasi-experimental study. PROMOTION OF CANCER REHABILITATION IN JAPAN: THE Sample and setting CAREER (CANCER REHABILITATION EDUCATIONAL We plan to recruit 60 (30 in the control group and 30 in the intervention PROGRAM FOR REHABILITATION TEAMS) PROJECT group) older adults aged 65 years and older with cancer diagnosis as T. Ts u j i 1, K. Mizuochi2,T.Koyama3, Y. Takakura4, T. Kobayashi5,K. many of the treatments for these older adults involve complex regimens Horaiya6,T.Kanda7, N. Sugimori8,E.Sasaki9, K. Masuoka10,K.Abe11 , with oral agents at the Stronach Regional Cancer Center, Southlake M. Kurihara12 Regional Health Centre in Newmarket, Ontario, Canada. 1Department of Rehabilitation Medicine, Keio University School of Med- Data analysis and interpretation icine, Tokyo, Japan; 2Department of Rehabilitation Medicine, Yokohama Repeated measures ANOVAwill be used to examine if the intervention City University Hospital, Yokohama, Japan; 3Department of Rehabilita- was effective in improving medication adherence and self-efficacy. tion, Tokyo Metropolitan Geriatric Hospital and Institue of Gerontology, Results Tokyo, Japan; 4School of Physical Therapy, Faculty of Health and Med- Will be discussed in the meeting ical Care Saitama Medical University, Saitama, Japan; 5Faculty of Conclusions Health Care Sciences, Chiba Prefectual University of Health Sciences, N/A Chiba, Japan; 6Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; 7Department of Rehabilitation Medicine, Shizu- oka Cancer Center Hospital, Suntogun, Japan; 8Rehabilitation Center, Tokyo Medical University Hospital, Tokyo, Japan; 9Graduate School, Wakayama Medical University, Wakayama, Japan; 10Nursing depart- MASCC-0073 ment, Hiroshima City General Rehabilitation Center,Hiroshima, Japan; 11 Education Graduate School of Nursing, Chiba University, Chiba, Japan; 12Nursing department, National Cancer Center Hospital East, Kashiwa, Japan RUSSIAN SUPPORTIVE CARE IN CANCER: TWO YEAR PROGRESS REPORT Background and Aims: Cancer rehabilitation resources are insufficient A. Snegovoy1,S.Tjulandin2, L. Manzyuk1,V.Larionova3,D.Nosov2,I. in Japan. In 2006, the National Cancer Control Act was approved. As part Tsimafeyeu4 of its measures, the Cancer Rehabilitation Educational Program for 1out-patients chemotherapy, N.N.Blokhin Russian Oncological Science Rehabilitation Teams (CAREER), which is a cancer rehabilitation train- Center, Moscow, Russia; 2clinical pharmacology, N.N.Blokhin Russian ing workshop project commissioned by the Ministry of Health, Labour Oncological Science Center,Moscow, Russia; 3hematology, N.N.Blokhin and Welfare, was launched in 2007. Russian Oncological Science Center,Moscow, Russia; 4director,Russian The aim of this study was to evaluate the effect of the CAREER Societ of Clinical Oncology, Moscow, Russia workshop. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S53

Methods: The purpose of the CAREER workshop is to develop medical MASCC-0360 care professionals who have the necessary knowledge and skills to work Fatigue together as a team across different disciplines when practicing cancer rehabilitation. Participants in a team of 4 people include a doctor, a nurse, THE EFFECTS OF TAIWANVERSION OF ENERGY and two rehabilitation therapists (PT,OT,SLHT). There were around 200 CONSERVATION AND ACTIVITY MANAGEMENT (T-ECAM) participants comprising 50 doctors, 50 nurses, and 100 therapists at each ON FATIGUE IN PATIENTS WITH BREAST CANCER workshop. The workshop was conducted over 2 days of lectures, group UNDERGOING CHEMOTHERAPY:DEVELOPMENTAND work, practice, and demonstration. We analyzed the demographic data of TEST all participants. Results: We performed a total of 28 workshops over the 4 years from H. Chou1 2010 to 2013. Five thousand two hundred sixty-one medical profes- 1Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan sionals participated. 304 (76.6 %) of 397 designated cancer care hospital facilities nationwide were represented. After completing the CAREER Background and Aims workshop, 197 facilities (49.6 %) have obtained the Cancer Patient Fatigue has been described as the most frequent and distressing problem Rehabilitation fee from the national health insurance system. of breast cancer patients who undergoing chemotherapy. The purpose of Conclusions: The survey demonstrated that many cancer rehabilitation the study was to evaluate the effectiveness of Taiwan version energy professionals have been educated and medical facilities have been devel- conservation and activity management (T-ECAM) intervention on fatigue oped by the CAREER workshop. Efforts will continue to equalize cancer among patients with breast cancer. medical services and improve the QOL of cancer patients. Methods The study’s aim was to evaluate the effectiveness of T-ECAM intervention, which is a randomized controlled trial. Qualified sub- jects who have been recruited from one medical center of oncology MASCC-0088 are randomly assigned into an experimental group (64 subjects) or Education 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 interven- TOWARDS RESOURCE-PROMOTING, CONTEXTUAL tion, and follow three times. The statistical methods include repeat PAT I E N T E D U C AT I O N – CANCER PATIENTS’ KNOWLEDGE measure analysis. EXPECTATIONS AND THE SIGNIFICANT FACTORS Results AFFECTING THESE EXPECTATIONS DURING THE ILLNESS The findings of the study were (1) Although the T-ECAM group had TRAJECTORY lower fatigue scores in the second cycle of chemotherapy than the control H. Vaartio-Rajalin1,H.Leino-Kilpi1, L. Iire2,H.Minn2 group, the difference was statistically significant; (2) As for the long-term 1Nursing Science, University of Turku, Turku, Finland; 2Oncologic clinic, pattern of fatigue in lung cancer patients who underwent chemotherapy, Turku University Hospital, Turku, Finland the fatigue associated with chemotherapy peaked after treatment and remained elevated 1 week after each cycle of chemotherapy, and was Background and Aims observed to gradually diminish over time but never reached baseline Cancer is today seen as a chronic illness that impacts multiple aspects of values. an individual’s life, including possible cognitive deterioration with an Conclusions effect on self-confidence and independence. These new perspectives These findings will help health care providers to understand fatigue should be reflected within patient education practices. patterns over time. They also can improve quality of care and fatigue The study aimed to explicate adult cancer patients’ knowledge expecta- management strategies for breast cancer patients undergoing tions (the content and meaning of information in light of empowerment) chemotherapy. and to identify the significant factors affecting these expectations during the illness trajectory. Methods A mixed methodology study: patients’ knowledge expectations were MASCC-0485 assessed through focus group interviews (n=37) and in-depth interviews Fatigue (n=16) in a sample of actual and former patients with cancer. In order to identify factors connected with patients’ knowledge expectations, a sur- PREVALENCE OF FATIGUE AMONG CANCER PATIENTS vey was conducted among patients at two university hospitals (n=332) RECEIVING VARIOUS ANTI-CANCER THERAPIES AND ITS using the Expected Knowledge of Hospital Patients® instrument. IMPACT ON QUALITY OF LIFE - A CROSS-SECTIONAL Results STUDY On the basis of interview datasets, nine categories describing patients’ knowledge expectations in light of empowerment were identified. The K. Guru1, D. Jumnani1,K.R.Prabhu1 survey data supported these categories and the identified personal, situa- 1Physiotherapy, Srinivas College of Physiotherapy & Research Center, tional and clinical factors affecting the patients’ knowledge expectations Mangalore, India during the illness trajectory. Conclusions Background and Aims Patient education seem to be focused into beginning of illness trajectory Fatigue is disabling and continuous phenomenon in cancer patients and into routine education about bio-physiological facts, when cancer during and after various anticancer treatments which can continue patients are expecting individual, resource-promoting knowledge about for many years after treatment and has profound effect on the life self-care in order to enact into cancer management as equal partners. quality. There is growing evidence to show that cancer related Inattentiveness for the different personal, situational and clinical factors fatigue (CRF) due to various anticancer treatment. However, deter- affecting patient’s knowledge expectations during care process have mining its severity is still underestimated among the cancer patients negative consequences for patient education outcomes and thus also to those who are suffering with this distressing symptom. and its the patients’ quality of life. association with quality of life (QOL). S54 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Aim was to find out the prevalence of rate of fatigue and its relative MASCC-0226 impact on QOL in cancer patients receiving radiotherapy, chemotherapy Fatigue and concurrent radio-chemotherapy. Methods GENE EXPRESSION PROFILING OF EVENING FATIGUE IN This Cross Sectional observational study included a total 121 cancer WOMEN UNDERGOING CHEMOTHERAPY FOR BREAST patients receiving radiotherapy, chemotherapy and concurrent CANCER chemo-radiation with the age group of above 15 years who fulfilled the inclusion criteria. All the patients were assessed for severity of K.M. Kober1,L.Dunn2,S.Paul1,B.Cooper1, C. Miaskowski1,B.E. fatigue using Brief Fatigue Inventory and QOL by using FACT-G Aouizerat1 while they were receiving the anti-cancer therapies as an in-patient 1School of Nursing, University of California, San Francisco, USA; in the cancer centers. 2School of Medicine, University of California, San Francisco, USA Results The severity of fatigue was more in chemotherapy (98.30 %) and con- Background and Aims current chemo-radiation (78.57 %) as compare to radiotherapy (45 %). Cancer-related fatigue (CRF) is a common and debilitating symptom that Moderate correlations were exhibited between fatigue due to radiotherapy occurs in patients undergoing treatment. A major impediment to the and QOL (r=−0.71, p<0.01, respectively). development of effective treatments is a lack of understanding of the Conclusions mechanisms underlying CRF, which can be identified by evaluating pat- Severity of fatigue was found more after chemotherapy and concurrent terns of gene expression associated with CRF. Our aim was to correlate chemo-radiation therapy while impact on QOL was more after the phenotypic and gene expression differences with severity of evening CRF. radiotherapy. 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< MASCC-0497 5.6, n=19) and higher (LFS>5.6, n=25) evening CRF. Total RNA was Fatigue extracted from blood and gene expression was measured using the Illumina HumanHT-12 microarray. Results ASSESSMENT OF THE IMPACT OF CANCER-RELATED Compared to the lower evening fatigue group, patients in the higher FATIGUE ON BREAST CANCER SURVIVORS evening fatigue group reported a lower functioning, a higher comorbidity J.M. Jones1,C.Longo2,K.Olsen3,P. Bedard4,E.Amir4, D. Howell5 score, and a lower number of prior cancer treatments (all p<0.05). One 1Cancer Survivorship, Princess Margaret Cancer Centre, Toronto, gene was up-regulated (p<0.05) and 11 genes were down-regulated (all Canada; 2Health Services Management, McMaster University, Hamilton, p<0.001) in the higher evening fatigue group. Gene set analysis revealed Canada; 3Nursing, University of Alberta, Edmonton, Canada; 4Medical 24 down-regulated and 94 simultaneously up and down perturbed path- Oncology, Princess Margaret Cancer Centre, Toronto, Canada; ways between the two evening fatigue groups. Transcript Origin Analysis 5Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Canada found differential expression originated from monocytes and dendritic cell types. Query of public data sources found 18 experiments (e.g., Background and Aims exhaustive exercise, sickness behavior) with similar expression profiles. Cancer-related fatigue (CRF) is a well documented symptom following This comprehensive set of analyses revealed that inflammation is associ- breast cancer (BrCa) treatments. The purpose of the current study was to ated with evening fatigue severity. examine and compare the social functioning, work absenteeism and Conclusions presenteeism, and the use of health and supportive care services between These results suggest that the mechanisms that underlie CRF in oncology breast cancer survivors with and without CRF. patients include an inflammatory component. 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. MASCC-0425 Those with (≤34) and without (>34) significant CRF were compared Fatigue on the Social Difficulties Inventory (SDI-21); WHO Health and Work Performance Questionnaire; and Health Service Utilization FEASIBILITY STUDY:RESTORATIVE YOGA FOR CANCER Questionnaire. PATIENTS WITH FATIGUE ASSOCIATED WITH RADIATION Results AND CHEMOTHERAPY 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. S. Lorhan1, H.M.L. Daudt2, M. van der Westhuizen3 Respondents with CRF had higher levels of social difficulties: SD-16 1Volunteer Services, BC Cancer Agency, Victoria, Canada; 2Clinical To t a l ( p<0.0001), Everyday living (p<0.0001), Money matters Research Management, BC Cancer Agency, Victoria, Canada; (p<0.001), and Self and others (P<0.0001). Those with CRF were more 3Administration, BC Cancer Agency, Victoria, Canada 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 Background and Aims use of physician (p=0.043), hospital (p=0.025), allied health (p=0.007) Up to 80 % of patients with cancer undergoing treatment experience and psychosocial (p<0.0001) services. fatigue. Yoga has been found to improve fatigue, quality of life, sleep Conclusions quality,and cancer related distress. Restorative yoga is a modifiable, light- CRF was related to higher levels of social difficulties and health care intensity type of yoga suitable for patients with cancer. Our primary study utilization and less work productivity. These finding help to personify the objective is to determine the operational feasibility of providing 2 months impact of CRF and highlights the need for active screening procedures of weekly 90 min yoga sessions for cancer patients undergoing treatment. and interventions which include these outcomes. Full data set (n=300) Secondary objectives are to observe the trends in cancer related fatigue and analyses will be presented. (CRF) and quality of life (QoL) within this sample population. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S55

Methods Conclusions Wewill conduct a single arm trial using a mixed methods research design This ongoing review will describe physiologic pathways that influence at the BC Cancer Agency, Vancouver Island centre. The intervention will CRF. Gaps in knowledge are identified and recommendations for future include restorative yoga therapy taught by volunteer instructors. Sixteen research are discussed. cancer patients undergoing radiation and/or chemotherapy will be recruit- ed. CRF and QoL data will be collected at baseline, 8 weeks, and 16 weeks. Qualitative interviews will be held one and 8 weeks post- intervention to explore the patients’ perceptions. Demographics will be MASCC-0256 reported using descriptive statistics. Fatigue Results Patient recruitment starts in February 2014. The impact of the interven- ACUPUNCTURE AND RELAXATION WITH GUIDED tion on CRF and QoL will be evaluated using a pre- and post-intervention IMAGERY ON THE SYMPTOMS OF FATIGUE, DEPRESSION paired t-test. The qualitative data will be analyzed using thematic analysis AND HEALTH-RELATED QUALITY OF LIFE IN CANCER and will be used in interpretation of the quantitative findings. We predict PAT I E N T S that the project will be feasible, and trends towards an increase in QoL N. Sawada1, A.C. Nicolussi1,J.M.Paula1, L. Okino1,B.F. Toneti1 and decrease in fatigue will be observed during the intervention. 1General of specialized, College of Nursing at ribeirão Preto at Univer- Conclusions sity of São Paulo, Ribeirão Preto São Paulo, Brazil The results will inform a future larger sample sized study. Introduction: Complementary therapies such as acupuncture and relaxa- tion with guided imagery have been used by cancer patients to reduce symptoms of treatment. Objective: To evaluate these therapies on symp- MASCC-0426 toms of depression, fatigue and health-related quality of life (HRQoL) in Fatigue cancer patients undergoing chemotherapy through instruments Quality of Life Questionnaire Core-30, Beck Depression Inventory and fatigue PIPER THE BIOLOGY OF CANCER-RELATED FATIGUE: A REVIEW at the beginning (baseline) and at the end of treatment (6 months later). OF THE LITERATURE Methods: a nonrandomized clinical study with a control group (CG) and intervention (IG), at Ribeirão Preto-SP,Brazil. The IG received acupunc- L. Saligan1,F. Cramp2,C.Escalante3,K.Filler1,D.Larkin4, K. Mustian5, ture and relaxation with guided imagery sessions, once a week and the K. Olson6, O. Palesh7, S. Yennu8 CG only replied instruments 1National Institute of Nursing Research, National Institutes of Health, Results: The initial sample consisted of IG=50 and CG=40 patients, and Bethesda, USA; 2Health and Life Sciences, University of the West of late IG=32 and CG=40. Comparing the beginning and end of treatment, England, Bristol, United Kingdom; 3General Internal Medicine, The the results showed that the IG had improvement in all functions and University of Texas MD Anderson Cancer Center, Houston, USA; reduction of symptoms except loss of appetite, constipation and diarrhea 4Capital Region Cancer Service, The Canberra Hospital, Garran, and for CG worsened in physical, emotional, cognitive, and social func- Australia; 5School of Medicine and Dentistry, University of Rochester tions and an increased in all symptom scales except pain. Beck Depres- Medical Center, Rochester, USA; 6Faculty of Nursing, University of sion Inventory: the baseline data showed that most of the patients in the Alberta, Edmonton, Canada; 7Psychiatry and Behavioral Sciences, IG and CG were without depression and in the end, the IG exhibited Stanford University Medical Center, Stanford, USA; 8Palliative Care reduced depression and the GC increased. In both groups, the mean total and Rehabilitation Medicine, The University of Texas MD Anderson fatigue increased after the treatment. Cancer Center,Houston, USA Conclusion: Comparing the IG and CG by Student’s t-test did not find statistically significant differences, but we can infer that complementary Background and Aims therapies have improved the functions and decreased symptoms of pa- Understanding the causative mechanisms of cancer-related fatigue (CRF) tients and consequently influenced to better HRQoL. 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,’‘neo- MASCC-0257 plasm,’‘biomarker,’‘immune,’‘inflammation,’ OR ‘fatigue’ was conduct- Fatigue ed in PubMed, Scopus, Embase, and CINAHL. Duplicates were removed and the search was refined by applying the exclusion criteria to only include PRESENCE OF FATIGUE IN PATIENTS WITH HEAD AND articles published from 2004 to 2013, articles written in English, human NECK CANCER UNDERGOING RADIOTHERAPY adult studies, and original natural history articles (e.g. letters, literature reviews, meeting abstracts, editorials, and dissertations were excluded). N. Sawada1,J.M.Paula1,A.C.Nicolussi1,B.F. Toneti1,H.M.Sonobe1 Final list of articles was determined by visual examination of the titles 1General of specialized, College of Nursing at ribeirão Preto at Univer- and abstracts of the remaining articles. Articles with a sample size <50 were sity of São Paulo, Ribeirão Preto São Paulo, Brazil further excluded. Full text review of the final list of manuscripts determines biomarkers that have significant associations with CRF. Background and Aims Results Head and neck cancers represent the fifth position in the list of the most The initial literature query yielded 11,129 articles. After duplicates were common cancers. One of the most common for this type of cancer removed and exclusion criteria applied, 7,175 articles remained. Visual treatment is radiation therapy, with fatigue as one of their most frequent review of the titles left 3,811 articles for consideration. The abstracts of side effects. the remaining articles were inspected and 75 articles were selected for an Objective ongoing full-text review. Biomarkers with significant associations with Toraise the frequency of fatigue symptoms in patients with head and neck CRF were related to immune response, inflammation, metabolism, and cancer undergoing radiotherapy treatment at the beginning, middle and neuroendocrine function. Covariates especially the effect of age on the end of treatment and influence on quality of life related to health association of CRF with the biomarkers will be further examined. (HRQOL). S56 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0194 An exploratory prospective study conducted in outpatient radiation ther- Fatigue 2 apy in a public hospital in Ribeirão Preto - Brazil. Three instruments were used: the clinical/demographic data, the FACT H&N - Functional As- THE PREVALENCE, SEVERITYAND TRAJECTORY OF sessment Cancer Therapy Head and Neck and Piper Fatigue Scale. Data FATIGUE WITH PRO-INFLAMMATORY BIOMARKERS IN analysis was quantitative, using SPSS version 15.0. ASIAN BREAST CANCER PATIENTS: A PROSPECTIVE Results COHORT STUDY 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 Y. C h e u n g 1,T.R.D.Ng1,M.Shwe1,Y.C.Kee2,H.K.Ho1,W.K.Chui1,G. increased throughout the treatment, showing increased fatigue. While the Fan3, W.S. Yong4,P. Madhukumar4,W.S.Ooi5,W.Y.Chay5,R.A.Dent5,S.F. mean FACT H&N decreased at the middle and end of treatment, indicat- Ang5,M.Wong5,S.K.Lo5,Y.S.Yap5,R.Ng5,A.Chan1 ing deterioration in HRQL these patients. 1Pharmacy, National University of Singapore, Singapore, Singapore; Conclusions 2Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; This study we can conclude that radiotherapy increases the symptoms of 3Psychosocial Oncology, National Cancer Centre Singapore, Singapore, fatigue in patients with negative influence on quality of life. The presence Singapore; 4Surgical Oncology, National Cancer Centre Singapore, Sin- of fatigue symptoms indicates the need for nurses to orient patients early gapore, Singapore; 5Medical Oncology, National Cancer Centre Singa- in treatment as this possibility and plan a tour so this symptom is reduced. pore, Singapore, Singapore

Background and Aims Early-stage breast cancer (ESBC) patients commonly experience MASCC-0063 cancer-related fatigue (CRF) during chemotherapy. However, the Fatigue 2 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 INTEGRATIVE MEDICINE: APPROACHES TO changes in ESBC patients. MANAGEMENT OF CANCER-RELATED FATIGUE Methods K. Anderson1 This is a prospective cohort study conducted at the largest cancer center in 1Naturopathic Medicine, Cancer Treatment Centers of America, Tulsa, Singapore. Chemotherapy-receiving ESBC patients were recruited. The USA Brief Fatigue Inventory (BFI) was administered and a panel of pro- inflammatory plasma cytokines (IL-1β, IL-4, IL-6, IL-8 and TNF-α) Background and Aims was evaluated using multiplex immunoassay prior to chemotherapy Cancer-related fatigue (CRF) is a distressing symptom for cancer patients (T1), at midpoint (T2), and end of chemotherapy (T3). Fatigue was impacting their function and QOL. Causal factors include physical con- defined as patients whose T2 and/or T3 BFI severity score increased by ditions, cognitive states, pro-inflammatory cytokines, and metabolic fac- 0.25 standard deviation comparing to baseline. tors. Problems associated with CRF include treatment side effects, weight Results changes, sleep disturbances, psychological effects, and co-morbid Fifty-eight patients were included (mean age 49.5±8.5 years; 81 % conditions. Chinese). Overall, patients’ fatigue levels were mild but they reported Methods more fatigue progressively from T1 to T3 [median (IQR): 1.30 (0.1–2.4) EBM areas evaluated and discussed include: vs 1.45 (0.2–2.5) vs 1.70 (0.6–3.7), p=0.001]. From T1 to T2, patients Rehabilitation Therapy: Exercise has the best non-pharmacologic experiencing fatigue had higher baseline levels of IL-6 [2.56 (1.07–4.58) evidence for managing CRF (1) especially when patients choose pg/ml vs 1.85 (1.31–2.82) pg/ml; p=0.06)], IL-8 [5.80 (3.84–7.34) pg/ml exercises they enjoy, receive specific implementation strategies, (1,2) vs 4.72 (2.89–6.13) pg/ml; p=0.083)] and TNF-α [1.80 (0.35–4.08) pg/ and combine cognitive and spiritual elements with movement, ml vs 1.51 (0.49–2.78) pg/ml; p=0.086)] (controlling for age, body mass stretching, and balance (Tai Chi, Qi Gong or Yoga). Studies confirm index, cancer stage and chemotherapy regimen). No significant associa- Qi Gong improves QOL, reduces treatment side-effects and produces tions were identified with IL-1β and IL-4. anti-inflammatory benefits. (3) Conclusions Mind Body Medicine: Cognitive Behavioral therapy has strong evi- Asian ESBC patients experienced mild level of fatigue during chemo- dence in managing CRF (4) and specific self-care/coping strategies shown therapy.Patients with higher baseline levels of IL-6, IL-8 and TNF-α may more effective than non-specific strategies. (5) be more likely to experience CRF. Acupuncture: Improves QOL and CRF Naturopathic Medicine: Education on lifestyle modifications including sleep, smoking cessation, stress management, drug-drug and drug- nutrient interactions along with evidence based therapies including cold MASCC-0011 (8) laser therapy, and nutriceuticals such as Omega three fatty acids , Fatigue 2 American Ginseng (9), B vitamins, L-Carnitine, CoQ10 (10) and Vitamin D (11) aidinmanagingCRF. BIOMARKERS FOR CHEMOTHERAPY INDUCED FATIGUE Nutrition: Education on managing weight changes, measuring caloric intake, fluid and electrolyte imbalances all assist in managing CRF.Small F.M. Cruz1, B.A. Munhoz1, B.C. Alves1,F.S. Gehrke1,L.L.A.Fonseca1, frequent meals with complex carbohydrates and protein support optimal R.K. Kuniyoshi1, D.I.G. Cubero1,A.DelGiglio1 energy levels. 1Clinical Oncology, ABC Foundation School of Medicine, Santo André, Results Brazil Lit review&clin exp; see above Conclusions Background and Aims Often part of a “symptom cluster” alongside anxiety, depression, pain, Fatigue is a common complain in cancer patients receiving adjuvant nausea and insomnia, CRF is best addressed through a mutidisciplinary chemotherapy. In order to further understand its mechanism and search integrative personalized approach. for potential biomarkers we conducted this prospective study. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S57

Methods Conclusions We enrolled Breast Cancer (BC) patients prior to their first adjuvant The use of CTs can improve symptoms of CRF and psychological stress Adriamycin based chemotherapy cycle. Patients answered to the BFI in children and adolescents with cancer. 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,Cortisolinthe MASCC-0102 plasma and IL2, IL10, IL6, TGF-β,KLRC1,TNF,BTP,SNCA,SOD1, Fatigue 2 BLNK, PTGS2 and INF γ expression in the PMNCF. Results FATIGUE IN CHILDREN AND ADOLESCENTS WITH A total of 43 patients were enrolled in this trial, 11 patients did not have an CANCER: EXPERIENCE OF HEALTHPROFESSIONALS increase in their BFI scores and were considered as controls whereas 32 M.C.M. Silva1, L.C. Lopes-Júnior1, R. Lima1 had an increase in their BFI scores as compared to baseline. From the 1Maternal-Infant and Public Health, School of Nursing University of São biomarkers we evaluated in the PMNCF, the only one significantly Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil associated with fatigue was TGF-β (p=0.0343). We observed no evi- dence of significant associations of any plasmatic biomarkers with the Background and Aims development of fatigue. However when we analyzed patients with more Cancer-related fatigue is a common and treatable symptom that interferes sever fatigue, plasma IL1-RA levels correlated directly with higher fa- deeply into many aspects of quality of life of cancer patients. In the case tigue scores (p=0.0136). of Brazilian children and adolescents with cancer, it is an undernotified, Conclusions undertreated symptom that is neglected by the health team, considering it We conclude that Fatigue induced by chemotherapy in BC patients may as an unavoidable consequence of the disease and its treatment. have a different mechanism than that seen in long term BC survivors or Objective: Todescribe the experience of health professionals with knowl- that induced by radiation therapy. Future studies with expanded panels of edge, assessment and intervention in cancer-related fatigue in children biomarkers may shed light into the physiopathology of adjuvant chemo- and adolescents with cancer. therapy induced fatigue. Methods A descriptive and exploratory study with qualitative data analysis, con- ducted through interviews and guided by an instrument consisting of two parts: the first containing informations of the participants (age, sex, MASCC-0217 profession, years of experience in the health team and continuing educa- Fatigue 2 tion activities) and the second part with the following guiding questions: What is fatigue?, How do you identify and evaluate a child or adolescent NONPHARMACOLOGICAL INTERVENTIONS USED FOR with cancer-related fatigue?, What are you the interventions used to THE MANAGEMENT OF FATIGUE AND PSYCHOLOGICAL relieve fatigue? The study included 53 professionals (10 nurses, 33 STRESS IN CHILDREN AND ADOLESCENTS WITH CANCER nursing assistants, 3 physicians, 3 nutritionists, 2 psychologists and 2 physiotherapists). For data analysis we used the content analysis of L.C. Lopes-Júnior1, E. Bonfim1,M.D.R.Nunes1,L.C.Nascimento1,M.F. inductive thematic type. Santos1,M.C.M.Silva1, G.S. Bisson1, R. Lima1 Results 1Maternal-Infant and Public Health, School of Nursing University of São Data were organized around three themes: knowledge of fatigue, fatigue Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil identification and interventions for relief of fatigue. The results point to the limited knowledge of health professionals about fatigue and little Background and Aims investment in formal training. Cancer-related fatigue (CRF) has been described as the most stressful and Conclusions prevalent symptom in pediatric oncology patients, occurring in 35.6 to Scarcity of studies on the issue in the Brazilian scenario is still a barrier to 93 % of cases. Psychological stress generated during hospitalization can provide insight for the improvement of symptoms in patients with cancer. negatively influence the immune system through neuroendocrine and be- havioral 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 MASCC-0170 fatigue and psychological stress in children and adolescents with cancer. Fatigue 2 Methods We conducted an integrative literature review in which eight databases CORRELATION BETWEEN FATIGUE AND REACTIVAT I O N were accessed for the search: PubMed, Web of Science, CINAHL, OF SALIVARY HHV6 AND HHV7 IN MULTIPLE MYELOMA LILACS, EMBASE, SCOPUS, PsycINFO and Cochrane Library. Full- text articles were included, studies in English, Spanish or Portuguese K. Suzuki1, N. Kobayashi2, Y. Ogasawara1, Y. Yahagi1, S. Yano1,T. published in the last 14 years (2000 until 2013). Controlled and uncon- Shimada1, E. Nagasaki1,K.Kondo2, K. Aiba1 trolled descriptors, as well as its synonyms, were crossed for location of 1Department of Clinical Oncology/Hematology, the Jikei University the articles. Tworesearchers independently analyzed the studies. Initially, School of Medicine, Tokyo, Japan; 2Department of Virology, the Jikei 273 articles were found. After the exclusion of duplicate articles and of University School of Medicine, Tokyo, Japan those that did not match inclusion criteria, and after full reading, we obtained a final sample of nine articles. Background and Aims Results Fatigue often occurs in multiple myeloma patients treated with novel The nine studies were grouped into five themes: physical exercises, agents, such as bortezomib, lenalidomide, and thalidomide. Moreover, the therapeutic touch, music therapy, massage therapy and nursing interven- incidence of viral infection, especially herpes zoster, increases during tions & health education. Among the nine studies, six (66.6 %) showed a chemotherapy with bortezomib. We evaluated the correlation between significant p value for CRF and/or psychological stress, evidencing that fatigue and reactivation of salivary HHV6 and HHV7, and several bio- the use of CTs led to a decrease in such symptoms. chemical parameters in multiple myeloma treated with novel agents. S58 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0220 We prospectively analyzed 20 of salivary sample from 8 patients with Fatigue 2 multiple myeloma treated with novel agents from May 2013 to December 2013 in our institute. We evaluated the correlation between fatigue and EXPERIENCE OFAWEEKLYADAPTED PHYSICAL ACTIVITY reactivation of salivary HHV6 and HHV7 and several laboratory data by SESSION (APA) FOR CANCER PATIENTS Pearson’sproduct–moment correlation method. Fatigue was evaluated by Cancer Fatigue Scale (CFS) and Brief fatigue Inventory (BFI). DNA copy S. Trager1, M. Malgouzou1,D.Franco1, L. Cotinaut1,E.Carola1 numbers of HHV6 and HHV7 in salivary samples were also measured 1Oncology, Groupe Hospitalier Public du Sud de l’Oise, Senlis, France using real-time PCR methods. The moderate correlation was defined as r- value>0.4, respectively. Background and Aims Results The APA has shown its efficiency for cancer patients by reducing tired- The numbers of patients treated with bortezomib were 7, thalidomide 2, ness and improving survival rates for some types of cancers. A regular, and lenalidomide 1, respectively. All of the patients received dexameth- rather intense and framed activity is recommended. asone or predonisone. There is moderate correlation between CFS and Evaluation of the efficiency of 12 weekly session of APAon tiredness and DNA copy number of salivary HHV7 (r=0.443), CFS and serum level of physical abilities of cancer patients. C-reactive protein (CRP) (r=0.675), and CFS and serum level of lactate Methods dehydrogenase (LDH) (r=0.45). DNA copy number of salivary HHV6 Twelve group sessions of 1 h a week of gymnastics have been and complete blood count were not correlated with CFS, significantly. proposed for cancer patients suffering from fatigue, when they are Conclusions under surveillance or during treatment. These sessions were con- There was correlation between fatigue and the reactivation of salivary ducted by physical therapists in the hospital. Two assessments were HHV7, elevated level of serum CRP and LDH. 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 MASCC-0048 Thirty-one patients completed the 12 sessions. – Fatigue 2 The average age was 53.5 years [41 78]. Eighty-one percent (25) of patients had a localized breast cancer. VARIATION IN FATIGUE AMONG 6011 CANCER SURVIVORS Seventy-one percent of the patients (22) started the APA being AND THE NORMATIVE POPULATION: A STUDY FROM THE processed. POPULATION-BASED PROFILES REGISTRY The intensity of the sessions was between 55 and 88 % of maximum heart rate for 87 % of patients (27). 1 1 1 1 2 M. Thong ,O.Husson,F. Mols ,J.deVries,G.Schep, L. van de Poll- Between the beginning and the end of the program: 84 % (26) patients 1 Franse have improved their test 6-minute walking and 84 % (26) improved their 1 Medical and Clinical Psychology, Tilburg University, Tilburg, PIPER score. 2 Netherlands; Sports Medicine, Maxima Medical Center, Veldhoven, Conclusions Netherlands An APA of 1 h a week reduces tiredness and improves the functional capacity of the cancer patients included in this study. Background and Aims This modality of relieved APAis easily practicable and less expensive. Studies have shown that cancer survivors commonly experience fatigue, The next work will only focus on metastatic patients, poorly represented probably due to the disease and its treatment. However, few studies have in our sample. 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 MASCC-0216 the population-based PROFILES registry. Individuals diagnosed with Fatigue 2 endometrial (EC, n=741) or colorectal cancer (CRC, n=3,878) (1998– 2007), thyroid cancer (TC, n=306) (1990–2008), Hodgkin (HL, n=150) PATIENTAND PROVIDER PERSPECTIVES ON PAIN, FATIGUE, or non-Hodgkin lymphoma (NHL, n=716) or multiple myeloma (MM, AND OTHER SIDE EFFECTS n=120) (1999–2008) were included. Participation rates for the studies ranged from 75 to 86 %. A normative population (n=2,040), representa- L. Williams1, C. Bohac2,S.Hunter3,D.Cella4 tive of the Dutch population, was also assessed. All participants complet- 1Symptom Research, The University of Texas M. D. Anderson Cancer ed the Fatigue Assessment Scale. Center, Houston, USA; 2Global Development, Amgen Inc., Thousand Results Oaks, USA; 3Biostatistics, Amgen Inc., Thousand Oaks, USA; 4Medical Cancer survivors were more often classified as fatigued or very fatigued Social Sciences, Northwestern University Feinberg School of Medicine, (EC/CRC: 39 %; HL:40 %; NHL:43 %; MM:51 %; TC:44 %) compared Chicago, USA with the normative population (21 %; p<0.001). MM survivors reported the highest levels of fatigue and differed significantly from EC and CRC Background and Aims survivors (p=0.02). Older age (>65 years) was associated with fatigue, In 1997, Vogelzang reported that 61 % of cancer patients indi- 42 % versus 39 %; p<0.01. Females were more likely to be fatigued cated fatigue impacted daily life more than pain, and only 37 % (p<0.01). Chemotherapy treatment was associated with more fatigue of oncologists shared this perception. Our study provides an (43 % versus 39 %, p<0.01), as was comorbidity (no versus 1 versus update to this estimate, which can help prioritize symptom as- ≥2: 26 %, 35 %, 53 %, respectively, p<0.01). sessment and management in the clinic. Study aims were to Conclusions determine and compare perceptions of cancer patients and Our population-based study on a large sample of cancer survivors showed healthcare providers (HCPs) about the impact of fatigue and pain, that fatigue levels vary depending on cancer type, age, gender, treatment and gather perspectives on which side effects concern HCPs and with chemotherapy and number of comorbid conditions. their patients. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S59

Methods MASCC-0442 A random sample of patients was recruited in the US by Harris Poll Geriatric Oncology Online and Schlesinger Associates. Oncology HCPs were recruited by Food and Drug Research, Inc. and Toluna, Inc. IMPACT OF CHEMOTHERAPY DOSE INTENSITY IN THE Results GERIATRIC POPULATION WITH LOCALLYADVANCED From June to November 2012, 550 of 1,122 eligible patients (49 %), 400 BREAST CANCER TREATED IN NEOADJUVANT SETTING AT of 533 eligible oncologists (75 %), and 400 of 617 eligible oncology THE NATIONAL CANCER INSTITUTE, MEXICO CITY nurses (64.8 %) completed a survey. 58.4 % of patients reported fatigue affected their daily life more than pain during chemotherapy versus C. Arce-Salinas1, L. Mendoza-Galindo1, G. Alamilla1, A. Alvarado- 28.8 % of oncologists and 25.0 % of nurses. 97.5 % of patients reported Miranda1,F.U. Lara-Medina1 experiencing fatigue and 86.2 % reported pain during chemotherapy. 1Breast Cancer,Nacional Cancer Institute Mexico City (INCan), Mexico HCPs estimated 77.9 % of patients experienced fatigue, and 43.6 % of City, Mexico patients experienced pain. HCPs felt nausea/vomiting concern patients most (87.9 %) and it was the symptom most likely to be documented in Background and Aims the patient chart (97.4 %). Introduction: Breast cancer in older women is usually undertreated; this Conclusions population is considered fragile and received chemotherapy in doses below This study shows the importance of assessing side effects by direct standards. Objectives: To evaluate the relation of dose intensity with complete patient report during chemotherapy. HCPs continue to underestimate pathological response (pCR) in geriatric patients, and its impact on survival. the prevalence of fatigue and pain in cancer patients, a finding that Methods should be considered in the management of treatment-related Retrospective analysis of patients treated with neoadjuvant anthracyclines, symptoms. 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 MASCC-0172 Three hundred seventeen were eligible and divided into two subgroups: 79 Geriatric Oncology 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 DEFINITIVE RADIOTHERAPY FOR ELDERLYPATIENTS groups. ER+73.4 % and 62.2 %; HER2+ 16.5 % and 21.4 % and 15.4 % HEAD NECK SQUAMOUS CANCER: THE OUTCOMES AND and 19 % were identified as triple negative, respectively (p=0.2). Most PROGNOSTIC FACTORS patients were treated with 8 cycles of anthracyclines and taxanes, before J. Agarwal1,S.Rathod1,T.Gupta1, S. Ghosh-Laskar1, C. Hotwani1,A. surgery. More cases of the elderly-women subgroup were treated <80 % Budrukkar1,V. Murthy1,N.Kalyani1 anthracyclines planned dose compared with younger-women (17.3 % vs 1Radiation Oncology, Tata Memorial Hospital, Mumbai, India 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 dose- Background and Aims intensity >80 % and 71.4 % for dose-intensity <80 %, both with a Log- In recent decade’s life expectancy has increased and 25 % of head neck rank of 0.012. There was no difference in adverse events grade 3–4. squamous cancers (HNC) patients are aging beyond 70. Radiotherapy Conclusions (RT) plays a dominant role in treatment along with interaction of comor- Breast cancer in older women has the same clinical and pathological bidity, on outcomes. This study presents patterns of presentation, treat- presentation as younger women. Older group was undertreated respect to ment and prognostic factors in geriatric HNC undergoing RT in tertiary chemotherapy dose intense, with impact in pCR and disease free survival. cancer over 20 years. Methods From 1991 to 2012 treatment naïve patients, > 70 years and treated with RTwere retrieved in a single unit. Demographic, treatment and outcome MASCC-0483 factors were studied. Geriatric Oncology Results Total 256 patients with median age 73 yrs (70–87), tobacco/ethanol habits BISPHOSPHONATE PRESCRIPTIONS IN MEN ON in 75 %, co-morbidity was seen in 31 %, with median KPS being 80. The ANDROGEN DEPRIVATION THERAPY (ADT): A common sites were oropharynx/hypopharynx/larynx in 32,30, & 22 % POPULATION-BASED ANALYSIS OF 38,955 PATIENTS OVER respectively.Stage wise presentation Tx:T1:T2:T3:T4 was 7(3 %): 17 YEARS 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 H. Gulamhusein1,L.Yun2, A.M. Cheung1, R. Sutradhar2,P. Warde3,L. dose was 66Gy(IQ range 60–70) and overall treatment time was 48 days Paszat4,S.M.H.Alibhai1 (IQ range 43–52). Conventional/altered fractionation was used for 1Medicine, University Health Network, Toronto, Canada; 2Biostatistics, 231(90 %) and 25(10 %) patients respectively. Compliance to therapy Institute of Clinical Evaluative Sciences, Toronto, Canada; 3Radiation was good with 215(84 %) completed without interruption. The incidence Medicine Program, University Health Network, Toronto, Canada; of grade II:III skin and mucosal toxicity was 159(62 %): 59(23) and 4Radiation Medicine Program, Institute of Clinical Evaluative Sciences, 147(57 %): 46(18 %) respectively. Toronto, Canada Overall survival was 38 % 3 years . In Multivariate analysis primary site, Tstage, N stage radiation dose were significant prognostic factors for OS. Background and Aims Conclusions ADT is commonly used in men with prostate cancer. Side effects include Radical radiation therapy offers good survival is geriatric population. osteoporosis and fragility fractures. Use of bisphosphonates has been Though incidence of acute treatment related toxicity is more, treatment recommended for osteoporosis, but adherence to this recommendation is well tolerated. T stage, N stage and radiation dose are important by clinicians is not well known. This study investigates the use of prognostic factors. bisphosphonates to treat bone loss in men on ADTat a population level. S60 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods Methods Linked administrative databases at the Institute for Clinical Evaluative Ninety-five patients, age ≥65 with cancer and an unplanned hospitaliza- Sciences in Ontario, Canada and the Ontario Cancer Registry were used. tion, and their primary caregivers, were enrolled at one institution. Care- Thirty-eight thousand nine hundred fifty-five men age 66+ (mean age givers completed a questionnaire about their health, social supports, 75.9 y) with prostate cancer treated with either minimum 6 months of a Caregiver QOL-Cancer (CQOLC) index, caregiving situation, patient luteinizing hormone-releasing hormone agent or bilateral orchiectomy in demographics, diagnosis, and function. Ontario between 1995 and 2012 were identified. Bisphosphonate usage Results was captured through drug database claims. Annual rates per 100 person- Patients were a median age of 70 (65–91), GI malignancies/acute years were calculated. leukemia most common (20 %/14.7 %), 60 % had stage IV disease. Results Caregiver median age was 65 (29–84), 72.6 % female, 77.9 % Among all prior non-users, bisphosphonate use in the first year after patient’s spouse and 89.5 % live with patient. Results summarized starting ADT increased from 0.33 per 100 person-years during 1995–97 in Table 1. Median CQOLC was comparable to those caring for to 3.45 in 2010–12 (p<0.0001). Among prior non-users with osteoporo- hospice patients. sis, bisphosphonate usage increased from 0.58 to 9.32 per 100 person- years between 1995 and 97 and 2010–12 (p<0.0001); in those with prior Table 1: Summary of assessments done by caregiver fragility fractures, usage increased from 1.05 to 5.45 (p=.0046) over this time (Figure). Median (range) Patient characteristics Physical function 20 (0–100)* (MOS-physical health) Caregiver-assessed patient KPS 60 % (30–100 %)* Caregiving characteristics Caregiving hours/week 35 h/week (0–168) Caregiving duration 13.5 months (0–384) Professional help 0 h/week (0–99) Perceived supports 61.7 (0–100)* (MOS-social support survey) Caregiver characteristics Charlson comorbidity index 0 (0–7) Conclusions Self-rated health 30.5 % excellent; Although bisphosphonate use has increased over time among all older 48.4 % good men starting ADT and among those at high risk of fracture (i.e. prior 21.1 % fair/poor osteoporosis or fragility fracture), rates still remain very low. Further Mental Health Index-18 70 (0–96.7)* studies are needed to understand and improve this apparent gap in quality CQOLC 88 (22–121) of bone health care. (max range 0–140)*

MOS=Medical Outcomes Survey *=higher scores indicate better function/outcomes MASCC-0542 Conclusions Geriatric Oncology 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. MASCC-0604 1 2 1 5 1 Twardowski , A. Nademanee ,S.Pal,M.Hein,C.Akiba,L. Geriatric Oncology Goldstein6,D.Smith6, A. Hurria1 1Medical Oncology, City of Hope, Duarte, USA; 2Hematology,Cityof 5-FU WITH PHALLUS IMPUDICUS JUICE IN ELDERLY Hope, Duarte, USA; 3Patient and Family Resources, City of Hope, PATIENTS WITH ADVANCED COLORECTAL CANCER: 20 Duarte, USA; 4Nursing Research, City of Hope, Duarte, USA; 5Nursing, YEARS OF EXPERIENCE City of Hope, Duarte, USA; 6Population Sciences, City of Hope, Duarte, USA S. Kuznecovs1, I. Kuznecovs1, L. Gromcakova1,K.Jegina1 1Supportive Care, Institute of Preventive Medicine, Riga, Latvia Background and Aims There is increasing reliance on family members for informal caregiving. Background and Aims Caring for older adults may present challenges due to comorbidities and The incidence of advanced colorectal cancer is high among the elderly. increased frailty. Furthermore, unexpected hospitalization can be particu- Zemestauki (Phallus impidicus) belongs to Traditional Baltic Medicine larly stressful for caregivers impacting their QOL. Few studies have and is used to improve the quality of life in old people with advanced focused on caregivers of older adults with cancer. Aims: a) Tocharacterize cancer . The aim of this study was to evaluate the objective tumor caregivers of hospitalized older adults with cancer and b) to determine response rates and toxicities in elderly patients with advanced colorectal caregiver QOL. cancer treated with 5-FU. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S61

Methods MASCC-0180 One hundred twenty six patients were enrolled in retrospective study Geriatric Oncology 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) A SYSTEMATIC REVIEW OF FACTORS INFLUENCING (66 cases). The median survival time, relapse-metastasis rate, median OLDER ADULTS’ DECISION TO ACCEPT OR DECLINE time of relapses, changes of symptoms, Karnofsky (KPS) score and CANCER TREATMENT immune function were observed. Results M. Puts1, B. Tapscott1,M.Fitch2,M.Howell3,M.Krzyzanowska4,N. The estimated median survival time in the comprehensive group was Leighl4,J.Monette5, D. Wan-Chow-Wah5, E. Springall6, S. Alibhai7 24,7 months, longer than 8,2 months in the control group (P<0.05). The 1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, scores of function and symptom of EORTC QLQ-C30 in the comprehen- Toronto, Canada; 2Odette Cancer Centre Patient and Family Support sive group decreased, while the overall health status increased, and the Program, Sunnybrook Health Sciences Centre, Toronto, Canada; results indicated that the quality of life of the patients in the comprehen- 3Oncology Nursing, University Health Network, Toronto, Canada; sive group was improved. In the comprehensive group, the body weight, 4Medical Oncology, University Health Network, Toronto, Canada; Karnofsky score and immune status after treatment was higher than in 5Division of Geriatric Medicine, Jewish General Hospital, Montreal, control group (P<0.05). Patients with advanced colorectal cancer treated Canada; 6Health Sciences Library, University of Toronto, Toronto, with 5-FU alone had modestly higher rates of severe toxicity: diarrhea, Canada; 7Medicine, University Health Network, Toronto, Canada stomatitis and infections. Conclusions Background: The majority of patients with cancer are 65 years and older. Palliative 5-FU therapy for colorectal cancer patients in eldery may be Several studies have shown that older adults decline cancer treatments used in combination with Phallus impudicus. Combination shows benefit more than younger adults. We conducted a systematic review to synthe- for reducing relapse and metastasis rates, and prolonging survival for size the evidence why older adults accept or decline treatment for cancer elderly patients. 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 MASCC-0333 two independent reviewers. Geriatric Oncology Results: Of 17343 abstracts reviewed, 56 publications reporting on 51 unique studies were included. 38 studies examined actual treat- ment decisions and 13 studies examined a hypothetical decision. TREATMENT PATTERN OF ELDERLYPATIENTS WITH Regarding study design, five were prospective, 20 were cross- BREAST CANCER IN A SINGLE INSTITUTE sectional, 18 were qualitative and eight were retrospective studies. J. Park1,K.Kim1,J.Kim1,I.Choi1,S.Kim2,E.Ko3,K.Hwang3 However, only two studies explicitly asked older adults why they 1Internal medicine, Boramae medical center, Seoul, Korea; 2Radiation declined. The majority focused on decisions for prostate and breast oncology, Boramae medical center, Seoul, Korea; 3General surgery, cancer. The most important factors accepting treatment were trust in Boramae medical center,Seoul, Korea the physician and following the physician’s recommendation. Fac- tors most important for refusing cancer treatments were perceived Background and Aims feeling discomfort of the treatments, fear of side effects and trans- Introduction: Although number of elderly breast cancer patients increased, portation difficulties. The studies examining hypothetical scenarios elderly patients were excluded from clinical trials and standard treatment. showed that older adults are willing to accept cancer treatments for Objective: We aimed to investigate treatment pattern of elderly breast varying levels of benefit, but in general required larger benefits than cancer patients older than 68 years old. younger patients. Methods Conclusion: The reasons why older adults accepted or refused treatment We included 133 breast cancer cases in our study cohort at Boramae vary considerable. Further studies using large representative samples and Medical Center between 2001 and 2012. exploring treatment decision-making incorporating health literacy and Results comorbidities are needed. 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 underly- ing comorbidiy and median number of comorbidities was 1 (1–4). Inva- sive ductal carcinoma was most common subtype (116 patients, 87.2 %). MASCC-0293 At the time of diagnosis, 17 patients (12.8 %) had distant metastasis and 8 Geriatric Oncology (6.0 %) refused staging work up. Only 118 patients (88.7 %) were treated immediately after diagnosis. Of curatively resected 94 cases (70.7 %), THE DEVELOPMENT OFA QUESTIONNAIRE TO MEASURE total mastectomy or modified radical mastectomy and breast conserving REASONS WHY OLDER ADULTSACCEPT OR DECLINE surgery were done in 71 patients (75.5 %) and 23 (24.5 %), respectively. CANCER TREATMENT 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 M. Puts1,M.Fitch2, A. Tourangeau1,M.Krzyzanowska3, N. Leighl3,S. postoperative radiation was performed in 28 patients (29.8 %) and 19 Alibhai4 (20.2 %), respectively. Of 73 patients (77.7 %) with hormone receptor 1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, positive breast cancer, 67 (91 %) received adjuvant hormone therapy. Toronto, Canada; 2Odette Cancer Centre, Sunnybrook Health Sciences Recurrence occurred in 25 patients (26.6 %) and median relapse free Centre, Toronto, Canada; 3Medical Oncology, University Health Net- survival was 40.3 months (CI 17.6–62.9). work, Toronto, Canada; 4Medicine, University Health Network, Toronto, Conclusions Canada Surgical resection and adjuvant hormone therapy were actively per- formed and tolerable in elderly breast cancer patients, although small Background: Cancer is a significant health problem in older population of patients tended to receive adjuvant chemotherapy. persons. Little is known concerning which factors influence the S62 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 acceptance or refusal of treatment. Currently, there is no instru- MASCC-0275 ment available to measure reasons for accepting or refusing Geriatric Oncology cancer treatment. Therefore, the aim of this study was to gener- ate a framework which delineates the factors that are important HEALTH-RELATED QUALITY OF LIFE OF OLDER PEOPLE for accepting or refusing cancer treatment by older adults under- WITH CANCER IN THE ADJUVANT TREATMENT going chemotherapy and/or radiation therapy. In subsequent steps we will develop and test a new instrument measuring reasons for N. Sawada1,B.F. Toneti1,J.M.Paula1, A.C. Nicolussi1 accepting or refusing cancer treatments in older adults with 1General of specialized, College of Nursing at ribeirão Preto at Univer- cancer. sity of São Paulo, Ribeirão Preto São Paulo, Brazil Methods: in the first phase of the project in-depth interviews are con- ducted with older adults undergoing surgery/chemotherapy and/or radia- Background and Aims tion therapy recently diagnosed with cancer to generate possible items for Cancer is one of the most deadly diseases nowadays, victimizing elderly the instrument. Older adults were recruited at the Odette Cancer Centre people in most cases, who become vulnerable through the aging process. and the Princess Margaret Cancer Centre in Toronto. The data are ana- The oncologic treatment significantly affects the patients’ quality of life lyzed using content analysis. and is frequently related to their functional disability. Results: So far 17 participants have been included, and the majority The aim of this project was to identify variations in the quality of life of accepted treatment. Older adults find the ease of treatment, expected elderly people with cancer, characterizing social-demographic, clinical risks and benefits, and anticipated side-effects important in making and therapeutic data, correlating them to the quality of life. the treatment decision. Patients interviewed to this point have per- Methods ceived the guidance of their primary care physician and/or oncolo- This is an exploratory descriptive cross-sectional study. Data were col- gist as the most crucial factor in accepting or declining treatment. lected with instrument EORTCQLQ C 30 in a clinical oncology of Brazil. Most made the initial treatment decision very quickly, the subse- Results quent decisions were not seen as new decisions but a result of the The results of this study concluded that health-related quality of life of first decision to accept the treatment. elderly patients in the sample was satisfactory (mean=69.04). The corre- Conclusion: Most older adult choose the treatment that was recommend- lations observed in this study indicate that the main domains of HRQOL ed by their physician. 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 MASCC-0313 important to enhance the process of rehabilitation of elderly people with Geriatric Oncology cancer adjuvant treatment. According to the literature, understand the variables related to HRQOL of elderly cancer patients undergoing treat- ment assists in the care and interventions during treatment, which can MELANOMA IN THE ORAL CAVITY.A CLINICAL CASE improve health and enhance the HRQoL of these patients. A. Rosello1,E.Jané1, J. Rosello1, R. Rodriguez1, C.J. Omaña1,J.Lopez1 1Oral Medicine, University of Barcelona, Barcelona, Spain

Background and Aims MASCC-0395 Melanoma is a malignant neoplasm, pigmented in most cases. In the Geriatric Oncology 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 BIOSIMILAR EPOETIN FOR THE MANAGEMENT OF of safety, causing large defects that require a very complex rehabili- CHEMOTHERAPY-INDUCED ANAEMIA IN ELDERLY tation treatment. PATIENTS: A SUBANALYSIS OF THE ORHEO STUDY Methods A 74 old years woman, with a diagnosis of Melanoma (Clark Level II), P. Soubeyran1,J.E.Kurtz2, M. Michallet3, E. Luporsi4, H. Albrand5 located on the hard palate attends to University Hospital. At the first 1Medical Oncology, Institut Bergonié and Bordeaux Segalen University, surgical time, a partial maxillectomy was performed. In a second phase, Bordeaux, France; 2Hématologie et oncologie, Pôle d’Oncologie et 24 months later, 4 osteointegrated implants were placed in the upper d’Hématologie, Strasbourg Cedex, France; 3Hematology Department, maxilar, to stabilize the removable upper dental prosthesis with 2 Centre Hospitalier de Lyon Sud, Cedex, France; 4Medical Oncology, micromilled bars. ICL, Vandoeuvre les Nancy, France; 5Médical, Hospira France SAS, Results Meudon La Forêt, France The oral Melanoma is rare malignancy, more common in women, representing 0.2 to about 8 % of all melanomas. It has a poor Background and Aims prognosis and it may remains asymptomatic for a long time. Gen- Chemotherapy-induced anaemia (CIA) requires transfusion, or epoetin erally the lesion occurs in the palate, followed by the ridge of the administration. Elderly patients may experience severe complications maxilla. The treatment of choice is a radical surgery with regional from CIA, such as fatigue and cardiovascular side effects. lymphadenectomy. The ORHEO (place of biOsimilaRs in the therapeutic management of The oral rehabilitation in this patients has a great complexity. In anaemia secondary to chemotherapy in HaEmatology and Oncology) our case, 10 months after the placement of the implants, they are study explores the efficacy and tolerability of epoetin alfa biosimilar stable and radiologically osteointegrated . The patient has a high (EAB) treatment in elderly patients. degree of satisfaction with the rehabilitation, functionally and Methods aesthetically . Patients with CIA (haemoglobin [Hb] <11.0 g/dL) due to treatment for Conclusions solid tumours, lymphoma or myeloma and eligible for treatment with Early diagnosis of pigmented lesions in the mouth and adequate tumor EAB were included. Response rate (RR) was assessed at Month 3 (M3) resection may improve the prognosis of patients with melanoma of the and Month 6 (M6). Secondary endpoints included changes in Hb level, oral cavity. transfusion rates and adverse events. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S63

Results Nursing home interventions N% Patients were subdivided into those aged ≥70 years (n=1009) and Blood tests 61 75 <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 Intravenous antibiotics 50 62 M3 and 86.8 % at M6 in the elderly cohort; 79.8 % at M3 and 86.3 % at Intravenous hydratation 4 5 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 Subcutaneous medication 4 5 cohort. Adverse events were declared in 17.6 % of elderly and 16.4 % of younger patients. Thromboembolic events were more frequent (4.5 % vs Eighty-one episodes were included in the HBIP program involving 70 2.7 %; p=0.011) while infections were less frequent (3.0 % vs 6.6 %; p= patients (48.6 % men; mean age 61.5, SD 12.2, range 32 to 86 years old) 0.0002) in the elderly cohort compared to the younger cohort. from October 2013 to January 2014. The most frequent cancers were: Conclusions lung 26 %, breast 21 %, and colorectal 11 %. Most patients had metastatic EAB therapy was effective and well-tolerated in the management of CIA cancer (74 %) and were receiving active anticancer therapies (72 %). in elderly patients with solid tumours, lymphoma and myeloma. 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 MASCC-0575 HBIP program was 5 (range 1–16) days, with no deaths reported at home. Health Services Unplanned hospital readmissions occurred in 5 (6 %) patients. Conclusions BRIDGING THE GAP BETWEEN HOSPITAL AND HOME: A The HIBP program was safe and avoided or reduced the length of NEW MODEL OF CARE IN CANCER PATIENTS hospitalization in selected cancer patients. Strategies to reduce potentially avoidable hospital admissions can promote quality of care along the C. Font1, N. Arab2,C.Calderon3, A. Carmona-Bayonas4,P.Ayora5,C. cancer-care continuum. Moreno5, C. Gallego5, A. Hernando5, M. Carreño5, C. Barrera1,E. Buxo2,N.Reguart2,B.Mellado2,F. Fernandez-Avilés2,A.Tuca1 1Supportive and Palliative Care Unit (SPCU)-Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; MASCC-0502 2Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Health Services Clinic, Barcelona, Spain; 3University of Barcelona, Psychology, Barce- lona, Spain; 4Sociedad Española de Oncología Médica (SEOM), Con- 5 BRIDGING THE GAP BETWEEN HOSPITAL AND HOME: A tinuum Cancer Care Section, Barcelona, Spain; Institut Clinic malalties NEW MODEL OF CARE IN CANCER PATIENTS Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain C. Font1,N.Arab2, C. Calderon3,P. Ayora2,C.Moreno2, C. Gallego2,A. 2 2 1 4 4 Background and Aims Hernando ,M.Carreño,C.Barrera,E.Buxo, N. Reguart ,B. 4 5 1 Hospital admissions have a negative impact on quality of life and are a Mellado ,F. Fernandez-Avilés , A. Tuca 1 major contributor to health-care costs among cancer patients. We devel- Supportive and Palliative Care Unit (SPCU)-Institut Clinic Malalties oped a home-based intervention program (HBIP) addressed to avoid or Hemato-Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain; 2 reduce the length of conventional hospital admission in cancer patients Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital 3 treated in a tertiary care institution. Clinic, Barcelona, Spain; Personality Assessment and Psychological 4 The aim of this present report was to describe the preliminary results of Treatment, Barcelona University, Barcelona, Spain; Medical Oncology- our ongoing program, the primary end-points being safety and frequency Institut Clinic Malalties Hemato-Oncològiques (ICMHO), Hospital Clin- 5 of unplanned readmissions. ic, Barcelona, Spain; Hematology-Institut Clinic Malalties Hemato- Methods Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain Observational study including consecutive adult (≥ 18 years) cancer pa- tients with an acute medical condition requiring specific interventions Background and Aims usually in hospital. Home-based interventions were performed by Hospital admissions have a negative impact on quality of life and are a oncology-specialized nurses in coordination with the hospital medical staff. major contributor to health-care costs among cancer patients. We devel- Results oped a home-based intervention program (HBIP) addressed to avoid or Table 1. Medical conditions and home interventions in 81 episodes. 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 N%our ongoing program, the primary end-points being safety and frequency Medical conditions of unplanned readmissions. Methods Non neutropenic infections 36 44 Observational study including consecutive adult (≥ 18 years) cancer pa- Febrile neutropenia 18 22 tients with an acute medical condition requiring specific interventions Cancer pain 10 12 usually in hospital. Home-based interventions were performed by Bowel obstruction 7 9 oncology-specialized nurses in coordination with the hospital medical staff. Results Grade 3 intestinal toxicity 4 5 81 episodes were included in the HBIP program involving 70 patients Venous thromboembolism 2 2 (48.6 % men; mean age 61.5, SD 12.2, range 32 to 86 years old) from Dyspnea 2 2 October 2013 to January 2014. The most frequent cancers were: lung 26 %, breast 21 %, and colorectal 11 %. Most patients had metastatic cancer (74 %) Grade 4 thrombocytopenia 1 1 and were receiving active anticancer therapies (72 %). Table 1 summarizes Hypocalcemia 1 1 the most common medical conditions treated and home intervention. S64 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

The HBIP program avoided admission in 43 (53 %) outpatients and MASCC-0424 shortened hospital stay in 38 (47 %) inpatients. The median duration of Health Services HBIP program was 5 (range 1–16) days, with no deaths reported at home. Unplanned hospital readmissions occurred in 5 (6 %) patients. INFORMATION REFERRAL PROGRAM FOR CANCER Conclusions PATIENTS ATAN OUTPATIENT CANCER CENTRE The HIBP program was safe and avoided or reduced the length of hospitalization in selected cancer patients. Strategies to reduce potentially S. Lorhan1,L.Leitz2,H.M.L.Daudt3, S. Mahovlich4 avoidable hospital admissions can promote quality of care along the 1Volunteer Services, BC Cancer Agency, Victoria, Canada; 2Library, BC cancer-care continuum. Cancer Agency, Victoria, Canada; 3Clinical Research Management, BC Cancer Agency, Victoria, Canada; 4Administration, BC Cancer Agency, Victoria, Canada

MASCC-0580 Background and Aims Health Services Providing patients with current and reliable information can empower patients to participate in health care decisions about their own treatment A CASE OFACUTE PROMYELOCYTIC LEUKEMIA (APL) and follow-up strategies. However, many patients are not made aware of WITH ISOCHROMOSOME (17Q) AS THE SOLE the medical library and the services it offers. The objective of the Infor- ABNORMALITY mation Referral Program is to increase awareness of the medical library and ensure patients receive accurate and tailored information. 1 1 2 2 2 B. Ganguly ,S.Mandal, T.K. Dolai ,M.Bhattacharyya,R.De Methods 1 2 Genetics, Genetics Center,Mumbai, India; Haematology, NRS Medical A feasibility pilot was conducted in 2012. Health Care Providers (HCPs) College, Kolkata, India 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 Background and Aims they would be in contact with the librarian. Information packages pro- Chromosome abnormalities have been recorded in 50–60 % of acute vided to patients were based on their information needs, preferred plat- myeloid leukemia (AML). Pre-treatment cytogenetic analysis of AML form, and comprehension level. A satisfaction survey posed questions is important for risk stratification and prognostication. In M3 sub-class of about where they previously accessed information and if they would AML, rearrangement of RARA gene at 17(q21) is recorded predominant- come back to the library. A qualitative interview was conducted with a ly with PML gene at 15(q22) and occasionally with PLZF, NPM and medical oncologist to understand the impact for physicians. NUMA genes. However, isochromosome 17(q) has been reported in three Results APL cases. Treatment with all-trans retinoic acid did not favor prognosis Patients reported that the information referral was useful and informative. in two of these cases and cases with variant rearrangements. Wepresent a The qualitative interview indicated that the program is important for both 8-year old girl reported with bleeding manifestation for 20 days, low Hb, the care of the patient and improving interactions with patients. However, WBC 9800 cu/cmm, atypical promyelocytes 46 %, platelet 40,000 cu/ in the months following the pilot, there was little uptake by HCPs. cmm and multiple auer rods in peripheral blood smear. Conclusions Methods There are barriers to the expansion of the program that have not been Cytogenetic followed by FISH and RT-PCR were employed for detection identified during the feasibility phase. Using the knowledge exchange- of PML-RARA fusion. decision support model we are conducting a series of meetings with staff Results to collect feedback and address barriers. The program will be revised Conventional cytogenetic study has detected i(17q) as the only abnor- based on the assessment conducted. mality in 25 cells evaluated (Fig. 1). Furthermore, PML-RARA fusion was not detected in FISH and RT-PCR study. Ider(17q) indicates mono- somy (17p) and trisomy 17(q). Fig. 1. The karyotype with 46,XX,ider(17q) MASCC-0487 Health Services

UNPLANNED 30-DAYREADMISSIONS AMONG ELDERLY PATIENTS WITH GASTROINTESTINAL CANCER J.G. Manzano1,R.Luo2, L.S. Elting2,M.George1, M.E. Suarez-Almazor1 1General Internal Medicine, UT MD Anderson Cancer Center,Houston, USA; 2Health Services Research, UT MD Anderson Cancer Center, Houston, USA

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. Conclusions Methods Ider(17q) has been detected in this center among 150 APL cases studied. We conducted a retrospective cohort study using linked Texas Cancer The pathogenesis and treatment choice for these patients with ider(17q) Registry and Medicare data. Short stays to acute care hospitals were are not clear at this stage. included. Claims data were analyzed for 2 years after cancer diagnosis. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S65

Multilevel analysis, with claims nested within patients, was used to MASCC-0594 identify factors associated with unplanned readmission. Health Services Results We analyzed 46,454 claims from 21,292 patients with GI cancer SUPPORTIVE CARE IN CANCER PATIENTS: REPORT OF aged 66 and above. The unplanned readmission rate was 17.4 %, ACTIVITY and the median time to readmission was 11 days. The most common diagnoses for readmission were volume depletion (4.3 %), conges- M. Lucchesi1, E. Vasile1, L. Ginocchi1, I.M. Brunetti1, S. Ricci1,A. tive heart failure (4.2 %) and pneumonia (3.6 %). Increased odds for Falcone1, A. Antonuzzo1 readmission were seen with age ≥80 years (OR 1.12;CI 1.04–1.21), 1Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy 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 Background and Aims hospitalization (1.52;1.44–1.61). Recent advances in the treatment of solid tumors create a growing Conclusions number of complications and relevant toxicities or symptoms that Unplanned readmissions are common among elderly patients with may require hospitalization of a significant number of these GI cancer. Top reasons for readmission were potentially prevent- patients. able and amenable to outpatient management. Our findings empha- An integrated model dedicated to symptoms management and supportive size the importance of improving transitions of care processes, as therapies, may be more effective for cancer patients’ care and reduce well as promoting coordinated care in this patient population. hospital admissions. Knowledge of risk factors can help identify patients who would Methods benefit from closer follow up, and other targeted interventions to A dedicated supportive-care team receives patients without appoint- prevent readmission. ment, in order of the severity of cases, and gives a mobile phone consult. Results Nine hundred fifty-eight visits (March 2013–February 2014) have MASCC-0595 been performed and more than 2,000 phone calls from patients Health Services 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 thera- THE ECONOMIC COSTS OF SYMPTOM MANAGEMENTAND pies. Main reasons for access were: toxicities (304 patients), un- TOXICITIES IN CANCER PATIENTS TREATED IN controlled symptoms (448) and logistic problems (82); other rea- AMBULATORY SETTING sons were suspected progressive disease (52) and lab test abnor- L. Ginocchi1, A. Pasdera2, E. Vasile1,M.Lucchesi1, I.M. Brunetti1,S. malities (72). Ricci1, A. Falcone1, A. Antonuzzo1 One hundred seventy-three patients received i.v. supportive therapy 1Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; at the unit while 718 had a prescription for domiciliary treatment. 2, Studio Pasdera srl, Mirano (VE), Italy Two hundred sixty-one blood tests cases were controlled and in 169 a radiological exam was required. In 13 cases a paracentesis or Background and Aims thoracentesis was performed and 197 patients were submitted to The economic burden of cancer is associated with costs of interventions other specialist consults. for prevention and treatment and with the lost earnings due to inability to For only 62 patients (6.5 %), hospitalization was required, while 896 work. (93.5 %) were fully managed as outpatients; 186 patients needed repeated The costs for cancer care represent a high proportion of the total accesses to the unit and 13 were addressed to home care. healthcare costs. The main item of the costs is represented by disease Conclusions treatment. However an important charge is also due to management of A careful and dedicated management of supportive care for cancer toxicities and symptoms. patients may reduce the need for hospitalizations and optimize patients The main aim of our analysis was to evaluate the economic costs of care. hospitalizations due to toxicities and/or symptoms management for can- cer patients receiving chemotherapy in an outpatient service. Methods We evaluated all the patients receiving chemotherapy at our outpatient MASCC-0593 service during 2011 and 2012 and collected data about their hospitaliza- Health Services tions during treatment. Wehave considered hospitalizations due to symp- toms and/or toxicities management excluding all the others being neces- SUPPORTIVE CARE ACTIVITYAND REDUCTION OF sary for treatment of the disease or for reasons unrelated to cancer. HOSPITALIZATIONS FOR CANCER PATIENTS We counted the costs according to standard reference data taking into account the duration and the department of each hospitalization. E. Vasile1, M. Lucchesi1, I.M. Brunetti1, L. Ginocchi1, S. Ricci1,A. Results Falcone1, A. Antonuzzo1 A total of 413 admissions among over 2,500 patients have been consid- 1Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy ered 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 Background and Aims each admission of about 5,600 euros and a cost per patient of about 1,000 Growing problems for oncologic patients (pts) during treatments euro. is the management of related toxicities and symptoms due to Conclusions disease. Symptoms and toxicities management for cancer patients may have high Aim: to analyze the number of hospitalizations due to toxicities and/or economic costs. However, the costs of hospitalizations for these reasons symptoms management for outpatients receiving active oncologic treat- should be reduced improving the outpatient network for supportive care ments after the introduction of a supportive care team inside oncologic in cancer. department. S66 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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 exclud- ing 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 in- creased 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 hospitali- zations 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 Conclusions Health Services 2 From a first data analysis, on the management side the presence of a dedicated Supportive Care Unit has made available direct resources such as REDUCTION OF HOSPITALIZATION AFTER THE hospital beds and staff. The outcome on the patient side is a reduction in the IMPLEMENTATION OF THE OUT-PATIENT SUPPORTIVE number of hospitalizations. Further studies should be carried out to assess CARE UNIT (SCU) IN A COMPREHENSIVE NATIONAL whether patients’ quality of life has been maintained at the best possible level. CANCER CENTER IN ITALY C.I. Ripamonti1,C.DiCristo2, G. Barone1,M.A.Pessi1,P. Molani2,G. Boscagli2,C.Desti2 MASCC-0263 1 Haematology and Pediatric Onco-Haematology, Fondazione IRCCS Health Services 2 Istituto Nazionale Tumori, Milan, Italy; 2Management Control, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy BLOOD COMPONENT TRANSFUSIONS ATTHE SUPPORTIVE CARE OUT-PATIENT UNIT (SCU) DECREASE Background and Aims HOSPITALIZATION IN ONCOLOGICALWARDS IN A During oncological treatments with curative or palliative intent, patients COMPREHENSIVE NATIONAL CANCER CENTER IN ITALY require supportive medical therapies aimed to manage toxicity/ complications of the treatments, thus ensuring greater adherence to the C.I. Ripamonti1,P. Molani2, G. Barone1,M.A.Pessi1,F. Ravagnani3,C. treatment protocols in terms of dose-intensity and interval of Desti2,G.Boscagli2,C.DiCristo2 administration. 1Supportive Care in Cancer Department of Haematology and Pediatric Aim of the study is to evaluate the role of a dedicate out-patient SCU Onco-Haematolgy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, in reducing the hospitalization of the patients in the Oncological Italy; 2Management Control, Fondazione IRCCS Istituto Nazionale Wa r d s . Tumori, Milan, Italy; 3Transfusion Medicine Service, Fondazione IRCCS Methods Istituto Nazionale Tumori, Milan, Italy Considering that SCU Unit started the activity on June 4th 2009, we collected the information regarding the Diagnostic Related Group Background and Aims (DRG) of the Oncological Department, the Haematological Depart- Blood Component (BC) transfusions is one of the activities of the out- ment and the Oncological Day Hospital starting from January 2008 patient SCU ancillary for the oncological wards of the Hospital dedicated (1 year and half before the SCU inception) until December 2013. to active anti-cancer treatments with curative or palliative intent. The same methodology was applied for the Oncological out –patient The aim of this study was to assess the changes in the number of services and SCU of the INT. transfusions performed from 2009 until December 2013. Results Methods The number of the hospitalized Patients (DRG) considered from 2009 We compared the transfusion activity in different wards. We considered: until 2013 decreased from 843 to 374. Oncological Day Hospital, Bone Marrow Transplantation Unit, Radio- It is remarkable to point out that Oncological Patients have been treated therapy Ward, Medical Oncology Unit I and II. Wecollected data from the more frequently in an ambulatorial setting. The evidence is in the increas- Management Control department from 2009 until 2013 and compared the ing number of patients admitted at the out-patient setting of the SCU (see quantities and the costs of the global number of transfusions performed the chart). within the different structures. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S67

Results Background and Aims As shown in Chart 1, the trend is negative for every ward considered and ‘Supportive care’ is the prevention and treatment of the oncological therapy- reflects a decrease in the amount of BC transfusions performed during the related complications as well as the maintenance of physical, psychosocial, hospitalization. On the contrary, the chart shows a consistent and steady spiritual well being of the patients thus to improve their adherence to growth for the Supportive Care Unit, which in less than 3 years from its treatment protocols in terms of dose-intensity and interval of administration. inception outperformed every other ward, both in total quantities and To reach those aims, the SCU of the NCI of Milan (born on June 2009) created value for transfusions. We need to remark that for what concerns has mainly four approaches: to collaborate with the individual specialists the costs (Chart 2), the expenses related to hospitalization in the onco- of NCI through integrated and ancillary activities by means of specific logical wards are not included. pharmacological interventions; to assess all patients’ needs through Ital- ian 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 (pharma- cological 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 high- dose chemotherapy,for acute and chronic renal failure, electrolyte supply, and/or multivitamin, protein and lipid supply in patients with compro- mised ability to eat and drink properly, or with toxicity due to radiother- apy 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, MASCC-0311 so we can conclude that in terms of cost efficiency and availability Health Services 2 of hospital beds, the effects could be underrated and should be investigated further. CORRELATES AND OUTCOMES OF LESBIAN, GAY, BISEXUAL, AND TRANSGENDER (LGBT) IDENTITY DISCLOSURE TO CANCER CARE PROVIDERS MASCC-0204 C. Kamen1, L. Margolies2, M. Smith-Stoner3,M.Flannery1, M. Tejani1,A. 1 1 1 Health Services 2 Peoples , G. Morrow , K. Mustian 1Department of Surgery, University of Rochester Medical Center,Roch- ester, USA; 2National LGBT Cancer Network, National LGBT Cancer SUPPORTIVE CARE UNIT (SCU) ATTHE NATIONAL CANCER Network, New York City, USA; 3Nursing, California State University San INSTITUTE (NCI) OF MILAN Berdardino, San Bernardino, USA C.I. Ripamonti1, G. Barone1,M.A.Pessi1 1Supportive Care in Cancer Department of Haematology and Pediatric Background and Aims Onco-Haematolgy, Fondazione IRCCS Istituto Nazionale dei Tumori, LGBTcancer patients are often invisible in United States cancer studies. Milan, Italy Non-cancer studies indicate that LGBT patients have difficulty disclosing S68 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 their LGBT identity to medical providers and that lack of disclosure message reminders on symptom control, accessibility to drugs and results in poorer health outcomes. The current study explores correlates other provisions used in symptom management. Post test question- of disclosure to cancer care providers and outcomes of disclosure. naires were administered after 6 weeks to assess the impact of the Methods biweekly lectures and short text messages on the quality of pallia- Three hundred eleven LGBT cancer patients (mixed cancers; 88.5 % tive care service provision. Caucasian; 50.1 % gay, 36.3 % lesbian, 7 % bisexual, 3 % trans- Results gender) completed an online survey assessing experiences of diag- The physicians felt empowered and easily provided palliative care nosis and treatment, including items asking about demographics, to 2) Cancer patients reported improved care whom patients had disclosed, how they disclosed, which provider Conclusions delivered their cancer diagnosis, and about current self-reported Short term discussions, lectures and even sort text messages are useful in health. empowering health workers in providing palliative care. 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 MASCC-0330 assumptions (40.8 %). Surgeons were most likely to deliver cancer Health Services 2 diagnoses (30.9 %), though less than half of patients had disclosed to their surgeons (45 %). Bisexuals were less likely (χ2=16.49, p= IN-PATIENT SUPPORTIVE CARE UNIT IN ONCOLOGY:A 0.002), while same-ex partnered individuals were more likely THREE YEAR ASSESSMENT (2011–2013) (OR=2.89, p=0.01) to disclose to providers. Lesbian women who 1 1 2 3 2 4 disclosed were more likely to report good or better health currently P.Leroy,M.Kfoury,S.Hans,C.Herve,D.Brasnu,S.Oudard,C. 2 1 2 2 4 than women who did not disclose (r=0.21, p=0.018). Sauvajot , C. Aubaret ,L.Tripault,A.Guillou,F.Scotté 1 Conclusions Supportive Care in Cancer Unit, Georges Pompidou European Hospital, 2 Disclosure of LGBT identity is a common experience in the context of Paris, France; Oncology Department, Georges Pompidou European 3 cancer care and is associated with better self-reported health among Hospital, Paris, France; Ethics Department, Paris Descartes University, 4 certain LGBT patients. Creating safe environments for LGBT patients Paris, France; Medical Oncology AND Supportive Care in Cancer Unit, to disclose could improve cancer care delivery to this underserved Georges Pompidou European Hospital, Paris, France population. 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. MASCC-0415 Ayearly evaluation was conducted to monitor the unit’sactivity. Health Services 2 Methods An observational prospective study was performed in the 4-bed unit from THE ROLE OFA PHYSICIAN IN PALLIATIVE CARE OF January 1 – December 31, 2013. CANCER PATIENTS ADMITTED IN AWESTERN KENYA Results COUNTY HOSPITAL A total of 244 patients were included in the study. In 2013, 67.6 % of patients came directly from home. The predominant diseases S. Obuya1, M. Liru2, C. Kasera2,W.Aketch2,J.Oguda3,P.Were4 observed were head and neck cancer 37.7 % and lung cancer 1Clinical, Moi Teaching and Referral Hospital, Eldoret, Kenya; 2Clinical, 24.1 %. The main reasons for hospitalization were bad performance Homabay District Hospital, Homabay, Kenya; 3Gynea-Oncology, Moi status 30.3 %, pain 13.5 %, invasive procedures 12.7 %, and University, Eldoret, Kenya; 4EMBLEm Project, Moi Teaching & Referral nutritional disorders 9.1 %. In USSO, an interdisciplinary approach Hospital, Eldoret, Kenya remains the cornerstone of treatment with a daily collaboration of dieticians, psychologists, physiotherapists, and the palliative care Background and Aims team. Based on this policy, the patient’s average length of stay The physician handling a large doctor to patient ratio in Homabay was reduced to 8.3 days. Finally, 61 % of the patients were County hospital feels over whelmed offering palliative care services. discharged home. A total of 9 % patients were transferred to a However, emphasis on the significance of these services has had recovery unit and 12.7 % to a palliative care unit (total 9 % deaths impact on the quality of palliative care of patients admitted with recorded). cancer at Homabay County Hospital. The hospital serves a popula- tion of 963,794, is situated on the Southern shores of Lake Victoria. It has neither a trained oncologist nor palliative care specialist, 2011 2012 2013 Total hence the need to sensitize the physicians and other health care providers on the ground to offer this service. Number of stays 158 192 244 584 Objectives Home admissions/Discharge (%) 59.4/51.8 64/60 67.6/61 1) To sensitize physicians and other health care providers on palliative Emergency admissions (%) 17.7 8.3 6.5 care service. 2) To include early symptom control as part of management of cancer patients. Conclusions Methods With the development of an interdisciplinary strategy we greatly amended Pretest questionnaires were administered to 24 health care providers patient management. These results enabled to increase USSO capacity to terminally ill cancer patients on basic palliative care knowledge. from 4 to 8 beds, which not only improved the supportive care organiza- This was followed by a 6 weeks twice weekly lectures and short text tion but also the patient’s quality of life. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S69

gouvernance, École nationale d’administration publique, Montréal, MASCC-0341 4 Health Services 2 Canada; Département de médecine sociale et préventive Faculté de médecine et des sciences de la santé, Université Laval, Québec, Canada; 5Centre de recherche CSSS Champlain—Charles-Le Moyne Faculté de IS A SUPPORTIVE CARE UNIT MORE COST EFFECTIVE médecine et des sciences de la santé, Université de Sherbrooke (Campus THAN AN ONCOLOGY UNIT? Longueuil), Longueuil, Canada F. Scotté1,C.Sauvajot2,P. Leroy3, M. Kfoury3,D.Brasnu2,C.Herve4,S. Oudard5,C.Aubaret3, L. Tripault2, A. Guillou2,I.Borget6 Background and Aims 1Medical Oncology AND Supportive Care in Cancer Unit, Georges Pompi- Interdisciplinary teamwork (ITW) has been advocated in a number of dou European Hospital, Paris, France; 2Oncology Department, Georges forums for improving the quality of primary and specialized care. Pompidou European Hospital, Paris, France; 3Supportive Care in Cancer The objective of the study is to evaluate the effects of ITW on cancer Unit, Georges Pompidou European Hospital, Paris, France; 4Ethics Depart- patients’ perceived experience of care. ment, Paris Descartes University, Paris, France; 5Medical Oncology, Methods Georges Pompidou European Hospital, Paris, France; 6Pharmacy Depart- Data was collected in 2010–11 in 15 % of Quebec’s oncology outpatient ment, Gustave Roussy Cancer Campus, Villejuif, France 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 Background and Aims patients. Perceived experience of care was documented by means of a A specific SCC unit (SCCU) may create a financial burden compared to self-administered questionnaire divided into six validated sub-scales: standard cancer department. timeliness of services (TIM), communication (COM), patient-centered Costs of stays and benefits of SCCU were compared to Medical (MO) care (PCC), quality of physical environment (QPE), continuity (CONT) and Gastro-Intestinal (GI) Oncology departments, to estimate the cost and results of care (RES). Multiple logistic regression models were used effectiveness of both units. to estimate the extent to which patients’ ratings of their care experience Methods differed between levels of ITW. Data were analyzed over a two year period (2011–2012). Costs of hospital Results stays and costs per day were calculated based on the hospital cost accounting Patients who were treated in clinics where the ITW level is high were 3.99 method. Benefit for the hospital was calculated as the difference between times (95 % CI: 1.89–8.41) more likely to rate positively TIM and more cost and Diagnosis Related Group tariffs in the stay and was classified. likely to have a favorable opinion of COM (OR: 2.37; 95 % CI: 1.25– Results 5.45), of PCC (OR: 2.11; 95 % CI: 1.05–4.24), and of CONT (OR: 2.18; A total of 158 and 192 patients were respectively admitted to 4 beds in the 95 % CI: 1.07–4.47). Patients’ perception of QPE and RES were not SCCU in 2011 and 2012. The performance index-median length of stay (IP- related to the level of ITW teamwork. Various patients’ characteristics and DMS) was cost effective (<1.00) for the SCCU compared to MO and GI 0.79, organizational attributes were associated with patients’ ratings of their 1.09, 1.1 respectively in 2012 (enhanced result compared to 2011). Average care experience. costs per day of stay were lower for the SCCU compared to MO and GI in 2011 Conclusions and 2012. Benefit per day was also higher in favor of the SCCU permitting the Results suggest that ITW can improve various aspects of cancer patients’ unit to benefit financially compared to the two other oncology units. care experience. Remaining challenges to draw clear conclusions about the key elements of ITWand its benefits will be discussed.

SCCU MO GI 4 b 12 b MASCC-0176 Benefit per day of stay (euros) 2011 492 387 346 (9b) Health Services 2 2012 521 424 394 (17b) THE PRODUCTION CONDITIONS OF THE EFFECTS OF Conclusions INTERDISCIPLINARY TEAMWORK IN ONCOLOGY TEAMS: The SCCU was less expensive than the other oncology units and resulted AREALISTEVALUATION PROTOCOL in shorter hospital stays, suggesting that its development should allow the D. Tremblay1, N. Touati2, D. Roberge3, J.L. Denis4, A. Turcotte1,B. oncology department to enhance the quality of care without occurring any Samson5 additional expenses. 1École 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 sci- MASCC-0183 ences de la santé communautaire Faculté de médecine et des sciences de Health Services 2 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, DOES INTERDISCIPLINARY TEAMWORK IMPROVE Montréal, Canada; 5Centre intégré de cancérologie de la Montérégie, CANCER PATIENTS’ PERCEPTIONS OF THEIR CARE CSSS Champlain-Charles Le Moyne, Brossard, Canada EXPERIENCE? RESULTSOFA QUEBEC’S ONCOLOGY CLINICS SURVEY Background and Aims D. Tremblay1, D. Roberge2, N. Touati3,E.Maunsell4,D.Berbiche5 Due to the nature of the illness and its multimodal treatment, cancer 1École des sciences infirmières Faculté de médecine et des sciences de la patients are particularly exposed to problems of fragmentation, coordina- santé, Université de Sherbrooke (Campus Longueuil), Longueuil, tion, communication and continuity of care. Interdisciplinary team work Canada; 2Département des sciences de la santé communautaire Faculté (ITW) is considered as a key element in cancer programs, but models de médecine et des sciences de la santé, Université de Sherbrooke differ considerably, as well as the expected effects on healthcare (Campus Longueuil), Longueuil, Canada; 3Centre de rechercher sur la experiences. S70 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

The objectives of the present study are 1) identify the contextual pulmonary embolism. The Pulmonary Severity Index is always High factors and mechanisms associated with the production of effects of for cancer patients and does not seem appropriate for assessing risk of ITW 2) determine the synergetic or antagonistic influence of con- home treatment. textual factors and mechanisms of ITW on the production of effects Observational studies are needed to make recommendations. on the patient, 3) explore the occurrence of unanticipated mecha- nisms and effects of ITW. Methods This retrospective multiple case study draws on realist evaluation princi- MASCC-0597 ples which explore the context, mechanism, and outcome (CMO) asso- Hemostasis ciations. Qualitative data sources will be used to build a picture of CMO and to capture the patient and professional perspective about ITW. PERFORMANCE OF PROGNOSTIC SCALES IN Results CANCER-RELATED PULMONARY EMBOLISM: DATA FROM Results are yet to come, but we anticipate that the research project will 650 CONSECUTIVE PATIENTS FROM THE EPIPHANY STUDY contribute to fill the knowledge gap on professional team processes C. Font Puig1, A. Carmona-Bayonas2,C.Beato3,P.Jiménez-Fonseca4,L. identifying the critical conditions associated to a positive patient- 5 2 6 7 8 reported care experience. Faez , M.A. Vicente , M. Biosca , M. Antonio Rebollo ,I.delaHaba ,O. Madridano9,J.Plasencia10, D. Calvo-Temprano11 ,A.Domínguez12,A. Conclusions 13 14 15 This study will mobilize realist evaluation principles to draw lessons Puerta ,P.Arguis , R. Otero-Candelera 1Hematology and Medical Oncology, Hospital Clínic, Barcelona, about how combinations of contextual factors and mechanisms produce 2 particular outcomes. The results could permit to target more specifically Spain; Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; 3Hematology and Medical On- the actions needed for optimizing the structures and activate the mecha- 4 nisms responding to the needs of cancer patients and could make an cology, Hospital Nisa Aljafarate, Sevilla, Spain; Hematology and important contribution regarding developing new research methods better Medical Oncology, Hospital Central de Asturias, Oviedo, Spain; 5Hematology and Medical Oncology, Hospital Central de Asturias, suited for realist evaluations of complex interventions in the healthcare 6 sector. Sevilla, Spain; Hematology and Medical Oncology, Hospital Vall d’Hebrón, Barcelona, Spain; 7Hematology and Medical Oncology, ICO- Duran i Reynals, Barcelona, Spain; 8Internal Medicine, ICO- Duran i Reynals, Barcelona, Spain; 9Internal Medicine, Hospital MASCC-0547 Universitario Infanta Sofía, Madrid, Spain; 10Radiology, Hospital 11 Hemostasis Universitario Morales Meseguer, Murcia, Spain; Radiology, Hos- pital Central de Asturias, Murcia, Spain; 12Radiology, Hospital Virgen del Rocío, Sevilla, Spain; 13Radiology, Hospital Reína Sofía, OUTPATIENT TREATMENT FOR UNSUSPECTED Murcia, Spain; 14Radiology, Hospital Clinic, Barcelona, Spain; PULMONARY EMBOLISM IN CANCER PATIENTS 15Pneumology, Hospital Virgen del Rocío, Sevilla, Spain A. Burnod1, M.N. Guilhaume2,J.Danis1, E. Renault-Tessier1,L.Copel1, C. Bouleuc1 Background and Aims 1Supportive and palliative care, Institute Curie, Paris, France; 2Medical The simplified Pulmonary Embolism Severity Index (sPESI), Gene- Oncology, Institute Curie, Paris, France va Prognostic Score (GPS) and RIETE registry scale have been validated to predict short-term mortality in patients with symptom- Background and Aims atic pulmonary embolism (PE). However, incidental PE currently Unsuspected pulmonary embolism (UPE) found on routine cancer stag- represents half of cancer-related PEs. The European Cooperative ing multi-row detector computed tomography scan is known. Practice Oncology Group Performance Status (ECOG-PS) scale is the single guidelines recommend treating these patients as comparable patients with most important predictive factor in cancer. OBJECTIVE To assess symptomatic pulmonary embolism. Is outpatient treatment for selected the accuracy of 3 prognostic models to predict 30-days mortality in cancer patients with UPE safe ? cancer-related PE. Methods Methods We conducted a retrospective study from January 2012 to December EPIPHANY is an ongoing, ambispective, multicenter study to 2013. Oncology patients in whom UPE was proved by scan were includ- assess prognostic factors in patients with cancer-related PE, in- ed. Patient characteristics were reported and analysed. cluding symptomatic and incidental events. We substituted the Results predictor ‘history of cancer’ by ‘active cancer’ in sPESI and We included 56 patients, 57 % were women. Mean age was 63 years. GPS scores. 82 % of them had metastatic cancer. Breast and lung cancers accounted Results for 57 % of the cancers in the UPE cohort. Twenty three patients (41 %) From January-2006 to November- 2014, 650 consecutive patients had a WHO performance status score greather or equal to 2. Among 56 were recruited. Data were prospectively collected in 299(46 %). 319 patients, 46 % had proximal UPE. episodes (48.8 %) were incidentally diagnosed. Table 1 shows the A total of 44 patients (79 %) were identified by the Pulmonary baseline data of our cohort. Overall 30-days mortality was 14 % (CI Embolism Severity Index (sPESI) of 3 or more. Outpatient treatment 95 %, 11.2–17.1 %), being cancer progression the most common was managed for 50 patients (88 %) with low molecular weight cause of death (70.8 %). The AUCs were: 0.711 (95 % confidence heparin. None of them had a complication of UPE or mortality 30- interval [CI], 0.675–0.746) for sPESI; 0.706 (95 % CI, 0.670– day outcome. Other patients were hospitalized due to hemorrhagic 0.741) for GPS; 0.775 (95 % CI, 0.741–0.807) for RIETE and risk. 0.780 (95 % CI, 0.748–0.813) for ECOG-PS. Pairwise comparison Conclusions of ROC curves did not reveal significant differences between The results of the current study demonstrated that outpatient treatment is RIETE and ECOG-PS, and both were superior to sPESI and GPS safe for most of cancer patients newly diagnosed with unsuspected (p<0.05) (Table 2). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S71

Table 1. Baseline and acute variables 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 Category N (%) of this study is to analyze the incidence of cancer-associated thrombosis Age (mean ± SD) 64±12 in ambulatory pts with gliomas receiving CTor CRT. Body weight (mean ± SD) 71±14 Methods Male gender 361 (55.5 %) We performed a retrospective review to determine the incidence of symp- tomatic and incidental VTE in pts attended in our service. One hundred Chronic bronchitis 82 (12.6 %) eight consecutive pts who received CT or CRT for gliomas from January Cardiovascular disease 35 (5.4 %) 2008 through December 2012 were identified and included in the analysis. ECOG PS ≥2 310 (47 %) Results History of previous DVT 79 (12.2 %) VTE was identified in 14 (13.0 %) pts. Median follow-up: 26 months. TNM stage IV 482 (74.3 %) Median age-year old: 59 (range 19–85). Male/female: 55.6 %/44.4 %. Tumor assessment Type of glioma: glioblastoma multiforme 67.7 %; anaplastic astrocytoma 26.9; oligodendroglioma 6,5 %. CT-RT: 90 patients (83.3 %). CT: Diagnosis/not yet evaluated 247 (38 %) temozolamida 94 (87 %); bevacizumab 8 (7.4 %). Median time to Tumor progression 130 (20 %) diagnosis VTE: 3.5 months (range 0–36 months). VTE in first 6 months All tumors removed 57 (8.8 %) after diagnosis: 64,3 %. Type of VTE: 42.9 % pulmonary embolism (PE), Chemotheraphy 360 (55.4 %) 50.0 % deep vein thrombosis, 7.1 % visceral vein thrombosis (VVT). PE-specific symptoms 331 (51.2 %) 28.6 % of the events were incidentally discovered (50 % PE, 100 % Heart rate≥11 0 154 (23.7 %) VVT). Recurrent rate: 7,1 %. 50 % of pts treated with bevacizumab developed VTE. Systolic Blood pressure<100 mmHg 75 (11.5 %) Conclusions Arterial blood oxygen saturation<90 % 104 (16 %) The high incidence of VTE observed in this study is consistent with prior reports. The incidence of bevacizumab-associated thrombosis outside Table 2. Prognostic values of sPESI, GPS, RIETE, ECOG-PS to predict clinical trials must be specifically assessed. 30-days mortality

Parameter sPESI GPS RIETE ECOG PS (0 vs. ≥1) (<3 vs. ≥3) (<2 vs. ≥2) (<2 vs. ≥2) MASCC-0385 Sensitivity, % 100 % 62.6 % 98.8 % 89 % Hemostasis (CI–95 %) (96–100) (51.8–72.5) (93.9–99.9) (80.7–94.6) Specificity, % 16.8 % 65.5 % 20.7 % 59.1 % VTE-RELATED HOSPITAL COSTS FOR FRENCH PATIENTS – – – – – (CI 95 %) (13.8 20.2) (61.4 69.5 %) (17.4 24.4) (54.9 63.2) WITH BREAST OR PROSTATE CANCER PPV,% 16.4 % 22.8 % 16.7 % 26.2 % 1 2 3 (CI–95 %) (13.4–19.7) (17.8–28.6) (13.6–20.2) (21.4–31.4) F.Scotté, A. Vainchtock , I. Borget 1 NPV,% 100 % 91.5 % 99.1 % 97 % Oncology, Hôpital Européen Georges Pompidou, Paris, France; 2 3 (CI–95 %) (96.1–100) (88.3–94) (95.3–99.9) (94.6–98.5) Medico Economy, Health Evaluation, Lyon, France; Health Economy, pLR 1.20 1.82 1.25 2.18 Institut Gustave Roussy, Villejuif, France (CI–95 %) (1.16–1.25) (1.50–2.21) (1.19–1.31) (1.93–2.46) Background and Aims nLR 00.570.05 0.19 (CI–95 %) (0.43–0.75) (0.01–0.38) (0.10–0.33) Cancer patients are known to have an increased risk of venous thrombo- embolism (VTE). Our objective was to determine the number of hospital Conclusions stays related to VTE in patients with breast or prostate cancer and to RIETE and ECOG-PS are equally accurate to predict short-term mortality, calculate the associated hospital costs. being more reliable than sPESI and GPS. The large influence of cancer Methods progression on overall mortality limits the applicability of PE-specific scales From the French Medical Information System, we identified patients in this setting. diagnosed with breast cancer (BC) or prostate cancer (PC) in 2010 and hospitalized for VTE at least once during the following 2 years. Associ- ated hospital costs were estimated from the perspective of the third-party MASCC-0504 payer, using the French official tariffs. Hemostasis Results Table: Cost of hospital stays for patients with BC or PC and VTE INCIDENCE OF VENOUS THROMBOEMBOLISM (VTE) IN AMBULATORY PATIENTS WITH GLIOMAS RECEIVING Breast cancer 1st event Recurrence Total CHEMOTHERAPY (CT) OR CHEMORADIOTHERAPY (CRT) Mean cost/stay €3,302 €2,916 €3,261 1 1 1 S. Custodio Cabello , A. Muñoz Martín , S. Pérez Ramírez ,A.B.. Total cost €1,789,615 €186,620 €1,976,235 Rupérez Blanco1,M.CavanaghPodesta1,B.MoyaOrtega1,M.Lobo Prostate cancer 1st event Recurrence Total de Mena1, I. Echavarría Díaz-Guardamino1, G. Torres Pérez-Solero1,I. Márquez-Rodas1, M. Martín Jiménez1 Mean cost/stay €3,611 €3,363 €3,584 1Medical Oncology, Hospital General Universitario Gregorio Marañón, Total cost €1,278,397 €147,959 €1,426,357 Madrid, Spain S72 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

In 2010, 62,365 patients newly diagnosed with BC and 45,551 with PC Results were admitted in French hospitals. Among them, 1,271 in the BC cohort From Oct/12 to Dec/13, 781 patients with ASFN were prospec- (2.0 %) and 997 in the PC cohort (2.2 %) were hospitalized for VTE at tively recruited from 21 Spanish hospitals. Most episodes were least once during the 2-year follow-up. In total, 1,604 stays for BC initially classified as low-risk by either MASCC ≥21 or Talcott- patients and 1,210 stays for PC patients were analyzed. In BC patients, IV criteria (95.5 %). The rate of infection-related complications the mean cost per stay amounted to €3,302 and €2,916 for first event and and death was 15.6 % (95 % CI, 12.9–18.6 %) and 1.7 % (95 % recurrence, respectively, and in PC patients, to €3,611 and €3,363 for first CI, 0.98–3 %). Concerning the site of treatment, 594 (76 %) were event and recurrence, respectively. Over a 2-year period, the total cost of admitted to hospital, 169 (21.6 %) received early discharge and 18 hospital stays induced by VTE reached €1.98 m for BC and €1.43 m for (2.3 %) were treated at home, with long stays detected even for PC. mild syndromes (Fig-1). Significant differences in complications Conclusions and mortality were observed according to the site of infection and The economic burden of VTE in cancer patients is high, both in breast specific tumors (Tables 1–2). Patients with breast and lung cancer, and prostate cancer, and could be reduced by decreasing the occurrence of respiratory infections, bacteremia and mucosa-associated infections thromboembolic complications in this at-risk population. represented particular sources of misclassification. Ta bl e 1 .

Tumor No. (%) % complications % mortality % bacteremia Length of MASCC-0549 stay median + Infections [CI 95 %] Breast 261 (33.4 %) 23 (8.8 %)* 2(0.8%) 20(7.7%)* 4[4.0,4.0] Lung 165 (2.11 %) 42 (25.5 %)* 5 (3 %) 22 (13.3 %) 6[5.0, 6.0] COMPLICATIONS, MORTALITYAND LENGTH OF HOSPITAL Colorectal 43 (5.5 %) 7 (16.3 %) 2 (4.7 %) 11 (25.6 %)* 7[5.0,8.0] STAYIN CANCER PATIENTS WITH LOW RISK FEBRILE Stomach 50 (6.4 %) 8 (16 %) 1 (2 %) 7 (14 %) 5 [4.0, 7.0] NEUTROPENIA: PROSPECTIVE DATA FROM THE FINITE Head and 32 (4.1 %) 7 (21.9 %) 1 (3.1 %) 5 (15.6 %) 7 [5.0, 8.0] STUDY COHORT neck Ovarian 26 (3.3 %) 3 (11.5 %) 0 5 (19.2 %) 5 [3.6, 6.0] Lymphoma 16 (2 %) 2 (12.5 %) 0 3 (18.8 %) 6 [5.0, 8.2] 1 2 3 P. Jiménez-Fonseca , A. Carmona-Bayonas , C. Font Puig ,M.Antonio Sarcoma 43 (5.5) 5 (11.6 %) 0 5 (11.6 %) 5 [4.0, 6.0] 4 5 6 7 Rebollo ,M.Biosca,J.Martínez,E.MartínezdeCastro,J. Prostate 12 (1.5 %) 3 (25 %) 1 (8.3 %) 2 (16.1 %) 4 [2.3, 8.0] 8 9 10 11 12 Hernando , A. Ramchandani ,J.Virizuela ,I.Ghanem ,C.Beato , Other 99 (12.7 %) 17 (17.2 %) 2 (2 %) 14 (14.1 %) 6 [5.0, 6.7] A. Blasco13,F. Casao14,Y.Bonilla15, R. Mondéjar16,J.Espinosa17,M.A. Pancreas/ 13 (1.7 %) 3 (23.1 %) 0 4 (30.8 %) 5 [4.0, 9.0] Arcusa-Lanza18, E. Gallardo19,F. Ayala de la Peña20 biliary 1 Germinal 21 (2.7 %) 3 (14.3 %) 0 4 (19 %) 8 [4.6, 9.7] Medical Oncology, Hospital Central de Asturias, Oviedo, Spain; All patients 781 (100 %) 123 (15.7 %) 14 (1.8 %) 102 (13.1 %) 5 [5.0, 5.0] 2Hematology and Medical Oncology, Hospital Universitario Morales Meseguer,Murcia, Spain; 3Medical Oncology, Hospital Clínic, Barcelo- na, Spain; 4Medical Oncology, ICO- Duran i Reynals, Barcelona, Spain; * p<0.05 (z-test of proportions adjusted using the Bonferroni method) 5Medical Oncology, Hospital Vall d’Hebrón, Barcelona, Spain; 6Medical + p<0.05 (Kruskal-Wallis test) Oncology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 7Medical Oncology, Hospital Marqués de Valdecilla, Santander, Spain; 8Medical Oncology, Hospital Miguel Servet, Zaragoza, Spain; 9Medical Oncology, Hospital de Las Palmas, Las Palmas, Spain; 10Medical On- Ta bl e 2 . cology, Hospital Virgen de la Macarena, Sevilla, Spain; 11 Medical On- cology, Hospital Universitario La Paz, Madrid, Spain; 12Medical Oncol- 13 ogy, Hospital Nisa Aljafarate, Sevilla, Spain; Medical Oncology, Hos- Infection No. (%) % complications % mortality % bacteremia Length of 14 stay median pital General Universitario Valencia, Valencia, Spain; Medical Oncol- + 15 [CI 95 %] ogy, Hospital de Campinas, Campinas, Brazil; Intensive Care Unit, * * 16 FOD 292 (37.4 %) 29 (9.9 %) 6 (2.1 %) 18 (6.2 %) 5 [4.0, 5.0] Hospital Santa Lucía, Cartagena, Spain; Medical Oncology, Hospital * * 17 Primary 17 (2.2 %) 7 (41.2 %) 2 (11.8 %) 17 (100 %) 7 [5.0, 10.9] de Cuenca, Cuenca, Spain; Medical Oncology, Hospital General bacteremia Universitario de Ciudad Real, Ciudad Real, Spain; 18Medical Oncology, Lower 75 (9.6 %) 19 (25.3 %)* 1 (1.3 %) 15 (20 %) 5 [5.0, 7.0] 19 respiratory Consorci Sanitari de Terrassa, Terrassa, Spain; Medical Oncology, Skin 21 (2.7 %) 4 (19 %) 0 3 (14.3 %) 6 [4.0, 7.6] 20 Hospital de Pontevedra, Pontevedra, Spain; Medical Oncology, Hos- Cholecystitis 1 (0.1 %) 0 0 1 (100 %) 11 pital Universitario Morales Meseguer, Murcia, Spain Enteritis 89 (11.4 %) 23 (25.8 %)* 1 (1.1 %) 14 (15.7 %) 6 [5.0, 7.0] Esophagitis 6 (0.8 %) 1 (16.1 %) 0 0 7 [2.7, 9.6] Background and Aims Stomatitis 57 (7.3 %) 3 (5.3 %)* 0 5 (8.8 %) 6 [5.0, 7.0] Home-based care is an option for patients with low-risk febrile neutrope- Odontogenic 11 (1.4 %) 1 (9.1 %) 0 1 (9.1 %) 5 [2.8, 6.0] nia (FN) but the adoption of this strategy is unknown in Spain. Clinical Catheter 11 (1.4 %) 3 (27.3 %) 0 8 (72.7 %)* 10 [7.9, 13.2] guidelines suggest two strategies to select patients for this approach: Perianal 4 (0.5 %) 1 (25 %) 0 0 6 [5–12.2] validated prognostic models and/or empiric sets of exclusion criteria. Cough 87 (11.1 %) 2 (2.3 %)* 0 3 (3.4 %)* 4 [3.0, 4.1] However, the prognostic role of specific infections/tumors remains un- Urinary 60 (7.7 %) 7 (11.7 %) 1 (1.7 %) 8 (13.3 %) 5 [4.0, 6.0] certain among clinically stable outpatients. Objectives: To assess dispar- Meningitis 1 (0.1 %) 1 (100 %) 0 1 (100 %) 16 ities on patterns of care, infection-related complications, mortality and Pneumonia 32 (4.1 %) 17 (53.1 %)* 3(9.4%)* 6 (18.8 %) 9 [7.0, 14.0] length of hospital stay among cancer patients with apparently stable FN Other 17 (2.2 %) 5 (29.4 %) 0 2 (11.8 %) 6 [4.0, 7.0] (ASFN). All patients 781 (100 %) 123 (15.7 %) 14 (1.8 %) 102 (13.1 %) 5 [5.0, 5.0] Methods FINITE is an ongoing, prospective, multicenter study to assess prognostic factors and patterns of care in patients with ASFN, defined by the absence * p<0.05 (z-test of proportions adjusted using the Bonferroni method) of shock, organ dysfunctions or major infections. +p<0.05 (Kruskal-Wallis test) Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S73

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 1Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 2Mycology, Federal University of Pernambuco, Recife, Brazil; 3Pharmacy, Federal University of Pernambuco, Recife, Brazil; 4Foundation 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 Introduction: Candidiasis is common in children receiving cancer and mortality. The adherence to home-based strategies for FN remains therapy, particularly during severe neutropenia. Among Candida low in Spain. species C. albicans is frequently involved in oral and life threaten- ing 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 MASCC-0509 case of oral and systemic candidiasis due to C. albicans and C. guilliermondii, respectively. Infections Methods: A 5-year-old child with juvenile myelocytic leukemia was admitted at the Oswaldo Cruz University Hospital, Recife, OUTCOME OF SEPTIC CANCER PATIENTS ADMITTED TO Brazil for chemotherapy. The child presented severe oral candi- THE INTENSIVE CARE UNIT WITH AND WITHOUT diasis with cream-colour deposits and high fever. Oral samples MEDICAL EMERGENCY TEAM INTERVENTION were obtained by swab from the palate and oral mucosa. Venous I. Khalid1,A.A.Saeedi1,K.AlHarbi1, M. Kadri1, I.A. Qushmaq1 blood samples were collected aseptically in three consecutive 1Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, days. Then, the samples were processed by standard methods Saudi Arabia for mycological diagnosis (direct examination and culture isola- tion) and identification was carried out by macroscopic, micro- Background and Aims scopic and physiologic characteristics, besides automated Cancer patients with sepsis have high mortality. However, there is methods. limited data regarding outcome of septic ward patients who are Results: Diagnostic was concluded with the observation of hyaline admitted to the intensive care unit (ICU) with and without Medical hyphae and oval yeast cells in oral secretion and oval yeast cells Emergency Team (MET) intervention. We evaluated this question in in blood samples (Figure 1A, 1B). The clinical isolates were our study. identified as C. albicans from the oral samples and Methods C. guilliermondii from blood specimens. Physicians prescribed We evaluated 4,852 oncology ward patients from January 2009 to July fluconazole (200 mg/day) with regression of the oral lesions, 2011. One hundred thirty-nine patients were included in analysis who although the patient remained with fever and died 3 weeks after were admitted to the ICU and divided into MET transfers (admitted to treatment beginning. ICU after MET involvement) and Non-MET transfers. Primary outcome was 28-day mortality. Data was analyzed using t-test and Pearson chi- square test, as appropriate. Results Out of 139 ICU transfers, 91 were MET transfers and 48 were non- MET 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). S74 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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 Conclusions 1Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; Early diagnosis of invasive fungal infections associated with early 2Mycology, Federal University of Pernambuco, Recife, Brazil; initiation of appropriate therapy is extremely important for a good 3Pharmacy, Federal University of Pernambuco, Recife, Brazil; prognosis. 4Mycology, 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 MASCC-0569 various clinical conditions. Geotrichum species are usually non- Infections pathogenic, although few reported cases related to disseminated infection as well as brain abscesses, traumatic joint infection, and oral and cutane- PENICILLIOSIS IN PATIENT WITH HEMATOLOGIC ous infections in immunocompromised hosts has been published, such as MALIGNANCY those with hematologic malignancies. G. candidum is ascomycetous 1 1 1 2 yeast, ubiquitous in the environment and can colonize the human gastro- D. Macêdo ,A.M.R.C.Parahym,P.J. Rolim-Neto ,C.M.Silva, R.G. Lima-Neto3, S.S. Gonçalves4, G.A.T.M. Henriques-Filho5,R.P.Neves2 intestinal tract. 1 Objectives: Report a case of pulmonary geotrichosis in a lymphoma Departament of Pharmacological Sciences, Federal University of Per- nambuco, Recife, Brazil; 2Departament of Mycology, Federal University patient. 3 Methods of Pernambuco, Recife, Brazil; Departament of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; 4Special Mycology A 43-year-old woman with non-Hodgkin lymphoma hospitalized for 5 1 month in Intensive Care Unit of the Foundation of Hematology of Laboratory, Federal University of São Paulo, Recife, Brazil; Intensive Pernambuco/Brazil, presenting febrile neutropenia and respiratory Care Unit, Foundation of Hematology of Pernambuco, Recife, Brazil failure. The patient had used mechanical ventilation, urinary and venous catheters. A chest X-ray was performed and a pulmonary Background and Aims radiological image was suggestive of fungal infection (Figure 1). Invasive fungal infections have become increasingly frequent and Based on this result and on clinical conditions the samples of tracheal a gradual increase of uncommon species causing infections has secretions were obtained in three consecutive days and subsequently been observed, including by Penicillium species. P. citrinum has processed for direct examination and culture. The identification of been involved in the etiology of keratitis, urinary tract infection. the isolates was performed trough of the morphophysiological The aim of this research was to describe the first case of characteristics. fungemia by P. citrinum in a patient with multiple myeloma and Results pneumonia. The diagnosis was based on the presence of hyaline yeast cells and Methods arthrospored septate hyaline hyphae in the direct examination and isola- A 77-year-old man with multiple myeloma was hospitalized in an tion of G. candidum in the cultures of all samples (Figure 2A and 2B). Intensive Care Unit of a Tertiary Brazilian hospital. The patient had The patient developed acute respiratory failure and pulmonary hemor- used ventilation support due to a chronic lung disease, renal failure, rhage which worsened her clinical condition with fatal outcome after septic shock and obstructive disease. Blood samples were collected 3daysfromthediagnosis. in triplicate and manipulated for mycological diagnosis. The identi- fication of the fungal isolate was performed by classical and molec- ular 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 iden- tification the isolate was identified as P. citrinum. After diagnosis treatment was started with amphotericin B (0.5 mg/kg/day). How- ever on the second day after therapy the patient died due to com- plications of the clinical conditions. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S75

Fig.1.Colony aspects after 10 days of growth (A) and microscopy fungus Paracoccidioides brasiliensis. More than 90 % of patients are showing septate hyaline hyphae, simple or branched conidiophores, affected with the chronic form, which appears mainly in male and rural matulae, phialides, and conidia typical of Penicillium citrinum.(B). 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 1Departament of Pharmacologycal Sciences, Federal University of Per- nambuco, 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 Figure 1. Direct examination showing the presence of yeasts cells with Paracoccidioidomycosis (PCM) is a systemic mycosis of great interest for double refractive rounded contour and multiple budding, consistent with Latin America countries. This disease is caused by the thermo-dimorphic Paracoccidiodes brasiliensis S76 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

No cultures were obtained. Serology by double immuno diffusion was 1Departament of Mycology, Federal University of Pernambuco, Recife, performed to detect antibodies, however this test was negative due to Brazil; 2Departament of Pharmacy, Federal University of Pernambuco, immunosuppression. He died 15 days after the diagnosis. Recife, Brazil; 3Pharmacy, Federal University of Pernambuco, Recife, Brazil; Conclusions 4Oncology Pediatric Center, Oswald Cruz University Hospital, Recife, Brazil; The occurrence of chronic diseases in immunocompromised individuals 5Tropical Medicine, Federal University of Pernambuco, Recife, Brazil complicates the prognosis, often leading to death. Thus the rapid and accurate diagnosis is extremely important in order to initiate specific therapy Introduction: Trichosporon species are yeasts that can be found in soil, avoiding the increase of lung injury fibrosis and the spread to other organs. water and occasionally in the normal human microbiota of the skin, nails and mucous membranes, respiratory and gastrointestinal tract. T. i n k i n is consid- ered the classic agent of white piedra and may cause various clinical manifestations from superficial skin involvement to invasive infections. MASCC-0591 Trichosporonosis is an uncommon opportunistic invasive mycosis often fatal. Infections Objectives: Describe a fatal case of invasive pulmonary infection by T. inkin in a patient with acute myeloid leukemia. DEVELOPMENT OFAN ALGORITHM FOR THE Methods: A 10-year-old female with acute myeloid leukemia was hos- MANAGEMENT OF FEBRILE PEDIATRIC ONCOLOGY pitalized in the Pediatric Oncology Centre from Oswaldo Cruz University PAT I E N T S I N D AVAO CITY,PHILIPPINES Hospital/Brazil, with respiratory failure and started empirical treatment with caspofungin for 12 days and amphotericin B for 8 days. Then was S. Mukkada1,D.Aguilar2, C.M. Castillo-Deluao2, M. Dolendo2,M.Caniza1 transferred to the Pediatric ICU of the same hospital for performance of 1Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, artificial ventilation and three samples of tracheal aspirates were obtained USA; 2Pediatric Oncology, Southern Philippines Medical Center,Davao for mycological diagnosis. Subsequently the samples were processed for City, Philippines direct examination and cultures. Results: At direct exam yeast cells and septate and arthrosporated hyaline Background and Aims mycelial filaments were visualized (Figure 1). After growth T. inkin was Evidence based guidelines used in high income countries to standardize isolated in pure culture from all clinical specimens (Figure 2A) and care of febrile oncology children are underutilized in low and middle- microscopic characteristics are presented in Figure 2B. Two days after income countries (LMIC) in part due to applicability concerns. diagnosis, the patient died with pulmonary hemorrhage leading to wors- Objective ening of the underlying disease condition. 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. Weconducted interviews with medical personnel, reviewed medical records, observed care practices, and verified pricing and availability of ancillary studies and antimicrobials. Algorithm and consensus building. Weconstructed 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 Conclusions: The occurrence of invasive disease in immunocompro- and nursing team members. mised patients complicates the course of the acute myeloid leukemia, During the algorithm building and consensus step, we adapted published often leading to death. Thus the rapid and accurate diagnosis is extremely guidelines to local resources. Following construction, stakeholders agreed important in order to initiate specific therapy. 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. MASCC-0556 Conclusion Infections By undertaking systematic review of practices and epidemiology, it is possible to construct site-specific algorithms that achieve local support in CANDIDIASIS IN CANCER PATIENTAND ANTIFUNGAL LMIC. Future studies will include review of adherence to the algorithm PROFILE and its effect on patient outcomes. 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 1Departament of Mycology, Federal University of Pernambuco, Recife, MASCC-0555 Brazil; 2Departament of Pharmacy, Federal University of Pernambuco, 3 Infections Recife, Brazil; Oncology Pediatric Center, Health Secretariat of the Pernambuco state, Recife, Brazil; 4Tropical Medicine, Federal University of Pernambuco, Recife, Brazil TRICHOSPORONOSIS IN A PATIENT WITH ACUTE MYELOID LEUKEMIA Background and Aims R.P.Neves1, A.M.R.C. Parahym1,P.J. Rolim-Neto2,C.M.Silva1,D.P.C. Introduction: The incidence of candidiasis has been increasing, espe- Macêdo3,V.L.L. Moraes4,R.G.Lima-Neto5 cially in immunocompromised as cancer patients. Several Candida Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S77 species are involved in the etiology of this mycosis, leading to occurrence Cerqueira Macedo2, R.G.L.N. Reginaldo Gonçalves de Lima Neto4, of superficial or systemic infections with fatal course. R.P.N. Rejane Pereira Neves1 Objectives: Conduct the diagnosis of candidiasis in patients with cancer 1Mycology,Ufpe,Recife,Brazil;2Ciências farmacêuticas, Ufpe, Recife, and evaluate the antifungal susceptibility profile of the aethiological agents. Brazil; 3Oncology Center, University Hospital Oswaldo Cruz, Recife, Methods Brazil; 4Tropical Medicine, Ufpe, Recife, Brazil The study was carried in the oncology center at the Oswaldo Cruz University Hospital. Samples of blood, urine and tracheal aspirates were Background and Aims collected and immediately sent to Medical Mycology Laboratory for Candidiasis infections are frequent in cancer patients presenting a wide mycological diagnosis. Microbiological identification was performed by spectrum of clinical manifestations as mucocutaneous infections to sys- classical taxonomy using the chromogenic method CHROMagar temic disease. Candida and the automated method VITEK 2. The antifungal suscepti- Objectives: Diagnose cases of candidiasis in pediatric leukemia patients bility tests were developed based on the method of broth microdilution and evaluate the isolates ability to form biofilms. according to CLSI M27-A3 protocol. Methods Results The study was carried out in the oncology center at a University Hospital/ Clinical samples of 120 patients were collected. The mycological diag- Brazil. Samples of blood, urine and tracheal aspirates were collected nosis was based on direct examination detection of hyaline oval yeast according to doctor request. All samples were immediately sent for cells and septate hyaline hyphae (Figure 1), and isolation of Candida laboratorial mycological diagnosis. Microbiological identification was species in pure culture. The isolated species and the association with the assessed by traditional and molecular taxonomy, CHROMagar Candida underlying disease of the patients are presented in Table 1. The antifungal and VITEK 2 system. The antifungal susceptibility tests were preceded susceptibility profile is expressed in Table 2. according to CLSI M27-A3. Evaluation on biofilm formation was per- formed 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 ALEUKEMIAPATIENT– FIRST CASE REPORT 1 2 Conclusions A. Parahym ,P.J.R.N. Pedro José Rolim Neto , C.M.S. Carolina Maria da 1 3 3 Candidiasis infections were prevalent in cancer patients, and malignant Silva , M.M.R. Márcia de Melo Rodrigues , T.J.M.S. Terezinha Salles , 3 hematology was the most predisposing condition. C. albicans was the A.L.M. Adriana Lins de Morais ,D.P.C.M. Danielle Patricia Cerqueira 2 4 most frequently isolated species and Candida non-albicans were consid- Macedo , R.G.L.N. Reginaldo Gonçalves de Lima Neto ,R.P.N. Rejane 1 ered prevalent in cancer patients. The acquired resistance to fluconazole Pereira Neves 1 2 was verified in C. albicans and C. tropicalis and these data strengthens the Mycology,Ufpe,Recife,Brazil; Ciências farmacêuticas, Ufpe, Recife, 3 importance of antifungal sensitivity tests before therapy management. Brazil; Oncology Center, University Hospital Oswaldo Cruz, Recife, Brazil; 4Tropical Medicine, Ufpe, Recife, Brazil

Introduction: Aspergillus infections have been described in immuno- MASCC-0553 compromised children and A. fumigatus and A. flavus are the most Infections 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 DIAGNOSTIC OF CANDIDIASIS IN LEUKEMIA PEDIATRIC child with acute lymphoblastic leukemia (ALL). PATIENTS, ANTIFUNGAL SUSCEPTIBILITYAND Methods: A 3-year-old boy with ALL was admitted in a Brazilian EVALUATION OF BIOFILM PRODUCTION Oncology Center with low neutrophil count, high fever, and swelling in A. Parahym1,P.J.R.N. Pedro José Rolim Neto2, C.M.S. Carolina Maria da nasal and paranasal regions. Computed tomography scans showed a Silva1, M.M.R. Márcia de Melo Rodrigues3, A.L.M. Adriana Lins de heterogeneous opacity in the maxillary sinus and clinical examination Morais3,V.L.L.M. Vera Lúcia Lins de Morais3,D.P.C.M. Danielle Patricia presented necrotic and hemorrhagic lesions with hyperemia in the S78 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 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 in- volved 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 taxono- my 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 mucocutane- ous infection in leukemia patients.

MASCC-0506 Infections

DISSEMINATED ASPERGILLOSIS IN LEUKEMIA PATIENT 1 2 2 2 C. Silva , A.M.R.C. Parahym ,P.J. Rolim-Neto ,D.P.C. Macêdo , R.G. Fig. 1 a Chest X-ray showing pulmonary infiltration. b Brain magnetic 3 4 5 5 Lima-Neto ,S.S.Gonçalves, G.A.T.M. Henriques-Filho ,O.B.Silva, resonance showing abscesses. c Dichotomous septate hyphae. d Micro- 1 R.P.Neves scopic characteristics of Aspergillus flavus. 1Departament of Mycology, Federal University of Pernambuco, Recife, 2 Brazil; Departament of Pharmacological Sciences, Federal University Conclusions 3 of Pernambuco, Recife, Brazil; Departament of Tropical Medicine, Disseminated aspergillosis is usually fatal when associated with haema- 4 Federal University of Pernambuco, Recife, Brazil; Special Mycology tological malignancies, although the early diagnosis is related to clinical Laboratory, Federal University of São Paulo, São Paulo, Brazil; improvement. 5Intensive Care Unit, Foundation of Hematology of Pernambuco, Recife, Brazil

Background and Aims MASCC-0315 Invasive aspergillosis is a cause of mortality and morbidity in Infections 2 haematological malignancies patients. The etiologic agents are ubiq- uitous fungi which may cause life-threatening infections in ATWO-YEAR SINGLE-CENTER ANALYSIS OF TREATMENT immunossupressed. The aim is to report a fatal case of disseminated AND OUTCOMES OF HOSPITALISED CANCER PATIENTS aspergillosis due to A. flavus in acute lymphoblastic leukemia WITH FEBRILE NEUTROPENIA IN ATERTIARY CARE (ALL) patient. HOSPITAL IN MONTREAL, CANADA Methods A 46-year-old male with ALL was admitted to Foundation of M.A. Fournier1,N.Letarte1,C.Messier1,L.A.St-Jean2,S.Doucet3,N. Hematology and Hemotherapy of Pernambuco/Brazil for chemother- Blais3 apy. The patient presented febrile neutropenia, thrombocytopenia, 1Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, respiratory insufficiency, hemoptysis and lowering of consciousness Canada; 2Microbiology, Centre Hospitalier de l’Université de Montréal, and was transferred to ICU for mechanical ventilation. At chest X- Montreal, Canada; 3Hemato-oncology,Centre Hospitalierde l’Université ray pulmonary infiltrations were observed (Fig. 1a). Brain magnetic de Montréal, Montreal, Canada resonance showed abscesses in both cerebral hemispheres (Fig. 1b). According to clinical aspects invasive fungal infection was Background and Aims suspected and Samples of tracheal secretion and blood cultures were IDSA recommends antipseudomonal monotherapy as empirical collected for mycological diagnosis. Identification was achieved treatment for febrile neutropenia (FN) in cancer patients. Ceftazi- using traditional taxonomy and sequencing fragments of the ITS dime combined with tobramycine has been the recommended thera- region of rDNA. py for years at the Centre Hospitalier Universitaire de Montréal in Results Montreal, Canada. Blood cultures were negative, but in three samples of tracheal secretions The primary objective was to evaluate empiric treatment response dichotomous septate hyaline hyphae were observed at direct examination at 96 h defined as a composite endpoint including fever deferves- (Fig. 1c). Also, A. flavus was isolated in cultures. The molecular tools cence, absence of hemodynamic instability, lack of antimicrobial confirmed the species (GenBank-HQ693703). Although treated with therapy change, and symptom improvement. Secondary objectives amphotericin B followed by voriconazole therapy, the patient died after included characterisation of isolated bacteria, survival and use of 13 days. GSCF. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S79

Methods MASCC-0229 A retrospective cohort analysis of all cancer patients hospitalized between Infections 2 April 2011 and March 2013 with FN was conducted. Results EVIDENCE SUPPORTING PATIENT RISK FACTORS FOR A total of 277 episodes of FN were identified in 216 patients. FEBRILE NEUTROPENIA IN NON-HODGKIN’S LYMPHOMA Solid tumour represented 49,1 % of episodes. Median age was 59 years. The empiric treatment response was 32,9 % B. Chou1,P.K. Morrow2, R. Ismail3 (CI95 %27,4–38,4). Survival to these episodes was 91,3 % 1Department of Pharmacy, University of Southern California, Los (CI95 %88,0–94,7). Angeles, USA; 2Clinical Development, Amgen, Thousand Oaks, USA; At least one microorganism was identified in 49,1 % (CI95 %43,2 %– 3Medical Communications, Amgen, Thousand Oaks, USA 55,0) of episodes. No gram-negative bacterium resistant to ceftazi- dime, tobramycin or piperacilline-tazobactam was identified among Background and Aims blood cultures. Eight cases of P.aeruginosa were identified, with only Treatment guidelines based on broad tumor populations list several risk two resistant to piperacilline-tazobactam and one to ceftazidime; all factors in the development of febrile neutropenia (FN) and include both isolated from two patients with known risk factors. GSCF was used in chemotherapy regimen and patient-specific risk factors. However, patient 204 episodes with 54 where no ASCO guideline criteria could be risk factors have limited primary literature supporting their impact on identified. development of FN. Aim: Toprovide a novel, comprehensive assessment Conclusions of existing primary literature that supports patient risk factors for devel- The empirical regimen used seems adequate according to isolated bacteria oping FN in patients with Non-Hodgkin’s Lymphoma (NHL). sensitivities despite failure rate of primary objective. The low response Methods rate could be explained in part by individualized therapy modifications. Patient risk factors were compiled from US and EU Guidelines, and However, the double coverage against P.aeruginosa does not seem to be PubMed was searched using MeSH terms of ‘Non-Hodgkin’s Lympho- necessary in all patients. ma’, ‘febrile neutropenia,’‘patient risk factors,’‘risk factors,’‘patient- specific 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 MASCC-0205 found to vary based on the number of total publications and those publi- Infections 2 cations showing a statistically significant correlation with FN risk com- pared to a control group (table below). Further data about the publications CEFEPIME AS MONOTHERAPY TREATMENT OF FEBRILE (ie, included FN as endpoint, prospective studies, randomized phase III NEUTROPENIC PATIENTS WITH LUNG CANCER 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 Publications with statistically significant Background and Aims FN risk vs control, n Toevaluate the efficacy of cefepime as monotherapy as initial treatment in Age≥65 11 7 febrile neutropenic patients with lung cancer (lc) that required hospitalization. Bone Marrow Involvement 6 4 Methods General Comorbidities 4 4 – We have treated 25 grade 3 4 neutropenic patients, median age Liver Disease 3 2 60 (44–76 years) most of the patients presented as Karnofsky index of 80–90 %, 22 patients presented fever (3 during hospi- Previous FN 3 1 talization). All of them have received chemotherapy. Treatment Body Surface Area 3 2 consisted of cefepime: 2 g i.v./8 h. All patients received GCSF. Previous Radiation Therapy 2 1 We took peripheral blood cultures in all patients before treatment, with 2 bacteriemias (E. Coli, and K. Pneumoniae) , infection Conclusions without bacteria in 10 patients(respiratory:7 patients, genitouri- Current analysis supports that clinicians should utilize a tiered, evidence- nary:2, oropharingeal:1) and fever of unknown origin :13 based approach when assessing FN risk in NHL, and information illus- patients. trates the need for comprehensive analyses and practical guidance in Results assessing FN risk. 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. Nine- teen presented a good response to treatment without any adverse event. Six patients died during hospitalization. (1 sepsis, 2 persistent MASCC-0470 neutropenia and other complication not related to febrile neutrope- Infections 2 nia: 3 patients). Conclusions MAINTAINING ADHERENCE TO OPTIMAL BLOOD In our experience, cefepime as monotherapy has efficacy in the initial CULTURE PRACTICES ATA PEDIATRIC CANCER UNIT IN management of more than 75 % of our febrile neutropenic lung cancer MANAGUA, NICARAGUA patients. The persistence of fever and neutropenia suggests worse evolu- tion and possible complication. K.M. Johnson1,R.P.Ojha2, M.M. Somarriba3,C.G.Lam4,M.A.Caniza5 S80 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

1Department of Infectious Diseases, St. Jude Children’s Research Hospi- Results tal, Memphis, USA; 2Department of Epidemiology and Cancer Control, The prevalence of active tuberculosis among lung cancer patients St. Jude Children’s Research Hospital, Memphis, USA; 3Department of varies depending on spatial and regional factors. Lung cancer Hematology/Oncology, Hospital Infantil Manuel de Jesus Rivera, Mana- patients that are more prone to developing tuberculosis are Asian gua, Nicaragua; 4Department of Oncology and the International Out- and Caucasian males, with an average age of 60 years old. The reach Program, St. Jude Children’s Research Hosptial, Memphis, USA; prevalence of tuberculosis is higher in patients with chest X-ray 5Department of Infectious Diseases and the International Outreach Pro- evidence of old tuberculosis and/or history of tuberculosis, chron- gram, St. Jude Children’s Research Hosptial, Memphis, USA ic obstructive pulmonary disease, heavy cigarette smoking, in- creased alcohol consumption and/or diabetes mellitus. A high Background and Aims mortality rate due to tuberculosis in lung cancer patients was also Blood cultures are critical for diagnosis of bloodstream infections, but estimated. blood culture practices are often suboptimal for pediatric cancer units in Conclusions low- and middle-income countries. We implemented a systematic quality Active tuberculosis complicating lung cancer is a significant clinical issue improvement program in November 2012 at the pediatric cancer unit of in countries with high prevalence of tuberculosis. However, as the there is Hospital Infantil Manuel de Jesús Rivera (Managua, Nicaragua) to pro- a lack of reports from developed countries over the last 20 years, the vide blood culture supplies and reagents, and train oncology staff about significance of this interaction in countries with low tuberculosis burden indications for blood cultures. remains controversial. 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 MASCC-0493 We reviewed blood culture surveillance data between November 2012 Infections 2 and December 2013 to assess the monthly proportion of blood cultures that were drawn from those that were indicated for blood culture (i.e. IMPROVING HOSPITAL PERFORMANCE TO FEBRILE adherence rate). We estimated the difference in adherence rates (RD) and NEUTROPENIA: A MIXED-METHOD ANALYSIS OF ROOT corresponding 95 % confidence limits (CL) for each month compared CAUSE PROBLEMS AND RESULTING SYSTEM SOLUTIONS with baseline. Results B. Meisenberg1,J.Clemons1,J.Ness2,N.Faust1,M.Clance3 The adherence rate for the first month after intervention was 75 %. The 1DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, adherence rate peaked at month 5 (100 %, RD=25 %, 95 % CL: 8.9 %, USA; 2Department of Pharmacy, Anne Arundel Medical Center,Annap- 41 %) but gradually decreased to 78 % by month 12 (RD=3.2 %, 95 % olis, USA; 3Department of Epidemiology, Anne Arundel Medical Center, CL: −20 %, 27 %). The adherence rate modestly improved by the end of Annapolis, USA the assessment period to 88 % (RD=13 %, 95 % CL: −10 %, 35 %). Conclusions Background and Aims Our results suggest that optimal blood culture practices in this setting can Febrile neutropenia (FN) remains a common and dangerous complication result in adherence rates ≥75 % if a quality improvement program is of cancer treatment. Guidelines from the Infectious Disease Society of maintained. Modifications to the training regimen may be required to America urge initiating antibiotics within2hofpresentation.We ensure that the oncology staff remain informed about the indications for reviewed our institution’s performance to identify areas of needed im- blood culture among pediatric cancer patients. provement and design performance improvement steps. Methods FN management was deconstructed into discrete tasks and experienced practitioners estimated maximal appropriate time to complete these tasks. MASCC-0280 Cycle time analysis data on a baseline cohort (Baseline group) identified Infections 2 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 INTERACTION BETWEEN TUBERCULOSIS INFECTION AND post-Intervention group). LUNG CANCER Results M. Kiagia1, A. Christopoulos1,A.Charpidou1,I.Gkiozos1,M.Zontanos1, Sixty-nine episodes of FN were analyzed. Delays were noted in S. Tsagkouli1,K.Syrigos1 almost every discrete step in management. System solutions in- 1Oncology Unit GPP, Sotiria General Hospital, Athens, Greece cluded standardized order sets, releasing preliminary lab results immediately, and dispensing pre-formulated antibiotics in the ED Background and Aims rather than central pharmacy. Median time to antibiotics improved: Nowadays, there is strong evidence to support that preexisting TB is 252 min, 188 min and 118 min for the Baseline, Transitional and an independent factor highly associated with increased risk of lung post-Intervention groups, respectively (p=0.0002 for the Baseline cancer. The aim of this review article is to evaluate the available vs. the post-Intervention). Variability was reduced with the inter- literature concerning the prevalence of active tuberculosis in lung quartile range falling from 174 min (Baseline) to 65 min (post- cancer patients. Intervention). Despite improvement, there were still episodes of Methods prolonged delays, often due to competing priorities from other MEDLINE, PubMed, EMBASE and Medscape databases were patients. Standardized order sets eliminated improper antibiotic searched for studies with quantitative data on the interaction be- choices. tween TB and lung cancer, published since 1952. We used the Conclusions Medical Subject Headings’ term “tuberculosis” and the text-word Improvements in the management of FN can be accomplished and terms ”TB” and “Mycobacterium infection”, and also, the Medical sustained by the focused study of performance of individual steps, Subject Headings’ terms “neoplasm” and “lung neoplasm” or the streamlining processes and ongoing review of performance with feedback text-word term “lung cancer”. to clinical departments. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S81

MASCC-0082 Methods Infections 2 This cross-sectional study was conducted in Civil Hospital Kara- chi. Total 662 patients admitted in surgical department were approached. All patients were screened for HBsAg and anti- THE ASSOCIATION BETWEEN NEUTROPENIA AND GAST HCV using immunochromatography ICT. The information about ROENTERITIS AMONG PEDIATRIC CANCER PATIENTS IN risk factors was also assessed. The data was analyzed on SPSS LA PLATA, ARGENTINA 17. R.P. Ojha1, K.M. Johnson2,S.Gomez3,M.A.Caniza2 Results 1Department of Epidemiology and Cancer Control, St. Jude Chil- Out of 662, 325 (49.1 %) were males and 337 (50.9 %) were females. dren’s Research Hospital, Memphis, USA; 2Department of Infectious Mean age of patients was 37.52. Hepatitis B surface antigen (HBsAg) Diseases, St. Jude Children’s Research Hospital, Memphis, USA; was positive in 19 (2.9 %) and Hepatitis C (anti-HCV) in 45 (6.8 %) 3Department of Hematology, Hospital de Niños Sor Maria Ludovica, patients. HBsAg was positive in 12 (63.15 %) males and 7 (36.84 %) La Plata, Argentina 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 Background and Aims HBsAg, 17 (89.47 %) have history of intravenous injections and out of 45 Neutropenia is associated with various infectious conditions anti-HCV, 44 (97.77 %) have the same history. The other major risk among pediatric cancer patients. Nonetheless, the association factors found were blood transfusion, blood donation, ear-nose piercing, between neutropenia and gastroenteritis has not been systemati- dental procedure and barber shave. cally assessed, particularly in low- and middle-income countries Conclusions with a high burden of pathogens that are associated with gastro- The study suggests a moderate to high prevalence of hepatitis B and enteritis. We assessed the association between neutropenia and hepatitis C in surgical patients. Routine serological screening prior to gastroenteritis among pediatric cancer patients in La Plata, surgery should be made mandatory so that health care workers especially Argentina. surgeons can take precaution before surgery. Methods We reviewed infection surveillance data that was prospectively col- lected for all patients aged <20 years treated at the Pediatric Cancer Center of Hospital de Niños Sor Maria Ludovica (La Plata, Argen- MASCC-0023 tina) between September 2010 and June 2013. Gastroenteritis was Infections 2 defined as diarrhea with or without vomiting, and neutropenia was defined as an absolute neutrophil count <500. We used random- KNOWLEDGE & SELF-PERCEIVED PRACTICE REGARDING effects Poisson regression to estimate overall and subgroup-specific INFECTION CONTROL AMONG NURSING STUDENTS OF risk ratios (RR) and corresponding 95 % confidence limits (CL) for CIVIL HOSPITAL KARACHI the association between neutropenia and gastroenteritis after adjust- ment for age, sex, and treatment phase. R. Rafaqat1 Results 1medicine, dow medical college, Karachi, Pakistan Our study population comprised 151 patients. We observed 23 cases of gastroenteritis, of which 19 occurred among neutropenic patients (RR= Background and Aims 10, 95 % CL: 3.3, 30). The association between neutropenia and gastro- Health-care associated infections cover all clinically evident infections enteritis was stronger among pediatric cancer patients aged <10 years that are not the part of patient’s original illness for which patient is (RR=14, 95 % CL: 1.7, 118) than patients aged 10–19 years (RR=7.2, admitted. Most of these infections clinically become evident after 48 h 95 % CL: 1.9, 27). of admission. In all settings, nurses can play a dominant role in infection Conclusions prevention and control by using their knowledge, skill and judgment. Our results suggest that neutropenia is a strong risk factor for gastroen- This reflects the importance and need of such type of study among teritis among pediatric cancer patients, particularly at younger ages. nursing students. Future studies should assess the distribution of pathogens associated with Methods gastroenteritis to better inform prevention and management in similar A cross-sectional study was conducted at Civil Hospital Karachi. Nursing settings. 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 MASCC-0022 Total 241 students were interviewed including 41.5 % males and Infections 2 58.5 % females. Of all students, 71.4 % had received guidelines about infection control from their seniors nursing staff. Hand hy- giene facility was available in 78.8 % of wards. Among all students FREQUENCY OF HEPATITIS B AND C AND ITS ASSOCIATED 80.9 % were aware of WHO guidlines on hand washing but only RISK FACTORS IN SURGICAL PATIENTS, CIVIL HOSPITAL 20.3 % performed complete steps. Only 128 students (53.1 %) were KARACHI aware of the term Health-care Associated Infections. Overall half of R. Rafaqat1 the students of this study reported lack of proper practice such as 1medicine, dow medical college, Karachi, Pakistan washing hand before and after procedure, using gloves and applying proper alcohol. Background and Aims Conclusions Hepatitis B and C is a serious health problem worldwide. Infections with There is lack of proper practice among nursing students and lack of hepatitis B and C virus have been escalating in Pakistan and it has reached knowledge regarding health care associated infections. This study war- in endemic state. This study was carried out to determine the frequency of rants the health associated education programs to fill the gap in knowl- hepatitis B and C in surgical patients. edge as well as in practice. S82 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0056 patient with hematological malignancies after empirical antifungal thera- Infections 2 py with caspofungin. Methods A 15-years-old man with acute myeloid leukemia was admitted in a PROCALCITONIN IS THE FIRST BIOMARKER THAT Hospital for chemotherapy. Thereafter, antifungal prophylaxis with SIGNIFICANTLYCORRELATED WITH THE INFECTION caspofungin (50 mg/day) was conducted. After 8 days of hospitalization RELATED MORTALITY INDEPENDENT FROM C-REACTIVE the patient was admitted to the ICU and a computerized tomography of PROTEIN, SEDIMENTATION RATE, PERFORMANCE SCALE, the chest showed pleural effusion in the right lung and pulmonary nodules AND LEUKOCYTE COUNT in the left lung. Blood and urine samples were collected and processed for A. Sedef1,F. Kose1,O.Dogan1,H.Mertsoylu1,A.Sezer1, S. Muallaoglu1, mycological diagnosis. Microbiological identification was achieved by A. Besen1, O. Ozyilkan1 traditional taxonomy and sequencing of fragments from rDNA ITS 1medical oncology, baskent university, Adana, Turkey region. Antifungal susceptibility test was performed in accordance with CLSI M27-A3 protocol. Background and Aims Results Infection is one of the major causes for mortality and morbidity that Direct examination of urine showed hyaline septate hyphae and requires long hospitalization in cancer patients. Serum procalcitonin is arthroconidia (Fig. 1A), after growth in the culture of all samples were highly sensitive and specific biomarker fro bacterial infection and not visualized dry and white to cream-colored colonies. Microscopic exam- affected from primary malignancy as CRP, ESR did. Main aim of this ination showed arthroconidia and septated hyaline hyphae (Fig. 1B). 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 infec- tion 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 perfor- mance 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 The isolates were identified as S. capitata by traditional taxonomy and ITS to show significant relation between CRP, ESR, leukocyte count, LDH, sequence. The DNA sequence was submitted to GenBank (JN573270). Calcium, albumin and positive culture result. The isolates were susceptible for amphotericin B, anidulafungin and Conclusions voriconazole, but dose-dependent for fluconazole. Amphotericin B lipid Infection is the most feared complication during oncologic follow-up. Infec- complex (5 mg/kg/day) was administered intravenously for 24 days and tious complication usually requires wide-spectrum antibiotics, long hospital- then oral voriconazole (400 mg/day) with good response. ization stay and high costs. So, this study clearly demonstrated prognostic Conclusions role of procalcitonin for cancer patients those who were hospitalized by Invasive infection by S. capitata occurs in patient with leukemia and infection. Using the procalcitonin levels as a prognostic biomarker may result empirical treatment with caspofungin is not effective. decrease in hospitalization stay and wide-spectrum antibiotic costs.

MASCC-0076 MASCC-0491 Information Technology Infections 2 DEVELOPMENT OFAN IT-BASED INTERVENTION INVASIVE INFECTION DUE TO EMERGING YEAST IN A FURTHERING RESILIENCE AND SUPPORTIVE CARE FOR YOUNG PATIENT WITH HEMATOLOGIC MALIGNANCIES PATIENTS DURING EARLY SYSTEMIC TREATMENT: AFTER CASPOFUNGIN THERAPY RESIL-SHEET C. Silva1, A.M.R.C. Parahym2,P.J. Rolim-Neto2,D.P.C. Macêdo2, R.G. M. Eicher1, F. Carrino2, E. Mugellini2, K. Ribi3, D. Betticher4,C. Lima-Neto3, S.S. Gonçalves4,V.L.L. Morais5,R.P.Neves1 Hoeppli5, C. Dubey5 1Departament of Mycology, Federal University of Pernambuco, Recife, 1School of Health Science, University of Applied Arts and Sciences Western Brazil; 2Departament of Pharmacological Sciences, Federal University Switzerland, Fribourg, Switzerland; 2Technology for Human Wellbeing of Pernambuco, Recife, Brazil; 3Departament of Tropical Medicine, Institute, University of Applied Arts and Sciences Western Switzerland, Federal University of Pernambuco, Recife, Brazil; 4Special Mycology Fribourg, Switzerland; 3Quality of Life, International Breast Cancer Study Laboratory, Federal University of São Paulo, São Paulo, Brazil; 5- Group, Berne, Switzerland; 4Oncology and internal medicine, Hopital Oncology Center,Oswaldo Cruz University Hospital, Recife, Brazil Fribourgeois, Frbourg, Switzerland; 5School of Health Science, University of Applied Arts and Sciences Western Switzerland, Frbourg, Switzerland Background and Aims Emerging yeast species may cause invasive infections in cancer patients, Background and Aims however Saprochaete capitata is uncommonly involved as aethiological Electronic recorded patient response with direct feed-back to agent. We report a case of invasive infection caused by S. capitata in a professionals positively impacts psychosocial care. The concept Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S83 of resilience is gaining increasing importance as a key component Methods for integrated psychosocial care in cancer. However, it has been Newly diagnosed men who chose curative treatment and those who chose today rarely addressed in intervention studies for adult cancer AS, and their partners, from 3 hospitals completed semi-structured tele- patients. phone interviews. Transcribed interviews underwent inductive, cyclic, The aim is to present a newly developed, IT-based complex intervention and comparative analysis with inter-rater reliability. Findings were fed furthering resilience and supportive care for patients during early system- into the development of an online DA. ic treatment. Results Methods Twenty-one men and 14 partners participated. Prostate cancer treat- According to the Medical Research Councils Framework for the devel- ment information was regularly described as contradictory, confus- opment and evaluation of complex interventions, we followed three ing, and stressful. AS was commonly misunderstood. Men and part- phases: ners were sometimes encumbered by memories of treatment 1) Conduction of a descriptive study to analyze the level of resilience decision-making, ongoing conflicting information and unanswered and supportive care needs of newly diagnosed cancer patients, medical questions. Radical treatment was selected when cancer pro- gression was feared or medically indicated. The online DA presents 2) interdisciplinary development of interventions furthering resilience unbiased, evidence-based information in a clear form - written, and addressing unmet needs based on international guidelines for graphical and audio-visual - then lead the patient and partner through psychosocial care by the use of an electronic device providing a a process of weighing up the benefits and costs of whether to adopt direct feed-back (RESIL-Sheet) to the oncologist and the nurse in AS or a curative treatment. The video-clips involve men, their part- charge of the patient, 3) ners, urologists and radiation oncologists presenting information and testing the feasibility of the interventions. personal experiences. Results Conclusions Phase 1: We found a strong association between high resilience and low Rigorously-tested, up-to-date and culturally-specific DAs for LRPC unmet supportive care needs. whichiseasilyaccessibleisurgentlyneededtoassistwithtreatment Phase 2: The electronic RESIL-Sheet includes an individual resilience decision-making involving both men and partner. score (Connor-Davidson-Resilience Scale), prompted unmet needs (Sup- portive Care Needs Survey Short Form – 10 items) and tailored interven- tions to unmet needs. Phase 3: The interventions applied three times over 16 weeks are current- ly tested in a phase II trial supported by the European Oncology Nursing MASCC-0267 Society and Swiss Cancer Research. Information Technology Conclusions Preliminary results of the phase II trial (interim analysis) will be shown at TABLET COMPUTER ASSESSMENT OF SYMPTOM BURDEN the meeting. IN OUTPATIENT ONCOLOGY S. Thomas1, A. Aktas1, S. Shrotriya1, D. Walsh1,B.Hullihen1,B.Estfan2 1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, USA; 2Department of Solid Tumor Oncology, Cleveland Clin- MASCC-0319 ic Taussig Cancer Institute, Cleveland, USA Information Technology Background and Aims “WHAT IS THIS AS THING?”: THE DEVELOPMENT OFAN Little is known about symptom burden in cancer populations at diagnosis. ONLINE TREATMENT DECISION-MAKING AID FOR LOW Utilization of tablet computers (TC) like iPads (© 2013 Apple Inc, RISK PROSTATE CANCER WHEN ACTIVE SURVEILLANCE Cupertino, California) for symptom assessment may streamline this IS ATREATMENT OPTION time-consuming process. 1 ’ 1 1 1 2 Theaimsofthisstudyare: P.Schofield,C.OCallaghan , T. Dryden ,A.Hyatt,J.Brooker,S. 1. Burney2, A. Wootten3,A.White4, D. Murphy5, S. Williams6,M. Assess TC acceptability and practicality for symptom and quality of Frydenberg7 life (QOL) self-assessment 1Cancer Experiences Research, Peter MacCallum Cancer Centre, East 2. Capture symptom burden at first visit to Solid Tumor Oncology Melbourne, Australia; 2Cabrini Monash Psycho-oncology Unit, Monash (STO) Outpatients University, Melbourne, Australia; 3Department of Urology, Royal Mel- Methods bourne Hospital, Melbourne, Australia; 4Consumer Representative, Participants completed a symptom assessment instrument on TC at their Prostate Cancer Foundation Australia, Melbourne, Australia; 5Cancer first visit to STO Outpatients. The questions (17 symptoms; 17 QOL) Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia; were adapted from the European Palliative Care Research Collaborative- 6Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Computerized Symptom Assessment. Responses were simultaneously Australia; 7Urology, Cabrini Medical Centre, Malvern, Australia 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 Background and Aims before the patient encounter. The lack of survival advantage, adverse quality of life effects and health Results care costs associated with curative treatments have convinced health I. Survey authorities internationally to recommend Active Surveillance(AS) as a & Screened 348; Eligible 174; Participants 107 management strategy for most low risk prostate cancers(LRPC). Re- & search shows only 15– 40 % adopt AS. Completion rate 98 % (65 % self completed; 68 % completed Aim: To examine men with LLPC and partners’ experiences of choosing easily) between AS and the radical treatments; and using these findings, develop & Completion time: mean (SD) 10 (+/− 2.6) minutes - without any an online treatment decision aid(DA). appointment delays S84 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

II. Demographics Background and Aims Pharmacogenomics is becoming increasingly important to ensure optimal & Age: median (range) 64 (23–95) yrs & medication use. Mobile apps are a potential resource of Males 65 %; College education>4 yrs 17 % pharmacogenomics information. However, it is unclear whether the qual- & Cancer: Respiratory 16 %; Genitourinary 26 %; Digestive ity of pharmacogenomics information in mobile health apps (MHA) is 39 %; Metastases 51 % current, accurate and reliable. The objective of this project is to develop a tool to assess the quality of pharmacogenomics information on chemo- therapy drugs in MHA. III. Symptoms Methods & ≥ Pain score 8 20 %; clinically significant depression 20 %; A tool assessing 4 aspects of quality (reliability, ease-of-use, privacy, drowsiness 28 %; moderate-severe anxiety 33 %; decreased content accuracy) was developed and used to evaluate a list of relevant food intake 42 %; tiredness 48 % MHA from iTunes and Google Play stores. Reference monographs com- & Poor QOL 24 % prising of pharmacogenomics-related information were developed for irinotecan and tamoxifen. Conclusions Results Twenty apps were assessed, among which, 14 apps scored more than 1. TC-based symptom assessment in newly diagnosed oncology out- 50 % for the first 3 criteria. Davis Drug Guide and FDA Drugs obtained patients is practical 2. the highest (30/36, 83 %) and lowest composite scores (10/36, 28 %) Completion rate 98 %; mean completion time 10 min respectively. None of the apps scored above 50 % for content accuracy – 3. Participants had significant symptom/QOL burden at diagnosis Drugs Guide and iPharmacy Direct scored the highest score of 12/26 (46.2 %), while Drugs Dictionary, Drugs Interaction, Drugs and Medica- tions, McGraw-Hill Nurse’s Drug Handbook (NDH2011) and Top 100 Drug Interactions scored zero. Conclusions MASCC-0590 Majority of MHA fared well in the quality assessment with regards to Information Technology 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 PATIENT HEALTH RECORDS (PHR) FOR MEDICINE and up-to-date information to oncology practitioners and cancer patients. N. Shklovskiy-Kordi1,B.V. Zingerman1 1Medical Informatics, National Center fo Hematology, Moscow, Russia

Background and Aims MASCC-0584 Medical records — the key question of the integrity of Medicine. Doctor Mucositis has to record the results of his research and reflections — it is the fundament of the continuity and development in Medicine. No one but IN SEARCH OF THE SUSPICIOUS LINK: SMOKELESS the patient can collect ALL the records relating to his health. Only patient TOBACCO USE AND ORAL MUCOSITIS IN HEAD AND NECK has right to share his information for research. CANCER PATIENTS Methods System of electronic health records, constructed to be patient-driven and S. Begum1, S. Mukhopadhyay2 comfortable for doctor. Patient takes responsibility for the collection, 1Pharmacology, R.G.Kar Medical College & Hospital, Kolkata, India; storing, and policies of use of his personal medical records. 2Pharmacology, Christian Medical College Ludhiana India, Ludhiana, India Results Based on our experience in creating the National Standard of Russain Background and Aims Federation “Electron Medical Records”, developed the Internet-based Smoking of tobacco is implicated as one of the major risk factors for devel- System for Patient Health Records. The System accepts records in any opment of oral mucositis (OM). Tobacco in other smokeless forms is a major format. Main features are: 1. Ensuring the origin and credibility of records. form of addiction in many countries. However, the association of smokeless 2. Integral presentation of all data on a single time axes allows estimation tobacco with oral mucositis has hardly studied. The present study aims at of the real-time correlations of dynamic changes in clinical parameters. finding the association, if any, with different types of tobacco use with OM. Conclusions Methods The system of Patient Health Records facilitates development of modern In this cross-sectional study, head and neck cancer patients receiving medicine with respectful role of the patient and medical specialists. 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. MASCC-0052 Results Information Technology 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 QUALITYASSESSMENT OF MOBILE HEALTHAPPS FOR historyoftobaccoaddiction(p=0.01). CHEMOTHERAPY-RELATED PHARMACOGENOMICS INFORMATION Similar numbers of smokers were detected to have OM. Poor dental C.J.Y.Chong1,J.Q.Chak1,P.S. Ong2, K. Yap2 hygene were noted in 72 % patients. 1Science Research Program, Hwa Chong Institution, Singapore, Conclusions Singapore; 2Department of Pharmacy, National University of Singapore, Smokeless tobacco, like its smoking counterpart, was found to be asso- Singapore, Singapore ciated significantly with oral mucositis among the head neck cancer Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S85 patients receiving radiation or chemotherapy. However, larger longitudi- 2012. All patients used Dentoxol® at the fist day of the cycle. Nine nal study is recommended to find out whether it is a mere association or a patients were at their first cycle while the other 23 patients had undergone significant risk factor. 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. MASCC-0475 Results Mucositis Results: The first row of Table 1 show first cycle patients. Patient * was a head and neck cancer patient who received radio/chemotherapy. The ORAL EVALUATION OFA PATIENT WITH TONGUE CANCER following rows show the comparison between cycles. GIVEN POST-SURGERY RADIOTHERAPY:A CASE REPORT Table 1: Effect of DENTOXOL® in OM E.I. Bustamante1,J.Wettlin1, L. Carmona2 1 2 R&D, Fundación Arturo López Pérez, Santiago, Chile; Radiotherapy, OM previous Dentoxol® OM post Dentoxol® Total Fundación Arturo López Pérez, Santiago, Chile 01234 0801*009 Background and Aims Introduction: Oral Mucositis (OM) is a frequent secondary complication 110000010 affecting close to 96 % of patients undergoing chemo-radiotherapy for 2 4 30 007 head and neck (H&N) cancer. This painful process interferes with food 3 1 41 006 intake and oral hygiene causing local and systemic infections and interrupting treatment regimes. 4 0 00 000 Objective: Evaluate the preventive effect of Dentoxol® in a H&N cancer To ta l 2 3 7 2 0 0 3 2 patient. Methods Conclusions Methods: 25 year-old male patient with diagnosed tongue cancer. Treatment Conclusion: Oral ulcers are rapidly colonized by bacteria aggravating the was 5.000 cGy divided in 28 sessions. Dentoxol®, following a standard oral OM and delaying healing. While this study lacks a control, the results hygiene protocol, was given five times a day for 2 weeks from the beginning suggest that Dentoxol® is a safe and effective product that may reduce therapy. OM based on the WHO scale was weekly evaluated. OM incidence. Further controlled studies are justified. 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 MASCC-0617 the tongue that persisted for 5 days. No pain was reported, nor interfer- Mucositis ence with communication and eating (Grade 1). The seventh and eighth evaluation showed a healthy mucosa. LOW LEVEL LASER TREATMENT FOR THE MANAGEMENT Conclusions OF ORAL MUCOSITIS: MECHANISMS OFACTION, Conclusions: The patient presented just an erythema attributable to IRRADIATION PARAMETERS AND DOSE radiotherapy, without perception of pain. Normal consumption and com- J.D. Carroll1,A.Barasch2, J.A. Dominguez3,J.B.Epstein4,R.G.Nair5, munication was reported and treatment was completed without interrup- J.E. Raber-Durlacher6,R.J.Bensadoun7 tion. Together with previous reports, our results support a controlled 1, THOR Photomedicine, Chesham, United Kingdom; 2, Winthrop Uni- clinical study of Dentoxol® to determine preventive value. versity Hospital, Mineola NY.,USA; 3, University of Barcelona, Barcelo- na, Spain; 4Division of Otolaryngology and Head and Neck Surgery, City of Hope National Medical Center, Duarte, USA; 5Dept of Haematology MASCC-0474 and Oncology, Gold Coast University Hospital, Gold Coast, Australia; 6 Mucositis Department of Oral and Maxillofacial Surgery, University of Amster- dam, Amsterdam, Netherlands; 7Service d’Oncologie Radiothérapique, Poitiers University Hospital, CHU de Poitiers, France CLINICAL EVALUATION OF THE EFFECT OF DENTOXOL® IN ORAL MUCOSITIS OF CANCER PATIENTS E.I. Bustamante1,J.Wettlin1, N. Sandoval2 Background and Aims 1R&D, Fundación Arturo López Pérez, Santiago, Chile; 2Chemotherapy, Introduction: The role of low level laser/light therapy (LLLT) for the Fundación Arturo López Pérez, Santiago, Chile management of oral mucositis (OM) has been evaluated in a number of studies including randomised clinical trials (RCTs). Subsequently the Background and Aims MASCC/ISOO clinical practice guidelines have included LLLT as a Introduction: recommended treatment option for the prevention of OM in Oral Mucositis (OM) is a pathological process characterized by lesion of haematopoietic stem cell transplantation recipients conditioned with the mucosa, which ranges from minor inflammation to deep ulceration, high-dose chemotherapy, with or without total body irradiation, and depending on cancer type, treatment and patient characteristics. Dentoxol® suggested its use for the prevention of OM in patients undergoing is an authorized Chilean mouthwash that combines active components radiotherapy, without concomitant chemotherapy, for head and neck with antibacterial, antiinflammatory and analgesic properties. cancer. The mechanism of action, and optimal irradiation parameters Objective: Determine the effect of Dentoxol® in the reduction of OM. and treatment dose have been reported in other pathologies but are not Methods well defined in OM. Methods: Using the WHO scale, the OM of 32 patients undergoing Objectives: To assess the mechanisms of action, optimal irradiation mucotoxic cancer treatments were tracked from June 2011 to April parameters, and treatment dose. S86 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods Background and Aims Methods: A systematic review was performed of in vitro and in vivo Stomatitis is a frequent adverse event that occurs with mTOR inhibitors studies focusing upon mechanisms of action, and of irradiation parame- that significantly affects patient quality of life. Knowledge of effective ters and dose used in RCTs of LLLTin OM. strategies to manage stomatitis may help improve tolerability and patient Results outcomes. To describe the experiences and techniques from a single Results: We identified 12 papers addressing mechanism \and 19 RCTs. center to manage mTOR-related stomatitis in patients with HR+/HER2- Studies provided evidence for a reduced inflammatory response (e.g., negative advanced breast cancer. reduced COX-2 expression, reduced numbers of neutrophils), and im- Methods proved wound healing (e.g., increased expression of growth factors, fibro- Use of a prophylactic measure to prevent stomatitis is essential. A blasts proliferation, increased angiogenesis). A dose response pattern could baseline oral assessment must be performed to ensure no gum irritation be established, although irradiation parameters appeared to be inconsistent. or mouth sores are noted before initiating treatment. Combination of Conclusions mouth rinses strongly recommended, and should be used as directed. If Conclusion: There is evidence for LLLT efficacy in OM management, but mouth sores develop, stop medication and call the nurse immediately. reporting of irradiation parameters needs improvement. More studies are needed Communication between nurse and patient is important, so continued to provide a better understanding of LLLT mechanisms in OM management. reinforcement of symptom prevention and management is imperative. If there are no changes from baseline oral assessment, medication is con- tinued. Using triamcinolone oral paste can assist in healing mouth ulcers. Results MASCC-0564 Patient will have office visits every 2 weeks with an oral assessment. If Mucositis there are no changes from baseline oral assessment, medication is con- tinued. If changes develop, patient is instructed to hold dose of medica- A PILOT STUDY OF EFFICACY OF LACTOBACILLUS CD2 tion until grade of stomatitis is determined by the clinical team. LOZENGES IN PREVENTING HIGH-DOSE CHEMOTHERAPY Conclusions INDUCED ORAL MUCOSITIS IN PATIENTS UNDERGOING Prevention is the key to managing stomatitis associated with mTOR HEMATOPOIETIC STEM CELLTRANSPLANTATION inhibitors. By teaching the patient to recognize any changes in the mouth, communicate those changes to nursing staff, and be compliant with oral S. chaudhary1,A.Sharma1,T.Tilak1, S. Bakhshi1,V. Raina1, L. kumar1 rinses, our center has been successful in minimizing stomatitis. 1Medical Oncology, All India Institute of Medical Science, Delhi, India Funding for abstract preparation supported by Novartis. 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 chemo- MASCC-0516 radiotherapy induced oral mucositis in head and neck squamous cell Mucositis carcinoma patients. Thirty one patients undergoing high dose chemother- apy and stem cell transplantation were enrolled into this single center HANGESHASHINTO, A KAMPO MEDICATION, INHIBIT THE phase II study. Primary endpoint was grade III or IV mucositis. DEVELOPMENT OF RADIOTHERAPY INDUCED ORAL Methods MUCOSITIS HEAD AND NECK CANCER PATIENTS 4-6 lozenges of Lactobacillus brevis CD 2 were given to eligible patients R. Hosokawa1, T. Tamahara1,E.Ito1, N. Tanda2, W. Iijima2,M.Dodo1, beginning 7 days before initiation of chemotherapy and continued until T. K a t o 1, T. Koseki1 resolution of mucositis or day +24. 1Graduate School of Dentistry, Tohoku University, Sendai, Japan; Results 2University Hospital, Tohoku University, Sendai, Japan Median age was 29 years (range 10–64), 22 were autologous transplan- tation. Out of 31 patients 7 (22.6 %) did not develop any mucositis, 6 Background and Aims (19.4 %) developed grade I, 12 (38.79 %) developed grade II, 4 (12.9 %) Oral mucositis is one of severe side effect during anti cancer therapy. developed grade III, and 2 (6.5 %) developed grade IV mucositis. Median Especially radiotherapy for head and neck cancer showed severe oral time to onset of mucositis was 6 days (range 3–9) and median time to mucositis, which cause interruption of cancer therapy sometimes. Thus it resolution of mucositis was 8 days (range 5–40). One patient died of is very important to prevent or palliate pain related to oral mucositis. sepsis. Traditionally, it has been known that Hangeshashinto (HST), a Kampo Conclusions medication, heals stomatitis of oral mucosa. However, it is unknown No side effect attributed to study medication was observed. However we whether it works for radiotherapy induced oral mucositis. would like to stress the need of a randomized study to confirm finding of Our aim of this presentation is to evaluate the effect of HST for the this phase II study. prevention of oral mucositis at both clinical and experiment level. Methods We applied HSTas oral rinse for eight patients who were suffering from MASCC-0488 head and neck cancer. Then we evaluate the grade of mucositis. Control Mucositis was former 11 patients who did not take HST. The severity of oral mucositis was graded by using common Terminology Criteria of muco- sitis, CTACAE v3.0. MANAGEMENT OF STOMATITIS ASSOCIATED WITH MTOR We applied HST for cell culture medium. Cell line we used was TR146, INHIBITORS IN HORMONE RECEPTOR–POSITIVE/HER2- human squamous cell carcinoma. Then we analyzed activity of cell NEGATIVE ADVANCED BREAST CANCER: CLINICAL proliferation induced by HST. EXPERIENCES FROM A SINGLE CENTER Results J. Divers1 The mean of oral mucositis grade in HSTapplied group (Grade 1.6) was 1Breast Cancer, Texas Oncology - Baylor Charles A. Sammons Cancer lower than that of control group (Grade 2.8) significantly (P<0.01). The Center,Dallas, USA ratio of BrdU positive cells was higher in 100 ug/ml when compared with Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S87

0 ug/ml significantly (P<0.05). The ratio was increasing slightly dose- Background and Aims dependently (0, 1, 10, and 100 ug/ml). Glucagon-like peptide 1 (GLP-1) and glucagon-like peptide-2 Conclusions (GLP-2) are hormones co-secreted from the intestinal L-cells in Our data suggests that HST might activate cell proliferation and then respond to nutrient intake, but also in response to intestinal injury inhibit oral mucositis. 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 MASCC-0599 the ability to secrete both hormones would be more susceptible to Mucositis chemotherapy. Methods ROLE OF SALIVARY DYSFUNCTION IN HEMATOPOIETIC We used the diphtheria-toxin-receptor-cellular knock-out mice, STEM CELLTRANSPLANT PATIENTS (HCST): ORASTEM TgN(GCG.DTR) which allowed us to study the effects of chemo- STUDY therapy in mice with acute ablation of L- cells. In different experi- ments WT mice and TgN(GCG.DTR) mice were treated with 5-FU I. von Bultzingslowen1,P.M. Williams2,P. Samim2,P. Johansson3,K. (400 mg/kg) or PBS, and euthanized 2, 4 and 6 days after this Garming Legert4,B.Hasséus5,M.T.Brennan6 injection. Body and intestinal weight, villus height and crypth depth 1Oral Microbiology and Immunology, Sahlgrenska Acaemy, Gothenburg, were measured and mucositis grade was scored histologically. GLP- Sweden; 2Oral Oncology/Dentistry, BC Cancer Agency, Vancouver Brit- 2 concentration in plasma was measured using an in-house ish Columbia, Canada; 3Hospital Dentistry and Oral Medicine, Public radioimmuno assay. Dental Health, Gothenburg, Sweden; 4Orofacial Medicine and Patholo- Results gy, Karolinska Institute, Huddinge, Sweden; 5Oral Medicine and Pathol- The TgN(GCG.DTR) mice were unable to secrete GLP-2 both 2 ogy, Sahlgrenska Academy, Gothenburg, Sweden; 6Oral Medicine, Caro- and 4 days after 5-FU, while the 5-FU treated WT mice had a linas Medical Center,Charlotte North Carolina, USA highly significant increase in GLP-2 concentration compared to healthy WT mice. There was no difference between 5-FU treated Background and Aims TgN(GCG.DTR) mice and 5-FU treated WT mice in body weight HSCT patients experience oral complications which can increase risk of loss, intestinal weight loss, morphometric parameters or grade of infection, pain, poor nutrition, increased hospitalization and decrease mucositis. QoL. We evaluated the relationship of salivary dysfunction and Conclusions xerostomia on mucositis, pain and pain-related QoL after HSCT. We conclude that the severity of mucositis does not depend on the Methods functionality of L-cells and the hormones are probably not implicated in Patients were seen at baseline and 3 days/week during hospitalization after the pathophysiology of mucositis. 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 MASCC-0527 CTC pain scale. Descriptive statistics, correlations and non-parametric com- Mucositis parisons between the low and high salivary groups were assessed. Results NEW LOCAL ANESTHETIC LOZENGE FOR ORAL This interim analysis included 52 patients, age 54.8 years (SD=9.5), 58 % MUCOSITIS PAIN: IS THERE A RISK OF TOXIC PLASMA male. Common medical diagnoses were lymphoma (n=15), multiple CONCENTRATION AND SIDE EFFECTS? myeloma (n=14) and acute myelogenous leukemia (n=10). Mean and S. Mogensen1, K. Sveindottier1,C.Treldal1, C.A. Kristensen2, worst xerostomia scores were positively correlated with mean and worst J. Jacobsen3, J. Petersen1, M. Kreilgaard4,O.Andersen1 mucositis and pain measures: WHO mucositis, OMAS ulceration and 1Clinical Research Centre, Copenhagen University Hospital Hvidovre, erythema, WHO pain, and mean and CTC pain (range r=0.41–0.80, p= Hvidovre, Denmark; 2Oncology, Rigshospitalet, Copenhagen, Denmark; 0.02–<0.0001). Comparing low (mean=4.4, SD=3.3 ml/5 min) and high 3Department of Pharmacy, SUND Copenhagen University, Copenhagen, (mean=10.0, SD=8.5 ml/5 min) baseline salivary groups, there was Denmark; 4Department of Drug Design and Pharmacology, SUND Co- significant differences in mean xerostomia score; 1.1 (0.6) versus 0.6 penhagen University, Copenhagen, Denmark (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). Background and Aims Conclusions Oral mucositis is a common and serious complication to cancer treatment. Xerostomia and salivary dysfunction have a relationship with mucositis, Mucositis is caused by a damage of the mucosa in the oral cavity and pain and QoL after HSCT. This study will continue to enroll patients for pharynx which induces server pain. There is currently no sufficient pain more robust analyses. 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 MASCC-0505 a topical oral anesthetic lozenge. The inflammation of the mucosa Mucositis could theoretical lead to toxic side effects of bupivacaine due to rapid absorption. The aim was to investigate the absorption of topical administered THE INTESTINAL HORMONES GLP-1 AND GLP-2 ARE NOT bupivacaine and monitor possible side effects, in healthy subject with IMPLICATED IN THE PATHOPHYSIOLOGY OF MUCOSITIS normal mucosa and in patient with oral mucositis. H. Kissow1, J. Pedersen1,B.Hartmann1, J.J. Holst1 Methods 1Department of Biomedical Sciences, University of Copenhagen, Copen- The bupivacaine plasma concentration was measured after adminis- hagen, Denmark tration of a 25 mg bupivacaine lozenge as single dose. Baseline S88 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 blood sample was drawn before administration of the lozenge and MASCC-0443 followed by ongoing blood samples for 6 h on 10 healthy subjects Mucositis and 3 h on 10 patients. Results STOMATITIS PREVENTION DURING No side effects were observed in both groups. The healthy subjects EVEROLIMUS/EXEMESTANE TREATMENT FOR METAST had a maximum concentration of 376 ng/ml bupivacaine in the ATIC BREAST CANCER: A PHASE 2 STUDY OF plasma after administration of the lozenge. This is far below the STEROID-BASED MOUTHWASH toxic concentration which is estimated to 2,000–4,000 ng/ml. The plasma samples from the patients will be fully analysed in March D. Weikel1,S.Lindsay2, A.J. Ajmera2 2014, but a preliminary analysis showed similar results as the 1Oncology and Diagnostic Sciences, University of Maryland Marlene healthy subjects. and Stewart Greenebaum Cancer Center, Baltimore, USA; 2Cancer Conclusions Center-Breast Medicine, University of California at San Francisco Helen The preliminary results showed that patients with oral mucositis can use Diller Family Comprehensive Cancer Center,San Francisco, USA the bupivacaine lozenge as pain management safely without risk of toxic side effects. 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 MASCC-0529 mouthwash in women with hormone receptor–positive (HR+) metastatic Mucositis breast cancer prescribed everolimus plus exemestane. Methods This phase 2, single-arm study will evaluate the effectiveness of a dexa- NEW LOCAL ANESTHETIC LOZENGE FOR ORAL methasone oral solution in preventing stomatitis during treatment of MUCOSITIS PAIN: IS THERE RISK OF DYSPHAGIA AND HR+/HER2– breast cancer with everolimus 10 mg/day plus exemestane ASPIRATION IN HEAD AND NECK CANCER PATIENTS AND 25 mg/day. Eligible patients will receive a steroid-based mouthwash HEALTHY SUBJECTS? (alcohol-free 0.5 mg/5 mL dexamethasone solution) prophylactically. S. Mogensen1, K. Sveindottier1,C.Treldal1, A. Nygaard2,A. Patients will be instructed to perform the mouthwash regimen 4 times Mohammad2, C.A. Kristensen3, J. Petersen4, O. Andersen4 per day and to swish the mouthwash in the mouth for a minimum of 2 min 1Clinical Research Centre, Copenhagen University Hospital Hvidovre, 4 times per day. Patients will be instructed to abstain from eating or Copenhagen SV, Denmark; 2Department of Diagnostic Radiology, drinking for at least 1 h after using the mouthwash. The mouthwash Rigshospitalet, Copenhagen, Denmark; 3Department of Oncology, regimen will begin on the first day of everolimus administration, after Rigshospitalet, Copenhagen, Denmark; 4Clinical Research Centre, Co- dosing. Preventive therapy will continue for 56 days, with optional penhagen University Hospital Hvidovre, Hvidovre, Denmark continued use for an additional 56 days. Primary endpoint: incidence of stomatitis (grade ≥2) at 56 days. Background and Aims Results Oral mucositis induces server oral pain and is a serious compli- Enrollment for this in-progress study is planned for 97 patients. The cation to cancer treatment with severe negative influences the definition of grade ≥2 stomatitis will be strictly defined using physical patient’s nutritional status. Many patients undergoing high-dose examination, the Normalcy of Diet Subscale, and patient-reported Visual chemotherapy or radiation treatment for head and neck cancer Analogue Scale scores to ensure objective and consistent grading. develops oral mucositis. There is currently no sufficient pain Conclusions management for oral mucositis pain. Therefore there is an urgent This study is expected to reveal specific treatment strategies to prevent need for new treatments. Therefore a bupivacaine lozenge as a everolimus-associated stomatitis or to ameliorate its severity. local oromucosal and pharynx anesthesia could be interesting. Supported by Novartis Pharmaceuticals Corporation. However, it has previously been assumed that pharyngeal anes- thesia with local anaesthetics induces a risk of dysphagia and aspiration, including that it affects the self-regulating swallowing reflex. MASCC-0148 The aim of this study was to investigate the risk of aspiration after Mucositis 2 administration of a bupivacaine lozenge to healthy subjects with normal mucosa and to oral mucositis patients. CLONIDINE INHIBITS PRO-INFLAMMATORY CYTOKINE Methods (PIC) LEVELS IN EX-VIVO HUMAN ORAL MUCOSA The risk of dysphagia and aspiration in 10 healthy subjects and 5 patients with mucositis was included in the study before and after administration P.Attali1,V. Rouley2, S. Boisnic3,V. Trochon-Joseph4,C.Lemarchand4,L. of a 25 mg bupivacaine lozenge. They swallowed 20 ml barium-contrast Zakin2 agent and this was recorded using video radiography which were then 1Medical Affairs and Strategy, BioAlliance Pharma, Paris, France; analysed for sign of aspiration. 2Clinical development, BioAlliance Pharma, Paris, France; 3Research, Results GREDECO Research Association, Paris, France; 4Preclinical R&D, None of the 10 healthy subjects and the 5 oral mucositis patient showed BioAlliance Pharma, Paris, France any signs of dysphagia or aspiration after administration of the bupivacaine lozenge. Additional five patients will be included in the Background and Aims study by March 2014. PIC are rapidly produced and released at the initiation stage of Oral Conclusions Mucositis. Clonidine inhibits the expression and production of PIC, The preliminary results showed that the bupivacaine lozenge is safe to use presumably through the NF-kB pathway. as local anesthetic for head and neck cancer patients with oral mucositis Evaluation of the effects of clonidine on PIC in an ex vivo model of before eating and drinking. human oral mucosa. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S89

Methods p<0.001) and 30.2 % (300 μg/kg, p<0.001). In S2, % days was reduced Five cubic millimeter biopsy samples of non-keratinized oral mucosa from 35.4 % in controls to 21.9 % (100 μg/kg, p=0.003), 28.1 % obtained from healthy volunteers were transferred onto permeable poly- (12.5 μg/kg, p=0.12) and 26 % (25 μg/kg, p=0.04). OM severity was carbonate membrane transwells (12 mm diameter, 12 μmporesize). significantly (p<0.01) reduced in the clonidine 100 and 300 μg/kg QD Saline (control group), Clonidine in 6 different concentrations or cloni- groups in S1, and in the clonidine 100 μg/kg QD, 12.5 and 25 μg/kg qid dine+salinewereapicallyaddedevery2hfor6doses.SubstanceP(SP) in S2. was added simultaneously with the last clonidine dose. 24 h later, super- Conclusions natants were removed and selected PIC levels were measured using Topically administered clonidine mitigated Ri-OM in hamsters in a dose- ELISA (AbCys, France). dependent manner. QD administration was as effective as QID dosing. 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. MASCC-0072 Mucositis 2

Cytokine Untreated SP-treated Clonidine Clonidine EFFECTS OF PRE-RADIATION EXPOSURE TO SOFT LASER μ (pg/mg) control control 0.9 g/mL 3 g/mL OF NORMAL AND MALIGNANT CELLS TNF-α 0.63±0.44 1.7±1.1 0.74±0.36 0.67±0.27 A. barasch1, J.B. epstein2, J.B. Raber-Durlacher3 IL-10 0.21±0.16 0.96±0.59 0.37±0.23 0.41±0.47 1oral diagnosis, University of Alabama at Birmingham, Birmingham, IL-6 9.8±7.7 38.2±34.2 20±15 22.4±19.3 USA; 2oral diagnosis, Cancer Center City of Hope CA, Duarte, USA; 3 IL-1β 1.83±0.53 5.85±4.5 3.61±1.64 4.29±3.18 periodontology, ACTA-University of Amsterdam, Amsterdam, Netherlands Conclusions Clonidine significantly reduced TNF-α and modulated measurable IL-6 Background and Aims and IL-1β (not significant). This suggests that topical application of Low Level Laser Therapy (LLLT) efficacy for prevention of cancer clonidine may be active in the prevention of OM and supports further treatment-induced oral mucositis (OM) has been amply described. How- investigations in animal models. ever, potential protection of malignant cells remains a legitimate concern for clinicians. Methods Wetreated normal human lymphoblasts (TK6) and human leukemia cells MASCC-0150 (HL60) with LLLT prior to ionizing radiation (IR). Cells were then incubated and counted daily for 6 days to determine their survival. Mucositis 2 Growth curves were compared to calculate differences between LLLT- exposed and control cells. TOPICAL CLONIDINE REDUCES THE DURATION AND Results SEVERITY OF RADIATION-INDUCED ORAL MUCOSITIS Growth curves for both cell lines showed significant declines after expo- (RIOM) IN ATRANSLATIONAL HAMSTER MODEL sure to 50 cGy IR. Pre-radiation exposure to LLLT (4.0 J/cm2) blocked P. Attali1,L.Zakin2,G.Lyng3,V.Roulet2, V. Trochon-Joseph4,C. this decline in TK6 but not in HL60. The latter were sensitized to the Lemarchand4,S.Sonis5 killing effects of IR in an energy dose-dependent manner . 1Medical Affairs and Strategy, BioAlliance Pharma, Paris, France; Ta b l e 1 . TK6 response (50 cGy IR) 2Clinical development, BioAlliance Pharma, Paris, France; 3Research, 4 BioModels, Watertown, USA; Preclinical R&D, BioAlliance Pharma, CELLTREATMENT RELATIVE CELL NUMBER (Nt/No) 5 Paris, France; , BioModels, Watertown, USA Day 1 Day2 Day 3 Day4 Day5 Day6 Control 2.1±0.1 4.5±0.2 10.6±0.6 18.9±2.7 57.0±0.9 111±1.4 Background and Aims Laser (4 J/cm2) 1.6±0.2 3.9±0.2 7.2±0.3 18.2±2.1* 53.0±7.5 100.5±1.8* NF-kappaB is an attractive interventional target for RIOM. Clonidine 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 inhibits NF-kappaB-mediated pro-inflammatory cytokines expression and release. * p<0.01 To assess the efficacy of a novel topical clonidine formulation on RiOM in an established animal model. Ta b l e 2 . HL60 response (50 cGy IR) Methods Male Golden Syrian hamsters were randomly assigned to equally-sized groups in 2 independent studies. Clonidine administered topically starting CELLTREATMENT RELATIVE CELL NUMBER (Nt/No) before radiation (D-1) and continuing until D20 was compared to saline Day1 Day 2 Day 3 Day 4 Day5 Day 6 controls. The left buccal cheek pouch of hamsters was irradiated once Control 1.5±0.1 3.5±0.2 9.9±0.1 16.3±2.4 28.4±0.4 50.0±0.8 with 40 Gy on D0. Standardized Images of the cheek pouch mucosa IR 1.6±0.3 1.7±0.2 4.8±1.2* 6.5±1.3* 12.8±0.5* 28.8±2.3* obtained on alternate days (D6-D26) were blindly scored for RiOM Laser 1.0 J/cm2 1.4±0.1 2.6±0.1 6.7±0.1 9.8±1.0 27.9±0.9 46.1±2.1 severity. The number of days of ulcerative OM and the individual daily Laser 4.0 J/cm2 1.0±0.1 2.4±0.3 5.2±0.7* 5.9±0.8* 13.5±0.6* 24.3±6.0* group scores were evaluated. In Studies 1 (S1) and 2 (S2), clonidine was Laser 8.0 J/cm2 1.0±0.0 2.5±1.1 5.8±0.2* 7.4±0.2* 12.3±0.6* 19.1±1.3* 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). * p<0.05 Results Conclusions In S1, clonidine dose-dependently reduced the % days of score≥3 from Pre-IR LLLT results in a differential response of normal vs. malignant 46.9 % in controls to 41.7 % (30 μg/kg), p=0.35), 29.2 % (100 μg/kg, cells, suggesting that LLLTdoes not confer IR protection to cancer cells. S90 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0098 secondary to orotopical application of an adrenergic agonist vasoconstric- Mucositis 2 tor, would prevent or suppress oral mucositis induced by irradiation or systemic chemotherapy. Methods SERUM-DERIVED IMMUNOGLOBULIN SHOWS EARLY Topical vasoconstrictor was applied once to oral cavity; 20 min later PROMISE IN THE ALLEVIATION OF IRINOTECAN-INDUCED hamsters or mice received 19–30 Gy to the oral mucosa. Oral mucositis MUCOSITIS was scored using a functional assay, gross morphology, and histology of E. Bateman1, E. Weaver2,G.Klein2, E. Plews3, A. Wignall4, B. Wozniak4, mucosal tissue over the next 12–16 days. D. Keefe4 Results 1Mucositis Research Group School of Medicine, University of Adelaide, A single application of phenylephrine (14–136 mM) 20 min before Adelaide, Australia; 2Research, Entera Health Inc, Cary, USA; 3Animal irradiation conferred highly significant (P<0.001), dose-dependent sup- Facility, Flinders University, Adelaide, Australia; 4Health and Medical pression of weight loss, oral secretion, and histopathology of mucosa seen Sciences, Adelaide University, Adelaide, Australia in mice treated with 0 mM phenylephrine+19 Gy radiation. Epinephrine, norepinephrine and phenylephrine showed up to 100 % radioprotective Background and Aims efficacy at concentrations that reflected their rank-ordered affinities for BACKGROUND: Gastrointestinal (GI) mucositis is associated with di- the a1 adrenergic receptor. arrhoea and intestinal barrier dysfunction caused by apoptosis, immune dysfunction, and microbiome alterations. Serum-derived bovine immu- noglobulin (SBI) has been shown to ameliorate inflammation in colitis models, has been shown to improve HIV-induced enteropathy and nutri- tional status, and is being investigated in post-surgical recovery in oncol- ogy patients. Weinvestigated in a rat model whether SBI was effective in alleviating symptoms of GI mucositis. OBJECTIVES: Todetermine 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 Conclusions day 4, and for 6 days post-irinotecan. Animals were monitored for Animal model results indicate that this strategy could provide a simple bodyweight and diarrhoea. Tissues were collected at necropsy 6, 48, 96 orotopical formulation to prevent or suppress oral mucositis in humans, and 144 h post-irinotecan. H&E-stained colon and jejunum were and a Phase I/IIa proof of concept trial to determine efficacy of orotopical analysed for histological damage. phenylephrine in suppressing oral mucositis in adult and pediatric cyclo- Results phosphamide + total body irradiation bone marrow transplant patients is RESULTS: The overall incidence, severity and duration of diarrhoea, and about to be undertaken. 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 irinotecan- induced changes in neutrophil (P=0.04959) and lymphocyte (P= MASCC-0108 0.0035) levels, and lower tissue damage scores than those receiving Mucositis 2 irinotecan alone (P<0.0001). Conclusions PAT I E N T ’S PERCEPTIONS WITH THE USE OF CONCLUSIONS CRYOTHERAPY FOR THE PREVENTION OF ORAL Twice daily oral gavage of SBI was well-tolerated, and reduced the MUCOSITIS incidence, severity and duration of irinotecan-induced mucositis. SBI was associated with less pronounced changes in inflammatory cell levels M. Geuke1,A.P.Mank2, J.E. Raber-Durlacher1,M.D.Hazenberg2,J. and intestinal tissue damage. Ongoing experiments aim to elucidate the Lange de1 mechanisms of SBI-associated gastrointestinal protection. 1department of oral- and maxillofacial surgery, Academic Medical Cen- ter,Amsterdam, Netherlands; 2department of hematology,Academic Med- ical Center,Amsterdam, Netherlands

MASCC-0124 Background and Aims Mucositis 2 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 ANEWTOPICALVASOCONSTRICTOR-BASED STRATEGY to hold ice chips in their mouth is considerable and this may negatively FOR PREVENTION OF ORAL MUCOSITIS affect their compliance. This study was aimed to obtain more insight into W.Fahl1, M.L. Hoover-Regan2, A. Graul-Conroy2 patient’s perceptions and their ability to complete CRYOtx. 1UW Carbone Cancer Center, University of Wisconsin-Madison Methods: 41 consecutive dentate patients diagnosed with multiple mye- ProCertus BioPharm, Madison, USA; 2UW Carbone Cancer Center, loma or non-Hodgkin lymphoma and scheduled for high-dose melphalan University of Wisconsin-Madison, Madison, USA (HDM) containing conditioning regimens followed by autologous stem cell transplant were included (58,9 % male, mean age 55,9 years, range Background and Aims 20–69 years) after giving informed consent. Patients were instructed to Oral mucositis is a common, significant, and costly side effect in bone keep ice chips 15 min before, during the complete HDM infusion, and marrow transplant and other cancer therapy patients. We sought to deter- 15 min after HDM infusion. Nurses assisted patients and supervised mine whether transient vasoconstriction and hypoxia of oral mucosa, compliance. Patients filled out a 5-point Likert type questionnaire. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S91

Results: As depicted in the Table, most patients (89.4 %) reported not MASCC-0189 having any trouble or just a little with CRYOtx and all were able to Mucositis 2 complete this regimen. Tooth sensitivity, nausea and developing a head- ache (frost bite) were not a problem in most of the patients. A RANDOMISED PHASE IIB TRIALTO ASSESS THE EFFICACY OF ICE-CREAM-FORMULATED IRON- Not at all A little Moderate Severe Complaints so SATURATED LACTOFERRIN AND ANHYDROUS MILK FATIN severe that I PREVENTING CHEMOTHERAPY INDUCED DIARRHEA had to stop CRYOtx D. Perez1,K.J.Sharples2,R.Broom3,M.Jeffery4,J.Proctor5,V. Hinder5, n% n% n% n%n % S. Pollard5, J. Edwards6,A.Simpson6, R. Isaacs7, M.B. Jameson8,R. Did you have trouble 23 60,5 11 28,9 4 10,5 0 0 0 0 9 5 5 5 10 10 using cryotherapy? North ,J.Scott ,S.Benge , G. Krissensen ,A.Geursen ,K.Palmano , Were your teeth sensitive/ 23 62,2 10 27 4 10,8 0 0 0 0 D. Keefe11 ,M.Findlay5 painful during CRYOtx? 1Oncology, Dunedin Hospital, Dunedin, New Zealand; 2Preventive and Were you nauseous? 31 81,6 3 7,9 4 10,5 0 0 0 0 3 Did you develop a headache? 32 84,2 5 13,2 1 2,6 0 0 0 0 Social Medicine, University of Otago, Dunedin, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 4Medical Oncology, Christchurch Hospital, Christchurch, New 5 Conclusions Zealand; Cancer Trials New Zealand, University of Auckland, Auckland, 6 Conclusion: All patients were able to complete 60 min of oral CRYtx. New Zealand; Wellington Blood and Cancer Centre, Wellington Hospi- 7 Our results indicate this was well tolerated by the majority of patients. tal, Wellington, New Zealand; Medical Oncology, Palmerston North Hospital, Palmerston North, New Zealand; 8Medical Oncology, Waikato Hospital, Hamilton, New Zealand; 9Medical Oncology, Tauranga Hospi- tal, Tauranga, New Zealand; 10Research, LactoPharma NZ, Auckland, New Zealand; 11 Cancer Medicine, University of Adelaide, Adelaide, MASCC-0187 Australia Mucositis 2 Background and Aims Background: HIGH POTENCY POLYMERIZED (CROSS-LINKED) A medicinal food product containing iron-saturated lactoferrin and anhy- SUCRALFATE MANAGES BOTH ORAL AND ALIMENTARY drous milk fat (ReChargeTM) has been shown to reduce the effects of MUCOSITIS SIMULTANEOUSLY chemotherapy on the gut in animals. We report results of a randomized R. McCullough1 blinded placebo-controlled Phase IIb trial investigating the efficacy and 1Translational Medicine Research, Mueller Medical International LLC, safety of ReCharge formulated as ice-cream in preventing chemotherapy Foster,USA induced diarrhea (CID) in patients receiving chemotherapy. Objectives: Background and Aims To determine whether ReCharge reduces the number of days with CID Background: High potency sucralfate (HPS) is standard sucralfate poly- and, as a key secondary measure, the incidence of diarrhea. merized by chelated calcium into cross-linked sheets. Three hours post- Methods administration, when, HPS achieves and maintains a sucralfate surface Patients (197) were randomized 1:1 to ReCharge or placebo. Patients concentration that is 800 % greater on normal lining and 2,400 % greater consumed 100 ml study product for 14±4 days before starting chemo- on ulcerated lining compared to non-polymerized sucralfate . HPS has a therapy and for 6 weeks after starting chemotherapy; completed daily 7 day 80 % healing rate on esophageal erosions compared to 30 % for diaries for 8 weeks and attended clinic visits until 12 weeks (2- omeprazole. week cycles) or 14 weeks (3-week cycles). Aims: Manage oral and alimentary mucositis using HPS Results Methods The mean number of days with diary-recorded CID was marginally but Subjects: A 43 yo male with advanced head and neck squamous cell not statistically significantly lower on ReCharge than placebo (−2.0, 95 % carcinoma (T3 N3 M0 Stage IVb) requiring 6 weeks concurrent chemo- confidence interval (−4.7 to 0.7)), (p=0.2). However the proportion radiation (Paclitaxel and Carboplatin; radiation totaling 201 Gy) devel- reporting diarrhea at clinic was 30 % lower (p=0.012). Missing diary oped Grade 2 oral mucositis and Grade 2 alimentary mucositis within data may have contributed to the discrepancy. 1 week. A 48 yo female with Stage 4 melanoma developed chemo- Conclusions induced diarrhea on ipilimumab. We found no clear evidence of a benefit from ReCharge in reducing CID Intervention: 1.5 g of HPS in suspension taken three times daily for as measured by patient self-report diary. The converse finding of benefit 2 days then twice daily. as measured at clinic visits (secondary endpoint) and the incomplete Outcome Measures: (1) change from baseline in (a) oropharyngeal adherence to diary completion however indicate further research is re- lesions and (b) patient-reported odynophagia, nausea, vomiting and diar- quired into optimal methods for measuring CID. rhea; (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 MASCC-0223 pain, nausea and diarrhea (alimentary mucositis). (2) Patients required no Mucositis 2 analgesia, no tube-feeding and tolerated a regular diet. (3) A modified Naranjo Questionnaire score of 10 supported HPS as cause of observed COMPLETION OF THE JAPANESE TRANSLATION OF THE clinical effects. No adverse reactions were noted. MASCC/ISOO MUCOSITIS GUIDELINES Conclusions Polymerized cross-linked (high potency) sucralfate should be considered Y.Soga1,T.Mori2,R.Hosokawa3,T.Yurikusa4 for use in cancer treatment patients with known or anticipated oral and 1Division of Hospital Dentistry, Okayama University Hospital, Okayama, alimentary mucositis. Japan; 2Division of Hematology Department of Internal Medicine, Keio S92 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

University School of Medicine, Tokyo, Japan; 3Division of Preventive Results Dentistry Department of Oral Health and Development Sciences, Tohoku Seventy-five patients were evaluated, 11 already receiving background University Graduate School of Dentistry, Sendai, Japan; 4Department of opioid therapy for cancer pain. Globally, all the patients developed OM Dentistry and Oral Surgery,Shizuoka Cancer Center Hospital, Sunto-gun (67 % WHO grade 3–4) and received opioid treatment (80 % with strong Shizuoka, Japan opioids) for OM-related pain during chemoradiation (starting from the 1st to the 7th week of radiotherapy, median 4th). The highest dose of opioids Background and Aims was reached in a range between the 3rd and the 11th week (median 7th), A major effort of the Mucositis Study Group of MASCC/ISOO has been consisting in a daily oral morphine equivalent dose (OMED) of 5 to comprehensive review of the literature related to mucositis and develop- 450 mg (median 90 mg). Intentional breakthrough pain during eating/ ment of evidence-based clinical practice guidelines. A summary of the drinking due to OM was recognized in 84 % of patients and treated with most recent update (2013–2014) of the MASCC/ISOO Mucositis Guide- strong (68 %) or weak (16 %) opioids. Opioid treatment for OM finished lines is now available on this website. One of the points of discussion at from 0 to 25 weeks after the end of treatment (median 6). the Mucositis Study Group Business Meeting held in 2013 in Berlin was Conclusions dissemination of the guidelines, including translation into multiple lan- Opioid therapy remains the mainstay for the management of background guages. The objective was translation of MASCC/ISOO Mucositis Guide- and breakthrough pain in OPC patients receiving chemoradiation. Pro- lines into Japanese to facilitate dissemination of the guidelines in Japan. spective studies are strongly necessary to evaluate: Methods 1. patient reported outcome We translated the MASCC/ISOO Mucositis Guidelines into Japanese 2. correlation of analgesic therapy with nutritional issues as well as according to the MASCC policy for translation from English to other with compliance to oncologic treatment. 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. MASCC-0392 Results Mucositis 3 The Japanese translation of the MASCC/ISOO Mucositis Guidelines was completed in 2 months. With permission from the Chair of Mucositis BACTERIAL PROFILING OF THE ORAL COMMUNITY OF Study Group, MASCC/ISOO, the pdf version was posted on the HEAD AND NECK CANCER PATIENTS TREATED WITH homepage of the university hospital of one of the editing members RADIOTHERAPY (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 T. D e Ry c k 1,F.Duprez2, M. Bracke1, T. Vande Wiele3, B. Vanhoecke3 the Japanese translation (Dec 1, 2013). 1Laboratory of experimental cancer research, Ghent University, Ghent, Conclusions Belgium; 2Department of Radiotherapy, Ghent University Hospital, The Japanese translation of the MASCC/ISOO Mucositis Guidelines was Ghent, Belgium; 3Laboratory of Microbial Ecology and Technology, completed and is publicly available. Ghent University, Ghent, Belgium

Background and Aims Oral mucositis is an important side effect of radiotherapy for head and MASCC-0251 neck cancer. Preliminary data suggest a role for the oral microbiota in the Mucositis 3 onset, duration and severity of mucositis, although large clinical datasets are missing. In this prospective cohort study, the oral microbial composition and ANALGESIC OPIOID THERAPY FOR ORAL MUCOSITIS (OM) diversity of 30 patients was analysed before, during and after their ASSOCIATED PAIN DURING CURATIVE radio(chemo)therapy. CHEMORADIOTHERAPY IN OROPHARYNGEAL CANCER Methods (OPC) PATIENTS Buccal mucosa and tongue swabs of 30 patients with squamous cell P. Bossi1, R. Granata1, S. Alfieri1, C. Ripamonti2, L.D. Locati1,C. carcinoma of oral cavity, oropharynx, larynx, hypopharynx and neck Bergamini1,M.Imbimbo1, C. Resteghini1, E. Orlandi3, C. Fallai3,L. metastasis of unknown primary origin were collected before, during and Licitra1 after radio(chemo)therapy and bacterial 16S rDNA was extracted for 1Head and Neck Medical Oncology, Fondazione IRCCS Istituto DGGE analysis. Cluster analysis, and Pareto Lorenz curves were gener- Nazionale dei Tumori, Milano, Italy; 2Supportive Care Unit, Fondazione ated to evaluate microbial shifts. IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Radiation Therapy, Results Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Analysis of the DGGE data revealed interesting shifts of the oral micro- biota, which evolved to more uneven communities at the end of treat- Background and Aims ment. At the inflammatory sites, the microbial diversity was characterised OM-related pain is one of the most distressing symptoms in head and by the dominance of particular species as evidenced by higher gini neck cancer patients receiving chemoradiation. Its management results in coefficients. Pareto Lorenz curves and gini coefficients further indicated better compliance to therapy and improvement in quality of life. We that, at least in the tongue swabs, there was a correlation between the assessed systemic opioid therapy use in an homogeneous setting of initial oral composition and the mucositis grade, marking its prognostic OPC patients during curative treatment. value. Methods Conclusions We retrospectively examined all the locally advanced OPC patients This is the first large clinical study, which shows that oral microbial shifts treated at our Institution between 2009 and 2013 with intensity modulated indeed occur during radiation therapy. Identification of species that are radiotherapy and concurrent cisplatin, considering analgesic systemic modified during radio(chemo)therapy is ongoing and outcomes should opioid therapy use for OM -related pain. help us to develop new management strategies for oral mucositis. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S93

MASCC-0396 0–7 and injected with saline (control) or 5-FU (150 mg/kg) on day 5. Intestinal Mucositis 3 tissues were collected on day 8 for quantitative histological analysis and myeloperoxidase activity (MPO). p<0.05 was considered significant. Results HOST-MICROBE CROSSTALK IN CANCER THERAPY 5-FU administration significantly elevated ileal MPO levels by 4.1-fold T. D e Ry c k 1, E. Vanlancker2,T.Boterberg3,M.Bracke1, T. Vande Wiele2, relative to saline controls (p<0.001). Amongst 5-FU-injected groups, only B. Vanhoecke2 EO+Lyprinol™ reduced ileal MPO activity by 1.7-fold compared to 5-FU 1Laboratory of Experimental Cancer Research, Ghent University, Ghent, controls (p=0.012). Moreover, OO and EO+Lyprinol™ administration to Belgium; 2Laboratory of Microbial Ecology and Technology, Ghent Uni- 5-FU-treated rats resulted in decreased ileal MPO levels (1.2-fold and 1.4- versity, Ghent, Belgium; 3Department of Radiotherapy, Ghent University fold respectively; p<0.05) compared with EO+OO treatment. Furthermore, Hospital, Ghent, Belgium all oil treatments decreased histological severity scores in the jejunum and ileum, and normalised crypt depth in the mid small intestine (≥24 %), Background and Aims relative to 5-FU controls (p<0.05). Additionally, OO maintained ileal villus Crosstalk between the human host and its microbiota is reported to height (21 %) and crypt depth (24 %) relative to 5-FU controls (p<0.05). influence various diseases such as mucositis. Fundamental research in Conclusions this area is however complicated by the timeframe restrictions during Emu Oil in combination with Lyprinol™ reduced damage associated with which host-microbe interactions can be studied in vitro. intestinal mucositis; however, Olive Oil demonstrated similar effects. Further For this study, we developed a new model, consisting of an oral epithe- studies are warranted to isolate the bioactive constituents of these naturally- lium and a biofilm to study host-microbe crosstalk in vitro in non- sourced oils for their potential utility in protection against mucositis. infectious 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 MASCC-0238 microbiota and epithelial cells were treated with anti-cancer agents like 5- Mucositis 3 FU or radiotherapy. Results 5-FLUOROURACIL-INDUCED MUCOSITIS LEADS TO The overall microbial biofilm composition in terms of species diversity SPINAL GFAP EXPRESSION CHANGES IN RATS remained representative for the oral microbiome, whilst the epithelial cell morphology and viability were unaffected. Applying the model to inves- J.E. Bajic1, G.S. Howarth2, G.L. Eden2, L.L. Lampton2, S. Mashtoub3, tigate wound healing revealed a reduced healing in presence of oral M.R. Hutchinson1 microbiota, which was not caused by a reduction of the proliferation 1School of Medical Sciences, The University of Adelaide, Adelaide, index or a significantly increased number of apoptotic or necrotic cells. Australia; 2School of Animal and Veterinary Sciences, The University of The use of anti-cancer treatments revealed important alterations in this Adelaide, Roseworthy, Australia; 3School of Medicine and Pharmacolo- microbial effect, bringing new insights in the host-microbe interactions gy, The University of Western Australia, Fremantle, Australia along the treatment. Conclusions Background and Aims This new model should help us to understand the role of host-microbe 5-Fluorouracil (5-FU) is a widely utilised chemotherapy agent that induces crosstalk before and during the development of mucositis and to develop side-effects, termed mucositis in the gastrointestinal tract (GIT) and glial new preventive and/or therapeutic drugs. dysregulation in the central nervous system (CNS). Glia, particularly astro- cytes, are vital in neuronal and CNS homeostasis; increased expression of their marker, glial fibrillary-associated protein (GFAP), implies neuroinflam- mation, linked with neuropathic pain and memory impairment. We deter- MASCC-0235 mined whether 5-FU-induced neuroinflammation via mucositis by immune- Mucositis 3 to-CNS signalling pathways (neuronal vs humoral) and secondly, examined if astrocyte reactivity persisted beyond the mucositis-driven GIT injury. Methods A FORMULATION OF EMU OIL AND LYPRINOL™ REDUCES Female Dark Agouti rats (n=8) were randomly allocated to saline control ACUTE SMALL INTESTINAL INFLAMMATION IN A RAT or 5-FU (i.p. 150 mg/kg) groups and tissues collected at either injury peak MODEL OF 5-FLUOROURACIL-INDUCED MUCOSITIS (day 3) or recovery (day 5). Western Blot analysed hippocampal and L.L. Lampton1,G.L.Eden1,K.Y.Cheah2,K.A.Lymn1, S. Mashtoub3, thoracic sections for GFAP and Interleukin-1 beta (IL-1β) expression. G.S. Howarth1 Myeloperoxidase (MPO) assay quantified intestinal inflammation. Sta- 1School of Animal and Veterinary Sciences, The University of Adelaide, tistical comparisons conducted using a linear model in R studio. Roseworthy, Australia; 2Gastroenterology Department, Women’s and Chil- Results dren’s Hospital, North Adelaide, Australia; 3School of Medicine and 5-FU reduced bodyweight (p<0.01) and increased MPO activity at day 3 Pharmacology, The University of Western Australia, Fremantle, Australia compared to vehicle controls (p<0.01). Although hippocampal GFAP expression showed little variance (p>0.05), interestingly thoracic GFAP Background and Aims expression was significantly reduced by 28 % in 5-FU treated rats — Mucositis is typified by ulceration and inflammation of the alimentary compared to vehicle controls at injury peak (p<0.05) but normalised tract following chemotherapy. Emu Oil (EO) and Lyprinol™ have indi- during the recovery phase (day 5; p>0.05). IL-1β expression levels vidually demonstrated anti-inflammatory properties in gastrointestinal remained unchanged at both time-points. ailments, including intestinal mucositis. We investigated EO and Conclusions Lyprinol™ in combination for their potential to further reduce the severity Down-regulation of thoracic GFAP expression reflects astrocyte dysreg- of chemotherapy (5-Fluorouracil; 5-FU)-induced mucositis in rats. ulation in rats with 5-FU-induced mucositis. This may have further Methods implications for CNS homeostasis and neuronal signalling. Future studies Female Dark Agouti rats (n=8/group) were oro-gastrically gavaged (1 ml) with should clarify the role of glial dysregulation in 5-FU-related cognitive Water, Olive Oil (OO), EO+OO, Lyprinol™+OO or EO+Lyprinol™ from days impairment and neuropathic pain. S94 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0234 20 mg/kg) for 8 days. Mucositis was induced on day five following an Mucositis 3 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 histo- ORAL NUCLEOTIDES PARTIALLYATTENUATE logical structure. Statistical significance was assumed at P<0.05byone- 5-FLUOROURACIL-INDUCED MUCOSITIS IN RATS way ANOVA. S. Mashtoub1,B.Feo2, A.L. Whittaker2,K.A.Lymn2, D. Martinez-Puig3, Results G.S. Howarth2 5-FU significantly reduced intestinal mucosal thickness (≥29 %; 1School of Medicine and Pharmacology, The University of Western Aus- P<0.001) compared to healthy controls. However, LDR significantly tralia, Fremantle, Australia; 2School of Animal and Veterinary Sciences, increased ileal mucosal thickness in 5-FU treated rats (19 %; P<0.05), The University of Adelaide, Roseworthy, Australia; 3Bioiberica, S.A., back towards normal values, relative to 5-FU controls. Although 5-FU Barcelona, Spain significantly increased MPO levels (≥307 %; P<0.001) in all intestinal regions, compared to healthy controls, LDR in 5-FU treated rats was able Background and Aims to significantly decrease ileal MPO activity (45 %; P<0.05), compared to Chemotherapy-induced mucositis is characterized by inflammation and 5-FU controls; suggesting a reduction of acute inflammation in the ileum. ulceration of the intestinal mucosa, compromising intestinal function. Conclusions Exogenous nucleotides have been reported to repair the mucosa. The In conclusion, LDR improved ileal mucosal integrity and reduced nucleotide preparation, Nucleoforce F0328 (Nucleoforce), was investi- inflammation manifested as a result of 5-FU cytotoxicity. RE has the gated for its potential to ameliorate intestinal mucositis in rats. potential to act as an adjunct to chemotherapy regimens by reducing Methods inflammation and protecting against mucosal damage associated with Female Dark Agouti rats (110–130 g; n=8/group) were oro-gastrically intestinal mucositis. 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, MASCC-0264 crypt depth and villus height measurements) and myeloperoxidase activ- Mucositis 3 ity (indicative of acute inflammation) analyses. p Results PREVENTIVE EFFECT OF REBAMIPIDE ON 5-FU significantly decreased (81 %) the %cumulative dose of 13C CHEMOTHERAPY-INDUCED ORAL MUCOSITIS IN (%CD), compared to normal controls, indicative of decreased sucrase PATIENTS WITH BREAST CANCER (THE RANDOMIZED activity (p0.05). Intestinal myeloperoxidase activity was significantly MULTI-CENTER PHASE II STUDY) elevated by 5-FU (8.8-fold), compared to normal controls (p0.05). Conclusions S. Nishimura1, S. Ohno2, A. Enami3, N. Matsunami4, T. Morimoto5, Nucleoforce only partially improved parameters associated with S. Kamigaki6, K. Higaki7, K. Shiota8, A. Hidaka9, M. Takahashi10, experimentally-induced mucositis. Future studies could investigate in- K. Aogi11 , M. Kagawa12, T. Kadoya13, Y. Hamaguchi14, Y. Sagara15, creased concentrations, more frequent administration, or protective mi- K. Shibuta16, S. Saji17,S.Anami18, T. Yamanaka19, N. Masuda20 croencapsulation delivery methods, to increase bioavailability. 1Department of Breast Oncology, National Kyushu Cancer Center,Fuku- oka, Japan; 2Clinical Research Center,National Kyushu Cancer Center, Fukuoka, Japan; 3Department of nursing, NHO Osaka National Hospi- tal, Osaka, Japan; 4Department of Breast Surgery, Osaka Rosai Hospital, MASCC-0237 Osaka, Japan; 5Department of Breast Surgery, Yao Municipal Hospital, 6 Mucositis 3 Osaka, Japan; Department of Surgery, Sakai City Hospital, Osaka, Japan; 7Department of Breast Surgery, Hiroshima City Hospital, Hiro- shima, Japan; 8Department of Pharmacy, NHO Kumamoto Medical AQUEOUS RHUBARB EXTRACT IMPROVES MUCOSAL Center, Kumamoto, Japan; 9Department of Nursing, Osaka Rosai Hos- INTEGRITYAND REDUCES ACUTE INFLAMMATION IN THE pital, Osaka, Japan; 10Department of Breast Surgery, NHO Hokkaido ILEUM IN A RAT MODEL OF CHEMOTHERAPY-INDUCED Cancer Center, Hokkaido, Japan; 11 Department of Breast Oncology, INTESTINAL MUCOSITIS NHO Shikoku Cancer Center,Ehime, Japan; 12Department of Pharmacy, G.L. Eden1, L.L. Lampton1,K.Y.Cheah2,K.A.Lymn1, A.J. Yool3, YaoMunicipal Hospital, Osaka, Japan; 13Department of Surgical Oncol- S. Mashtoub4, G.S. Howarth1 ogy Research Institute for Radiation biology and Medicine, Hiroshima 1School of Animal and Veterinary Sciences, The University of Adelaide, University, Hiroshima, Japan 14Department of Nursing, Sakai City Hos- Roseworthy, Australia; 2Gastroenterology Department, The Women’sand pital, Osaka, Japan; 15Department of Surgery Breast Oncology, Children’s Hospital, North Adelaide, Australia; 3School of Medical Sciences, Hakuaikai Sagara Hospital, Kagoshima, Japan; 16Department of Breast The University of Adelaide, Adelaide, Australia; 4School of Medicine and Surgery, Ueo Breast Cancer Hospital, Oita, Japan; 17Department of Pharmacology, The University of Western Australia, Fremantle, Australia Target Therapy Oncology, Kyoto University Graduate School of Medi- cine, Kyoto, Japan; 18Education and Research Center for Clinical phar- Background and Aims macy, Doshisha Women’s College of Liberal Arts, Kyoto, Japan; Mucositis, a common side-effect of chemotherapy, is characterised by 19Department of Biostatistics, National Cancer Center, Chiba, Japan; acute intestinal inflammation and impaired mucosal integrity. Currently, 20Department of Surgery Breast Oncology, NHO Osaka National Hospi- no effective treatment has been established for this debilitating disorder. tal, Osaka, Japan In the present study, aqueous rhubarb extract (RE) was investigated as a therapeutic modality for intestinal mucositis due to its anti-inflammatory Background and Aims properties and its potential to protect against mucosal damage. Introduction: Methods Chemotherapy-induced oral mucositis is a common adverse event. Female dark agouti rats (n=8/group) received a daily gavage (1 mL) of Rebamipide, a gastro protective drug, has been reported to suppress water, high-dose RE (HDR; 200 mg/kg) or low-dose RE (LDR; gastric mucosal inflammation. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S95

Objectives: Methods The purpose of this study is to assess the efficacy and safety of rebamipide Having developed oral care guidelines, which have been widely used in preventing chemotherapy-induced oral mucositis in patients with in the United Kingdom and other countries, the group continue to breast cancer. deliver educational opportunities for clinical staff. This presentation Methods will address the content, the learning and the evaluations from 3 study Methods days which were delivered in London, Glasgow and Manchester. The Patients with early breast cancer who were scheduled to receive chemo- days were attended by over 230 delegates including, radiographers, therapy including 5-FU/epirubicine/cyclophosphamide or docetaxel/ nurses, oncologists, dentists, pharmacists, oral surgeons, therapists cyclophosphamide were randomized to usual oral care with or without and educators. rebamipide. Patients in the rebamipide group had an oral administration Results of rebamipide 300 mg daily during three cycles of chemotherapy. The Using a combination of learning approaches including, lectures, case primary endpoint was incidence of oral mucositis assessed by the NCI- studies and interactive workshops led by experts, the content of each CTC v 4.0. day covered the key principles of good oral care based on accurate Results assessment, good care, instigating prevention measures and correct Results treatment. Each interactive session focussed on an aspect of oral Between August 2011 and January 2013, 163 patients were random- mucositis including, anatomy and physiology of the oral cavity, ly assigned to either rebamipide group (n=81) or control group (n= pathophysiology of OM, pharmacology, nutrition, dysphagia, pain 83). There were no significant difference in frequency of oral mu- management and the patient experience. Each day was carefully cositis during 3 cycles of chemotherapy between these two groups evaluated and each attendee was asked to consider how they would (p=0.476). In patients with no mucositis at 1st cycle, the incidence put the learning into practice. of mucositis at 2nd and 3rd cycle was significantly lower in the Conclusions rebamipide group than the control (p=0.029). The reduction of taste The learning from each study day has not only informed further was significantly less frequent in the rebamipide group than the educational events but has been used to develop the work of the control (p=0.004 at 3rd cycle). The self-report by patients showed expert group. higher incidence of oral mucositis and reduction of taste as com- pared to observation by physicians. Conclusions Conclusion MASCC-0289 These results could not show the efficacy of rebamipide in preventing Mucositis 3 chemotherapy-induced oral mucositis, whereas rebamipide may be effec- tive to protect the sensory of taste, in breast cancer patients receiving REDUCTION OF ORAL MUCOSITIS AFTER ADOPTION OF chemotherapy. (-UMIN000005712) CRYOTHERAPYAS A STANDARD OF CARE FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA MASCC-0240 J.J. Toro1,D.Haile1,F. Gushiken1,C.O.Freytes1 1 Mucositis 3 Medicine, South Texas Veterans Health Care System, San Antonio, USA

Background and Aims ORAL CARE: DISSEMINATING BEST PRACTICE Oral mucositis (OM) is a frequent complication of high-dose melphalan B. Quinn1, M. Thompson2,F. Campbell3, C. mc Gowan4,J.Treleaven5, (HDM - 200 mg/m2) followed by autologous hematopoietic stem cell S. Hoy6,J.Horn7, L. Fullman8,E.Riley9,M.Davis10,D.Houghton11 , transplantation (AHSCT) in patients with multiple myeloma (MM). In A. Beasley12, K. Mais10 previous studies oral cryotherapy significantly decreased OM. There is 1Cancer, Chelsea and Westminster NHS Foundation Trust, London, limited information regarding the effectiveness of cryotherapy outside a United Kingdom; 2Radiotherapy, NHS Greater Glasgow & Clyde, clinical trial. Glasgow, United Kingdom; 3Head & Neck Cancer, NHS Greater Our goal was to evaluate the efficacy of a cryotherapy protocol (CP), Glasgow & Clyde, Glasgow, United Kingdom; 4Palliative Care, St which was adopted at our institution, based on results obtained in a George’s NHS Trust, London, United Kingdom; 5Haematology, Roy- randomized study. We wanted to determine if the same results could be al Marsden Hospital NHS Foundation Trust, London, United replicated outside a clinical trial setting. Kingdom; 6Head & Neck Cancer, Royal Marsden Hospital NHS Methods Foundation Trust, London, United Kingdom; 7Haematology, NHS The CP consisted of placing ice chips in the mouth for 2 h. Patients were Grampian, Abberdeen, United Kingdom; 8Radiotherapy, Indepen- assessed every other day for OM, until OM resolution or hospital dis- dent, Nottingham, United Kingdom; 9Dentistry, Pennines NHS charge, using the World Health Organization (WHO) mucositis scale. Trust, Manchester, United Kingdom; 10Cancer, Christie NHS Foun- Thirty-nine patients who received CP were matched with the most recent dation Trust, Manchester, United Kingdom; 11 Pharmacy, Rivers Hos- 39 patients who received saline solution mouth rinses (SSR) 4 times a day, pital, Hertfordshire, United Kingdom; 12Cancer, Cardiff Royal Infir- our previous standard of care. mary NHS Trust, Wales, United Kingdom Results Thirty-four (87 %) subjects did not develop OM in the CP group. Only 5 Background and Aims patients (13 %) in the CP group experienced OM, compared to 29 (74 %) Despite the advances made in understanding the pathophysiology of in the SSR group (p<0.0001). Length of hospital stay was significantly oral mucositis OM and the variety of treatment options available, shorter in the CP group compare to the SSR group, mean duration in days clinical teams still struggle to address OM in a consistent manner. 16.5 vs. 19.6 (p=0.005). The United Kingdom Oral Mucositis in Cancer Care (UKOMiC), was Conclusions founded 3 years ago to address the challenges of oral complications Cryotherapy was associated with a significant lower incidence of OM secondary to disease and treatment in the cancer and supportive care severity and hospital length of stay compared to SSR in MM patients who setting. received HDM followed by AHSCT. S96 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Table. Patient Characteristics 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 Saline Solution Cryotheraphy using validated clinical and histopathological markers. Patients, n 39 39 Barrier function will be assessed through FITC-dextran permeability, Age, years transepithelial resistance and short circuit current, measured using Ussing Median (range) 61 (52–73) 62 (27–74) chambers. TJs will be assessed by immunofluorescence, western blotting and RT-PCR for key TJ components, ZO-1, claudin-1 and occludin. Mean (SD) 61.5 (4.7) 60.5 (8.9) ELISAwill assess PKC activity. Gender, n (%) Results Male 38 (97 %) 37 (95 %) Please see ‘conclusions’. Female 1 (3 %) 2 (5 %) Conclusions Race/Ethnicity, n (%) Expected outcomes: Caucasian 19 (49 %) 22 (56 %) 1. PKC/TLR4 inhibition/silencing will improve barrier function and TJ African Americans 11 (28 %) 11 (28 %) integrity following irinotecan. −/− Hispanic 9 (23 %) 4 (10 %) 2. Irinotecan-treated TLR4 KO mice will have reduced gastrointes- Native American 0 (0 %) 2 (5 %) tinal mucositis severity, improved barrier integrity and decreased PKC activity compared to wild-type. MM Stage, n (%) Stage I 9 (23 %) 10 (26 %) Stage II 5 (13 %) 6 (15 %) Stage III 25 (64 %) 23 (59 %) Smoking, n (%) MASCC-0437 Yes(at any given time) 27 (69 %) 30 (77 %) Nausea-Vomiting No (ever) 12 (31 %) 9 (23 %) Oral mucositis (WHO), n (%) EFFICACY OFATRANSDERMAL GRANISETRON PATCH IN Grade 0 10 (26 %) 34 (87 %) CONTROLLING CHEMOTHERAPY-INDUCED NAUSEA AND Grades 1–3 29(74%) 5(13%) VOMITING (CINV) IN HEAD AND NECK CANCER PATIENTS Length of hospital stay D. Paul1, D. Wong2,A.Yellowlees3,F. Herr4,D.Braccia5 Median (range) 17 (13–48) 16 (12–25) 1Medical Oncology, Monter Cancer Center,Lake Success, USA; 2Medical Median (SD) 19.64 (6.77) 16.51 (2.99) Affairs, ProStrakan, Bridgewater,USA; 3Statistics, Quantics Consulting 4 Days to ANC engraftment Ltd, Edinburgh, United Kingdom; Scientific Communications, Aranmore 5 Median (range) 10 (9–13) 10 (9–12) Medical Communications LLC, Lawrenceville, USA; Medical Affairs, ProStrakan Inc, Bridgewater,USA Mean (SD) 10.51 (0.85) 10.41 (0.64) Background and Aims Head and neck cancer patients can experience mechanical obstruction or dysphagia making adherence to oral antiemetics difficult. A granisetron MASCC-0302 transdermal system (GTS) has been shown to be as effective as oral Mucositis 3 granisetron in controlling CINVacross multiple tumor types. This post- hoc analysis examined the efficacy and safety of GTS in head and neck cancer patients. The objectives were to compare the rates of complete DOES TLR4/PKC SIGNALLING DRIVE CHEMOTHERAPY control (CC; no vomiting, mild nausea, no resuce medication), complete INDUCED BARRIER DYSFUNCTION AND MUCOSITIS? response (CR; no vomiting, no rescue medication), need for rescue H.R. Wardill1, R.J. Gibson1,R.M.Logan2, J.M. Bowen1 medication, and patient-reported assessment in head and neck cancer 1Medical Sciences, University of Adelaide, Adelaide, Australia; patients using either GTS or oral granisetron. 2Dentistry, University of Adelaide, Adelaide, Australia Methods A randomized, phase 3 study has been published comparing GTS Background and Aims (7 day application) to oral granisetron (2 mg/day) in patients receiv- Chemotherapy-induced mucositis is a major clinical and economic bur- ing either moderately or highly emetogenic chemotherapy for 3– den. We have identified functional and structural alterations in TJs fol- 5 days. Data for this analysis were limited to patients with head and lowing chemotherapy, however the mechanisms responsible are ill- neck primary tumors. defined. Protein kinase C (PKC) is able to modulate TJ proteins, with Results recent links established with toll-like receptor (TLR) 4, a key mediator of Seventy one patients (38 GTS, 33 oral granisetron) were included. The mucositis. TLR4/PKC signalling in the setting of chemotherapy-induced CC rate of 66 % and CR rate of 68 % in the GTS group were similar to barrier dysfunction and mucositis has not been investigated. rates in the overall population. There was no difference in CC, CR, and We therefore aim to determine the impact of TLR4/PKC signalling on use of rescue medication between GTS and oral granisetron (P=0.94, gastrointestinal barrier integrity and mucositis development. 0.91, and 0.57, respectively). Patient assessment of overall response to Methods therapy was not different between arms (P=0.26). GTS was well tolerated In vitro: Polarised T84 monolayers will be grown on permeable, mixed-cellulose and treatment related adverse events were mild. inserts. TEM analysis will confirm differentiated epithelial phenotype and the Conclusions presence of TJs. Expression knockdown of PKCtheta and/or TLR4 by shRNA This retrospective analysis suggests GTS may be an appropriate option transfection, followed by treatment with SN-38, will elucidate signalling depen- for prevention of CINV in head and neck cancer patients at high risk of dence. Cells will also be treated with Go6976, an established PKC inhibitor. dysphagia treated with chemotherapy. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S97

MASCC-0438 Ovid versions of EMBASE and EMBASE Classic, MEDLINE and Nausea-Vomiting PsychINFO for relevant references. Four authors independently screened and abstracted data according to pre-determined criteria. Results COMPARISON OF ORAL AND TRANSDERMAL From 611 references we selected 10 articles for review. These described GRANISETRON IN CONTROLLING 10 randomised trials published between 2003 and 2013 that cumulatively CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING enrolled 1,367 patients (range: 31–744) with a variety of primary tumors. (CINV) IN PATIENTS WITH LUNG CANCER (LC) GIVEN All trials involved ginger prophylaxis to prevent CINV induced from MULTI-DAYCHEMOTHERAPY either highly- or moderately-emetogenic chemotherapy. Ginger prophy- D. Wong1,R.Gralla2,F.Herr3, D. Braccia1 laxis consisted of ginger added to ‘standard’ antiemetic regimens in 9 1Medical Affairs, ProStrakan Inc, Bridgewater,USA; 2Medical Oncology, trials and ginger alone in 1 trial. Ginger doses ranged from 0.5 to 2.0 g. Albert Einstein College of Medicine Jacobi Medical Center,Bronx, USA; Control arms contained a variety of antiemetics, with 8 having a 5-HT3 3Scientific Communications, Aranmore Medical Communications, receptor antagonist base. Endpoints varied; 10 trials studied acute CINV Lawrenceville, USA (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 Background and Aims chemotherapy). Heterogeneity of chemotherapy agents, trial designs and Chemotherapy for small cell (SCLC) and non-small cell lung cancer quality precluded formal modelling analyses. A significant benefit from (NSCLC) frequently requires agents likely to cause emesis. Adherence to ginger was reported in 7 of 10 trials. antiemetic regimens over several days is difficult for many patients. A Conclusions granisetron transdermal system (GTS) has been shown to be as effective as More trials with methodologic rigor involving homogeneous patient pop- oral granisetron (OG) in controlling multi-day CINVacross multiple tumor ulations are required to determine the efficacy of ginger prophylaxis for the types. This analysis examined the efficacy and safety of GTS specifically in prevention of CINVand RINV. Research into RINV is underrepresented. 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. MASCC-0567 Methods Nausea-Vomiting A randomized phase 3 study (N=715, clinicaltrial.gov NCT00273468) compared GTS (7-day application) to OG (2 mg/day) in patients receiv- A PROSPECTIVE PILOT STUDY OF RADIATION ing moderately or highly emetic chemotherapy for 3–5 days. This post THERAPY-INDUCED NAUSEA AND VOMITING AMONG hoc analysis examines results only in patients with lung cancer. PATIENTS RECEIVING NEOADJUVANT LONG COURSE Results RADIATION THERAPYAND CONCURRENT 5-FU-BASED One hundred twenty-eight patients (64 GTS, 64 OG) were included. CHEMOTHERAPY FOR RECTAL ADENOCARCINOMA Ninety-four percent received cisplatin for≤3 days. Fifty-one patients given GTS (80 %) and 41 on OG (64 %) received chemotherapy with a K. Dennis1,M.Poon2,J.Stinson3,G.Cramarossa2, L. Zeng2,C.De Hesketh score of 5. CC & CR rates, the use of rescue medication, and Angelis3,H.Chung2,N.Coburn4, C.S. Wong2,E.Chow2 patient assessment of response were not significantly different between 1Radiation Oncology, University of Ottawa & Ottawa Hospital Research GTS and OG. Constipation was more frequent with GTS; all treatment Institute, Ottawa, Canada; 2Radiation Oncology, Sunnybrook Health related adverse events were mild. Sciences Centre University of Toronto, Toronto, Canada; 3Pharmacy, Conclusions Sunnybrook Health Sciences Centre University of Toronto, Toronto, This analysis indicates that the convenient single application of GTS can Canada; 4General Surgery, Sunnybrook Health Sciences Centre Univer- be an effective option for preventing CINVin lung cancer patients treated sity of Toronto, Toronto, Canada with highly-emetic multi-day chemotherapy. Background and Aims Antiemetic guidelines estimate pelvic radiation therapy (RT)carries a 30– 60 % risk of inducing vomiting and suggest 5-HT3 receptor antagonist (5- MASCC-0571 HT3RA) prophylaxis as an approach to prevent RT-induced nausea and Nausea-Vomiting 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, GINGERTHERAPY FOR CHEMOTHERAPY-AND RADIATION whether 5-HT RA prophylaxis is warranted for them is unclear. THERAPY-INDUCED NAUSEA AND VOMITING: A 3 We studied the incidence of RINVamong patients with rectal adenocar- SYSTEMATIC REVIEW cinoma receiving neoadjuvant long-course pelvic RTwith concurrent 5- E. Nguyen1,P. Ciesielski2,A.Tsang1,A.Steinmetz3,K.Dennis4 FU-based chemotherapy (CT). 1Faculty of Medicine, University of Ottawa, Ottawa, Canada; 2Faculty of Methods Medicine, Jagiellonian University Medical College, Krakow, Poland; Patients recorded symptoms and antiemetic use until 7 days following RT 3Library Services and Learning Centre, The Ottawa Hospital, Ottawa, completion. Staff verified data daily. Antiemetic therapy was not pre-specified. Canada; 4Radiation Oncology, Ottawa Hospital Research Institute The Results Ottawa Hospital Cancer Centre Universit, Ottawa, Canada Patients enrolled: 34. Patients evaluable: 33 [male(64 %), female(36 %)]. None received prophylactic antiemetics. RT median duration: Background and Aims 41 days(range: 32–51). RT median dose: 50.4 Gy (range: 40–50.4). Mean We reviewed the literature describing ginger therapy for chemotherapy- planning target volume: 1,393 cc(SD:444). Small bowel dose level vol- and radiation therapy-induced nausea and vomiting (CINVand RINV). umes [mean(SD)]: V15Gy[169 cc(143)], V45Gy[36 cc(52)], Methods V50Gy[19 cc(28)]. CT received: capecitabine(94 %), infusional 5- We followed the guidelines of Preferred Reporting Items for Systematic FU(3 %), none(3 %). Days of evaluable symptom data: 1407(89 % of Reviews and Meta-Analyses (PRISMA). A medical librarian searched the 1575 potential days). Patients reporting vomiting: 7(21 %); for them, S98 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 median days with vomiting: 2(range:1–9), median days until vomiting: Background and Aims 20(range: 2–43). Cumulative days with vomiting for cohort: 22(1.6 % of Chemotherapy induced nausea and vomiting (CINV) is a recognized 1,407 evaluable days). Patients reporting nausea: 21(63 %); for them, burden for oncology patients. Studies have demonstrated the overall median days with nausea: 4(range: 1–36), median days until nausea: impact of CINV, but little information exists on the effects of nausea in 4(range: 1–36). Cumulative days with nausea for cohort: 210(15 % of the absence of vomiting. The purpose of this study was to evaluate the 1,407 evaluable days). Patients receiving rescue antiemetics: 11(33 %). implications of nausea alone on resource utilization and costs. Conclusions Methods The reported incidence of vomiting was considerably lower than guide- Retrospective database utilizing claims from 2005 to 2011 from a com- line estimates. Confirmation studies are planned. 5-HT3RA prophylaxis mercial (96 %) and Medicaid (4 %) population. Patients with a diagnosis may not be warranted in this setting. of cancer receiving a single-day chemotherapy regimen and a 5-HT3-RA were eligible. Medical claims from chemotherapy days 2–5wereevalu- ated for an ICD-9 code of nausea with vomiting (n+v, 78701), nausea only (78702), or vomiting only (78703). Costs were compared among MASCC-0459 cohorts. Nausea-Vomiting Results Twenty six thousand nine hundred seventy-four patients met in- CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN clusion criteria, and 1,514 experienced CINV (70.3 % n+v, CHILDREN RECEIVING HIGH DOSE METHOTREXATE 23.8 % nausea only, 1.8 % vomiting only, 4.1 % with multiple WITH OR WITHOUT VINCRISTINE diagnoses). For overall costs, nausea only patients had the highest mean per patient cost at $1,672, but due to the skewed data had J. Flank1,H.Vol1, S. Lavoratore1, T. Taylor1, E. Zelunka1,P.Nathan2, the lowest median cost ($596) compared to n+v and vomiting A.M. Maloney2, L.L. Dupuis1 only ($804 and $674, respectively). Median emergency room (ER) 1Pharmacy, The Hospital for Sick Children, Toronto, Canada; costs were highest for nausea only ($1,021; n=11) compared to 2Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada n+v or vomiting alone ($864; n=25 and $758; n=12, respective- ly). Inpatient costs were highest for n+v ($1290; n=76), followed Background and Aims by nausea only and vomiting only ($923; n=10, and $674; n=5). Chemotherapy-induced nausea and vomiting (CINV) negatively influ- Similar trends occurred for rescue medications: median $204 for ences the quality of life of children receiving chemotherapy. Little is n+v (n=659), $193 for nausea only (n=201), and $65 for known about the severity of CINVexperienced by children receiving IV vomiting only (n=4). methotrexate≥1g/m2/dose (HD-MTX). Conclusions Objective: Todescribe the prevalence of acute and delayed phase CINVin Nausea alone has economic implications for patients receiving children receiving HD-MTX±vincristine. chemotherapy. 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 MASCC-0356 after achievement of the protocol-specific threshold MTX concentration Nausea-Vomiting (acute phase), and for an additional 7 days (delayed phase). Complete CINV control was defined as: no vomiting, no retching and a maximum PATIENT SATISFACTION DURING TREATMENT WITH SANC nausea assessment score of 1 (out of 4). USO FOR CINV Results R. Musch1, D. Maessen2 Data are available for 29 patients (mean age: 11.7±4.0 years; 19 boys). 1Office for Oncology, Krebsheilkunde Lichtenberg, Berlin, Germany; Nineteen patients received HD-MTX plus vincristine while 10 received 2Medical Affairs, ProStrakan Pharma GmbH, Düsseldorf, Germany 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 Background and Aims granisetron (9) with (12) or without (17) dexamethasone. Two (7 %) Sancuso transdermal Granisetron has demonstrated efficacy for preven- and 10 (34 %) patients experienced complete CINV control during the tion of CINV in patients receiving multi-day moderately to highly acute and delayed phases, respectively. More patients experienced com- emetogenic chemotherapy. The objective of this study is to examine plete vomiting control during the acute (55 %) and delayed (59 %) phases patient satisfaction with Sancuso in clinical practice. than experienced complete nausea control (7 % vs 34 %). Methods Conclusions The study is being conducted in 19 oncology units in Germany. All Acute and delayed phase CINV control, and more specifically nausea control, patients scheduled to receive Sancuso at the prescribing physician’s following HD-MTX administration is sub-optimal. The emetogenicity rank- discretion for prevention of CINV in moderately or highly emetogenic ing of HD-MTX should be reconsidered in light of these findings. 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 MASCC-0394 used. Basic demographic and clinical information is also collected about Nausea-Vomiting each patient. Results Overall, the study is planned to recruit 250 patients. Of the first 34 RESOURCE UTILIZATION AND COSTS ASSOCIATED WITH patients observed, 18 (53 %) were male. The average age of NAUSEA IN PATIENTS EXPERIENCING CHEMOTHERAPY patients to date was 67. The maximum number of cycles of INDUCED NAUSEA AND VOMITING chemotherapy for an individual patient was five (one patient only). C. Faria1,X.Li1,R.Knoth1,A.Powers1 Nineteen patients contributed one cycle each. In all, information 1Health Economics and Outcomes Research, Eisai Inc., WoodcliffLake, USA was collected on 63 cycles. The most common cancers were Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S99 colorectal/anal (19 patients) and urological (6 patients). FOLFOX Olanzapine treated patients had better control of delayed emesis (inci- and FOLFIRI were the most common regimens; 83 % of cycles dence 3.3 % versus 27 % in control group, p=0.02) and overall emesis. were moderately emetogenic. Additional anti-emetics were co- (Fig 1) administered 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.

MASCC-0403 Nausea-Vomiting

OLANZAPINE, CONCURRENT CHEMO-RADIATION PATIENTS AND CHEMOTHERAPY INDUCED NAUSEA AND VOMITING: THE SURPRISE CONTINUES Nausea was also significantly less severe in olanzapine treated patients. S. Mukhopadhyay1,G.Kwatra1,D.Badyal1,P.Kingsley2 However, acute emesis was equally controlled in both groups. (Fig 2) 1Pharmacology, Christian Medical College Ludhiana, Ludhiana, India; 2Radiotherapy, 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 break- through emesis and improved outcome of chemotherapy induced nausea and vomiting (CINV), was hardly ever tested on chemo- radiation 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 random- ized 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 Conclusions analysed. Olanzapine significantly improves the control of emesis when used as an Results add-on in prophylaxis of CINV in chemo-radiation patients. Distribution of patients in different groups were similar.(Table 1)

Table 1: Distribution of patients MASCC-0398 Nausea-Vomiting Control (n=30) Test (n=30) Gender (M/F) 19/11(63.3/36.7) 15/15 (50/50) PHASE 1 POSITRON EMISSION TOMOGRAPHY (PET) STUDY Alcoholism 9 (30) 9 (30) OF THE RECEPTOR OCCUPANCY OF ROLAPITANT, A NOVEL NK-1 RECEPTOR ANTAGONIST Smoking 11 (39.3) 13 (44.8) 1 1 1 2 3 Type of Cancer A. Poma ,J.Christensen,J.Davis,V. Kansra , R. Martell 1 2 HNCa 18 (60) 19 (63.3) Medical, Tesaro, Waltham, USA; Clinical Pharmacology, Tesaro, Wal- tham, USA; 3Oncology, Division of Hematology Oncology Tufts Medical Ca Cervix 8 (26.7) 7 (23.3) Center,Boston, USA Ca Esophagus 4 (13.3) 4 (13.3) Regimen Background and Aims Rolapitant is highly selective, competitive and long-acting NK-1 receptor Cisplatin 29 (96.7) 29 (96.7) antagonist in development for prevention of chemotherapy-induced nau- Carboplatin 0 1 (3.3) sea and vomiting (CINV) in patients receiving moderately or highly Oxaliplatin 1 (3.3) 0 emetogenic chemotherapy. NK-1 receptor occupancy (RO) is a critical predictor of delayed efficacy in CINV. This PET study determined the Figure in number (percent). levels and duration of RO achieved by rolapitant. M: Male, F: Female Methods HNCa: head & neck cancer Fourteen healthy subjects were enrolled into this open-label, single-dose, Ca: Carcinoma pharmacodynamic, dose-escalation phase 1 study. Baseline PET scans S100 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

11 with C-GR205171, a radiolabeled tracer NK-1 ligand, alone followed MASCC-0387 by repeat PET scans 120 h post administration of rolapitant were per- Nausea-Vomiting formed. Blood samples were collected up to 120 h following rolapitant administration to determine rolapitant plasma concentration. The Patlak PHASE 3 TRIAL RESULTSFOR ROLAPITANT, A NOVEL NK-1 method was used to assess the baseline (uptake of 11C-GR205171) for the RECEPTOR ANTAGONIST, IN THE PREVENTION OF regions of interest. Regional occupancies (%) for each individual subject CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING were then calculated as ((Ki’baseline – Ki’blocked)/Ki’baseline) * 100. (CINV) IN SUBJECTS RECEIVING HIGHLYEMETOGENIC Results CHEMOTHERAPY (HEC) Oral rolapitant was rapidly absorbed. Exposure, both Cmaxand AUC, increased dose proportionally.NK-1 RO in the cortex was directly related B. Rapoport1, A. Poma2,M.L.Hedley3,R.Martell4,R.Navari5 to rolapitant dose and plasma concentration. A PK/PD model based on 1Oncology, The Medical Oncology Center of Rosebank, Johannesburg, the sigmoid Emax model demonstrated that rolapitant concentrations South Africa; 2Medical, Tesaro, Waltham, USA; 3President, Tesaro, Wal- >348 ng/mL, achieved at 120 h with 200 mg dose level, corresponded tham, USA; 4Oncology, Division of Hematology Oncology Tufts Medical to >90 % NK-1 RO. No adverse event (AE) were reported. Center,Boston, USA; 5Oncology, Indiana University School of Medicine Conclusions South Bend Center,South Bend, USA 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 Background and Aims rolapitant administered prior to chemotherapy may protect a patient for Rolapitant is a highly selective competitive long-acting NK-1 receptor- the entire 5-day period during which the patient is at risk of developing antagonist that demonstrated efficacy and safety in a large randomized P2 CINV. Rolapitant was safe and well tolerated in this study. 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 cisplatin- 2 MASCC-0391 naïve subjects treated with HEC (≥60 mg/m cisplatin) were randomized Nausea-Vomiting 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 SAFETY OF ROLAPITANT, A NOVEL NK-1 RECEPTOR- delayed phase (>24–120 h) post-chemotherapy. Secondary endpoints ANTAGONIST, FOR PREVENTION OF included CR during the acute (0–24 h) and overall (0–120 h) phases. CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING Treatment comparisons were performed using a Mantel-Haenszel chi- (CINV) IN SUBJECTS RECEIVING MODERATELYOR HIGHLY square test. Subjects recorded episodes of emesis, nausea and rescue EMETOGENIC CHEMOTHERAPY (MEC OR HEC) medication using a subject diary during 0–120 h post-chemotherapy. L. Urban1, A. Poma2,M.Dardeno2, R. Martell3 Results 1Oncology, Matrahaza Healthcare Center and University Teaching Hos- Five hundred forty-four evaluable subjects. Subjects in the rolapitant pital, Matrahaza, Hungary; 2Medical, Tesaro, Waltham, USA; 3Oncology, group had a significantly higher CR rate for the primary study endpoint Division of Hematology Oncology Tufts Medical Center,Boston, USA 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 Background and Aims phases (83.4 % vs 79.5 %, p=0.233; 67.5 % vs 60.4 %, p=0.084, Rolapitant is a selective competitive-long acting NK-1 receptor- respectively). The rolapitant group achieved higher rates of no nausea antagonist that successfully achieved the primary endpoint of complete (maximum VAS<5 mm, 0–100 mm) in both the delayed and overall response (no emesis and no rescue medication) in the delayed phase of phases compared to control (58.3 % vs 46.9 %, p=0.007; 55.0 % vs CINV in two phase 3 studies in subjects receiving MEC or HEC. These 44.0 %, p=0.009, respectively). AE rates were similar across both groups. studies further evaluated the safety and tolerability of rolapitant in these Conclusions subjects. Rolapitant in combination with a 5-HT3 receptor antagonist and dexa- Methods methasone was well-tolerated and demonstrated superior efficacy over Two separate phase 3 double-blind active-control studies were conducted. control in the primary endpoint of the prevention of delayed CINV in One thousand three hundred sixty-nine subjects scheduled to receive MEC subjects receiving HEC in a global phase 3 study. and 555 subjects scheduled to receive HEC (≥60 mg/m2 cisplatin) were randomized 1:1 to either (1) rolapitant 200 mg + granisetron + dexameth- asone or (2) placebo + granisetron + dexamethasone. Adverse events (AE) and serious adverse events (SAE) were collected for all subjects. MASCC-0384 Results Nausea-Vomiting 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 %, PHASE 3 TRIAL RESULTSFOR ROLAPITANT, A NOVEL NK-1 respectively). The most frequent AEs observed across both rolapitant and RECEPTOR ANTAGONIST, IN THE PREVENTION OF control groups, respectively, for the MEC study were fatigue (16.3 % vs CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING 15.4 %), constipation (10.3 % vs 14.1 %) and alopecia (11.3 % vs (CINV) IN SUBJECTS RECEIVING MODERATELY 12.3 %); and for HEC study were constipation (7.4 % vs 10.9 %), asthenia EMETOGENIC CHEMOTHERAPY (MEC) (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 I. Schnadig1,M.Modiano2, A. Poma3, M.L. Hedley4,R.Martell5, HEC studies (6.6 % vs 7.1 %; 12.5 % vs 14.2 %, respectively). No L. Schwartzberg6 serious, related and unexpected AEs were reported for either study. 1Oncology, Compass Oncology and The US Oncology Network, Portland, Conclusions USA; 2Oncology, Arizona Clinical Research Center,Tucson,USA;3Medical, Rolapitant 200 mg in combination with a 5-HT3 receptor antagonist and Tesaro, Waltham, USA; 4President, Tesaro, Waltham, USA; 5Oncology, Divi- dexamethasone was demonstrated to be safe and well tolerated in two sion of Hematology Oncology Tufts Medical Center, Boston, USA; global phase 3 studies in subjects receiving HEC or MEC. 6Oncology, University of Tennessee Health Sciences Center,Memphis, USA Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S101

Background and Aims Methods Rolapitant is a selective competitive long-acting NK-1 receptor- A literature search of Ovid MEDLINE, EMBASE, and Cochrane CEN- antagonist that demonstrated efficacy in a large randomized phase 2 study. TRAL was conducted. Primary endpoints were complete response, no This study evaluated the 200 mg dose for efficacy and safety in the emesis and no nausea in the overall phase. Secondary endpoints spanned prevention of CINV in subjects receiving MEC. the acute and delayed phases. Review Manager was used for meta- Methods analysis. Randomized P3 double-blind active-control study. One thousand three Results hundred sixty-nine chemo-naïve subjects treated with MEC (cyclophos- Sixteen RCTs were identified, with 2,896 patients randomized to phamide, doxorubicin, epirubicin, carboplatin, irinotecan, daunorubicin palonosetron and 3,187 patients randomized to other 5-HT3RAs. or cytarabine) were randomized 1:1 to either (1) rolapitant + granisetron + Palonosetron was statistically superior in all outcomes. As judged by dexamethasone or (2) placebo + granisetron + dexamethasone. The MASCC guidelines, clinical superiority of palonosetron in primary end- primary endpoint was complete response (CR = no emesis and no rescue points were 10 % for complete response, 10 % for no emesis, and 9 % for medication) in delayed phase (>24–120 h). Secondary endpoints included no nausea. Absolute differences were substantially greater in the delayed CR in acute (0–24 h) and overall (0–120 h) phases. Treatment compari- than the acute phase. sons were performed using Mantel-Haenszel chi-square test. Subjects Conclusions recorded episodes of emesis, nausea and rescue medication using a diary Palonosetron is statistically superior to other 5-HT3RAs irrespective of during 0–120 h post-chemo. endpoint. Certain point estimates of absolute differences met the MASCC Results criterion for clinical significance; some but not all of the superiority may One thousand three hundred forty-four evaluable subjects (>50 % re- be explained by the longer half-life of palonosetron versus its compara- ceived anthracycline-cyclophosphamide therapy). Subjects in rolapitant tors. It is unknown what differences would be observed had the compar- group had a significantly higher CR rate for the primary study endpoint ator arms contained a neurokinin-1 RA or a corticosteroid beyond day 1. 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 MASCC-0358 protection (no emesis, no rescue medication and maximum nausea VAS Nausea-Vomiting <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 HOW OFFICE BASED GYNECO-ONCOLOGISTS IN were similar across groups. GERMANYAPPLYANTIEMETIC GUIDELINES IN PATIENTS Conclusions RECEIVING AC-CONTAINING (NEO) ADJUVANT Rolapitant in combination a with 5-HT3 receptor-antagonist and dexa- CHEMOTHERAPY methasone was well-tolerated and demonstrated superior efficacy over control in the primary endpoint of the prevention of delayed CINV in J. Schilling1, H.J. Hindenburg1 subjects receiving MEC in a global phase 3 study. 1BNGO e.V., BNGO e.V., Neuenhagen b. Berlin, Germany

Background and Aims Supportive care guidelines are an important instrument to maintain qual- MASCC-0448 ity of treatment and quality of life in cancer patients (pts). However, there Nausea-Vomiting are limitations in the adherence to guidelines and application of guideline changes. Toevaluate the awareness of modern antiemetic guidelines (GL) and their PALONOSETRON IN CHEMOTHERAPY-INDUCED NAUSEA practical use in pts receiving anthracycline plus cyclophosphamide (AC)- AND VOMITING: ARE STATISTICALLYSIGNIFICANT containing chemotherapy among German practice-based gyneco- DIFFERENCES ALWAYSCLINICALLYIMPORTANT? oncologists. ASCO recommends prophylaxis with 5-HT3- 1 2 3 1 4 M. Popovic , D.G. Warr , C. DeAngelis , M. Tsao , K.K.W. Chan , receptorantagonist (RA), Neurokinin1-RA and dexamethasone. M. Poon1,C.Yip1, N. Pulenzas1,H.Lam1,L.Zhang1, M. Milakovic1, Methods E. Chow1 Forty-nine practices used the ODM Quasi® GYN system for the online 1Rapid Response Radiotherapy Program, Odette Cancer Centre documentation of data on institutions, patients, knowledge and applica- Sunnybrook Health Sciences Centre University of Toronto, Toronto, tion of antiemetic GL. Antiemetic treatment was documented in 250 Canada; 2Department of Medical Oncology, Princess Margaret Cancer breast cancer pts who received cycle 1 and 3 of AC chemotherapy Centre University of Toronto, Toronto, Canada; 3Department of Pharma- (80 % adjuvant, 20 % neoadjuvant). cy, Odette Cancer Centre Sunnybrook Health Sciences Centre University Results of Toronto, Toronto, Canada; 4Department of Medical Oncology, Odette Awareness of antiemetic GL: AGO* 76 %, ASCO 82 %, NCCN 31 %, Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, MASCC 22 %; application of GL: AGO 57 %, ASCO 53 %, MASCC Toronto, Canada 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 Background and Aims antiemesis: 84 %, planned use: 12 %, no use: 4 %. MASCC and ASCO recommend palonosetron as the preferred 5-HT3 Antiemetic treatment documentation in 246 pts: Cycle 1: 82 (33 %) receptor antagonist (5-HT3RA) antiemetic for moderately emetogenic received the triple drug schedule according to GL, 113 (46 %) a combi- chemotherapy (MEC). Although previous palonosetron meta-analyses nation of 5HT3-RA and DEX. Cycle 3: triple: 35 %, 5HT3-RA + Dex: have focused on statistical significance, MASCC has suggested that an 44 %. Four pts were lost to follow up. absolute difference of 10 % between therapies is sufficient to warrant a * AGO - German Working Group of Gynecologic Oncology change in practice. We performed a meta-analysis of randomized con- Conclusions trolled trials (RCTs) examining the efficacy and safety of palonosetron Although current antiemesis GL were well known only 33 % of pts versus other 5-HT3RAs to determine whether the absolute differences received the triple combination according to GL in the first cycle of between arms met the MASCC criterion. AC, 35 % in the third cycle. S102 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0317 stimulus to the drug most likely to block that stimulus. The ‘empirical’ Nausea-Vomiting 3 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. SYMPTOM CLUSTERS USING THE FUNCTIONAL LIVING We aimed to determine whether guideline driven aetiology based anti- INDEX – EMESIS INSTRUMENT IN PATIENTS WITH emetic therapy (mechanistic approach) is superior to single agent therapy GASTROINTESTINAL CANCER RECEIVING with haloperidol (empirical approach) in patients with cancer and nausea RADIOTHERAPY TREATMENTS not related to anticancer therapy. P. M . C h e o n 1,M.Poon1, L. Zhang1,C.Deangelis1,K.Dennis2, Methods H. Chung1,J.Stinson1,G.Bedard1,M.Popovic1, S. Wong1,E.Chow1 Antiemetic guidelines were developed according to the presumed 1Odette Cancer Centre Sunnybrook Health Sciences Centre, University of cause of nausea by an expert consensus group using licensed anti- Toronto, Toronto, Canada; 2Division of Radiation Oncology University of emetics in a 3 step dose escalation schedule. Consenting participants Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada withanauseascore≥3/10 were randomized to guideline driven antiemetic therapy, or single agent therapy with haloperidol (1 mg/ Background and Aims 24 h to 3 mg/24 h) given orally or parenterally. Response was defined The Functional Living Index–Emesis (FLIE) instrument is a validated as a 2 point improvement on an 11 point nausea NRS for average nausea and vomiting specific tool. nausea and end score <3/10. The primary endpoint was average The primary objective of the present study was to determine symptom nausea score for the previous 24 h at 72 h. clusters within the FLIE on a weekly basis for the entirety of gastrointes- Results tinal cancer patients’ radiotherapy treatments. This trial is nearing completion. Preliminary analysis of the raw unblind- Methods ed data shows a high response rate (approximately 65 %) with no Quality of life (QOL) was assessed weekly using the 18-item FLIE difference between arms. questionnaire for 86 patients’ radiotherapy treatments. A principal com- Conclusions ponent analysis (PCA) with varimax rotation was performed on the 18 A targeted approach to antiemetic therapy does not appear superior to FLIE items at baseline and weekly visit. Inversed scores were applied for single agent therapy when given regularly for nausea not related to anti- Q3/Q6/Q11/Q15/Q18 to get the same direction as other items. The cancer therapy. internal consistency and reliability of the derived clusters was assessed with Cronbach’s alpha. Robust relationship and correlation among symp- toms was displayed with biplot graphics. Results MASCC-0163 Two symptom clusters were consistently identified except in week 5 Nausea-Vomiting 3 where only one was identified. Cluster 1 contained the items “Q1–Q9” which included all nausea items. Cluster 2 included all vomiting items A RANDOMIZED PHASE III TRIAL OF PALONOSETRON IN from “Q10–Q18”. All the variables are well accounted for by 2 compo- COMBINATION WITH 1-DAYVERSUS 3-DAY nents for most weeks with excellent internal consistency (Cronbach’s DEXAMETHASONE FOR PREVENTION OF NAUSEA AND alpha>0.96 for two clusters). Biplots indicate evidence of two symptom VOMITING INDUCED BY NON-AC MEC: HOPE-01 clusters at each week, except for week 1. Conclusions H. Isobe1, S. Yuki2, T.Furuhata3, T. Sagawa4, H. Masuko5, K. Hatanaka6, Assessment of patients with gastrointestinal cancers using the FLIE-18 T. M i y a gi s h i m a 7, K. Sasaki8, M. Nakamura9,T.Sasaki10, J. Nakajima11 , questionnaire revealed two symptom clusters that respectively address M. Tateyama12, R. Yokoyama13,S.Minami14,K.Eto15, I. Iwanaga16, nausea and vomiting. However, further investigation into the cause of H. Shibuya17,M.Kudo18,K.Oba19,Y.Komatsu20 RINVand their effects on QOL should be warranted in considering the 1Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan; FLIE-18 as a QOL assessment tool. 2Gastroenterology and Hepatology, Hokkaido University Hospital, Sap- poro, Japan; 3Surgical Oncology and Science, Sapporo Medical Univer- sity School of Medicine, Sapporo, Japan; 4Gastroenterology, Hokkaido Cancer Center,Sapporo, Japan; 5Surgery, Sapporo-Kosei General Hos- MASCC-0349 pital, Sapporo, Japan; 6Gastroenterology, Hakodate Municipal Hospital, 7 Nausea-Vomiting 3 Hakodate, Japan; Internal Medicine, Kushiro Rosai Hospital, Kushiro, Japan; 8Surgery, Otaru Ekisaikai Hospital, Otaru, Japan; 9Gastroenterology, Sapporo City General Hospital, Sapporo, Japan; ATARGETED VERSUS EMPIRIC APPROACH TO 10Respiratory Center,Asahikawa Medical University, Asahikawa, Japan; ANTIEMETIC USE IN ADVANCED CANCER 11 3rd Internal Medicine, Obihiro-Kosei General Hospital, Obihiro, J. Hardy1,P. Yates2,J.Philip3,P. Martin4,P.Glare5, D. Currow6 Japan; 12Internal Medicine, Tomakomai Nisshou Hospital, Tomakomai, 1Palliative and Supportive Care, Mater Research Institute-The University Japan; 13Surgery, Iwamizawa Municipal General Hospital, Iwamizawa, of Queensland, Brisbane, Australia; 2School of Nursing, Queensland Japan; 14Gastroenterology, Oji General Hospital, Tomakomai, Japan; University of Technology, Brisbane, Australia; 3Centre for Palliative Care 15Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan; Education and Research, St Vincent’s Hospital and University of Mel- 16Gastroenterology, Japanese Red Cross Kitami Hospital, Kitami, Japan; bourne, Melbourne, Australia; 4Palliative care, Barwon Health, Gee- 17Surgery, Muroran City General Hospital, Muroran, Japan; long, Australia; 5Pain and Palliative Care, Memorial Sloan Kettering 18Gastroenterology, Sapporo Hokuyu Hospital, Sapporo, Japan; Cancer Centre, New York, USA; 6Palliative and Supportive Services, 19Translational Research and Clinical Trial Center,Hokkaido University Flinders University, Adelaide, Australia Hospital, Sapporo, Japan; 20Cancer Chemotherapy,Hokkaido University Hospital Cancer Center,Sapporo, Japan Background and Aims The ‘mechanistic’ approach to nausea management, uses specific anti- Background and Aims emetic drugs according to the aetiology of the nausea, and draws on 5HT3 receptor antagonist plus dexamethasone (DEX) is recom- knowledge of emetogenic pathways, matching supposed emetogenic mended for the prevention of CINV at the time of the MEC. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S103

However, administration schedule of DEX has been established 2–3) OR placebo (Days 1–3) + ondansetron (Day 1). Dexamethasone was based on the data obtained with the first-generation 5-HT3 recep- added at investigator discretion. tor antagonists. Results The purpose of this study was to compare the efficacy of DEX day1 Efficacy and safety were evaluated in 152 aprepitant and 150 con- single administration against DEX days1–3 administration in combina- trol patients. The proportion of patients achieving CR in the delayed tion with palonosetron (PALO), the 2nd-generation 5HT3 receptor antag- phase was significantly higher for aprepitant than controls (50.7 % onist, for CINV in non-AC MEC. vs 26.0 %, P<0.01). Significantly more aprepitant patients showed Methods CR during acute (66.4 % vs 52.0 %, P<0.05) and overall (40.1 % vs This phase III trial was conducted as a multi-center, randomized, 20.0 %, P<0.01) phases, and NV in the overall phase (46.7 % vs non-inferiority design. Patients who received non-AC MEC as an 21.3 %, P<0.01). Aprepitant was well tolerated; adverse events initial chemotherapy were randomly assigned to either a group were similar between regimens and consistent with those in patients which was administered PALO (0.75 mg, IV) and DEX (9.9 mg, undergoing chemotherapy. IV) prior to chemotherapy (armB), or a group which was adminis- Conclusions tered additional administration of DEX (8 mg, IVor PO) on days 2– In pediatric cancer patients 6 months to 17 years treated with EC, the 3- 3 (armA). Primary endpoint was Complete Response (CR) rate. CR day regimen containing aprepitant was well tolerated and significantly rate difference was estimated by logistic regression with stratifica- more effective than a control regimen for CINV prevention. tion 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 MASCC-0283 MEC were randomly assigned. Overall CR rate was 66.2 % in armB (n= Nausea-Vomiting 3 151) 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 SINGLE-DOSE PALONOSETRON AND DEXAMETHASONE for non-inferiority test=0.0004). There were no differences between two FOR PREVENTION OF CINV IN PATIENTS WITH SMALL arms on complete control rate (64.9 % vs 61.7 %) and total control rate CELL LUNG CARCINOMA RECEIVING MULTIPLE-DAYAND (49.7 % vs 47.4 %). MULTIPLE-CYCLE CHEMOTHERAPY:A RETROSPECTIVE Conclusions STUDY 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 M. Kiagia1, M. Panagiotarakou1, D. Vassos1,E.Dalakou1,A.Marioli1, MEC. E. Kainis1,K.Syrigos1 1Oncology Unit GPP, Sotiria General Hospital, Athens, Greece

Background and Aims MASCC-0286 Optimal prevention of chemotherapy-induced nausea and vomiting Nausea-Vomiting 3 (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 APREPITANT FOR PREVENTING palonosetron and dexamethasone for CINV prevention in patients CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING with small-cell lung cancer (SCLC) receiving multiple-day (CINV) IN CHILDREN chemotherapy. H. Kang1, S. Loftus2, A. Taylor3, C. DiCristina2,C.M.Zwaan4,S.Green5 Methods 1Pediatrics, Cancer Research Institute Seoul National University College Retrospective analysis of medical records of 417 patients with of Medicine, Seoul, Korea; 2Clinical Development Executive Organiza- SCLC receiving multiple cycles of 3-day platinum-based chemo- tion, Merck & Co. Inc., Whitehouse Station NJ, USA; 3Biostatistics, therapy was performed. Chemotherapy regimens administered in- Merck & Co. Inc., Whitehouse Station NJ, USA; 4Pediatric Oncology, cluded either 3-day carboplatin-based or cisplatin-based combina- Erasmus MC/Sophia Children’s Hospital, Rotterdam, Netherlands; 5Vi c e tions. The primary objectives were the assessment of the complete President Clinical Research, Merck & Co. Inc., Whitehouse Station NJ, response rate (CR: no vomiting, no rescue) and of the complete USA control rate (CC: no vomiting, no nausea, no rescue) across the overall period of treatment . All patients received antiemetic pro- Background and Aims phylaxis with a single pretreatment dose of palonosetron (0.25 mg, Aprepitant with a 5HT3-antagonist and corticosteroid is indicated for i.v.) and dexamethasone (8 mg, i.v.). prevention of CINV due to highly/moderately emetogenic chemotherapy Results (EC) in adults. To evaluate aprepitant for CINV prevention in children, a Carboplatin- and cisplatin-based chemotherapies were received by global, phase III, randomized, double-blind, active-comparator study was 93.3 % and 6.7 % of patients, respectively. The highest CR/CC conducted in patients 6 months to 17 years (NCT01362530). Objectives: rates (91.8 %/76.6 %) were observed in the carboplatin subgroup, Primary – compare an aprepitant vs control regimen in eliciting complete while the CR/CC rates in the cisplatin subgroup and the overall response (CR: no vomiting/retching/rescue medication) 25–120 h after study population were 60.7 %/46.4 % and 89.7 %/74.6 %, re- chemotherapy initiation (delayed phase) in Cycle 1. Secondary – CR in spectively. No serious adverse events related to the antiemetic acute (0–24 h) and overall phases (0–120 h), no vomiting (NV) in overall treatment were recorded. Logistic regression analysis showed that phase, safety. younger age, female gender, extensive disease stage and cisplatin- Methods based chemotherapy had an independent negative effect on the Patients 12–17 years undergoing EC received aprepitant capsule 125 mg/ CC rate. ondansetron before chemotherapy (Day 1) + aprepitant capsule 80 mg Conclusions (Days 2–3) OR placebo (Days 1–3) + ondansetron (Day 1). Patients Single-dose palonosetron and dexamethasone achieved complete control <12 years received aprepitant powder-for-suspension (PFS) 3 mg/kg (to of CINV throughout the entire period of consecutive platinum-based 125 mg)/ondansetron (Day 1) + aprepitant PFS 2 mg/kg (to 80 mg) (Days chemotherapy cycles in the majority of SCLC patients. S104 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0228 Methods Nausea-Vomiting 3 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 5HT RA from 4/1/ COMPARING THE INCIDENCE OF CHEMOTHERAPY 3 08 to 3/31/09, were identified and grouped into cohorts (palonosetron INDUCED NAUSEA AND VOMITING FOLLOWING 5HT3RA alone vs. other 5HT RA+NK ). CINV-related costs were calculated using AND NK1 ANTIEMETIC PROPHYLAXIS 3 1 claims with a primary diagnosis of nausea, vomiting, fluid depletion/ R. Knoth1,C.Faria1,E.Chang2,M.Broder2,A.Powers1 replacement, or rescue antiemetic, and measured from chemotherapy 1Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake initiation to end of first cycle. NJ, USA; 2Partnership for Health Analytic Research, LLC, Beverly Hills Results CA, USA 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 %) Background and Aims received the other 5HT3RA alone, and 231 (3.9 %) received the other Chemotherapy-induced nausea and vomiting (CINV) is a significant 5HT3RA+NK1 combination. Significant differences (p<0.05) were adverse effect of cancer treatment. The 5-hydroxytryptamine-3 receptor found by cohort (palonosetron alone vs. other 5HT3RA+NK1)formean antagonists (5HT3RAs) are recommended for the prevention of CINV. cost of antiemetic medications, $188 vs. $620, respectively, cost of This study compared the incidence of CINV in patients undergoing nonchemotherapy related medications, $446 vs. $1082, and total CINV- chemotherapy and treated prophylactically with either I.V.palonosetron related costs, $281 vs. $876. alone or another 5HT3RA (ondansetron, dolasetron, granisetron) in com- Conclusions bination with an I.V. or oral neurokinin1 receptor antagonist (NK1). Patients treated with I.V. palonosetron alone experienced significantly less Methods CINV-related treatment costs compared to those treated with a 5HT3RA+ A retrospective cohort analysis was conducted using the Optum LabRx NK1 combination. These results suggest that prophylactic use of database. Adult patients, treated with moderately (MEC) or highly palonosetron in patients undergoing MEC and HEC chemotherapy could emetogenic chemotherapy (HEC), who received a 5HT3RA from 4/1/ result in significant savings to payers. 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 MASCC-0343 from initiation of chemotherapy to end of the first cycle. Nausea-Vomiting 3 Results A total of 5,912 patients (age=56.1, 77 % female) were identified, 25.7 % GAPS BETWEEN CLINICIANS’ AWARENESS ABOUT CINV treated with HEC and 74.3 % with MEC, and 19.9 % experienced CINV. AND PATIENT EXPERIENCE For palonosetron-treated patients (n=4,243), 833 (19.6 %) received palonosetron alone and 3,140 (80.4 %) received it in combination with J. Lee1,S.Rha2,Y.Park1,S.Song3,C.Lee3 1 2 another antiemetic. For the other 5HT3RA -treated group (n=1,667), 414 College of Nursing, Eulji University, Daejeon, Korea; College of Med- (24.8 %) received it alone, 1,022 (61.3 %) with an oral antiemetic, and icine, Yonsei University, Seoul, Korea; 3Yonsei Cancer Hospital, Sever- 231 (13.9 %) with an NK1. Patients treated with palonosetron alone ance Hospital, Seoul, Korea demonstrated significantly less CINV than those treated with the combi- nation other 5HT3RA+NK1 (19.3 % vs. 34.6 %, respectively), OR=1.8, Background and Aims p=0.007. Corresponding clinicians’ understanding about symptom experience with Conclusions that of patients’ would contribute advancing symptom management. The Significant reductions in CINV were observed in patients treated with study aimed to evaluate clinicians’ awareness about CINVand compare it palonosetron alone vs. treated with another 5HT3RA+NK1 in combination. 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. MASCC-0227 The MATitems were utilized to generate survey questions and symptom Nausea-Vomiting 3 diary. Descriptive statistics were used to analyze the data. Results A total of 73 clinicians with mean oncology care experience of 6 yrs. and COMPARING THE COSTS OF CHEMOTHERAPY INDUCED 194 cancer patients receiving HEC or MEC completed study participa- NAUSEA AND VOMITING FOLLOWING 5HT3RA AND NK1 tion. Clinicians estimated acute vomiting to occur twice after HEC and ANTIEMETIC PROPHYLAXIS once after MEC, and delayed vomiting as three times after HEC and twice C. Faria1, R. Knoth1,E.Chang2,M.Broder2,A.Powers1 after MEC. However, patients’ average vomiting frequency was less than 1Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake once in both acute and delayed phase, either HEC or MEC. Intense acute NJ, USA; 2Partnership for Health Analytic Research, LLC, Beverly Hills and delayed nausea was expected by clinicians after HEC (6 out of 10), CA, USA whereas patients experienced less intense acute nausea (2 out of 10) and delayed nausea (3 out of 10). After MEC, moderate acute and delayed Background and Aims nausea was estimated (4 out of 10), whereas delayed nausea on day 3 and Chemotherapy-induced nausea and vomiting (CINV) is a significant day4onlyreachedtheintensity. adverse effect of cancer treatment. The 5-hydroxytryptamine3 receptor Conclusions antagonists (5HT3RA) are recommended for the prevention of CINV. This study demonstrated gaps between clinicians’ awareness and pa- This study compared the costs to prevent CINV in patients undergoing tients’ symptom experience of CINV. In general, clinicians overestimated chemotherapy and treated prophylactically with either I.V.palonosetron CINVexperience. Nausea is a still a significant symptom with room for alone vs. with another 5HT3RA (ondansetron, dolasetron, or granisetron) further improvement. Further data collection and analyses regarding in combination with an I.V. or oral neurokinin1 receptor antagonist (NK1). patients’ CINVexperience will be ensued. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S105

MASCC-0307 Nausea-Vomiting 3

FOSAPREPITANTAS 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 1Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; 2Oncology, Credit Valley Hospital, Mississauga, Canada; 3Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada; 4Oncology, Cen- tre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada; 5Oncology, Toronto East General Hospital, Toronto, Canada; 6Oncology, McGill University Health Centre, Montreal, Canada; 7Oncology, Vancou- ver Cancer Centre, Vancouver, Canada; 8Oncology,Centrehospitalier universitaire de Montreal, Montreal, Canada; 9Oncology, Tom Baker Cancer Centre, Calgary, Canada; 10Oncology, Princess Margaret Cancer Centre, Toronto, Canada; 11 Medical 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 Similar observations were made for the timing of nausea and use of rescue undermines optimal emesis prevention in a significant proportion of medications. Most common side effects, irrespective of causality, were: patients. fatigue (26 %), headache (19 %) and constipation (18 %). Objective: To demonstrate that fosaprepitant significantly improves CIV Conclusions control in subjects who experienced vomiting or retching in the first cycle Fosaprepitant can successfully rescue majority of patients who experi- of chemotherapy. enced CIV during the first cycle of chemotherapy, suggesting that most Methods vomiting episodes can be prevented when fosaprepitant is used in con- This study enrolled one hundred and six patients with either breast (FEC junction with conventional anti-emetics. 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) MASCC-0347 when combined with standard anti-emetic therapy. Nausea, rescue med- Nausea-Vomiting 3 ication, and Complete Response were also assessed. Results CAN APREPITANT IMPROVE DOSE INTENSITY OFANTH Median age was 45 and 55 years for breast and gynecological cancer RACYCLINE AND SURVIVAL IN BREAST CANCER patients, respectively. The overall control rate was 58 %, with 63 % in PAT I E N T S ? breast cancer and 50 % in gynecological cancer. Vomiting episodes occurred early in breast cancer, while a delayed pattern was observed in T. Nakayama1, S. Tokunaga2, K. Yoshidome3,M.Ishitobi1, M. Morimoto4, gynecological cancers (Figure 1). M. Yamaguchi5,M.Baba6,M.Okishiro7,T.Ito8, T. Yanagisawa9, M. Tsubota10,M.Iwamoto11 ,J.Tsurutani12,M.Nomura13,K.Oshima14, S. Morita15, N. Masuda16 1Breast Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; 2Medical Oncology, Osaka City General Hos- pital, Osaka, Japan; 3Breast Surgery, Osaka Police Hospital, Osaka, Japan; 4Breast Surgery, Yao City Hospital, Osaka, Japan; 5Breast Sur- gery, 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; 10Breast Surgery, Kansai Medical Uiversity, Osaka, Japan; 11 Breast and Endocrine Surgery, Osaka Medical College, Osaka, Japan; 12Medical Oncology, Kinki University, Osaka, Japan; 13Breast Surgery, Osaka Gen- eral 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 S106 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 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 prospec- tively 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 Fig. 1 a Percentage of patients with no nausea, any nausea, occasional In this study, we could not show the benefit of aprepitant in improving nausea or frequent nausea over time. D =day.b Percentage of patients RDI and survival. But it significantly reduced incidence of vomiting, with no emesis, any nemesis, occasional emesis or frequent emesis over which leads to maintain patients’ QOL during chemotherapy. 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 MASCC-0177 over time. D =day.e Percentage of patients who experienced nausea with Nausea-Vomiting 3 and without antiemetics over time. D =day.f Percentage of patients who experienced emesis with and without antiemetics over time. D =day

A PROSPECTIVE STUDY OF GASTROINTESTINAL Conclusions RADIATION THERAPY-INDUCED NAUSEA AND VOMITING RINV worsened QOL and was experienced even after treatment was M. Poon1,K.Dennis2, C. DeAngelis1,H.Chung1,J.Stinson1,L.Zhang1, completed; physicians should therefore be cognizant and monitor patients G. Bedard1,M.Popovic1,N.Lao1, N. Pulenzas1, S. Wong1, E. Chow1 in the week following radiotherapy. Concomitant chemoradiotherapy 1Rapid Response Radiotherapy Program Department of Radiation On- should potentially be included in the moderate emetogenic risk category. cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, To- ronto, Canada; 2Department of Radiation Oncology, Ottawa Hospital Research Institute, Ottawa, Canada MASCC-0171 Background and Aims Nausea-Vomiting 3 Nausea and vomiting are side effects from radiotherapy that can interfere with gastrointestinal (GI) cancer patients’ quality of life (QOL). CLINICAL IMPACTS OF GRANISETRON TRANSDERMAL A prospective study among patients with GI cancers was conducted to SYSTEM:SUSTAINED ANTI-EMETIC EFFICACYAND document the timing, incidence, and risk factors of radiation therapy- QUALITY OF LIFE IN CONTROL OF NAUSEA AND induced nausea and vomiting (RINV). VOMITING INDUCED BY HIGHLYEMETOGENIC Methods CHEMOTHERAPY Forty-eight patients planned to receive abdominal and/or pelvic radio- therapy alone or with concomitant chemoradiotherapy were followed D.S. SUN1,Y.H.Ko1,J.Y.Jin2,I.S.Woo3,Y.S.Park4,J.H.Kang5, H.K. prospectively. All episodes of nausea, vomiting, retching and antiemetic Kim6 use were recorded daily for the treatment period and the week following 1Internal Medicine, Uijeongbu St Mary’s hospital Catholic University completion of therapy. QOL was assessed weekly using the Functional Medical College, Uijeongbu-si Gyeonggi-do, Korea; 2Internal Medicine, Living Index – Emesis Quality of Life Tool and the EORTC QLQ-C30 Bucheon St Mary’s hospital Catholic University Medical College, questionnaire. Bucheon-si Gyeonggi-do, Korea; 3Internal Medicine, Yeouido St Mary’s Results hospital Catholic University Medical College, Seoul City, Korea; Nausea occurred in 83 % of patients and emesis in 54 %. Pancreatic 4Internal Medicine, Daejeon St Mary’s hospital Catholic University Med- cancer patients had significantly higher proportions of nausea and ical College, Daejeon City, Korea; 5Internal Medicine, Seoul St Mary’s emesis (p=0.002 and p=0.0003). There were no significant differ- hospital Catholic University Medical College, Seoul City, Korea; ences between concomitant chemoradiotherapy and radiotherapy on- 6Internal Medicine, St Vincent’s hospital Catholic University Medical ly patients for RINV. Patients had significantly greater proportions of College, Suwon City, Korea RINV during the first, second, and fifth weeks of treatment and during the first week following treatment. Vomiting was found to Background and Aims impair patients’ usual recreation or leisure activities and enjoyment The efficacy and safety of granisetron transdermal system(GTS, of their meals. Worse physical, role and social functioning, and Sancuso®) was investigated for the prevention of chemotherapy- greater fatigue and appetite loss over the course of treatment corre- induced nausea and vomiting(CINV) in the patients receiving highly lated directly with the timing of RINV symptoms. emetogenic chemotherapy (HEC). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S107

Methods ECCO,2009) where a cycle 1 no emesis rate of 84 % was seen in a In this multicenter, randomized, open-label, parallel-group, active- similar carboplatin subset (N=102). This compared with a no emesis rate controlled study, patients receiving HEC were randomized to GTS of 70 % for the 2-agent control group (N=90). This incremental benefit in or ondansetron. The GTS was applied onto the skin at least 24 h response (~10–14 %) for NEPA/APR is similar to the difference seen with before chemotherapy and maintained for 5 days after start of che- NK1RA cisplatin trials. motherapy; ondansetron was administered intravenously on chemo- Conclusions therapy Day 1 and orally on Day 2–5. Primary endpoint was the This NEPAdataset is the largest prospective report evaluating the contri- percentage of patients achieving Complete Response(CR) without bution of an NK1RA in preventing emesis in patients receiving rescue medication from the first administration to 24 h after start of carboplatin. Given the consistent evidence seen in >250 total patients the last chemotherapy. Quality of life(QoL) was assessed using the treated with NEPA+DEX or the aprepitant triplet, guideline groups should Functional Living Index-Emesis(FLI-E). Statistical analyses were strongly consider the addition of an NK1RA in patients receiving performed in per-protocol set. carboplatin. 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 non- MASCC-0161 inferiority of GTS (95 % CI: [−10.52 %, 3.48 %], Margin:−15 %). During Nausea-Vomiting 3 the study,CR and complete control(CC) rates were gradually decreased in the ondansetron, those in the GTS were sustained. Moreover, CC rate at DO NK1 RECEPTOR ANTAGONISTS (RA) CONTRIBUTE TO Day 5 was significantly higher with GTS than ondansetron (92.76 % vs NAUSEA CONTROL? EVALUATION OF THE NOVEL NEPA 84.94 %, p=0.0278). The total score of the FLI-E was significantly higher FIXED-DOSE COMBINATION OF NK1 RA+5-HT3 RA FROM with GTS than ondansetron(mean 1,547.38±306.00 and 1,494.07± PIVOTALTRIALS 312.05, p=0.0449). Adverse events between two groups were similar 1 2 3 4 5 each other. L. Schwartzberg ,M.Aapro,P.J.Hesketh,G.Rossi,G.Rizzi, M. Palmas4, R. Gralla6 Conclusions 1 Compared with ondansetron, the GTS showed sustained anti-emetic Division of Hematology & Oncology, West Clinic, Memphis, USA; 2Department of Medical Oncology, Clinique de Genolier, Genolier, efficacy and improvement in QoL in the patients receiving multi-day 3 HEC. Switzerland; Department of Hematology & Oncology, Lahey Hospital & Medical Center,Burlington, USA; 4Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 5Statistics & Data Manage- ment, Helsinn Healthcare, Lugano, Switzerland; 6Department of Oncol- ogy, Albert Einstein College of Medicine, Bronx, USA MASCC-0162 Nausea-Vomiting 3

IS THE ADDITION OFAN NK1 RECEPTOR ANTAGONIST Background and Aims BENEFICIAL IN PATIENTS RECEIVING CARBOPLATIN? Despite progress in more effective CINV prevention, nausea control SUPPLEMENTARY DATAWITH NEPA, A FIXED-DOSE remains suboptimal. Debate exists whether NK1 receptor antagonists COMBINATION OF NETUPITANTAND PALONOSETRON (RAs) enhance nausea control. NEPA, a fixed-dose oral combination of K. Jordan1,R.Gralla2, G. Rossi3,M.E.Borroni3, G. Rizzi4 the NK1RA, netupitant plus palonosetron (PALO) has shown superior 1Department of Oncology/Hematology, University of Halle, Halle, prevention of emesis compared with PALO. We evaluated whether the Germany; 2Department of Oncology, Albert Einstein College of Medi- addition of netupitant to PALO offers better nausea control than single- cine, Bronx, USA; 3Corporate Clinical Development, Helsinn agent PALO. Healthcare, Lugano, Switzerland; 4Statistics & Data Management, Methods Helsinn Healthcare, Lugano, Switzerland Patients from two randomized, multinational studies received a single dose of NEPA(netupitant 300 mg+PALO 0.50 mg) or PALO on Day 1+ Background and Aims dexamethasone prior to cisplatin or anthracycline+cyclosphosphamide (AC). The proportion of patients with no significant nausea (NSN:max A triplet regimen of an NK1 receptor antagonist (RA)+5-HT3RA+dexa- methasone (DEX) is unanimously recommended by Antiemetic Guide- <25 mm of 100 mm VAS) with odds ratios and mean VAS scores were line Committees for patients receiving cisplatin-based chemotherapy. calculated. Results However, there is limited data supporting an NK1 RA recommendation with other platinum agents. NEPA, a fixed-dose combination of the 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 NK1RA, netupitant (NETU), and palonosetron (PALO) was at least as effective as the aprepitant (APR) triplet in patients receiving cisplatin. We apparent in the delayed phase and cisplatin-treated patients, but improve- performed a post-hoc analysis from a prospective phase 3 trial to assess ment was also seen in AC. NEPA’s effectiveness in a subset of patients receiving carboplatin. Methods Study 1 (HEC) Study 2 (AC MEC) One hundred forty-nine chemotherapy-naïve patients from a randomized, % Pts NSN Mean VAS % Pts NSN Mean VAS (Odds Ratios) (Odds Ratios) multinational study were included. They received a single oral dose of NEPA PA L O NEPA PA L O NEPA PA L O NEPA PA L O N=135 N=136 N=135 N=136 N=724 N=725 N=724 N=725 NEPA (NETU 300 mg+PALO 0.50 mg)+DEX on day 1 of repeated Acute 99 % 93 % 3.0 6.5 87 % 88 % 8.7 9.2 carboplatin cycles. (4.74)* (0.95) Delayed 90 % 81 % 7.5* 15.2 77 % 71 % 15.2* 19.4 Results (2.25)* (1.35)* Overall 90 % 79 % 8.0* 16.9 75 % 69 % 16.7 21.0 The overall (0–120 h) complete response rates (no emesis/rescue) for (2.28)* (1.32)* NEPA (80 %, 91 %, 92 %, and 94 % for cycles 1–4, respectively) were consistent with the historical aprepitant triplet data (Gralla ESMO- *p≤0.05 vs PALO S108 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions MASCC-0054 The addition of the NK1RA, netupitant to PALO (NEPA) significantly Nausea-Vomiting2 improves prevention of nausea over PALO alone in patients receiving cisplatin or AC. META-ANALYSIS OF COADJUVANT NON-NK1 ANTAGONIST MEDICATIONS FOR CONTROL OFACUTE AND DELAYED NAUSEA AND VOMITING INDUCED BY MODERATE AND HIGHLYEMETOGENIC CHEMOTHERAPY MASCC-0160 Nausea-Vomiting 3 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. 1 MULTIPLE CYCLE CINV CONTROL AND SAFETY OF NEPA, Auro Del Giglio 1Oncology, ABC Foundation School of Medicine, Santo André, Brazil; A CAPSULE CONTAINING NETUPITANTAND 2 PALONOSETRON ADMINISTERED ONCE PER CYCLE OF Head and Neck Surgery, ABC Foundation School of Medicine, Santo MODERATELYEMETOGENIC CHEMOTHERAPY (MEC) André, Brazil M. Aapro1,M.Karthaus2, L. Schwartzberg3,G.Rossi4,G.Rizzi5,M.E. Background and Aims Borroni4,M.Palmas4, H. Rugo6 Chemotherapy Induced Nausea and Vomiting (CINV) is a very distressing 1Department of Oncology, Clinique de Genolier, Genolier, Switzerland; chemotherapy induced symptom that may adversely impact cancer pa- 2Department of Hematology Oncology and Palliative Medicine, Hema- tients’ quality of life. tology & Oncology Staedt. Klinikum Neuperlach and Harlaching, Mu- Methods nich, Germany; 3Division of Hematology & Oncology, West Clinic, Mem- We conducted a systematic search in Pubmed, Bireme and Cochrane databases phis, USA; 4Corporate Clinical Development, Helsinn Healthcare, Lu- for randomized clinical trials, published in English, that evaluated the efficacy of gano, Switzerland; 5Statistics & Data Management, Helsinn Healthcare, combination of coadjuvant non-Neurokinin 1 (NK1) antagonists drugs (ie Lugano, Switzerland; 6Breast Oncology and Clinical Trials Education, neuroleptics, anti-convulsivants and benzodiazepines) with 5- University of California San Francisco Comprehensive Cancer Center, Hydroxitriptamine 3 (5-HT3) antagonists for adult cancer patients recruited to San Francisco, USA recieve moderate or highly emetogenic chemotherapy. We employed Review Manager (RevMan) Computer program Version 5.2 for statistical calculations. Background and Aims Results Antiemetic guidelines recommend co-administration of targeted prophy- We included 15 studies with 1,793 patients. We observed a significant lactic medications aimed at inhibiting several molecular pathways in- higher complete protection for acute CINV with coadjuvant medications 2 volved in emesis. NEPA is a fixed-dose combination of a new NK1 (OR=0.43; 95 % CI: 0.26–0.72; p=0.001; I 44 %) but not for the receptor antagonist (RA), netupitant (NETU 300 mg), and palonosetron delayed period (OR=0.80; 95 % CI: 0.58–1.09, p=0.16, I2 7%).We (PALO 0.50 mg), a pharmacologically distinct 5-HT3 RA, administered observed coadjuvant medications significantly increased complete con- orally in one capsule once per cycle. NEPAwas previously shown to be trol of nausea (OR=0.31; 95 % CI 0.24–0.40; p<0.00001, I2 73 %) and superior to PALO after a single chemotherapy cycle. The aim was to vomiting (OR=0.37; 95 % CI: 0.30–0.47; p<0.00001; I2 49 %). Wecould evaluate the maintenance of efficacy/safety over continuing cycles. not find in subgroup analysis evidence of superiority of any one of the Methods groups of coadjuvant medications over another. This was a randomized, double-blind Phase 3 study assessing the Conclusions efficacy/safety of a single dose of NEPAversus PALO in chemotherapy- We conclude that coadjuvant non-NK1antagonists medications may be naïve patients receiving multiple cycles of anthracycline- useful for CINV control. Prospective randomized studies incorporating cyclophosphamide. Patients received oral dexamethasone on Day 1 only. these low cost medications to new regimens combining 5-HT3 and NK1 Efficacy endpoints: complete response (CR: no emesis/no rescue) and no antagonists may be warranted. 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 MASCC-0039 cycle extension for 5969 chemotherapy cycles; 76 % completed at least Nausea-Vomiting2 4cycles. The superiority of NEPA over PALO during Cycle 1 for both complete response and no significant nausea was maintained over multiple cycles. TRAJECTORYAND RISK FACTORS FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN ASIAN HEAD AND NECK CANCER PATIENTS Cycle N=NEPA/PALO Complete Response No Significant Nausea A. Chan1,M.Shwe1,Y.X.Gan2,X.H.Low1,K.Yap1,D.Lim3 NEPA PALO NEPA PALO 1Pharmacy, National University of Singapore, Singapore, Singapore; 2 Cycle 1 N=724/725 74 %* 67 % 75 %* 69 % Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; 3Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore Cycle 2 N=635/651 80 %* 67 % 77 %* 72 % Cycle 3 N=598/606 84 %* 70 % 78 %* 73 % Background and Aims Cycle 4 N=551/560 84 %* 75 % 80 %* 75 % Head and neck cancers are highly prevalent in Asia. However, data regarding chemotherapy-induced nausea and vomiting in the head and *P≤0.05 vs PALO neck cancer population are lacking. This study was designed to analyze The type/incidence of adverse events was similar for NEPAand PALO. the trajectory of and risk factors for chemotherapy-induced nausea and vomiting in Asian head and neck cancer patients. Conclusions Methods NEPA, a novel, convenient fixed-dose combination targeting dual anti- This was a single-center, prospective, observational study conducted emetic pathways, is highly effective and safe over multiple cycles of MEC. between September 2008 and May 2013. Adult head and neck cancer Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S109 patients scheduled to receive cisplatin-based chemotherapy were recruit- MASCC-0127 ed for the study. Clinical events were collated from standardized diaries. Nausea-Vomiting2 Primary endpoints included overall significant nausea, overall vomiting, and complete response to antiemetics. META–ANALYSIS OFAPREPITANT COMBINATION Results REGIMENS FOR PREVENTION OF CHEMOTHERAPY– Two hundred thirty-five patients were included in the analyses. The majority INDUCED NAUSEA AND VOMITING (CINV) IN ADULTS (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 N. Gupta1,H.Hatoum2,O.AlUstwani2,P. Danchaivijitr2,K.Wang3,R.Pili4 aprepitant with their chemotherapy. The overall incidence of significant 1Palliative Care, State University of New York at Buffalo, Buffalo, USA; nausea and vomiting was 73.7 % and 24.7 %, respectively, with single-day 2Medical Oncology, Roswell Park Cancer Institute, Buffalo, USA; cisplatin regimens and 48.9 % and 28.9 %, respectively, with the multiple-day 3Biostatistics, Roswell Park Cancer Institute, Buffalo, USA; cisplatin regimen. The complete response to antiemetics was 63.2 % with the 4Genitourinary Oncology, Roswell Park Cancer Institute, Buffalo, USA single-day chemotherapy regimens and 68.9 % with the multiple-day regi- men. Patients using complementary alternative medicine were less likely than Background and Aims others to achieve a complete response to antiemetics, and patients who were Various randomized controlled trials (RCTs) have shown improved out- more educated and those with a poor performance status were more likely comes with addition of aprepitant to standard antiemetic treatment (SAT) than others to complain of post-chemotherapy nausea or vomiting. for CINV prevention. Conclusions We conducted a meta-analysis to compare the overall effectiveness and Whereas post-chemotherapy vomiting is relatively well controlled in toxicities of aprepitant combination regimens (ACR) versus SATin CINV. Asian head and neck cancer patients, post-chemotherapy nausea remains Methods problematic in this population. 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– MASCC-0149 120 h of chemotherapy), acute phase (AP; 0–24 h) and delayed phase (DP; – Nausea-Vomiting2 24 120 h). Additionally, we assessed nausea control and toxicity profile (TP). Stouffer’s Z-score method was used to calculate overall effect. Results SEROTONIN 5-HT3 RECEPTOR-MEDIATED VOMITING Sixteen RCTs (n=5,547 patients) were included. 3,314 patients received OCCURS VIA A ACTIVATION OF CA2+/CAMKII-DEPENDENT highly emetogenic chemotherapy (HEC) and 2,233 patients received ERK1/2 SIGNALING moderately emetogenic chemotherapy (MEC). ACR increased CR in N. Darmani1,W.Zhong1, T.E. Hutchinson1,S.Chebolu1 OP from 47 to 63 %(OR=0.52, CI=0.46 to 0.58; p<0.001), in AP from 1Basic Medical Sciences, COMP/WUHS, Pomona, USA 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. Background and Aims Slightly higher rate of fatigue (p=0.02), hiccups (p<0.001), and lower 5-hydroxytryptamine 3 receptors (5-HT3Rs) have high permeability to extra- rate of neutropenia (p=0.02) was seen in ACR group. cellular Ca2+ and upon stimulation allow increased Ca2+ influx. Stimulation Conclusions of 5-HT3Rs by 2-methyl serotonin (2-Me-5-HT) induces vomiting, however ACR is effective in CINV due to both HEC and MEC in adult cancer its downstream signaling pathways remain unknown. This study demon- patients. ACR improves the control of emesis in all phases, and nausea in strates the involvement Ca2+ sensor calmodulin and Ca2+/calmodulin-depen- delayed phase only. With the exception of causing more fatigue & dent protein kinase IIα (Ca2+/CaMKIIα) in 2-Me-5-HT-induced emesis. hiccups, and lesser neutropenia, overall TP of ACR is similar to SAT. Methods Ca2+ imaging, immunoprecipitation, immunoblot, immunostaining and behavioral emesis studies in the least shrew. Results MASCC-0008 Using fluo-4 AM dye, we found that the emetogen 2-Me-5-HT (1 μM) Nausea-Vomiting2 augments intracellular Ca2+ concentration in least shrew brainstem slices, which was abolished in the presence of the selective 5-HT R antagonist 3 RANDOMIZED STUDY OF THE EFFICACYAND SAFETY OF palonosetron (1 μM). Systemic 2-Me-5-HT administration (5 mg/kg, i.p.) TRANSDERMAL GRANISTERON COMPARED WITH significantly: i) enhanced the 5-HT R-calmodulin interaction in the least 3 INTRAVENOUS AND ORAL GRANISETRON WITH shrew brainstem as revealed by immunoprecipitation, and their MODERATELYEMETOGENIC CHEMOTHERAPY colocalization in the area postrema of brainstem and small intestine by immunohistochemistry; and ii) activated CaMKIIα in brainstem and en- J. Kim1, Y.S. Hong1, J.L. Lee1, K.P. Kim1, S.J. Park1, Y.O.O.N. S1, terochromaffin cells isolated from the small intestine by immunoblot and S.J. Sym2,D.B.Shin2,J.Y.Lee3, Y.S. Park3,J.S.Ahn3,T.W.Kim1 immunocytochemistry. These effects were also suppressed by pretreatment 1Department of Oncology, Asan Medical Center,Seoul, Korea; 2Division with palonosetron (5 mg/kg, s.c.). Moreover, the following pretreatments, i) of Hematology and Medical Oncology Department of Internal Medicine, amlodipine, an L-type Ca2+ channel (LTCC) blocker; ii) dantrolene, an Gachon University Gil Medical Center, Incheon, Korea; 3Division of inhibitor of ryanodine receptors (RyRs) Ca2+-release channels on the Hematology/Oncology Department of Medicine, Samsung Medical Cen- endoplasmic reticulum (ER); or iii) a combination of their less-effective ter Sungkyunkwan University School of Medicine, Seoul, Korea 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. Background and Aims Conclusions Granisetron transdermal system (GTS) showed non-inferior efficacy to 2+ During 5-HT3R-mediated emesis Ca mobilization occurs via extracel- oral granisetron in chemotherapy-induced nausea and vomiting (CINV) 2+ 2+ lular Ca influx through 5-HT3Rs/LTCCs and Ca release via intracel- with multi-day chemotherapy. We compared the efficacy and safety of lular RyRs, which initiate activation of Ca2+-dependent CaMKIIα and GTS with intravenous (iv) and oral (po) granisetron in Korean patient ERK1/2 signaling to invoke vomiting. (pts) receiving moderately emetogenic chemotherapy (MEC). S110 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0110 A total of 276 pts were randomized to GTS (n=139, one patch, Day 1 to Nausea-Vomiting2 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 NAUSEA PROFILE ACCORDING TO CONDITIONING complete response (CR: no vomiting and/or retching, no rescue medica- REGIMENS IN CANCER PATIENTS UNDERWENT HIGH DOSE tion) from chemotherapy initiation until 24 h after final administration CHEMOTHERAPYAND STEM CELLTRANSPLANTATION (non-inferiority margin, 15 %). Results S. Komurcu1, M. Ozturk2,N.Karadurmus2,S.Ozaydin2,G.Erdem2, Out of 234 pts (112 in GTS and 122 in control group) included in the per R. Ogur3,F. Arpaci2, M. Beyzadeoglu4, S. Demirbas5 protocol analysis, 0.229 pts had gastrointestinal origin cancer and 180 pts 1Medical Oncology, Memorial Ankara Hospital, Ankara, Turkey; received 3-day chemotherapy. The GTS showed non-inferior efficacy achiev- 2Medical Oncology, Gulhane Medical Academy, Ankara, Turkey; 3Public ing CR in 75.0 % of pts; 74.6 % in control group. (95 % confidence interval: Health, Gulhane Medical Academy, Ankara, Turkey; 4Radiation Oncolo- −10.73 % to 11.55 %).CR was not different with subgroup analyses by sex, gy, Gulhane Medical Academy, Ankara, Turkey; 5Internal Medicine, age, and chemotherapy naivety and analysis per day (D1, 2, 3, 4) and overall Gulhane Medical Academy, Ankara, Turkey 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 Background and Aims index-emesis (FLI-E), showed no difference. Both treatments were well Patients underwent high dose chemotherapy(HDC) and autologous or tolerated and safe with low incidence of severe adverse events. allogeneic stem cell infusion (SCI) experience nausea frequently. This Conclusions study was done to evaluate the severity of nausea in the first 10 days after GTS showed non-inferior and sustained efficacy with comparable toler- HDC and SCI. ability and FLI-E score in pts receiving MEC. It offers a convenient Methods alternative option for relieving CINV in this setting. 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 MASCC-0090 SCI. 127 patients, 89 (70 %) of them men, were included into the study. Nausea-Vomiting2 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 SAFETYAND EFFICACY OFAPREPITANT, RAMOSETRON, irradiation + Cyclophosphamide regimen (TBI+C) (22 %, n=28) were AND DEXAMETHASONE FOR CHEMOTHERAPY-INDUCED used as conditioning regimens. NAUSEA AND VOMITING IN PATIENTS WITH OVARIAN Results CANCER TREATED WITH PACLITAXEL/CARBOPLATIN All of the patients experienced nausea at any grade. Mean TNS in the first M. Kim1, C. Choi2,L.Lee2,B.Kim2,D.Bae2 5 days according to gender was higher in women when compared to the 1Obstetrics and Gynecology, Samsung Changwon Hospital men (1,34±0,14 vs 0,87±0,09) (p<0.05). No difference was found Sungkyunkwan University of Medicine, Changwon-si, Korea; 2Obstetrics according to the transplantation type (allogeneic or autologous). The and Gynecology, Samsung Medical Center Sungkyunkwan University of highest mean TNS was achieved at the fourth day after SCI (1,34± Medicine, Seoul, Korea 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 Background and Aims patients who received M200 was the highest when compared with the Women with ovarian carcinoma that are treated with paclitaxel/ other regimens (p<0.05). carboplatin are particularly susceptible to chemotherapy-induced nausea Conclusions and vomiting (CINV). The current study evaluated the new combination All patients that underwent HDC faced nausea at any grade. TNS was (aprepitant/ramosetron/dexamethasone, 20 mg) in ovarian cancer patients higher in women and in the fourth day after HDC and SCI. 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 MASCC-0037 aprepitant, 0.6 mg ramosetron, and 20 mg dexamethasone before chemo- Nausea-Vomiting2 therapy; and Days 2–3: 80 mg aprepitant each day.The primary end point was the proportion of patients with complete response (CR) during the GINGER - MECHANISM OFACTION IN 120 h following the first chemotherapy cycle. Toxicity assessments were CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: A conducted using the NCI-CTC investigator guide (Version 3.0). REVIEW Results Of the 89 patients enrolled, 85 patients were evaluable for efficacy and W. M a r x 1, E. Isenring1,K.Reid2,A.Sali2,L.Vitetta3,D.McKavanagh4, toxicity, and 68 (80 %) completed all 6 cycles. In cycle 1, the percentage of A. McCarthy5 patients who achieved CR in the acute, delayed, and overall phases was 1Health Sciences and Medicine, Bond University, Gold Coast, Australia; 98.8 %, 89.4 %, and 89.4 %, respectively. Of the 460 cycles, adverse events, 2Research Department, National Institute of Integrative Medicine, Mel- drug-related adverse events, and serious adverse events occurred in 179 cycles bourne, Australia; 3Research Department, Medlab, Sydney, Australia; (38.9 %), 35 cycles (7.6 %), and 10 cycles (2.2 %), respectively. The most 4Division of Cancer Services, Princess Alexandra Hospital, Brisbane, common adverse event was constipation (12.4 %) and headache (11.1 %). Australia; 5School of Nursing, Queensland University of Technology, None of the patients discontinued the study because of adverse events. Brisbane, Australia Conclusions The combination of aprepitant, ramosetron, and high-dose dexametha- Background and Aims sone demonstrated efficacy for CINV prevention in ovarian cancer pa- Despite advances in anti-emetic therapy, chemotherapy-induced tients receiving paclitaxel and carboplatin. nausea and vomiting (CINV) still poses a significant burden to Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S111 patients undergoing chemotherapy. Nausea, in particular, is still Methods highly prevalent in this population. Ginger has been traditionally A randomized double-blind study comparing A+D versus M+D was used as a folk remedy for gastrointestinal complaints and has been completed in previously untreated cancer patients. Before chemotherapy, suggested as a viable adjuvant treatment for nausea and vomiting all patients were treated with intravenous palonosetron 0.25 mg, dexa- in the cancer context. methasone 8 mg, and oral aprepitant 125 mg. On day 2–4 patients While there is a large body of research that has investigated the potential randomly received oral dexamethasone 8 mg qd plus aprepitant 80 mg mechanisms of action of gingers anti-nausea effect, this is the first review qd (days 2–3) or metoclopramide 20 mg qid plus dexamethasone 8 mg to systematically evaluate the evidence-base for these proposed bid. Primary endpoint was rate of complete response (no vomiting, no mechanisms. rescue treatment) in day 2–5 after chemotherapy. Methods Results A systematic literature review was conducted which included clinical, Of 303 enrolled patients 288 were evaluable, 147 receiving A+D, 137 M+ in vitro and animal studies both within the chemotherapy context and in D. Day 1 results were similar in both arms. On day 2–5, complete other relevant fields. response rate was not significantly different (80.3 % with A+D versus Results 82.5 % with M+D, p<0.38, respectively), and all secondary endpoints Substantial research has revealed ginger to possess properties that could were also similar (complete protection, total control, no vomiting, no exert multiple beneficial effects on chemotherapy patients who experi- nausea, score of Functional Living Index-Emesis; p<0.24). Adverse ence nausea and vomiting. Bioactive compounds within the rhizome of events incidence was not significantly different between the two ginger, particularly the gingerol and shogaol class of compounds, interact treatments. with several pathways that are directly implicated in CINVin addition to Conclusions pathways that could play secondary roles by exacerbating symptoms. In cancer patients submitted to cisplatin-based chemotherapy, receiving These properties include 5-HT3, substance P and acetylcholine receptor the same antiemetic prophylaxis for acute emesis, A+D is not superior to antagonism; anti-inflammatory properties; and modulation of cellular M+D in preventing delayed emesis, and both treatments present similar redox signalling, vasopressin release, gastrointestinal motility, and gastric toxicity. emptying rate. Conclusions The evidence presented in this review indicates that ginger possesses multiple properties that could be beneficial in reducing chemotherapy- MASCC-0130 induced nausea and vomiting. However, due to existing limitations within Nausea-Vomiting2 the literature, further studies are required before firm recommendations regarding its usage in the oncology setting can be made. RELATIONSHIP BETWEEN ALCOHOL METABOLISM & CHEMOTHERAPY INDUCED EMESIS T. U o m o r i 1, J. Matsuoka2, N. Yonemoto2,M.Saito1 1Breast oncology, Juntendo University Faculty of Medicine, Tokyo, MASCC-0083 Japan; 2Clinical research center, Juntendo University Faculty of Medi- Nausea-Vomiting2 cine, Tokyo, Japan

Background and Aims APREPITANT VERSUS METOCLOPRAMIDE, BOTH Chemotherapy induced nausea & vomiting (CINV) is a common COMBINED WITH DEXAMETHASONE, FOR PREVENTING occurrence. Emetic risk is reportedly low in habitual alcohol- CISPLATIN-INDUCED DELAYED EMESIS: A RANDOMIZED, drinking patients. Therefore, we hypothesized that CINV is influ- DOUBLE-BLIND STUDY enced by alcohol metabolism, which might be related to the meta- F.Roila1,E.Ballatori2,B.Ruggeri3,S.Fatigoni4, A. Mirabile5,B.Frau6, bolic pathways of chemotherapeutic drugs or neurotransmitters. We L. Cavanna7,S.Fava8,I.Colantonio9,L.Angelelli10, L. Ciuffreda11 ,S.E. thus aimed to develop a personalized antiemetic therapy based on Lutrino12,F.Zerilli13 genetic information. 1Medical Oncology, S.Maria Hospital, Terni, Italy; 2University of Methods L’Aquila, Medical Statistics Institute, L’Aquila, Italy; 3ASUR Marche, Seventy-three women between 20 and 75 years of age, diagnosed with Clinical Government, Ascoli Piceno, Italy; 4S.Maria Hospital, Medical primary breast cancer stage?-? and undergoing highly emetogenic che- Oncology, Terni, Italy; 5Istituto Nazionale Tumori, Fondazione IRCCS, motherapy, were enrolled after providing informed consent. We investi- Milano, Italy; 6Monserrato, Medical Oncology Division II, Cagliari, gated the relationship between ALDH2 gene typing with an ALDH2 Italy; 7Piacenza Hospital, Medical Oncology, Piacenza, Italy; 8Legnano typing kit® and CINV, especially in CR (complete response defined as the Hospital, Oncology Unit, Legnano, Italy; 9Azienda Ospedaliera S.Croce absence of vomiting without for rescue) cases, as assessed by patient e Carle, Medical Oncology, Confreria (CN), Italy; 10Mazzoni Hospital, diaries and MATscores. Medical Oncology, Ascoli Piceno, Italy; 11 Molinette Hospital, Medical Results Oncology Unit, Torino, Italy; 12Azienda Ospedaliera Universitaria, Med- 40/73 were ALDH2 wild type; 21 CR and 19 non-CR. ical Oncology, Udine, Italy; 13San Antonio Abate Hospital, Medical 31/73 were ALDH2 hetero type; 17 CR and 14 non-CR. Oncology, Trapani, Italy 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 Background and Aims ALDH2 wild type, there were 10 CR and 2 non-CR cases. However, A combination of aprepitant, a 5-HT3 receptor antagonist, and among 4 ALDH2 hetero type, there were 2 CR and 2 non-CR cases. dexamethasone is recommended for the prophylaxis of cisplatin- Conclusions induced nausea and vomiting in acute phase, and aprepitant+dexa- A relationship between alcohol habit and CINV was found in ALDH2 methasone (A+D) in delayed phase. Aim of this study was to verify wild type which is common among western countries where most of if A+D is superior to metoclopramide plus dexamethasone (M+D) in evidences were obtained. This is the first report investigating the rela- preventing delayed emesis in cancer patients receiving the same tionships with ALDH2 hetero types. Even though alcohol metabolism in prophylaxis for acute emesis. some populations influences the mechanism underlying CINV, other S112 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 pathways or mechanisms may also be involved. Further investigations are MASCC-0159 necessary to identify these mechanisms. Nausea-Vomiting2

NEPA, A FIXED-DOSE ANTIEMETIC COMBINATION OF NETUPITANTAND PALONOSETRON: RESULTSOF MASCC-0158 EFFECTIVENESS IN 407 PATIENTS RECEIVING CISPLATIN PLUS CHEMOTHERAPY OF VARIOUS EMETIC RISK Nausea-Vomiting2 P.J. Hesketh1, R.J. Gralla2,G.Rossi3, M. Palmas3,G.Rizzi4 1 SAFETY OF NEPA,AN ORAL FIXED-DOSE COMBINATION OF Department of Hematology & Oncology, Lahey Hospital & Medical 2 NETUPITANTAND PALONOSETRON: POOLED DATA FROM Center,Burlington, USA; Department of Oncology, Albert Einstein Col- 3 THE PHASE 2/3 CLINICAL PROGRAM lege of Medicine, Bronx, USA; Corporate Clinical Development, Helsinn Healthcare, Lugano, Switzerland; 4Statistics & Data Manage- 1 2 3 4 5 6 M. Aapro ,P.J. Hesketh ,K.Jordan, R. Gralla ,G.Rossi, G. Rizzi , ment, Helsinn Healthcare, Lugano, Switzerland M. Palmas5 1 Department of Medical Oncology, Clinique de Genolier, Genolier, Background and Aims 2 Switzerland; Department of Hematology & Oncology, Lahey Hospital Prior antiemetic trials have indicated that the emetogenicity of 3 & Medical Center, Burlington, USA; Department of Oncology/ chemotherapy added to cisplatin can affect antiemetic control. Re- 4 Hematology, University of Halle, Halle, Germany; Department of On- sults of the 3-agent aprepitant+ondansetron+dexamethasone regi- 5 cology, Albert Einstein College of Medicine, Bronx, USA; Corporate men showed less efficacy when anthracyclines and/or cyclophos- Clinical Development, Helsinn Healthcare, Lugano, Switzerland; phamide were added to cisplatin. Recent large trials have indicated 6 Statistics & Data Management, Helsinn Healthcare, Lugano, Switzerland high efficacy with the 3-agent NEPA+dexamethasone regimen. We analyzed results of a completed, double-blind, 3-agent NEPA study Background and Aims to determine if emetic prevention differed by the chemotherapy NEPA is a convenient dual-pathway antiemetic capsule offering added to cisplatin. guideline-based prophylaxis as a fixed-dose combination of the new Methods NK1 receptor antagonist (RA), netupitant (NETU), and the pharmacolog- This analysis evaluated combined NEPAgroups from a pivotal trial with ically distinct 5-HT3 RA, palonosetron (PALO). In Phase 2/3 clinical trials 407 chemotherapy-naïve patients receiving 100 mg, 200 mg or 300 mg NEPAwas shown to be superior to PALO in preventing CINV with highly netupitant+0.50 mg palonosetron on Day 1+dexamethasone during the (HEC) and moderately emetogenic (MEC) chemotherapy. We evaluated initial cycle of cisplatin. Results were then analyzed by: Group 1 (addi- the safety profile of NEPA from the 4 pivotal trials in the Phase 2/3 tional chemotherapy: none, minimal or low risk) or Group 2 (additional clinical program. chemotherapy: moderate or high risk). Methods Results Pooled adverse event (AE) data were evaluated for 3280 patients Median cisplatin dose: 75 mg/m2; most common additional chemothera- (7,930 cycles) who participated in 4 randomized, double-blind, multina- py: cyclophosphamide, fluorouracil, etoposide, doxorubicin. tional clinical trials. NEPA(NETU 300 mg+PALO 0.50 mg) was admin- istered with dexamethasone (DEX) prior to HEC/MEC on Day 1; either PALO 0.50 mg+DEX or aprepitant+5-HT3RA+DEX were comparators. Response GROUP 1 GROUP 2 Results category (Cisplatin + Lower (Cisplatin + Higher The AE profile for NEPAwas as expected, with the majority of AEs being Risk) N=265 Risk) N=142 related to the chemotherapy. Headache and constipation were the most Complete Response commonly reported treatment-related AEs. Serious AEs occurred infre- quently. The AE profile was similar over multiple cycles. Acute 96 % 94 % Delayed 91 % 91 % Overall 88 % 87 % Cycle 1 NEPA PA L O APR N=1,442 N=1,600 N=238 No Significant Nausea* Any AE 955 (65.5 %) 945 (59.1 %) 135 (56.7 %) Acute 96 % 94 % Treatment-related* AE 138 (9.6 %) 105 (6.6 %) 29 (12.2 %) Delayed 87 % 87 % Headache 32 (2.2 %) 32 (2.0 %) 4 (1.7 %) Overall 86 % 85 % Constipation 27 (1.9 %) 29 (1.8 %) 2 (0.8 %) Any serious AE 33 (2.3 %) 87 (5.4 %) 4 (1.7 %) *CR: no emesis/rescue; No Significant Nausea: max VAS<25 of 100 mm Treatment-related* 2 (0.1 %) 2 (0.1 %) 0 serious AE Conclusions In these patients receiving cisplatin-based chemotherapy, NEPA+ *Investigator assessed as possibly, probably, or definitely related to study dexamethasone resulted in good control in all risk categories; con- drug trol was similar no matter which type of additional chemotherapy was given. Interestingly these results differ from prior reports using Conclusions older NK1 and 5HT3 receptor antagonists in which poorer control NEPAwas safe and well-tolerated in the Phase 2/3 clinical program during occurred with cyclophosphamide and/or anthracyclines added to single and multiple cycles of chemotherapy. cisplatin. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S113

MASCC-0062 Methods Nausea-Vomiting2 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 OUTCOME OF SUPPORTIVE MANAGEMENT IN THE was performed to distinguish vomiting from running tap water (RTW) PREVENTION OF CHEMOTHERAPY INDUCED NAUSEA and coughing. AND VOMITING Results P. Gachigi Kamau1, J. Rotich1,P.Bartilol1 Fingerprint region of vomiting soundwave spectra generally comprised of 1Hemancology, Ampath, Eldoret, Kenya short intense peaks at the beginning, in contrast to coughing spectra, which had longer intense peaks. The RTW spectra were of uniform Background and Aims intensity with no obvious peaks. Amplitudes of coughing spectra were PURPOSE: Toasses the efficiency of using a 5-HT3 Receptor antagonist, higher than those of vomiting and RTW.Vomiting and coughing could be Ondansetron and corticosteroid Dexamethasone and hydration. In the distinguished from RTW within the first 6 PCs, accounting for 52 % of the prevention of chemotherapy induced nausea and vomiting in patients variance. Vomiting could be differentiated from coughing within the first with different malignancies receiving moderately ematogenic regime of 3 PCs (43 % variance). Individual spectra of vomiting, RTW and Doxorubicin and cyclophosphamide and those on high ematogenic single coughing sounds could be explained within the first 5 (82 %), 6 (82 %) regime Cisplatin. and 7 (84 %) PCs respectively. 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 intrave- nous 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 experi- enced 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 Conclusions Administration of Ondansetron, Dexamethasone and good hydration Vomiting soundwave spectra can be used to discriminate patients with CINV before and after chemotherapy is very affective in preventing nausea from associated background sounds/noise due to the high explanatory and vomiting due to chemotherapy. Supportive care makes excellent power. A clinical pathway based on CINV sound mapping can ultimately cancer care possible. be proposed for effective therapeutic management of cancer patients.

MASCC-0051 MASCC-0115 Nausea-Vomiting2 Nutrition

MAPPING OF ‘FINGERPRINT’ SOUNDWAVE SPECTRA AS A UNDER-DIAGNOSIS OF MALNUTRITION IN PALLIATIVE MEANS OF DISTINGUISHING CHEMOTHERAPY-INDUCED MEDICINE NAUSEA AND VOMITING A. Aktas1, D. Walsh1,M.Fischer1,L.Rybicki1 K . Y. Ya p 1,S.W.O.Tan2 1The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer 1Department of Pharmacy, National University of Singapore, Singapore, Institute, Cleveland, USA Singapore; 2Science Research Program, Anglo -Chinese School (Independent), Singapore, Singapore Background and Aims Malnutrition is common but likely under-diagnosed. Our objectives were Background and Aims to determine 1) prevalence and severity of malnutrition in cancer patients Most risk factors that have been used as clinical predictors of who received a nutrition therapy assessment (NTA) 2) if the registered chemotherapy-induced nausea and vomiting (CINV) are subjective. Uti- dietitian (RD) and physician (MD) agree on malnutrition prevalence 3) if lizing vomiting sounds in conjunction with these risk factors presents a malnutrition is associated with survival. more intuitive and objective approach to CINV prediction. This research Methods explores the feasibility of distinguishing vomiting sounds from associated N=182 consecutive NTA by a single RD. ≥2 of the 6 criteria were background sounds/noise based on recorded soundwave spectra. diagnostic of malnutrition: 1) any unintentional weight loss (WL) 2) S114 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

BMI 3) visual muscle wasting 4) nutrient intake 5) wounds 6) laboratory MASCC-0427 ’ values (pre-albumin, albumin, transferrin). McNemar s test determined Nutrition congruence between RD and MD. Cox analysis assessed the association between malnutrition and survival. A STUDY OF DIETARY INTAKE AND THE RELATIONSHIP TO Results NEUTROPHIL ENGRAFTMENTAMONG OUTPATIENT Median age 61 years (range 28–96); 51 % female. The commonest HEMATOPOIETIC STEM CELLTRANSPLANT PATIENTS primary cancer sites: lung (21 %), GI (16 %), GU (15 %). NTA done by WITH MULTIPLE MYELOMA RD in 145 patients and malnutrition present in 70 % (9 % mild, 31 % moderate, 30 % severe). The commonest RD malnutrition criteria were: J. Heimgartner1,F.K. Buadi2, J. Vruwink1, W.J. Hogan2,S.Hashmi2 1) unintentional WL (47 %) 2) low oral intake (39 %) 3) low serum 1Clinical Nutrition, Mayo Clinic, Rochester, USA; 2Hematology/BMT, albumin (29 %). N=91 (50 %) nutritional status recorded by MD; Mayo Clinic, Rochester,USA malnutrition was noted in 77 % (24 % mild, 22 % moderate, 22 % severe, 9 % unspecified). N=77 had both MD and RD assessment; there was high Background and Aims congruence between RD (77 %) and MD (75 %; P=0.78). Malnutrition At Mayo Clinic (MN) autologous hematopoietic stem cell transplants was an indicator for poor prognosis (hazard ratio 1.88, 95 % confidence (HSCT) for Multiple Myeloma (MM) are performed in an outpatient interval 1.26–2.81, P=0.002). basis and patients consume only an oral ad libitum diet. Current Conclusions literature suggests that calorie/protein needs following HSCT exceed Malnutrition was highly prevalent. Any WL, oral intake, and albumin basal requirements, despite lack of evidence that this improves were the commonest criteria used by RD to detect malnutrition. Physi- outcomes. cians under-recorded nutritional status. Physician and RD agreed on the Objectives: To describe the calorie and protein intake of MM patients prevalence of malnutrition. Malnutrition was an indicator of poor prog- receiving outpatient autologous HSCT,and explore relationships between nosis in cancer. intake and neutrophil engraftment. Methods Intake information from patient food records were reviewed retrospec- tively for adult MM patients who received auto-HSCT 2010–2012. Descriptive statistics were used to describe demographic/clinical charac- MASCC-0104 teristics. Pearson’s correlations were utilized to explore relationships Nutrition between calorie/protein intake and engraftment. Results THE EFFECT OF GINGER (ZINGIBER OFFICINALE The study population (n=230) was predominantly male (56.1 %) ROSCOE) IN PATIENTS WITH THE ANOREXIA CACHEXIA with mean age of 60.6 years (range 35–75 years). At time of SYNDROME (ACS) 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 M. Chasen1,R.Bhargava1 day (18.8±6.3 kcal/kg/day) and mean protein intake of 52.7±20.0 g 1Palliative Care, Bruyere Research Institute, Ottawa, Canada 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 Background and Aims significant weak positive correlations between calorie (r=+0.187, Our aim is (1) To determine effect of oral Ginger administration on p=0.004) and protein intake (r=+0.199, p=0.002) and engraftment, Gastric Myoelectrical activity (GMA) in patients with ACS (2) To eval- but not clinically meaningful given many other variables affecting uate symptoms in patients with ACS as measured by Edmonton symptom engraftment. assessment scale (ESAS), patient generated subjective global assessment (PGSGA) and dyspepsia symptom severity index (DSSI). (3) Tocorrelate level of inflammatory markers and Ghrelin in patients with ACS and Calorie & Protein Intake and Timing of Neutrophil Engraftment impaired GMA. Methods Patients with ACS are recruited to document a baseline and post water Mean ± SD Median Range load Electrogastrography (EGG) after oral ingestion of Ginger capsule Mean daily calorie intake (kcal) (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 Total 1,530.4±452.1 1,516.0 253.0–2,697.0 post intervention. Descriptive statistics of EGG findings will be presented Kcal/kg 18.8±6.3 18.5 3.2–38.5 reflecting the categories of dysfunction. Mean daily protein intake (grams) Results – This study is active. To-date 8 patients (M2;F6; median age 57 years) Total 52.7±20.0 50.7 4.5 109.4 were enrolled and all completed the 14 day trial. EGG Diagnosis before g/kg 0.65±0.26 0.63 0.06–1.48 the intervention: 4 Tachygastria, 3 Bradygastria, 1 Mixed Dysrythmia; Time to neutrophil 15.1±2.5 15.0 10–23 after the 14 day trial with Ginger-All 8 patients had Mixed Dysrythmia- engraftment (days) nonspecific type. All reported improvement in GI symptoms as measured by the DSSI, ESAS and PG-SGA. Results will be analyzed in May 2014. Conclusions Conclusions This study is primarily exploratory as there is no data on pattern of GMA Compared to the general population, study subjects had higher prevalence in response to Ginger in patients with ACS. Preliminary findings suggest of overweight or obesity. A majority of patients did not meet estimated that Ginger probably enhances gastric motility as measured by EGG. By basal energy or protein requirements; however there was no correlation increasing gastric emptying, ginger may improve a range of GI symptoms between calorie or protein intake and engraftment timing that could be that can affect oral intake and quality of life. considered clinically relevant. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S115

MASCC-0390 defined as more than 10 % weight loss compared with pretreatment body Nutrition weight at 6 months after the completion of CCRT. Results Fifteen patients (12.9 %) had BMI of less than 20, initially. After PREVALENCE OF LONG TERM CRITICALWEIGHT LOSS completion of CCRT, absolute and proportional weight loss was AND ITS EFFECT ON TREATMENT OUTCOMES IN PATIENTS 9.0 kg (SD 4.59) and 13.4 % (SD 6.25), respectively. Sixty three WITH HEAD AND NECK CANCERS TREATED WITH patients (54.3 %) had LT-SWL and 19 patients (16.4 %) experienced CONCURRENT CHEMORADIOTHERAPY more than 20 % weight loss at 6 months after completion of CCRT. J. Kim1,S.Park1, D. Yoon1,S.Kim1 The patients who required gastrostomy during CCRT showed in- 1Medical Oncology, Asan Medical Center,Seoul, Korea creased 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 Background and Aims (DFS) (median DFS, 44 months vs not reached p=0.010). The The incidence of long-term severe weight loss (LT-SWL) with its related patients with prophylactic gastrostomy and those without need for clinical factors and its effect on treatment outcomes were investigated in gastrostomy showed longer DFS than those who required patients with locally advanced head and neck cancers (LAHNC) treated gastrostomy during CCRT, respectively (median DFS, not reached with concurrent chemoradiotherapy (CCRT). in both groups vs 10.0 months, p=0.013). On multivariate analysis, Methods LT-SWL was the independent prognostic factor associated with DFS LT-SWL was defined as more than 10 % weight loss compared with (HR 3.01, 95 % CI 1.39–6.51; p=0.005). pretreatment body weight at 6 months after completion of CCRT. Be- Conclusions tween January 2008 and December 2009, a total of 116 patients with Significant proportion of patients treated with CCRT has experi- LAHNCs treated with CCRT in Asan Medical Center was identified LT- enced LT-SWL, and LT-SWL was associated with worse treatment SWL. outcomes. Early nutritional intervention via gastrostomy might be of Results help to ameliorate incidence of LT-SWL in patients with LAHNC Fifteen patients (12.9 %) had BMI of less than 20, initially. After com- receiving CCRT. pletion 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 MASCC-0087 gastrostomy during CCRT showed increased risk of LT-SWL [Hazard Nutrition 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 PATIENT SATISFACTION WITH AN INTENSIVE NUTRITION reached p=0.010). The patients with prophylactic gastrostomy and those INTERVENTION COMPARED TO USUAL CARE IN LUNG without need for gastrostomy showed longer DFS than those who re- CANCER PATIENTS RECEIVING (CHEMO)RADIOTHERAPY quired gastrostomy during CCRT,respectively (median DFS, not reached N. Kiss1, M. Krishnasamy1, K. Gough1, G. Wheeler2, A. Wirth2, in both groups vs 10.0 months, p=0.013). On multivariate analysis, LT- B. Campbell2, E. Isenring3 SWL was the independent prognostic factor associated with DFS (HR 1Department of Cancer Experiences Research, Peter MacCallum Cancer 3.01, 95 % CI 1.39–6.51; p=0.005). Centre, Melbourne, Australia; 2Lung Service, Peter MacCallum Cancer Conclusions Centre, Melbourne, Australia; 3Faculty of Health Sciences and Medicine, Significant proportion of patients treated with CCRT has experienced LT- Bond University, Melbourne, Australia SWL, and LT-SWL was associated with worse treatment outcomes. Early nutritional intervention via gastrostomy might be of help to ameliorate Background and Aims incidence of LT-SWL in patients with LAHNC receiving CCRT. 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. MASCC-0624 Objectives: To determine patient satisfaction with an intensive nutrition Nutrition intervention compared to usual care in lung cancer patients receiving (chemo)radiotherapy. Methods PREVALENCE OF LONG TERM CRITICALWEIGHT LOSS A phase II nutrition intervention study included 24 lung cancer AND ITS EFFECT ON TREATMENT OUTCOMES IN PATIENTS patients randomised to the intervention (n=12) or usual care (n= WITH HEAD AND NECK CANCERS TREATED WITH 12). The intervention employed a care pathway to guide intensive, CONCURRENT CHEMORADIOTHERAPY individualised nutritional management up to 6 weeks post- J. Kim1,S.Park1, D. Yoon1,S.Kim1 radiotherapy. Patient satisfaction was assessed at 6 weeks post- 1Medical Oncology, Asan Medical Center,Seoul, Korea radiotherapy using a valid satisfaction with nutrition services ques- tionnaire. A priori difference of 0.3 is clinically important. Groups Background and Aims were compared using independent t-tests. The incidence of long-term severe weight loss (LT-SWL) and its effect on Results treatment outcomes were investigated in patients with locally advanced Twenty-four patients consented to participate in the study (50 % male, head and neck cancers (LAHNC) treated with concurrent chemoradio- mean age 63.4±12.2 years), 19 completed the study to the end of the therapy (CCRT). intervention period and 14 patients completed the questionnaire (n=7 Methods usual care; n=7 intervention; 74 % response rate). Overall satisfaction We identified 116 patients with LAHNCs treated with CCRT in Asan was rated higher in intervention participants, which was clinically but not Medical Center from January 2008 to December 2009. LT-SWL was statistically significant (4.67±0.82 vs 4.00±0.58, p=0.11). Although not S116 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 statistically significant, patient-perceived health benefit was rated higher wellbeing had improved relative to baseline in both groups and in the intervention arm (4.37±0.64 vs 4.04±0.44, p=0.28). Dietitian between-groups differences were trivial to small. interpersonal skills were rated equally across groups (3.54±0.44 vs 3.54±0.80, p=1.00). Time point/ Maximum likelihood estimates of Between-groups variable within-groups change relative comparison to baseline Usual care Intervention arm Difference Effect Difference Difference (95 %CI) size Dimension Usual care Intervention Mean difference p (95 %CI) (95 %CI) n=7 n=7 (95 %CI) End of radiotheraphy Mean (SD) Mean (SD) Weight (kg) −0.88 (−3.47, 1.71) 2.15 (−0.64, 4.93) 3.0 (−0.8, 6.8) 0.70 Overall 4.00 (0.58) 4.67 (0.82) −0.67 (−1.5, 0.19) 0.11 Fat-free mass (kg) −0.03 (−1.87, 1.81) 0.56 (−1.44, 2.56) 0.6 (−2.1, 3.3) 0.19 satisfaction Physical −2.72 (−5.68, 0.24) −0.63 (−3.85, 2.59) 2.1 (−2.3, 6.5) 0.42 Perceived 4.04 (0.44) 4.37 (0.64) −0.33 (−0.97, 0.31) 0.28 well-being Functional −5.62 (−8.01, −3.22) −0.53 (−3.07, 2.01) 5.1 (1.6, 8.6) 1.29 benefit well-being Interpersonal 3.54 (0.44) 3.54 (0.80) 0.00 (−0.75, 0.75) 1.00 3 months post radiotherapy skills Weight (kg) 0.34 (−4.37, 5.05) 5.82 (0.87, 10.77) 5.5 (−1.4, 12.3) 0.71 Fat-free mass(kg) −0.25 (−1.62, 1.13) 1.24 (−0.24, 2.71) 1.48 (−0.5, 3.5) 0.67 Conclusions Physical well-being 2.96 (−0.32, 6.22) 2.25 (−1.11, 5.61) −0.7 (−5.39, 4.0) 0.13 Patient satisfaction was high in both study arms but higher overall Functional 0.27 (−3.08, 0.56) −1.19 (−4.29, 1.92) −1.4 (−5.8, 2.9) 0.31 satisfaction was observed in the intervention arm, indicating acceptability well-being of an intensive nutrition intervention in lung cancer patients receiving (chemo) radiotherapy. 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 MASCC-0278 CANCER PATIENTS RECEIVING (CHEMO)RADIOTHERAPY Nutrition – A PILOT RANDOMISED CONTROLLED TRIAL EVALUATION OF NUTRITIONAL ASSESSMENT BY N. Kiss1, E. Isenring2, K. Gough1, G. Wheeler3, A. Wirth3, B. Campbell3, RADIOLOGICALLYINSERTED GASTROSTOMY IN HEAD M. Krishnasamy1 AND NECK CANCER PATIENTS 1Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; 2Faculty of Health Sciences and Medicine, G. Gobert1, E. Tresch2, D. Chevalier3, L. Ceugnart4, C. Calcoen5, Bond University, Robina, Australia; 3Lung Service, Peter MacCallum F. Ghestem1,G.Lefebvre1 Cancer Centre, Melbourne, Australia 1Head and Neck Oncology, Oscar Lambret Center, Lille, France; 2Methodology and Biostatistics Unit, Oscar Lambret Center, Lille, France; 3Head Background and Aims and Neck Surgery Department, University Hospital C.Huriez, Lille, Despite a high prevalence of malnutrition, intensive dietary counselling France; 4Radiology Department, Oscar Lambret Center, Lille, France; has not been evaluated in lung cancer patients during (chemo)radiation. 5Supportive Care Department, Oscar Lambret Center,Lille, France Objectives: To evaluate the impact of intensive dietary counselling on nutritional, functional and fatigue outcomes. Background and Aims Methods Enteral nutrition using radiologically inserted gastrostomy (RIG) is cur- A phase II nutritional intervention study included 24 lung cancer rently a widespread technique in oncology. The real efficiency in weight patients randomised to the intervention or usual care. The interven- gain in addition to the life expectancy according to the performance status tion employed a care pathway to guide intensive, individualised (PS) of the patient is controversial, and the incidence of the undesirable nutritional management up to 6 weeks post-radiotherapy. Nutritional effects is unknown. (patient-generated subjective global assessment, weight, fat-free Methods mass) and QOL (FACT-L functional and physical wellbeing) out- This retrospective study focus on patients hospitalised in 2011 and 2012 comes were assessed before randomisation, start and end of radio- for RIG. We collected data at inclusion and after 1 month and 3 months. therapy, at one and 3 months post-radiotherapy. Outcomes were Results analysed with linear mixed models. One hundred twenty-nine patients were included in the study. The most Results frequent indication for RIG was malnutrition (n=79, 62 %). The median Twenty-four participants were recruited (50 % male, mean age 63.4± PS at inclusion was 2 [0–4] (43 % patients included). The median time for 12.2 years). Relative to baseline, intervention patients (n=12) showed hospitalization was 4 days [1–14]. A failure of insertion of the clinically important benefits at the end of radiotherapy compared to usual gastrostomy device occurred for 22 % of the patients (n=28), the most care patients (n=12): weight (3.0 kg; 95 %CI −0.8, 6.8, p=0.11) and fat- common reason was anatomic causes (n=20, 16 %). Digestive tolerance free mass (0.6 kg; 95 %CI −2.1, 3.3, p=0.66) improved, and physical was good (n=87, 96 %). Moderate complications occurred in 53 % (n= (2.1; 95 %CI −2.3, 6.5, p=0.33) and functional wellbeing (5.1; 95 %CI 53), most common cause was accidental removal of the tube (n=26, 1.6, 8.6, p=0.01) deteriorated less. Between-groups difference for func- 26 %). The average gap between the original weight and the normal tional wellbeing was large and statistically significant (p=0.01). Three weight was −11.1 kg (SD=6.8), with a more significant loss in the group months post-radiotherapy, intervention benefits for weight (5.5 kg; of PS≥3versusPS<3(p=0.031). The variation in weight after 1 month 95 %CI −1.4, 12.3, p=0.71) and fat-free mass (1.48 kg; 95 %CI −0.5, compared to the normal weight was also significantly more important in 3.5, p=0.14) were sustained. At this time, physical and functional the group of PS≥3versusPS<3(p=0.033). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S117

Conclusions Background and Aims In our study, the PS at the moment of the insertion was predictive to the Cancer diagnosis and the morbidities associated with cancer therapy can weight change after 1 month compared to the normal weight, with a more give rise to psychological distress and depressive symptoms in patients significant loss in patients with PS≥3. RIG was well tolerated. 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 MASCC-0373 with adjuvant cancer therapy were recruited and randomized either to an Nutrition experimental (homebased relaxation training program including progres- sive muscle relaxation, distraction and guided imagery) or a control ASSOCIATION OF NUTRITIONAL STATUS WITH group. Hospital and Depression Scale (HADS) was completed at baseline CHEMOTHERAPY RELATED ADVERSE EVENTS IN CURA (time 1), at 6 weeks from time 1 (time 2), at 12 weeks from time 1 (time TIVE OPERATED GASTRIC CANCER PATIENTS 3), and at 24 weeks from time 1 (time 4). Results S.H. Seo1,Y.K.Kang2,B.Y.Ryoo2,M.H.Ryu2, J.H. Jeong2,S.S.Kang1, One hundred forty-three subjects (mean age 54 years; 75 % with breast J.E. Lee3,M.K.Sung3 cancer) were accrued and randomized into experimental (n=72) or con- 1Dietetics and Nutrition Services Team, Asan Medical Cencer, Seoul, trol (n=71) group. Subject characteristics and HADS scores were equiv- Korea; 2Oncology, Asan Medical Cencer University of Ulsan College of alent at baseline. The mean HADS-A and HADS-D scores of both groups Medicine, Seoul, Korea; 3Food and Nutrition, Sookmyung Women’s Uni- varied significantly across the study points (p<0.01). In general, the versity, Seoul, Korea patterns of HADS-A and HADS-D scores were similar in the two groups, which peaked on time 2 and 3. Background and Aims Comparison between the groups showed that subjects in the experimental Gastric cancer patients who underwent gastrectomy often experience the group reported lower mean HADS-A and HADS-D scores than the increased susceptibility to chemotherapy-related side effects as well as the control group at time 2–3, but the differences were not significant decreased treatment responses. It is critical to perceive the rate of malnutrition (p>0.05). There was statistically significant difference in the mean in gastrectomized patients receiving chemotherapy and to identify indices of HADS-A and HADS-D scores between the groups at time 4 (p<0.05). malnutrition predicting the susceptibility to chemotherapy-related adverse Conclusions events. Tthe objective of this study was to determine malnutrition indices The finding suggests that relaxation training program may reduce the closely related to the side-effects in patients receiving chemotherapy. levels of anxiety and depression at 24 weeks. 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 MASCC-0350 weight, body mass index (BMI), serum albumin concentration and nutri- Oncology Nursing tion risk index (NRI). Chemotherapy-originated adverse events were determined during the entire treatment period. PARENTAL DECISION MAKING AND QUALITY OF LIFE IN Results CHILDREN WITH CANCER The mean age of the patients was 55 years-old (25 to 78 years-old) and M. Chen1, H.S. Yang2, L.H. Hung3,W.Y.Wu3, Y.L. Lee3, K.G. Yao4, 59 % of the patients were malnourished based on and 27.8 % of the Y.C. Chang5 patients revealed the PG-SGA score of ≥9, an indicator of serious malnu- 1Nursing, Tzu Chi College of Technology, Hualien, Taiwan; 2medical trition. Multivariate analysis using binary logistic regression showed that college, Tzu Chi university, Hualien, Taiwan; 3Nursing, National Taiwan female, lower BMI, and hypoalbuminemia were independent risk factors University, Taipei, Taiwan; 4Psychology, National Taiwan University, for grade 3/4 hematologic adverse events and that the old age was a risk Taipei, Taiwan; 5Mathematics, Tamkang University, Taipei, Taiwan factor for grade 3/4 nonhematologic adverse events. Neutropenia was the most frequently occurring hematological adverse event and associated risk Background and Aims factors were female, total gastrectomy and hypoalbuminemia. To understand how the cancer treatment decisions, and how the cultural Conclusions context of eastern Taiwan affect the quality of life of parents when their Proper nutrition intervention to retain body mass index and children are hospitalized. It is important of these integrations into the hypoabluminemia before starting chemotherapy may increase the success daily lives, as well as to serve as a reference for medical care. rate of chemotherapy in gastrectomized cancer patients. Methods There are a total of ten parents participating in this quantitative research. By In-depth interviews and focus group discussions. MASCC-0241 Results Oncology Nursing 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: A LONGITUDINAL STUDY OF THE EFFECTS OF They are concerned about (a) the side effects of the treatments on HOME-BASED RELAXATION TRAINING PROGRAM ON the children, and (b) the children’s emotional changes under the ANXIETYAND DEPRESSION FOR PATIENTS WITH BREAST invasive treatments; Feeling guilty when the other children in the AND COLORECTAL CANCER family are being neglected; Feeling difficult reconciling the de- K. Cheng1,N.Chan2, C. Chan3,N.K.E.Ang4 mands of work and caring for the sick children. (3) The changes 1Nursing, National University of Singapore, Singapore, Singapore; in everyday lives: the diets are mainly composed of self-grown 2Medicine, National University Cancer Institute, Singapore, Singapore; food; Timely isolations in the home environments; Living in one’s 3Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong tribe. (4) Using the support system: the mutual support among China; 4Nursing, National University Cancer Institute, Singapore, Singapore couples, siblings, and paramedical staff. S118 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Background and Aims They hope that the health of their children can be improved given that (1) This study aims at examining the helpfulness of a support group program the treatments are done in nearby hospitals; (2) they can spend more time for the families of outpatients undergoing chemotherapy for cancer. with their children; and (3) there are changes in the way of living. It is Methods recommended that the family members and paramedical staff be the The program consists of three sessions according to its three goals: 1) positive force supporting the healing of the children. 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 infor- MASCC-0375 mation and knowledge, and relaxation. Four nurses, a physical therapist Oncology Nursing and a dietitian worked together in conducting a pretest of the program. Results THE EFFECT OF MINDFULNESS-BASED STRESS Family members of four outpatients with cancer participated the program. REDUCTION PROGRAM ON PHYSICAL, PSYCHOLOGICAL Regarding the participants, the T-score for vigor in the Profile of Mood States STATUS AND QUALITY OF LIFE FOR PATIENTS WITH (POMS), which was 38.3 before they participated in the program, increased to METASTATIC BREAST CANCER 45.7 after the program. Also on Ozeki’s Coping Scale, the scores for emotion- focused coping and avoidance coping decreased from 5.66 to 3.66 and from L. Chung Eun1, L. Soohyeon2,K.SangHee3,K.Sue3, J. Hye Myung4 6.33 to 3, respectively. The participants were asked how they were caring for 1Medical oncology outpatient clinic, Yonsei cancer center Yonsei their own health. After the program, the number of participants who answered Univertiy Health System, Seoul, Korea; 2Yonsei University College of ‘It would be better if I didn’t express my own mental distress’ and ‘I’mnot Medicine, Division of Oncology Department of Internal Medicine, Seoul, supporting the patient sufficiently’ decreased, and the number of participants Korea; 3Yonsei University College of Nursing, Department of Clinical who answered ‘ThemoreI’m informed, the better I can cope’ increased. Nursing, Seoul, Korea; 4Instructor,Mindfulness Institute, Seoul, Korea Conclusions The pretest result suggests the helpfulness of the support group program Background and Aims as well as the situations that make it difficult for family members to take This study is to intervene metastatic breast cancer (MBC) patients under part in this kind of program. 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 psycho- logical status with MBC patients. MASCC-0355 Methods Oncology Nursing The MBSR program was conducted once a week, 2 h each, for 8 weeks at YonseiCancer center outpatient clinic in Korea from May 14th to August 21th NURSES’ RECOGNITION OF TEAM MEDICAL CARE THAT in 2013. Total 18 patients were assigned to both MBSR group and control SUPPORTS OUTPATIENTS UNDERGOING CHEMOTHERAPY arm. We assessed pain (Brief Pain Inventory, BPI), autonomic nervous func- FOR CANCER tion (Heart rate variability), anxiety and depression (Hospital Anxiety and H. narui1,N.hira2,T.honma1, A. denpoya1,G.urita1 Depression Scale, HADS), distress (distress thermometer), and quality of life 1Department of Nursing Faculty of Health Sciences, Aomori University of (Functional Assessment of Cancer Therapy–Breast, FACT-B) This data was Health and Welfare, Aomori, Japan; 2School of Nursing and Social assessed by of using nonparametric statistics because of insufficient number. Services, Health Sciences University of Hokkaido, Tobetsucho, Japan Results Average pain score slightly decreased (p=0.080), general activity, sleep, Background and Aims and enjoyment of life were improved (p=0.049, p=0.042, p=0.045 The research investigates how nurses recognize team medical care that respectively) between groups. Within MBSR-group, the mean of SDNN provides support to outpatients undergoing chemotherapy for cancer. showed improved tendency from 24.84 to 59.95 (p=0.051), DT was Methods significantly improved from 4.89 to 3.56 (p=0.042), and functional Research participants were 10 nurses taking care of outpatients undergo- well-being was increased (p=0.037). This study did not showed improve- ing chemotherapy for cancer. Data was collected in an interview survey, ment in anxiety, depression and quality of life. with the data being analyzed qualitatively and inductively. The ethics Conclusions boards of the university and the hospital approved of the study. The MBSR program had some mild effect to improve physical status and Results alleviate distress. All of them were satisfied with the MBSR program, felt The views were summarized in eight items, among which were the improved sleep quality and wanted to maintain the peer group activities following: 1) comprehensive support provided by health care profes- though the interview. Therefore, there should be the supportive interven- sionals from multiple fields who make a holistic assessment of each tion to help the MBC patients. 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 MASCC-0314 serve as coordinators who help the health care professionals from diverse Oncology Nursing 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. STUDY ON THE HELPFULNESS OF SUPPORT GROUPS FOR Conclusions THE FAMILIES OF OUTPATIENTS UNDERGOING The nurses hold the view that medical care teams for supporting outpatients CHEMOTHERAPY FOR CANCER undergoing chemotherapy for cancer should be interdisciplinary ones that N. Hira1,F. Karatsu1, I. Tanaka2,H.Narui3 place a high value on the process of reaching a mutual understanding among 1Nursing and Social Services, Health Sciences University of Hokkaido, team members, who work on equal terms. The nurses also consider it Tobetsu, Japan; 2Nursing, Teine Keijinkai Hospital, Sapporo, Japan; necessary that nurses be allowed to serve as coordinators who help the health 3Nursing, Aomori University of Health and Welfare, Aomori, Japan care professionals from diverse fields on medical care teams. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S119

MASCC-0511 loss and sadness when caring for the dying. They were inexperienced in Oncology Nursing psychological care and how to communicate with the dying, but tried their best at promoting comfort and maintaining dignity for patients and family members. SUPPORTIVE CARE NEEDS IN PATIENTS WITH LUNG Conclusions CANCER Nurses suffered but also benefited from their experiences. The more years K. Suwannapong1, S. Thanasilp1 that nurses have been working with dying patients, the more positive the 1Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand experience becomes. End-of-life care trainings are needed by Chinese oncology nurses, especially for younger and less experienced ones. 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 MASCC-0019 provided the appropriate resources for help. The purpose of this study Oncology Nursing 2 was to identify component of the supportive care needs for Thai patients with lung cancer. ASSESSING SYMPTOM USING AWEB-BASED SURVEY Methods PLATFORM AMONG CHINESE ONCOLOGY PATIENTS A total of 193 lung cancer patients who aged 20–59 year, attended at C. Chan1,K.Kwong2,W.So1,K.M.Chow1,J.Sit1 outpatient oncology units of tertiary hospitals in Bangkok, Thailand 1Nursing, The Chinese University of Hong Kong, Hong Kong, Hong participated in this study by completing a Supportive Care Needs Survey Kong China; 2Nursing, National University of Singaporre, Singapore, Short Form 34 (SCNS-SF34) questionnaire (Thai version). Principal Singapore factor analysis was used to identify component of the supportive care needs. Background and Aims Results This paper aimed to report a pilot study of using an electronic self-report The results found that supportive care needs in Thai patients with lung symptom assessment tool among Chinese oncology patients undergoing cancer comprise of five components with 81.84 % of variance explained. cancer therapy. Physical and daily living needs (5 items), Psychological needs (9 items), Methods Health information needs (9 items), Caring (Self-care & treatment) needs A web-based survey platform, the Electronic Self Report Assessment – (7 items), and Health system needs (4 items). Cancer (ESRA-C), developed by The University of Washington, Distrib- Conclusions uted Health Assessment and Intervention Research (DHAIR) group, was Oncology nurses should emphasize in terms of these naturally compo- translated and adapted into Chinese and tested in a cancer resource centre nents of supportive care needs when conducting intervention. Future in Hong Kong. The assessment of the severity and impacts of the researches are offered to find the factors effecting on supportive care symptoms was undertaken using four measures: quality of life (EORTC needs and the intervention for improving patients‘ needs of lung cancer QLQ-30 v.3), symptom distress (Symptom Distress Scale (SDS)), pain patients. (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 MASCC-0524 was assessed. Participants had very low scores on pain, symptoms, and Oncology Nursing 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= DOING ONE’S UTTERMOST: NURSES EXPERIENCES ON 22.57 (SD: 7.34), PHQ-9-overall depression scale=5.46 (SD: 5.8). CARING FOR DYING PATIENTS IN MAINLAND CHINA Conclusions The study suggested that electronic assessment can offer a feasible means R.Z. Zheng1,Q.G.Guo2,F.D. Dong3,G.O.Owens4 of implementing regular and comprehensive symptom assessment, which 1Department of Hepatobiliary Cancer,Tianjin Medical University Cancer can lead to better symptom management in cancer patients. 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 MASCC-0239 Oncology Nursing 2 Background and Aims Caring for dying patients may be very stressful for nurses. However, little A LONGITUDINAL STUDY OF THE SYMPTOM AND is known about Chinese oncology nurses’ experience of caring for dying QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH cancer patients. This study aims to elucidate the views of Chinese nurses’ CANCER experiences in caring for dying cancer patients who are on their final days. Methods K. Cheng1, C. Chan2,L.T.M.Tan3 A phenomenological study using a qualitative approach with semi- 1Nursing, National University of Singapore, Singapore, Singapore; structured interviews was utilized to explore views of convenient sample 2Nursing, The Chinese University of Hong Kong, Hong Kong, Hong of 23 nurses who have taken care of terminally ill patients in a cancer Kong China; 3Viva University Children Cancer Centre, National Univer- hospital in Tianjin, mainland China. Thematic analysis was used to sity Hospital, Singapore, Singapore analyze the data. Results Background and Aims Subjects expressed negative experiences and feelings when caring for To characterize the symptoms reported by cancer patients who were dying cancer patients. Nurses, especially the younger and inexperienced between 10 and 18 years of age, and to explore the relationship between ones reported feelings of fear, stress, and helplessness along with sense of symptom and quality of life (QoL) scores. S120 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0203 Thirty-one children (mean age, 14 years; 65 % was boys) diagnosed with Oncology Nursing 2 hematological malignancy (71 %) and solid tumor (29 %) were enrolled for analysis. Data were collected before commencement of chemotherapy THE TENOVUS ALLWALES NURSE-LED CANCER (time 1), at 2 months from time 1 (T2), at 4 months from time 1 (T3), and CALLBACK SERVICE at 6 months from time 1 (T4). Measuring instruments included Memorial Symptom Assessment Scale Pediatric 10–18 (MSAS) and Pediatric Can- P. Gill1,R.Skilton1,R.Iredale1 cer QoL Inventory. 1Cancer Support Team, Tenovus, Cardiff, United Kingdom Results The prevalence of symptoms ranged from 71 % for lack of energy to 3 % Background and Aims for diarrhea at T1. Early diagnoses and treatments have resulted in increased demands on The most common reporting symptoms (>45 %) were lack of existing cancer services. There are particular concerns about how effective energy, weight loss, lack of appetite, pain, dry mouth, nausea and and sustainable aspects of current UK hospital-based follow-up services are. feeling of sadness, and they decreased to 36 %, 23 %, 26 %, 13 %, Emerging evidence indicates that a dedicated telephone follow-up service 7 %, 26 % and 13 %, respectively, at T4. The median score for the may be helpful, although its use in an oncology setting is limited. This MSAS Physical (PHY) was the highest at T1 (0.85). All of the paper provides an overview of the innovative Tenovus, nurse-led cancer MSAS subscale and total scores decreased significantly over time callback project. (p<0.01). The median score for the Physical QoL was the lowest at Methods baseline (66.6), and it decreased significantly at T2 and T3 Seven hundred eleven cancer patients were purposively recruited into the (p<0.05). Significant strong correlations were noted between MSAS project via referrals from relevant health professionals and other Tenovus PSYCH and GDI scores, and Emotional and Psychosocial Health support services. Participants received dedicated phone calls from oncol- across study points (r>0.55; p<0.01). ogy nurses at 1 week, 1 month and 6 months after registration. Patients Conclusions were provided with information, advice and support regarding their Symptoms are highly prevalent but are in a descending pattern over time. condition, treatment and other relevant issues. Following each call, pa- The data also support the correlations between psychological symptoms tients were sent a questionnaire, which explored their views of the and the emotional sphere of QoL. callback service. Quantitative and qualitative data were respectively analysed descriptively and thematically. Results Two hundred sixty (37 %) completed survey one questionnaires were MASCC-0089 returned. Most participants (>70 %) were female and the most common Oncology Nursing 2 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 LUNG CANCER SCREENING: IS ITALL SMOKE? timing of calls were appropriate and subsequently rated the service as A. Devigne1, S.K. Keaveney1,N.R.Rizk1 good or excellent. Participants also found the service to be informative, 1Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York reassuring and supportive. City, USA Conclusions The project ends in summer 2014, evaluation is therefore ongoing. Early Background and Aims indications are that the callback service offers considerable potential for Lung cancer is the number one cause of cancer deaths in the US and supporting cancer patients and existing cancer services. 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 MASCC-0009 dose CT scan as a screening method. Findings from the study Oncology Nursing 2 resulted in a 20 % reduction in lung cancer mortality. At this NCI designated cancer center, our objective was to create a screening DEPRESSION, PAIN, SOCIAL SUPPORT, GENERAL program based on the results of the NLST using low dose CT scans INFORMATION IN PATIENTS WITH NON-SMALL CELL for at risk patients. LUNG CANCER Methods A pilot program was conducted from June to August 2013 enrolling L.L. Hou1, F.Gu1 former and current 30 pack year smokers aged 55 to 74. Each participant 1Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, met a nurse practitioner (NP) prior to their scan. Scans were read by a China thoracic radiologist. The NP reviewed the results with a thoracic surgeon and relayed the results to the participant. Background and Aims Results Background: Lung cancer is a disease with poor prognosis and psycho- To date, approximately 45 participants were screened. Although no lung logical impact. Lung cancer causes both physical and psychological cancers were detected, approximately 20 % of the scans demonstrated an burden on patients, and financial burden on families and society. abnormality requiring further evaluation. Objective: The aim of this study was to investigate the main factors Conclusions associated with depression among patients with lung cancer. Screening with a low dose CTscan can prevent lung cancer deaths among Methods this high risk population. Based on our pilot, we have established an Methods: Quantitative study was used in this study. The data was obtained ongoing NP screening program. We propose to expand the program from Shanghai Pulmonary Hospital in China. There were 104 in-patients beyond its current scope by: lowering the cost, offering flexible hours with non-small cell lung cancer surveyed. Self-rating depression scale (SDS), for participants, hiring a full time NP and increasing the funding for social support with the social support revalued scale (SSRS) and body pain marketing. with the visual analog scale (VAS)wereusedinthispaper. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S121

Results Background and Aims Results: Among the 104 patients, 16 (15.8 %) were diagnosed with Background: Recently, early movement on bed was encouraged to depression. Pain, age, marital status, education and the times of chemo- promote gastrointestinal function recovery. However, due to old ages therapy received as well as subjective supports were significantly associ- and weak physical strength, the effects remain limited. Objective: To ated with depression. evaluate the effects of electric stimulation to acupoints on gastrointestinal Conclusions hormones and motility among old postoperative patients with gastroin- Conclusions: Social supports have impact on depression among patients testinal tumors and explore an efficient and noninvasive method for with lung cancer. Effective social supports could decrease the incidence of postoperative recovery of bowl functions. Design: Randomized control depression and pain. Health care providers should give focused social and intervention study. supports to help patients to have positive attitude and increase compliance. Methods Nurses should provide focused intervention care according to pain, che- Participants: We selected 40 old patients with gastrointestinal tumors motherapy, age, education and marital status as well as subjective supports. 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 MASCC-0137 patients in the AES group received regular nursing care plus electric stim- Oncology Nursing 2 ulation on acupoints. Weevaluated the serum concentration of gastrin(GAS), motilin(MOT), cholecystokinin(CCK) and electrogastrogram(EGG) on the NURSE PRESCRIBING: THE EXPERIENCE OFA PALLIATIVE first, third and fifth day after surgery. We also recorded the anal exhaust time CARE CLINICAL NURSE SPECIALIST IN A UK CANCER and the number of cases with such gastrointestinal function disorders as CENTRE abdominal pain, abdominal distention and diarrhea. Results S. Hall1 Results: Comparison between two groups in GAS, MOT, EGG, the anal 1Supportive & Palliative Care, Royal Surrey County Hospital/St Luke’s exhaust time, abdominal pain, abdominal distention and diarrhea showed Cancer Centre, Guildford, United Kingdom significant statistical difference (P<0.05). Conclusions Background and Aims Conclusion: Electric stimulation on acupoints could increase postopera- In the UK, nurses have the authority to prescribe after completion of a tive GAS, MOT levels, promote recovery of gastrointestinal functions and recognised accredited prescribing course through a UK university. Nev- decrease complications among senile patients with gastrointestinal tumors. ertheless, 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 pre- scribing undertaken by a newly qualified Independent Nurse Prescriber (INP)/Clinical Nurse Specialist (CNS) in Palliative Care during the first MASCC-0106 year of practice in a UK cancer centre. Oncology Nursing 2 Methods The CNS prospectively recorded all inpatient/outpatient consultations COMMUNICATION OF BAD NEWS: EXPERIENCE OF and whether or not a prescription was written: if a prescription was MOTHERS OF CHILDREN AND ADOLESCENTS WITH written, then the drugs were recorded; if a prescription was not written, CANCER then the reason was recorded. T. B . M e l l o 1, L.C. Nascimento1,G.Dupas2, R.A.G. Lima1 Results 1Maternal-Infant and Public Health, School of Nursing University of São In the first year, the CNS undertook 256 inpatient consultations, and Paulo Ribeirão Preto Brazil, Ribeirão Preto, Brazil; 2Enfermagem, prescribed on 121 occasions; the reasons for not prescribing were: 1) no Universidade Federal de São Carlos, São Carlos, Brazil indication for prescription - 99 2) CNS reluctant to prescribe relevant drug (advice given) - 10; 3) CNS sought second opinion from consultant - 5; 4) Background and Aims issues with acceptance of INP by primary medical team - 19; 5) issues In oncology, the transmission of difficult news is a frequent event and with acceptance of INP by patient/family - 2. The most commonly complaints by patients and family members who received bad news about prescribed drugs were opioids, anti-emetics, anti-secretory agents, anti- their health in an inappropriate manner are not uncommon. Objective: psychotic agents, and oral care products (data to be presented). Describe the experience of mothers of children and adolescents with Conclusions cancer facing the communication of bad news. The ability to prescribe supportive care drugs significantly enhances the Methods role of the CNS in Palliative Care, and can lead to more timely/ This descriptive and exploratory study was conducted using qualitative appropriate management of pain and other symptoms. 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 MASCC-0010 the groups was based on the following questions: what did they consider Oncology Nursing 2 as difficult news; examples of difficult news and who communicated them. Thematic content analysis of the empirical material was carried out. Results EFFECTS OF ELECTRIC STIMULATION TO ACUPOINTS ON Organized considering three themes: Communication of bad news, de- GASTROINTESTINAL HORMONES AND MOTILITYAMONG scribed based on the disclosure of the cancer diagnosis, how it was OLD POSTOPERATIVE PATIENTS WITH GAST communicated, and how the news was understood; Revealing the news ROINTESTINALTUMORS to children and adolescents, comprising the communication with children L. Hou1,F.Gu1 and adolescents, those involved in disclosing the diagnosis, as well as self- 1Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, care and decision-making; Communication of palliative care, refers to China communication the change from curative care to palliative care. Bad news S122 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 related to the diagnosis of relapse, mutilating surgeries, the toxicity of to examine the extent to which colon cancer patients experience illness- chemotherapy and radiotherapy, and palliative care were also considered. related uncertainty and, thereby, generate baseline data for the conceptu- Conclusions alization of tailored uncertainty management interventions. The study can contribute to understand the experience of these mothers with a Methods view to producing healthcare that meets the real needs of children and adoles- A cross-sectional descriptive study was conducted in a convenience sample of cents with cancer and their parents facing the communication of bad news. colon cancer patients (n=54) currently undergoing chemotherapeutic treat- ment. Uncertainty was measured using the adult form of the Mishel Uncer- tainty in Illness Scale (MUIS-A). Data collection included a variety of socio- demographic variables as well as illness- and treatment-related variables. MASCC-0154 Results Oncology Nursing 2 The MUIS-Awas completed by 26 male and 20 female patients. Prelim- inary analysis revealed moderate levels of uncertainty in the overall sample DIFFERENCES IN SYMPTOM OCCURRENCE RATES (n=46), with slightly greater uncertainty perceived by women, compared BETWEEN PATIENTS WITH GASTROINTESTINAL CANCER to men. Female patients scored considerably higher in the complexity and WHO ARE AND ARE NOT RECEIVING TARGETED unpredictability subscales of the MUIS-A. Higher levels of education THERAPIES equated to lower levels of uncertainty. Patients 45 years of age and below experienced lower levels of uncertainty than patients aged 66 and above. I. Tantoy1,K.Kober1,L.Dunn2, S. Paul1,B.Cooper1,B.Aouizerat1, Patients who had undergone surgery prior to chemotherapy appeared to C. Miaskowski1 perceive higher levels of uncertainty, as did patients with a colostomy. 1School of Nursing, University of California San Francisco, San Conclusions Francisco, USA; 2School of Medicine, University of California San Preliminary results appear to be in line with previous research findings Francisco, San Francisco, USA and show socio-demographic and treatment-specific differences in the uncertainty experience of colon cancer patients. The results highlight the Background and Aims importance of tailored uncertainty management interventions to meet the Gastrointestinal cancers account for about 20 % of new cancer cases in individual needs of the patients. the US. Depending on the patient’s stage of disease and previous re- sponses 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 MASCC-0084 a targeted therapy using a comprehensive symptom inventory. Oncology Nursing 2 Study purposes were to evaluate for differences in the total number of symptoms and symptom occurrence rates for patients who did and did not NURSE-LED MANAGEMENT OF HYPERSENSITIVITY received a targeted therapy as part of their CTX regimen. REACTIONS IN LUNG CANCER PATIENTS WHO RECEIVING Methods CHEMOTHERAPY IN TAXANE GROUPS Patients (n=157) were enrolled prior to their next cycle of CTX. Patients K. Wangnum1,P. Piyabandidgool1,W.Damrongrajasak1,B.Panmeesub1, completed self-report questionnaires including the Memorial Symptom O. Wongsa1,K.Suppasun1 Assessment Scale (with 38 symptoms). Between group differences in 1Chemotherapy Unit, Rajavithi Hospital, Bangkok, Thailand total number of symptoms and symptom occurrence rates were evaluated using independent student’s t-tests and Chi square analyses, respectively. Background and Aims Results Adverse event in patients with lung cancer during chemotherapy in Compared to patients who did not receive a targeted therapy (69.2 %), taxane group had hypersensitivity reactions symptoms were recorded in patients on a targeted therapy (30.8 %) were significantly younger and the incidence report during 2011–2013. There were dyspnea, difficult had a higher number of metastatic sites. No between group differences breathing and facial flushing from 37 events. Clinical tracer to the process were found in the total number of symptoms (i.e., 12.9±6.7) or in the of care with gap analysis, found that the risk for HSRs of lung cancer occurrence rates for any of the MSAS symptoms. patients including; severe malnutrition, sleep disturbance or insomnia due Conclusions to the symptoms of disease, and fasting in the morning for early chemo- Whether or not a patient receives a targeted therapy for gastrointestinal cancer, therapy administration. In addition the surveillance of care is not good they experience a high symptom burden at the initiation of CTX. For the total enough. We would like to develop management processes for effective sample, the five most common symptoms were: lack of energy, pain, diffi- care and to reduce adverse event of hypersensitivity and there is no culty sleeping, numbness and tinglinginthehandsandfeet,andnausea. anaphylactic shock of 2 years (2013–2014). Methods Review the incidental report 37 events since 2011–2013. Clinical tracer to MASCC-0224 process of care, root cause analysis, gaps analysis and learned from the Oncology Nursing 2 experience to detect the risk factors with adjust nursing practice guideline by evidence based practices. Results ILLNESS-RELATED UNCERTAINTY IN COLON CANCER The most of HSRs by paclitaxel 30 events from total 1,110 of paclitaxel PAT I E N T S – PRELIMINARY RESULTSOFA administrations (2.70 %), followed by docetaxel 7 events from total 785 CROSS-SECTIONAL DESCRIPTIVE STUDY docetaxel administrations (0.89 %). Risk factors for anaphylactic shock M. Wallner1,H.Mayer1 are metastatic disease and weight loss 10 kg within 3 months. There was 1Department of Nursing Science, University of Vienna, Vienna, Austria one patient with anaphylactic shock and died in 2011 and one anaphy- lactic shock with moved to ICU and recovery one person in 2012. There Background and Aims was no anaphylactic shock in 2013. Uncertainty is a prevailing experience in cancer patients. While colon Conclusions cancer is among the most prevalent types of cancer worldwide, little is Hypersensitivity reactions induced by taxane groups were decreased after known about illness-related uncertainty in these patients. This study aims management of risk with development of nursing care processes. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S123

MASCC-0186 selective GLP-2 receptor agonist, is considered a potential treatment to Other improve these gastrointestinal cellular effects. Aim: Todetermine if elsiglutide reduces apoptosis and inflammation, and increases proliferation in the small intestinal crypts of the rat, following THE NEW SELECTIVE GLP-2 RECEPTOR AGONIST, irinotecan administration. ELSIGLUTIDE, IMPROVES IRINOTECAN-INDUCED Methods DIARRHOEA AND MUCOSITIS IN THE RAT Dark Agouti rats were given irinotecan once (200 mg/kg, 0 h) and B. Mayo1, E. Bateman2, A. Stringer1,E.Plews2, A. Wignall2, B. Wozniak2, elsiglutide (0.9 mg/kg or 1.8 mg/kg per day, sc) for 5 days, and killed at I. White3, C. Pietra4, S. Cantoreggi4,D.Keefe2 6, 72 or 120 h (n=6). Markers for apoptosis (Caspase-3), proliferation 1School of Pharmacy and Medical Sciences, University of South Austra- (Ki67) and inflammation (myeloperoxidase, MPO) were analysed using lia, Adelaide, Australia; 2Discipline of Medicine, University of Adelaide, immunohistochemistry in the jejunum and ileum. Positive stained cells Adelaide, Australia; 3School of Medical Sciences, University of Adelaide, were counted per crypt or field of view. Adelaide, Australia; 4Research and Development, Helsinn Healthcare Results SA, Lugano, Switzerland 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) Background and Aims compared with irinotecan control (Jejunum 14.84±1.15; Ileum 22.49±1.08 Elsiglutide has been shown to decrease diarrhoea and gastrointestinal (GI) cells/crypt). Proliferation was significantly increased at 72 h (peak damage) in damage caused by irinotecan administration. Previous results showed that this group (Jejunum 31.45±2.78; Ileum 28.47±2.64) compared with irinotecan 0.9 mg/kg/day sc (5 days) was more effective than 1.8 mg/kg sc of alone (Jejunum 18.98±2.13; Ileum 18.64±1.62). Preliminary results also elsiglutide, suggesting a bell-shape response. indicate that 0.9 mg/kg/day elsiglutide reduces the number of MPO positive Aim: To test whether a lower dose of elsiglutide further improves the GI inflammatory cells in the small intestine following irinotecan administration. toxicity of irinotecan in a rat model of irinotecan-induced mucositis. Conclusions Methods Elsiglutide (0.9 mg/kg/day) decreases apoptosis and inflammation, which A Dark Agouti rat model of irinotecan-induced mucositis was used to may be contributors to irinotecan-induced GIM. In addition, elsiglutide characterise effects of lower dose elsiglutide on irinotecan-induced diar- improves proliferation of crypt cells, which may shorten the duration of rhoea and GI damage. Animals received 200 mg/kg intraperitoneal GIM. These results provide a basis for future studies with elsiglutide to irinotecan, and daily sc dosing of 0.45 mg/kg elsiglutide for 5 days, then determine the exact mechanisms for this phenomenon. 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 MASCC-0463 increased significantly (p<0.05) following elsiglutide with irinotecan (3.75± Pain 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 RELATIONSHIP BETWEEN EFFECTIVE DOSES OF FENTAN enterocyte disruption improved, and inflammation decreased following YL SUBLINGUAL SPRAYAND AROUND-THE-CLOCK TRAN elsiglutide and irinotecan compared with irinotecan alone. Villous area sig- SDERMAL FENTANYL IN PATIENTS WITH nificantly increased (mm2, p<0.05) at 72 h following elsiglutide with BREAKTHROUGH CANCER PAIN 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). D. Alberts1,D.VonHoff2, N. Forman3,L.Dillaha3,R.Rauck4 Conclusions 1Medicine, University of Arizona Cancer Center, Tucson, USA; 2N/A, Transla- Elsiglutide 0.45 mg/kg/day following irinotecan administration may protect tional Genomics Research Institute, Phoenix, USA; 3N/A, INSYS Therapeutics, against and reduce damage to the small intestine. This preliminary data suggests Phoenix, USA; 4N/A, The Center for Clinical Research, Winston-Salem, USA 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 Background and Aims are required to explain the variations and to explore a range of effective doses. Fentanyl sublingual spray is used for the treatment of breakthrough cancer pain (BTCP) in opioid-tolerant patients who receive around-the- clock (ATC) opioids. This exploratory analysis determined the relation- ship between the dose of ATC transdermal fentanyl and the effective dose MASCC-0188 of fentanyl sublingual spray during the open-label titration phase of a Other previously published phase 3, randomized, placebo-controlled trial. Methods APOPTOSIS, PROLIFERATION AND INFLAMMATION ARE Opioid-tolerant adults receiving ATC opioids for baseline pain were enrolled IMPROVED AFTER TREATMENT WITH THE NEW in a 26-day open-label titration phase (N=130). This retrospective analysis SELECTIVE GLP-2 RECEPTOR AGONIST, ELSIGLUTIDE, IN focuses on the 32 patients who received ATC transdermal fentanyl during the A RAT MODEL OF IRINOTECAN-INDUCED MUCOSITIS titration phase of the trial. Pearson correlation analyses were conducted for B. Mayo1, A. Stringer1, E. Bateman2,J.Bowen3, C. Pietra4,S. the final and average transdermal fentanyl dose during the titration phase. Cantoreggi4,D.Keefe2 Results 1School of Pharmacy and Medical Sciences, University of South Austra- At the end of the titration phase, fentanyl sublingual spray showed a low lia, Adelaide, Australia; 2Discipline of Medicine, University of Adelaide, level of correlation with transdermal fentanyl in each analysis (Pearson Adelaide, Australia; 3School of Medical Sciences, University of Adelaide, correlation coefficient r=0.360,n=32,P=0.0433 for final dose; r=0.390, Adelaide, Australia; 4Research and Development, Helsinn Healthcare n=32, P=0.0275 for average dose). Specifically, final transdermal fenta- SA, Lugano, Switzerland nyl doses at the end of titration and mean effective fentanyl sublingual spray dose during double-blind treatment were, respectively: <50 mcg/h, Background and Aims 550 mcg (n=8); 50 to <100 mcg/h, 1,000 mcg (n=11); 100 to <150 mcg/h, Apoptosis, inflammation and decreased proliferation are associated with 933 mcg (n=9); 150 to <200 mcg/h, 800 mcg (n=1); 200 to <250 mcg/h, irinotecan-induced gastrointestinal mucositis (GIM). Elsiglutide, a 1,400 mcg (n=2); and ≥250 mcg/h, 1,200 mcg (n=1). S124 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Methods The results of these exploratory analyses showed no clinically meaningful We retrospectively analyzed 100 patients. We followed WHO analgesic correlation between the average or final doses of transdermal fentanyl and ladder. We analyzed the benefits of step I, II & III by Visual analogue fentanyl sublingual spray. This is consistent with previous analyses of score and also analyzed the reasons for under-treatment. other transmucosal immediate-release fentanyl products. 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 MASCC-0153 neuropathic pain & 20 % are having treatment related pain. Only 12 of Pain these patients (15 %) had adequate pain control, 68 patients (85 %) had no adequate pain relief. The mean duration of patients came with pain after SOURCES OF PAIN IN A PATIENT WITH METASTATIC starting step 1 is between 5 and 15 days. Once we started step 2 for these PROSTATE CANCER TO BONE AND MULTIPLE patients, patients having VAS score >6 to 9 it came under <5 almost in CO-MORBIDITIES 80 % of our patients, still 20 % are not responding due to various reasons. Conclusions E. Bain1, N. Pulenzas1, M. Popovic1, B. Lechner1, G. Bedard1,P. Our study questioned the justification for a need of overstaying in step 1 Sheehan1, L. Holden1, E. Wong1,R.McDonald1,E.Chow1 for a patient with severe pain and feared inadequate pain relief. We may 1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences directly start step 2 drugs as primary treatment thus bypassing step 1. Our Centre, Toronto, Canada study any how is not intended to advise against use of original ladder. However modifications are necessary to ensure its continued use for Background and Aims knowledge transfer in pain management. Bone pain is common in metastatic prostate cancer patients and can significantly reduce a patient’s quality of life. When patients have multi- ple 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 MASCC-0508 possible sources of pain in a patient with metastatic prostate cancer and Pain multiple co-morbidities. Methods ODYNOPHAGIA IN HEAD AND NECK CANCER (HNC) The current report documents the case of an 82-year old male who PATIENTS UNDERGOING (CHEMO) RADIOTHERAPY:IS IT presented with lower back and leg pain that was exacerbated with AN ORPHAN CONDITION? movement. The patient suffered from metastatic castrate resistant prostate M. Romero1, P. Bossi2, C. Ripamonti3 cancer with multiple bone lesions, but had no pain symptoms attributable 1Pharmacoepidemiology Unit Department of Clinical Pharmacology to his cancer. In addition, the patient had end-stage renal disease, and had and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro been on hemodialysis since 2007. (CH), Italy; 2Head and Neck Medical Oncology, Fondazione IRCCS Results Istituto Nazionale dei Tumori, Milano, Italy; 3Supportive Care in Cancer Investigations of the patient revealed a subacute burst fracture at L1, Unit Department of Haematology and Pediatric Onco-Haematology, however clinical examinations revealed that this was degenerative in Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy nature, and was not the source of the patient’s pain. Radiological imaging determined that there were no bone metastases in the lumbar region. Background and Aims Furthermore, neuropathic pain and side effects of his leuprolide treatment Odynophagia is a detrimental condition in HNC patients receiving were not congruent with the patient’s description of his pain. (chemo)radiotherapy causing inability to eat and drink and secondary Conclusions malnutrition and dehydration. Actually, no standard treatment is recom- Ultimately, this patient’s pain matched typical descriptions of muscle mended and a considerable variability in the real practice is observed. cramps, which are very prevalent in hemodialysis patients. However, it Objective of this work is to evaluate both the available evidences and the is important to regularly monitor the patient for bone metastases, as they ongoing clinical research on odynophagia management. could become a future source of pain. Overall, it is critical that all possible Methods sources of pain are explored in order to properly diagnose and treat Pubmed database and website clinicaltrial.gov were checked to identify similar patients with prostate cancer and multiple co-morbidities. 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, deglu- MASCC-0107 tition, clinical trials. Clinical trial.gov (1997–present) was tested to resem- Pain ble 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 IS IT MANDATORY TO START WHO STEP 1 DRUGS IN ALL one had odynophagia as subject in itself. Pain due to swallowing was consid- CANCER PAIN? OUR REGIONAL CANCER CENTER ered in trials having as main topics oral mucositis or surgery. Some studies have EXPERIENCE analyzed the needs of HNC patients, and although odynophagia was consid- L. Boregowda1,V. Vimalathithan1,S.Prabha1 ered a harmful condition, no trial evaluated specifically its management. About 1Palliative Medicine, Kidwai Memorial Institute of Oncology, Bangalore, clinicaltrial.gov, 19 ongoing trials were identified. Among these, 16 are ran- India domized clinical trials (RCTs) and 3 observational studies on genomic or QOL. RCTs concern pain overall or mucositis or post-surgerical pain. The study Background and Aims treatments range from various drugs to medical devices and surgical tech- In India, pain is still one of the most feared entities in cancer and niques. No study aimed to evaluate specifically management of odynophagia. about 75 % require opioids for severe pain. This study aims to discuss Conclusions reasons for under-treatment and also the current status of WHO No evidence is available on odynophagia treatment. Clinical studies on analgesic ladder. this condition are urgently needed. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S125

MASCC-0421 Conclusions Pain 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. 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 MASCC-0060 1Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Pain Centre, Toronto, Canada; 2Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada AN OBSERVATIONAL STUDY OF PARACETAMOL (ACETAMINOPHEN) DISCONTINUATION IN PATIENTS WITH Background and Aims CANCER PAIN RECEIVING OPIOIDS FOR Acute leukemia (AL) is a hematopoietic stem cell disorder that is associ- MODERATE-TO-SEVERE PAIN ated with significant morbidity and mortality. However, the burden of A. Davies1, J. Vriens2, A. Buchanan1, M. Waghorn1 pain in AL patients is not well understood. We examined pain and its 1Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s treatment in inpatients with AL. Cancer Centre, Guildford, United Kingdom; 2Palliative Care, Princess Methods Alice Hospice, Esher,United Kingdom In patients with newly-diagnosed or recently-relapsed AL completed the Memorial Symptom Assessment Scale (MSAS); two questions were Background and Aims added: “Is the symptom being treated?” and “Are you satisfied with the The objective of the study was to investigate the utility of paracetamol in relief?” We reviewed the charts of a subset of randomly selected patients cancer patients receiving opioids for moderate-to-severe pain. who reported moderate to very severe pain, perceived as not treated or Methods treated without satisfactory relief, in the week prior to and including the Patients with well controlled cancer pain (average pain intensity≤4/10), day of MSAS completion. who were receiving regular paracetamol and an opioid for moderate-to- Results severe pain, completed the Brief Pain Inventory – Short Form at baseline Of 280 inpatients recruited, 112 reported moderate to very severe pain; of and at 7 days post discontinuation of the paracetamol (or sooner if re- these, pain was reported as treated in 71, untreated in 17 and treated starting the paracetamol). The study employed a Simon optimal two stage unsatisfactorily in 23 (1 missing response). Chart reviews of 20 patients design with the aim of reducing the number of subjects exposed to a who reported moderate to very severe pain that was untreated or treated “futile” intervention. without satisfactory relief revealed that pain was documented for all 20 Results (pain sites listed in the Table). Pain medication was given to 18/20 Forty-four patients were enrolled, and 40 patients completed the study. patients, of whom 14 received opioids; opioid treatment was added or Eighteen (45 %) patients restarted the paracetamol, although an- increased for 6/16 patients with persistent pain (≥2 days). Adjuvant other four patients reported a worsening of pain control and/or an medication was prescribed for 1 patient; 9 refused analgesia once or more. increase in the use of rescue medication. The only factor associated with restarting paracetamol was the pathophysiology of the pain, Table. Pain sites in inpatients with AL with patients with mixed pain more likely to restart paracetamol Pain site Number of patients than patients with nociceptive pain (P=0.013). Conclusions Musculoskeletal 16 On the basis of these results we would recommend a trial of discontinuing Arm 2 paracetamol in all patients receiving opioids for moderate-to-severe pain, Back/Coccyx 5 who are deemed to be adequately pain controlled. Patients can be reassured that there is approximately a one-in-two chance of not needing Bone 1 to restart the paracetamol, and that if they do need to start the paracetamol Buttock/Knee/Leg/Pelvis 4 that pain control can be re-gained within a very short period of time. Flank 1 Neck 2 Rib 1 MASCC-0129 Cheek/Gum/Lip/Mouth/Oral 13 Pain mucosa/Orophyrynx/Palate/Throat/Tongue Epigastrium/Esophagus/Heartburn/Stomach 9 THE INFLUENCE OF LOW SALIVARY FLOW RATES ON THE Central venous catheter/Peripheral intravenous 8 ABSORPTION OFA SUBLINGUAL FENTANYL CITRATE Headache/Migraine 8 FORMULATION FOR BREAKTHROUGH CANCER PAIN Abdomen 7 A. Davies1, J. Vriens2,K.Webber3, M. Waghorn1, A. Buchanan1 1 ’ Jaw/Mandible/Tooth 5 Supportive & Palliative Care, Royal Surrey County Hospital/St. Lukes Cancer Centre, Guildford, United Kingdom; 2Palliative Care, Princess Chest 2 Alice Hopsice, Esher, United Kingdom; 3Palliative Care, Kings College Ear 1 Hospital, London, United Kingdom Eye 1 Background and Aims Hemorrhoid 1 There is no data on the pharmacokinetics of oral transmucosal opioids in Lumbar puncture site 1 patients with salivary gland hypofunction (SGH; ‘dry mouth’), despite Skin 1 the fact that SGH may significantly amend absorption through the oral mucosa. S126 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods background (persistent) pain. The presence of BTcP was associated with Nine cancer patients with pain and SGH (unstimulated whole salivary disease status (i.e. metastatic disease more than local disease; Fisher’s flow rate<0.1 ml/min) completed a series of pharmacokinetic studies exact test p<0.001), and performance status (i.e. poor performance status involving a sublingual fentanyl orally disintegrating tablet (Abstral®): more than good performance status; Fisher’s exact test p<0.001). on the first assessment, plasma fentanyl levels were measured after no Conclusions intervention for the SGH; on the second assessment, plasma fentanyl BTcPcan occur at any stage of the cancer journey,but is more common in levels were measured after moistening the mouth with water; on the third patients with metastatic/advanced disease. assessment, plasma fentanyl levels were measured after a 5 mg dose of pilocarpine (i.e. salivary stimulant). Results MASCC-0032 Pain

ADDITION OFADJUVANTS 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 1Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA; 2Tauaaig Cancer Institute, Cleveland Clinic, Cleveland, USA

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. Weevaluated adjuvant use in patients admitted The Cmax, Tmax, and AUC were lowest during the first assessment to an inpatient palliative unit, pain scores or opioids doses. phase (i.e. no intervention for SGH). The Cmax, Tmax, and AUC were Methods similar during the second and third assessment phases. Figure 1 shows the Methods: In this retrospective observational study, patients admitted to plasma concentration – time profiles. the palliative care unit over a 2 month period with cancer on opioids were Conclusions reviewed. Demographics, diagnosis, oral morphine dose equivalents on The results of this study suggest that moistening the mouth is an effective discharge, adjuvant analgesics, NSAIDs and pain scores were collected. intervention for improving the pharmacokinetic profile of the sublingual Results fentanyl orally disintegrating tablet (Abstral®) in patients with SGH. How- Results: Of 77 patients eligible, 65 (84 %) were on adjuvant medications. ever, these results cannot be extrapolated to other oral transmucosal opioids. 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 MASCC-0068 discharge morphine equivalents (180±160 v 459±833 p=0.19).Seventy- Pain five percent on adjuvants and 80 % on opioids alone responded deter- mined by a 2 point reduction in NRS. PREVALENCE OF BREAKTHROUGH CANCER PAIN IN THE Conclusions GENERAL CANCER POPULATION Discussion: Adjuvants are commonly used for cancer pain, half are on 2 adjuvants or an adjuvant plus NSAID plus opioid. Wedid not demonstrate A. Davies1, A. Buchanan1, M. Waghorn1 a benefit in terms of improved pain or opioid doses with adjuvants but this 1Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s may reflect confounding variables, small numbers and physician choice. Cancer Centre, Guildford, United Kingdom Prospective studies are needed to define improved pain or opioid sparing effects of adjuvants. Conclusion: Adjuvants are used in 80 % of inpa- Background and Aims tients. Adjuvants were not associated with reduced pain or opioid sparing. 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 MASCC-0558 Any/all oncology patients attending St. Luke’s Cancer Centre in the Pain United Kingdom (i.e. inpatient unit, outpatient department, chemotherapy unit, radiotherapy department) were eligible to take part in the project. CONTROLLING PAIN IN THE AMBULATORY SETTING The project involved a single assessment involving collection of USING A STANDARD OPIOID PROTOCOL demographic/oncological information, and completion of a diagnostic algorithm for BTcP [Davies et al., 2009]. In addition, patients with BTcP N. Wells1, M. Dietrich2, B. Murphy3 were requested to complete the Breakthrough pain Assessment Tool 1Nursing Administration, Vanderbilt University Medical Center, Nashville, (‘BAT’) [Webber et al., 2013]. USA; 2Research, Vanderbilt University School of Nursing, Nashville, USA; Results 3Internal Medicine, Vanderbilt Ingram Cancer Center, Nashville, USA One thousand patients were enrolled in the project. In total, 382 patients reported pain, although only 244 had background (persistent) pain. In Background and Aims total, 90 patients reported BTcP, which represents 9 % of the total Pain is poorly controlled for patients with cancer. Developing strategies to population, 24 % of patients with pain, and 37 % of patients with improve pain control are imperative. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S127

Aim: To examine the effect of standing opioid titration orders on pain experiencing ongoing pain from bone metastases regardless of the re- outcomes compared to standard care. sponse to initial irradiation. However, aspects of re-irradiation treatment Methods including dose fractionation, related adverse events and toxicities require Randomization: Arm 1 - pain managed by clinic nurses using an opioid further corroboration. 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 MASCC-0541 of analgesics prescribed and number of opioid titrations made and ana- Pain lyzed using Generalized Linear Modeling. Results MINIMAL CLINICALLYIMPORTANT DIFFERENCES IN THE Of 99 patients enrolled from 9 ambulatory clinics, 47 completed a BRIEF PAIN INVENTORY IN PATIENTS WITH BONE minimum of 5 weeks of data and were included in the analyses. At study METASTASES entry all patients had a fixed dose opioid and the majority (≥73 %) had a K. Wong1,L.Zeng1,L.Zhang1, G. Bedard1,E.Wong1,M.Tsao1, p.r.n. opioid prescribed. Patients in Arm 1 (n=25) had more opioid E. Barnes1,C.Danjoux1,A.Sahgal1, L. Holden1,N.Lauzon1,E.Chow1 titrations than patients in Arm 2 (n=22; p<0.05) and had higher opioid 1Rapid Response Radiotherapy Program, Sunnybrook Health Sciences consumption (p<0.05). Despite this, mean scores for average and worst Centre, Toronto, Canada pain did not differ by treatment or time. For both groups, worst pain remained moderate while average pain shifted from moderate to mild. Background and Aims There were no severe adverse events. Brief pain inventory (BPI) may be used to assess pain and functional Conclusions interference in cancer patients. However, statistically significant changes This trial confirmed the safety and feasibility of the protocol. Lack of in BPI due to large sample sizes may not necessarily be clinically relevant. impact on pain outcomes suggests further examination of pain report as a The objective was to determine the minimal clinically important differ- primary outcome. ences (MCID) of the BPI in patients with pain due to bone metastases. Supported by NCI RO1 CA095413 and the Department of Veterans Keywords: MCID, BPI, pain and functional interference Affairs Methods BPI pain and functional interference scores were collected from patients with painful bone metastases who visited the Rapid Response Radiother- apy Program, Sunnybrook Health Sciences Centre, for palliative radio- MASCC-0447 therapy. Follow-up data was available for 256 patients, who were catego- Pain rized into ‘complete or partial response,’‘pain progression,’ and ‘indeter- minate response’ groups based on pain scores. Anchor-based determina- RE-IRRADIATION FOR PAINFUL BONE METASTASES – A tion of MCIDs of functional interference scores was calculated utilizing SYSTEMATIC REVIEW the difference between mean follow-up and baseline scores. Distribution- based estimates were obtained utilizing 0.2, 0.3, and 0.5 standard devia- E. Wong1,P.Hoskin2, G. Bedard1, M. Poon1,L.Zeng1,H.Lam1, tion (SD) effect sizes and the standard error of measurement. H. Vulpe1,M.Tsao1, N. Pulenzas1,E.Chow1 Results 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Clinical Statistically significant MCIDs were determined for all BPI functional Oncology, Mount Vernon Hospital Cancer Centre, Middlesex, United interference items for patients with ‘complete or partial response’. Some Kingdom functional interference items had statistically significant MCIDs for pa- tients with ‘indeterminate response’.Aneffectsizeof0.5SDwasthe Background and Aims closest estimate for determining the MCID for patients with ‘indetermi- Radiotherapy is a widely accepted and effective way to palliate pain nate’ or ‘complete or partial’ response. caused by bone metastases. However there are instances when patients Conclusions require further radiation to the same site for secondary palliation of pain. Statistically significant MCIDs ranged from 1.8 to 4.1 units for pain The purpose of this review was to determine the efficacy of re-irradiation improvement, but could not be detected for pain deterioration. Knowl- in patients with bone metastases. edge of MCIDs for the BPI may improve ability to assess treatment and to Methods determine sample size in future clinical trials. A literature search was conducted in Ovid Medline, OldMedline, Embase, Embase Classic, and the Cochrane Central Register of Con- trolled Trials using keywords such as bone metastases, radiotherapy and palliative care. Articles with palliative external beam radiation MASCC-0587 retreatment response rates were included. Pain Results The literature search produced 2,164 references and 15 articles were THE EVIDENCES OFACUPUNCTURE IN THE included in the final selection. Complete, partial and overall response MANAGEMENT OF CHEMOTHERAPY INDUCED rates were calculated to be 20 %, 50 % and 68 % respectively.Information PERIPHERAL NEUROPATHY on retreatment toxicities was scarce with only 7 of the 15 articles includ- ing such information. Most studies reported none or low grade toxicities, A.P. Zandonai1,N.O.Sawada1 with the most common toxicity being nausea and vomiting. Only one 1Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, study reported a 2.2 % rate of pathological fracture and spinal cord Brazil compression. Current evidence also suggests initial non-responders may respond to re-irradiation. Background and Aims Conclusions Chemotherapy Induced Peripheral Neuropathy (CIPN) is the most fre- The efficacy of re-irradiation is comparable to initial radiation treatment. quent and distressing side effect of the cancer treatment. An estimated 30– Therefore, re-irradiation should be recommended for patients 40 % of the patients receiving neurotoxic chemotherapy (vinca alkaloids, S128 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 taxanes, platinum analogs, thalidomide and bortezomib) develop CIPN. MASCC-0605 Acupuncture is considered a popular and safety treatment intervention Pain 2 used to manage various conditions including peripheral neuropathy. The objectives were search and synthesize the evidences about the benefits of ORAL SEAWEED CALCIUM SUPPORT IS WELLTOLERATED acupuncture to CIPN. AND EFFECTIVE IN PAIN RELIEF IN ELDERLYPATIENTS Methods WITH MULTIPLE MYELOMA An integrative review, which consists in a methodological strategy to perform the evidence-based practice, was used in this study to search and G. Giordano1,F.D’Amico1, B. Carabellese2,G.Berardi3 synthesize the available evidence in the scientific literature. The databases 1Oncology, John Paul II Foundation, campobasso, Italy; 2Radiology, LILACS, MEDLINE, CINAHL, SCielo and COCHRANE Library were Cardarelli Hospital, campobasso, Italy; 3Territorial Medicine, Family consulted and eight relevant studies were selected. Medicine, campobasso, Italy Results Were identified studies of low evidence, three studies classified as evidence Background and Aims level 6, three studies with evidence level 4, one pilot randomized con- Introduction trolled trial with evidence level 2 and one systematic review with evidence Bone pain is frequent in elderly with multiple myeloma. level 1. The acupuncture points most used were Ba feng, Ba xie, LI4 and Objectives LV3 to CIPN management. None randomized controlled trial was found. Aim of this study is to verify if calcium supplementation reduces pain and Conclusions analgesic drugs intake in elderly patients with multiple myeloma. Although studies had low evidence, these demonstrated that acupuncture Methods relieves the symptoms of CIPN, decreased pain and consequently reduced Methods analgesic consumption, increased quality of life related to health and In this study were enrolled 12 patients. Median age was75 years (R69- improved the velocity and amplitude in nerve conduction. No adverse 83).M/F:3/2. All patients presented a symptomatic multiple myeloma effects were reported. It is suggested a rigorous randomized controlled treated with MPV regimen for a total of 9 cycles and Zoledronic acid. trial with a large sample to verify the safety and efficacy of acupuncture in Four patients received seaweed (lithotamnion) calcium 400 mg p.o. t.i.d, patients with CIPN. 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 evalu- ated by Visual Analogical Scale (VAS) support after 3 months of therapy. MASCC-0147 Median follow-up was 2 years (R6-24 months). Pain 2 Results Results Patients not receiving calcium support showed a pain with a VAS of8 (R6- SOURCES OF PAIN IN A PATIENT WITH METASTATIC 9), patients receiving seaweed calcium support showed a pain with a VAS PROSTATE CANCER, PAGET’S DISEASE AND RENAL of4(R4-6), patients receiving calcium lactate-gluconate and carbonate FAILURE support showed a pain with a VAS of7(R6-8). Patients not receiving A. Furfari1,G.Bedard1, E. Wong1, R. McDonald1,M.Popovic1,E.Chow1 calcium support took analgesic therapy two times a day (R 1time/day- 1Department of Radiation Oncology, Rapid Response Radiotherapy Pro- 2time/week), patients receiving seaweed calcium support took analgesic gram, Toronto, Canada therapy two times a week (R1time/15 day-3time/week), patients receiv- ing calcium lactate gluconate and carbonate support took analgesic ther- Background and Aims apy five times a week (R1time/day-3time/week). Introduction Conclusions Prostate cancer is the most common cancer to affect men. In advanced Conclusion prostate cancer, up to 80 % of patients can develop bone metastases, Calcium support seems to be effective in reducing pain and analgesic which can cause pain. Co-morbidities such as end-stage renal disease drug intake. (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 MASCC-0346 Paget’s disease, and furthermore highlights the importance of finding Pain 2 sources of pain in order for the patient to be successfully treated. Methods OPTIMISING THE USE OF FENTANYL FOR PAIN An 80-year-old male with prostate cancer and accompanying bone me- MANAGEMENT IN CANCER PATIENTS tastases presented to the Rapid Response Radiotherapy Clinic at the Sunnybrook Health Sciences Centre with severe pain in the lumbar spine. J. Hardy1,S.R.Bista2, A. Tapuni1,P. Good1, R. Norris2, A. Haywood2 Results 1Palliative and Supportive Care, Mater Research Institute-The University Previous imaging of the patient’s lumbar spine was unclear as to whether of Queensland, Brisbane, Australia; 2School of Pharmacy, Griffith Uni- pain was caused by bone metastases, renal failure, or Paget’s disease. Further versity, Brisbane, Australia x-rays of the patient’s lumbar spine were taken from which it was deter- mined that there were no definite bone metastases in that area. The x-ray did Background and Aims also reveal osteophytes and extensive pagetic changes. In the absence of As with other opioids, transdermal fentanyl has a narrow therapeutic bone metastases, it was concluded that this patient’s pain in the lumbar spine window between analgesia and toxicity with great inter-patient var- was caused by either renal failure, or more likely Paget’s disease. iation in the dose required to achieve pain relief. Relatively little is Conclusions known about the influence of factors such as age, gender, dose, This case illustrates the challenge faced by physicians who treat patients genetic variation, organ function, plasma protein binding (PPB) with multiple co-morbidities. In these cases, close examination of the and efficiency of patch adhesion, on the pharmacokinetics (PK) patient’s pain is essential to successful treatment. and pharmacodynamics (PD) of the drug. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S129

Weaimed to investigate the influence of demographic and clinical factors MASCC-0405 that have the potential to influence the PK of transdermal fentanyl and to Pain 2 describe any relationship between saliva and plasma concentrations, patient pain and degree of patch adhesion. THE DEVELOPMENT OFAN EDUCATIONAL INTERVENTION Methods FOR MANAGING END OF LIFE PAIN MEDICATION: CANCER Paired saliva and plasma samples are collected from cancer patients CARERS MEDICINES MANAGEMENT receiving fentanyl via a transdermal patch. The degree of adhesion of the fentanyl patch, pain scores and demographic data are recorded J. Hopkinson1, E. Lowson2,A.Richardson2,S.Duke2, S. Anstey1, at the time of sampling. NONMEM will be used to obtain estimates J. Hughes1,C.May2,P.Smith3, M. Bennett4, S. Latter2 of PK parameters and associated intra- and inter-individual 1School of Healthcare Sciences, Cardiff University, Cardiff, United variability. Kingdom; 2Health Sciences, University of Southampton, Southampton, Results United Kingdom; 3Statistical Sciences Research Institute, University of One hundred eleven paired plasma and saliva samples from 41 Southampton, Southampton, United Kingdom; 4Institute of Health Sci- patients have been assayed via HPLC-MS/MS. Plasma protein bind- ences, University of Leeds, Leeds, United Kingdom ing 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 Background and Aims between plasma and salivary concentrations on the naive pooled data In the UK, 1 in 4 deaths is a cancer death and most of these people will to date, with little correlation between pain scores and plasma or experience pain at the end of life. In the home, family carers can play an salivary concentration. important role in managing pain medication. Our scoping exercise of Conclusions international literature found evidence of unmet need for support in this A better understanding of the factors that influence the PK and pharma- role. codynamics of fentanyl will improve the way we manage cancer pain. 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 MASCC-0348 A staged multi-method approach was used. It included: Pain 2 & a systematic review of interventions for carer management of end of life pain medicines VALIDATION OFA FENTANYL PATCH ADHESION SCORING & a review examining the practice and theoretical context of pain TOOL FOR USE IN CLINICAL PRACTICE medicines management & J. Hardy1,S.R.Bista2,J.Fu3, K. Gibbons3,P.Good1,A.Haywood2 patient, carer and healthcare professional interviews (n=21) 1Palliative and Supportive Care, Mater Research Institute-The University & User Involvement Group consultations (n=29) 2 of Queensland, Brisbane, Australia; School of Pharmacy, Griffith Uni- & observations of usual care 3 versity, Brisbane, Australia; Mater Research Office, Mater Research & participatory action research workshops (n=2 with 16 nurses) to Institute-The University of Queensland, Brisbane, Australia develop the intervention & Background and Aims a carer and healthcare professional User Consultation review (n=16) The therapeutic efficacy of a transdermal system is directly related to the Results adhesion of the patch. Partial adhesion is likely to result in a lower plasma This multi-method, collaborative approach has been successful in concentration. Avalidated scoring system assessing adhesion at the time enabling the development of a theoretically informed, evidence- of sampling for pharmacokinetic (PK) studies is required. We aimed to based intervention with robust grounding in carer experience and test the US Food and Drug Administration (FDA) 5-point patch adhesion clinical practice. scoring tool (0 – >90 % adherence) that has never been validated for Conclusions clinical use in cancer patients. A Phase II study is now in progress to test the feasibility, accept- Methods ability & efficacy of CCMM to improve carers’ knowledge, beliefs, A library of images was created from photographs of fentanyl patches/ skills & self-efficacy for pain medicines management and decrease placebo on the limbs/chest of patients/volunteers. Thirty photographs, carer strain. reflecting varying degrees of adhesion, were selected for each of series A This project is funded by the Dimbleby Marie Curie Cancer Care Re- and B, with 10 photographs common to both series. Each series was search Fund, grant number DCMD-RF-12-05 shown to 30 health professionals asked to score the photographs using the 1. Craig et al. (2008) Developing and evaluating complex interventions. FDA scoring system. Validity was assessed using Spearman’s Rank Medical Research Council, London, UK. 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 MASCC-0435 Validity was high for both series (≥0.954). Inter-reliability ranged from Pain 2 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 PROPHYLACTIC DEXAMETHASONE FOR PAIN FLARE (PF) 2. The combined agreement across both series was 0.585. Intra-rater FOLLOWING SPINE STEREOTACTIC BODY agreement of the 10 common images was k 0.605 (SE 0.028). RADIOTHERAPY (SBRT) Conclusions The FDA scoring system is an adequate tool for assessing fentanyl patch L. Khan1,A.Chiang1,L.Zhang1,F.Lochray1, I. Thibault1, G. Bedard1, adhesion in clinical practice. Scoring partial adhesion remains a E. Wong1,A.Loblaw1,H.Soliman1,E.Chow1,A.Sahgal1 challenge. 1Radiation Oncology, Odette Cancer Center,Toronto, Canada S130 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims MASCC-0353 To determine the incidence of PF in spine SBRT patients prophylacticly Pain 2 treated with either 4 mg or 8 mg of dexamethasone (DEX), in a sequential prospective observational cohort study. PAIN MANAGEMENT IN PATIENTS WITH MALIGNANT Methods DISEASE IN CROATIA Forty-seven patients were accrued. Twenty-four patients treated with 4 mg of DEX, next 23 patients treated with 8 mg of DEX. Patients B. Svetec1, D. Kust1 completed the BPI during and for 10 days post SBRT. PF was defined 1Oncology and Nuclear Medicine, Univesity Hospital Center “Sestre as a two point increase in ‘worst pain ’score compared to baseline with no Milosrdnice”, Zagreb, Croatia decrease in analgesic intake, or 25 % increase in analgesic intake as compared to baseline with no decrease in worst pain score. The incidence Background and Aims of PF was recorded in each group and compared to our previously About half of all patients with malignant tumors are experiencing pain at published steroid naïve cohort (n=41). Subgroup analyses between the some point during their disease, and moderate or severe pain is present in 4 mg and 8 mg cohorts were also performed. one third of them (especially in advanced stage tumors). The quality and Results intensity of pain depends on tumor site, stage of the disease, and patient’s For the entire cohort, the incidence of PF was 19 % (9/47) Within the individual characteristics. This study was undertaken to assess the quality subgroups, PF was observed in 25 % (6/24) in the 4 mg group, and 13 % of analgesic support in patients suffering from malignant disease in (3/23) in the 8 mg group (p=0.46). When comparing functional interference Croatia, with special emphasis on the extent of transdermal analgesic scores between the 4 mg and 8 mg DEX cohorts, we observed a better patches usage. profile for the 4 mg subgroup with respect to walking ability(p<0.0466) and Methods relationship to others (p <0.0354). A significant reduction in the incidence of The study involved patients treated at universal hospital centers in Zagreb PF was observed when comparing the current cohort to our previously and Osijek, as well as several general hospitals and general community published steroid naïve cohort (68 % vs. 19 %, p<0.0001, respectively). centers. Trial was carried out in the form of a questionnaire. In total, Conclusions during the period from April 2013 to the end of September 2013, 153 No significant differences between 4 mg and 8 mg dosing were observed patients were included. All patients had confirmed diagnosis of malignant however 8 mg, was associated with increased functional interference in disease and gave their consent to participate in the study. selected domains. 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 MASCC-0520 fact is that in 14 % of patients after the first talk analgesic therapy was not Pain 2 introduced. Conclusions Severe pain can diminish quality of life significantly.Opioids are the basis THE COMBINATION OF THE KAMPO MEDICINE AND of chronic malignant pain treatment, so we need to continue our efforts to PREGABALIN FOR TREATING PERIPHERAL NEUROPATHY eliminate the fear of side effects, opioid addiction, analgesic tolerance and IN BREAST CANCER PATIENTS security concerns in long-term use. Y.Kikuchi1 1medicine, Tokyo university, Tokyo, Japan

Background and Aims MASCC-0327 Symptoms such as joint pains caused by hormone therapy and peripheral Pain 2 neuropathy due to chemotherapy appeared in breast cancer patients. However, there are no effective strategies to treat the pain. The Kampo, THE INCIDENCE OF NEUROPATHIC PAIN IN BONE METAST herbal medicine in Japan, are already blended, packed, and need not be ASES PATIENTS REFERRED FOR PALLIATIVE compound every time, each patients, thus it is often used in Japan. RADIOTHERAPY IN THE RAPID RESPONSE Effectiveness of peripheral neuropathy pain due to pregabalin is reported RADIOTHERAPY PROGRAM 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 B. Lechner1,N.Pulenzas1, R. McDonald1, E. Wong1, G. Bedard1, effectiveness about selecting Kampo medicines, or pregabalin, depending E. Chow1 on the condition of the patient, or combination therapy. 1Rapid Response Radiotherapy Program Department of Radiation On- Methods cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, To- We picked up patients who were receiving hormone therapy or chemo- ronto, Canada therapy in breast cancer, and also receiving prescription of Kampo med- icines, or pregabalin or each medicine. And we asked them whether pains Background and Aims were reduced or not by taking these medicine. Bone metastases can result from various primary cancer sites and can Results commonly lead to pain. For some patients, this pain can be neuropathic We checked six patients of taking medicine. One patient received due to compression or injury of neural structures. The purpose of this pregabalin only (A), two were Kampo medicines only (B), and three study was to examine the incidence of neuropathic pain in patients with patients were received both (C), who were received chemotherapy and bone metastases referred for palliative radiotherapy. hormone therapy after operation. One patient in (C) was reduced Methods pregabalin because of the side effect, and started taking Kampo medicines. A prospective study was conducted from January to April 2013. Patients Conclusions referred to the Rapid Response Radiotherapy Program at the Sunnybrook Kampo medicines has been suggested since the effect appears to relative- Health Sciences Centre for symptomatic bone metastases were eligible. ly mild, when side effects are strong by taking pregabalin, and may be Patients completed the Self-Reported Leeds Assessment of Neuropathic taken into account in the prescription of the Kampo. Symptoms and Signs (S-LANSS). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S131

Results Results Twenty-four patients agreed to participate; 13 (54.2 %) females and 11 Among 1,505 enrolled patients, 58.8 % had moderate to severe pain (45.8 %) males. The median age was 71. The most common primary (VAS≥4). Patients with NCP (DN4≥4) showed higher BPI-SF pain cancer sites were breast (29.2 %), prostate (29.2 %), and lung (25.0 %). severity score than patients without NCP (4.94±1.65 vs 4.58±1.68; p= Nineteen of the 24 patients (79.2 %) were treated with radiotherapy. The 0.001). BPI-SF pain severity score had clear negative correlation with most common dose schedules were 8 Gy in 1 fraction prescribed to 12 QOL measured by EQ-5D (r=−0.301, p 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. Neuro- pathic pain can be a significant concern for patients with bone metastases referred for palliative radiotherapy.

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 1Internal medicine, Seoul Medical Center, Seoul, Korea; 2Internal Conclusions medicine, Korea University College of Medicine, Seoul, Korea; This large-scaled survey shows that NCP has deteriorative effect 3Internal medicine, Soonchunhyang University College of Medi- on QOL by increasing pain intensity and management of NCP cine, Cheonan, Korea; 4Internal medicine, Yeoungnam University and QOL is not satisfactory in South Korea. Innovative approach College of Medicine, Daegu, Korea; 5Internal medicine, Ulsan for proper diagnosis and management of NCP is required to University College of Medicine, Ulsan, Korea; 6Internal medicine, improve QOL of patients with cancer. Chonbuk National University College of Medicine, Chonbuk, Korea; 7Internal medicine, Chung-Ang University College of Med- icine, Seoul, Korea; 8Internal medicine, Chungnam National Uni- versity College of Medicine, Chungnam, Korea; 9Internal medi- MASCC-0270 cine, Chungbuk National University College of Medicine, Pain 2 Chungbuk, Korea; 10Internal medicine, Hallym University Kangnam Medical Center, Seoul, Korea; 11 Internal medicine, EQUIANALGESIC CONVERSION RATIO (ECR) OF Hallym University Chuncheon Medical Center, Chuncheon, Korea; HYDROCODONE (HDC) TO STRONG OPIOIDS 12Internal medicine, Hallym University Medical Center, Seoul, Korea; 13Internal medicine, St. Vincent Hospital the Catholic A. Reddy1,S.Yennurajalingam1, H. Desai1,J.Wu1,D.Liu1, S. Reddy1, University College of Medicine, Suwon, Korea; 14Internal medi- M. de la Cruz1,E.Bruera1 cine, Konkuk University Medical Center Konkuk University School 1Palliative Care and Rehabilitation Medicine, University of Texas MD of Medicine, Seoul, Korea; 15Internal medicine, Fatima Hospital, Anderson Cancer Center,Houston, USA Daegu, Korea; 16Health and Value, Pfizer Pharmaceutical Korea Ltd., Seoul, Korea; 17Outcomes Research, Primecore consulting, Background and Aims Seoul, Korea Ninety percent of cancer patients experience pain. Patients are initially treated with HDC and escalated to stronger opioids as per the cancer pain Background and Aims ladder. However, there are no studies in cancer patients on the ECR of Diagnosis and management of neuropathic cancer pain (NCP) is HDC to strong opioids which may result in uncontrolled pain or difficult and complicating issue. Korean Cancer Study Group Neu- overdosing. ropathic Cancer Pain Survey (KCSG-NCPS) investigated current OBJECTIVES: To determine the morphine equivalent daily practice in the diagnosis and management of NCP and its impact dose(MEDD) for HDC. on quality of life (QOL). Methods Methods Outpatient supportive care visits in 2011–2012 were reviewed for Patients with cancer pain of visual analogue scales (VAS) ≥1 from opioid rotation(OR) from HDC to a stronger opioid. Data regarding 28 hospitals of Korea were enrolled in this cross-sectional observa- demographics, Edmonton Symptom Assessment Scale(ESAS), and tional study. If the patient was scored ≥4 by neuropathic pain MEDD was collected in patients who followed-up within 6 weeks. diagnostic questionnaire (DN4), he/she was diagnosed with NCP. Linear regression analysis was used to estimate the ECR between The clinical characteristics, pain severity by Brief Pain Inventory- HDC and MEDD. Successful OR was defined as 2 point or 30 % Short Form (BPI-SF), and the QOL by EuroQOL EQ-5D Health reduction in pain score and continuation of the new opioid at Questionnaire were evaluated. follow-up. S132 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Conclusions There was no significant difference in pain relief after palliative radio- therapy 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 ATA SINGLE ACADEMIC MEDICAL CENTER A. Bruggeman1,J.D.Ma2,S.F. Heavey3,E.J.Roeland4 1Medicine, University of California San Diego, San Diego, USA; 2Skaggs One hundred seventy patients underwent OR(partial/complete) from HDC School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San to stronger opioids. One hundred twenty patients had a complete OR. 81 % Diego, USA; 3Clinical Trials Office, UC San Diego Moores Cancer had advanced cancer. Median time between OR and follow-up was 21 days. Center, San Diego, USA; 4Hematology/Oncology and Palliative Medi- − − − Pain 2(P<0.0001), fatigue 1(P=0.006), insomnia 2(P=0.008), and cine, UC San Diego Moores Cancer Center,San Diego, USA symptom distress score −7(P=0.0002) improved with successful OR(53 %). In 100 patients with complete OR to HDC and no worsening Background and Aims – of pain at follow-up, the median ECR (Q1 Q3) from HDC to MEDD was Prognostication plays a key role in palliative care. It is critical for − 1.5(0.9 2) and was significantly correlated r=0.52(P<0.0001). ECR was advance care planning, communication, and for determining hospice significantly lower in patients receiving >40 mg/day of HDC. eligibility. In contrast to subjective assessment of prognostication, Conclusions evidence-based prognostic indicators (EBPIs) utilize existing data to The estimated ECR from HDC to MEDD was 1.5. Due to large interper- quantify prognosis. However, the extent to which palliative care sonal variation in ratio, personalized titration and frequent monitoring is providers utilize and document EBPIs remains unknown. The aim recommended. of this study was to analyze the current documentation of EBPIs in palliative care inpatient consult notes at a single academic medical center. MASCC-0499 Methods This was a retrospective chart review of all oncology patients who Pain 2 received an inpatient palliative care consultation at a single, academic hospital (2012–2013). SINGLE VERSUS MULTIPLE FRACTIONS OF PALLIATIVE Results RADIOTHERAPY FOR PAINFUL BONE METASTASES: 30 GY There were 412 inpatient palliative care consultations for oncology IN 10 FRACTIONS COMPARED WITH 8 GY IN SINGLE patients (2012–2013). Reasons for consultations included: goals of FRACTION care (GOC) (n=108), symptom management (n=181), or both (n= S. Roy1, A. Shankar2, R. Bhandari2,K.Kishor2 123). Total prognostic documentation was present in 36 % (n=148) 1Paediatrics, Safdarjung Hospital, New Delhi, India; 2Radiation Oncol- of all consultations [GOC (n=57), symptom (n=32), both (n=59)]. ogy, All India Institute of Medical Sciences, New Delhi, India For consultations with prognostic documentation, specific EBPIs were present in 9.7 % (40/412) [GOC (n=9), symptom (n=15), Background and Aims andboth(n=16)]. There was no difference between cohorts regard- Despite high-level evidence in the literature, the use of single-fraction ing the presence of an EBPI (p=0.34). When present, EBPI docu- radiotherapy (RT) for management of painful bone metastases is not mentation was greater for physician (n=33) than nurse practitioner widely practiced in the world. Fractionation of palliative RT for bone (n=7). metastases is very variable. Thus, we decided to perform a study com- paring 30 Gy in 10 fractions with 8 Gy in single fraction. Symptom Goals of care Both Methods management (n=108) (n=123) (n=181) Adult patients with multiple painful bone metastases were randomized to Total prognostic 32 (17.7) 57 (52.8) 59 (48.0) p<0.001 8Gy in a single fraction or 30 Gy in 10 fractions. Pain was graded by documentation—no. (%) patients on a scale of 1 to 4 just before and again 1 month after the end of EBPI—no. (%) 15 (8.3) 9 (8.3) 16 (13.0) p=0.34 RT. EBPI documenter credentials Results • Physician 14 8 11 (33/40) • Werandomized 100 patients (52 patients in single fraction and 48 in multiple Nurse Practitioner 1 1 5 (7/40) fractions) in this trial (63 % women; mean age: 51.6 years). Patients graded their pain before RTin a range from 1.8 to 4.0 (mean: 3.2). At that time, pain Table 1. Total prognostic documentation and use of EBPIs 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, Conclusions for an overall response rate of 71 %. Mean age of patients with a complete This retrospective analysis suggests that palliative care providers are poor response (38.7 years) was significantly lower than that of patients with a documenters of EBPIs. This data requires prospective validation and may partial response or no response (53.7 years, p=0.017). suggest educational opportunities surrounding EBPIs for palliative med- The only factor with a significant effect was age (p=0.002). icine providers. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S133

MASCC-0598 referral. Patients were classified as appropriate for referral based on extent Palliative Care of disease, prognosis and PC needs. Results Forty-one percent of patients had metastatic or locally advanced disease; DEVELOPING MOBILE PALLIATIVE CARE SERVICE FOR only 2 % had poor performance status. Twenty-two percent had a life- INCURABLE PATIENTS IN THE CAPITAL OF MOLDOVA: limiting complication and/or serious comorbidities and 36 % evidenced HOW BIG IT CAN BE? difficult symptom control or psychosocial distress. Among patients with N. Carafizi1 advanced disease, potential PC cases numbered 36 (24 %) when appro- 1Hospice “Angelus”, Charity Foundation for Public Health “Angelus- priateness for PC referral was broadly defined and 11 (7 %) when Moldova”, Chisinau, Moldova appropriateness was narrowly defined. Conclusions Background and Aims Between 7 and 24 % of GO patients with metastatic or locally advanced Background: Palliative care is a new field that was successfully imple- disease were potential PC cases. Routine screening of GO patients would mented in many countries of the world, but in some states it still remains facilitate appropriate referrals and enhance patient care without over- neglected by the national healthcare systems. In Moldova palliative care whelming the PC service. Although screening was time and labor inten- has been growing gradually since 2000. sive, findings suggest it is feasible and worthwhile. Future research Aims: To assess the activity of the Charity Foundation for Public Health should assess the clinical utility of the 10-item PC screening tool. ‘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 MASCC-0526 Public Health ‘Angelus-Moldova’ about its activity for different catego- Palliative Care ries of incurable patients. Results CHALLENGES IN CARE OF TERMINALLYILL PALLIATIVE Results: Charity Foundation for Public Health ‘Angelus-Moldova’ is a CARE PATIENT IN THE MIDDLE EAST, MANAGING OF leading provider of domiciliary palliative care services for incurable PATIENT SUFFERING BEYOND MEDICATION, EXPERIENCE patients in the capital of the country. It was started in November 2001 WITH PATIENT HAVING BOWEL OBSTRUCTION with the mobile palliative care service for incurable cancer and non- 1 1 1 cancer adult patients. In November 2008 the home based paediatric S. Emara ,M.Soror, G. Abudari 1 palliative care service for incurable cancer children was initiated, and Oncology/Palliative Care, King Faisal Specialist Hospital & Research later, in October 2011 the domiciliary palliative care service for incurable Center,Riyadh, Saudi Arabia non-cancer children was launched. In December 2013 home-based palli- ative care service for incurable HIV/AIDS patients was established. There Introduction are also two additional palliative care services at home for women, who Proper management of patient’s suffering needs multifactorial approach underwent surgical interventions due to the breast cancer and ostomy (Watson et al. 2009). Inadequacies in support at home contribute to the patients, when they become incurable. fact that terminal patients die in hospitals (Worth et al. 2006). The impact Conclusions of cancer on carers can be greater than on patients (Watson et al. 2009). Conclusions: Despite the fact that the National Program in Palliative Care is Case not developed, the Charity Foundation for Public Health ‘Angelus-Moldo- Mrs M, a 52 years old female patient with advanced ovarian carcinoma. Patient va’ still remains the only provider of qualitative domiciliary palliative care admitted because pain, vomiting, and constipation. After adjusting her medi- services for different categories of incurable patients in the country. cations she was able to remove nasogastric tube and swallow. After verifying family concerns; patient was discharged home under home health care service. Discussion MASCC-0613 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 Palliative Care 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). FEASIBILITYAND EFFECT OF SCREENING ON REFERRALS Conclusions FOR PALLIATIVE CARE SERVICES Future plain. We need to extend our social support and to improve K.A. Donovan1,S.Thirlwell1,S.Winn1,S.M.Apte2,D.G.Portman1 communication with local hospitals. 1Supportive Care Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA; 2Gynecologic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA MASCC-0518 Background and Aims Palliative Care The National Comprehensive Cancer Network (NCCN) palliative care (PC) guidelines recommend all oncology patients be screened for PC PALLIATIVE SEDATION FOR TERMINALLYILL CANCER needs and provide criteria for PC referral. Data regarding validity of these PATIENTS IN ATERTIARY CANCER CENTER IN SHANGHAI, criteria are limited. Few studies have examined the feasibility and effect CHINA of screening on PC referral rates. We piloted a newly developed PC D.R. Gu1,D.R.Cheng1, D.R. Chen1,D.R.Liu1,D.R.Zhang1 screening tool to examine the feasibility of screening and assess the 1 potential effect of screening on referrals. Department of Palliative Care, Fudan University Shanghai Cancer Methods Center Department, Shanghai, China All patients (N=151) attending the gynecologic oncology (GO) outpa- Background and Aims tient clinic during 1 week in December 2013 were screened using a pilot Palliative sedation is the lowering of patients’ consciousness using version of a 10-item PC screening tool based on NCCN criteria for PC medications for the purpose of limiting patients’ awareness of S134 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 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 symp- toms 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 Univer- sity 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 dif- ference in survival time since admission between sedated and non- Summary of Enrolled Patients sedated patients (p>0.05). Conclusions Subjects Status Sex Age Race/ HCP Presence of End-of-life Palliative sedation is an optional choice for terminally ill cancer patients Ethnicity Identified AD in wishes with refractory symptoms. in EMR EMR after honored? Intervention 1 Alive F 33 Non-White Yes No TBD 2 Alive F 51 White Yes No TBD 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 SINGLE CENTER, PILOT STUDY TO EVALUATE A NOVEL 9 Alive M 52 White Yes No TBD ADVANCE CARE PLANNING TOOLTO IDENTIFY INFORMED 10 Alive F 50 White Yes Yes TBD HEALTHCARE PROXIES IN AN ONCOLOGY PALLIATIVE 11 Alive M 73 White Yes No TBD 12 Alive M 41 White Yes Yes TBD CARE CLINIC 13 Alive F 62 White Yes Yes TBD S.F.Heavey1,M.Benn1,C.Revta1, R.S. Atayee1, J.D. Ma1, E.J. Roeland1 14 Alive F 90 White Yes No TBD 1 15 Alive M 36 White Yes No TBD Doris A. Howell Palliative Care Service, University of California San 16 Alive M 56 White Yes No TBD Diego Moores Cancer Center,San Diego, USA 17 Alive M 65 White Yes Yes TBD 18 Deceased F 63 White Yes No Yes Background and Aims 19 Deceased F 70 Non-White Yes Yes Yes 20 Deceased F 43 Non-White Yes No Yes Unfortunately, most advanced cancer patients will die. To increase the 21 Deceased M 56 Non-White Yes Yes Yes probability that cancer patients receive care consistent with their end- 22 Deceased F 53 White Yes Yes Yes of-life (EoL) wishes, medical providers require simple and effective 23 Deceased M 58 White Yes Yes Yes tools to initiate meaningful advance care planning (ACP) discus- 24 Deceased F 67 White Yes Yes Yes sions, which are ideally communicated to a health care proxy 25 Deceased F 45 White Yes No Unknown† 26 Deceased M 57 White Yes Yes No (HCP) and summarized in an advance directive (AD). The primary 27 Deceased M 54 White Yes Yes Yes aim of this study is to determine the proportion of advanced cancer 28 Deceased M 77 Non-White No No Unknown‡ patients who identify an informed HCP implementing a novel ACP 29 Deceased F 72 Non-White Yes No Yes tool vs. a historical standard of 20 %. Secondary objectives include: 30 Deceased F 75 White Yes Yes Yes documentation of AD, number of deaths, and determination if EoL 31 Deceased F 63 White Yes No Yes 32 Deceased F 75 Non-White Yes No Yes wishes were honored. 33 Deceased M 73 White Yes No Yes Methods 34 Withdrew† F 45 White n/a n/a n/a In an ACS sponsored pilot study, advanced cancer patients were Summary Alive: Male: Mean White: HCP AD: Ye s : 50 % 47 % Av e r a g e : 76 % Identified: 50 % 81 % evaluated in an academic oncology palliative care clinic (n=34). (17/34) (16) 57.5±14 (26/34) 94 % (17/34) (13/16) (32/34) Subjects engaged in a 1-h ACP discussion initiated utilizing a novel Deceased: Female: Non-White: No HCP No AD: No: 6 % 47 % 53 % 24 % Identified: 50 % (1/16) ACP tool developed by the investigators (Figure 1). Details of this (16/34) (18/ (8/34) 6% (17/34) 34) (2/34) ACP conversation were documented with the goal of completing an Withdrew: Unknown: ’ 3% 13 % AD. After subject s death, HCPs were contacted to determine if EoL (1/34) (2/16) wishes were honored. Results Todate, 94 % (32/34) of subjects have designated an informed HCP,50 % Abbreviations: AD = Advance Directive; EMR = Electronic Medical (17/34) have completed an AD, and 47 % (16/34) have died. Of the Record; HCP = Health Care Proxy patients that died, 81 % (13/16) died in a setting consistent with their EoL †Patient withdrew due to discomfort discussing advance care wishes. Consistency of EoL care could not be assessed in 13 % (2/16) of planning subjects. ‡Patients transitioned to hospice prior to goals of care discussion Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S135

Conclusions Methods Preliminary results suggest that this novel ACP tool may facilitate mean- All patients who were seen at an outpatient palliative radiotherapy clinic ingful ACP, as demonstrated by designation of an informed HCP, AD from 2007 to 2012 were included. Overall survival (OS) was calculated completion rate, and death consistent with EoL wishes. Results require from the date of consultation until date of death or censored at last follow- further prospective validation.> up 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 statisti- cally significant. MASCC-0611 Results Palliative Care 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 APREPITANT FOR REFRACTORY MALIGNAN seenfrom2007to2008(p<0.0001) and 2009–2010 (p=0.03) had CY-ASSOCIATED PRURITUS shorter survival when compared to those seen from 2011 to 2012. Significant difference also occurred for patients with KPS of 50–70 J. Sheu1, M. Tawa2,N.LeBoeuf3 seen in 2007–2008 (p=0.007) and 2009–2010 (p=0.0496) com- 1Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Insti- paredto2011–2012. Median OS for these patients were 2.73, tute, Harvard Medical School, Boston, USA; 2Dermatology, Dana- 2.96, and 3.02 months, respectively. For patients with KPS 80–100 Farber Cancer Institute, Boston, USA; 3Dermatology Brigham & seen in 2007–2008 and 2011–2012, median survival nearly doubled Wo m e n ’s Hospital/HMS, Dana-Farber Cancer Institute, Boston, USA from 6.6 to 12.1 months (p=0.0052). Conclusions Background and Aims Survival has increased for patients within the same KPS categories from Aprepitant, a recently approved medication for chemotherapy-induced 2007 to 2012. Improvements in systemic therapies are likely responsible nausea and vomiting, blocks the binding of substance P to neurokinin-1. forthisincrease. 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 conven- tional treatments. Methods MASCC-0608 We describe a series of oncology patients with pruritus refractory to conven- Palliative Care tional treatments, which improved dramatically with aprepitant treatment. Results ORAL MORBIDITY IN PATIENTS RECEIVING PALLIATIVE We report a series of cases of malignancy-associated pruritus responsive CARE to aprepitant treatment after failure of symptom relief on conventional S.ar.PS1,M.P. Mohan1 treatments. Most notably, a 73-year-old man with a 12-year history of a 1Oral Medicine, Mar Baselios Dental College, Cochin, India 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 Background and Aims remaining patients carried a diagnosis of cutaneous lymphoma and also This study aims to assess oral problems in patients receiving palliative experienced marked pruritus reduction with aprepitant treatment. care for cancers including the head and neck region. Conclusions Methods Aprepitant has been shown to be efficacious for treatment of pruritus One hundred forty patients were recruited to the study following associated with malignancy and in cases of chronic pruritus. Aprepitant the inclusion and exclusion criteria. All patients went through a does not change the clinical efficacy of certain chemotherapeutic medi- face-to-face interview, covering 10 frequent cancer-related symp- cations and clinical trials for its use in preventing nausea and vomiting toms, and an oral examination including a mouth swab to test for have validated its safety.These cases suggest that aprepitant can be highly Candida carriage. All patients had undergone an oral examination effective in malignancy-associated pruritus and should be considered as a according to standard clinical practice with a systemic registration therapeutic option. 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 MASCC-0446 the WHO classification of the oral candidiasis; registration of Palliative Care teeth include number of teeth remaining, decayed, missing, DMFT index score, a functional dentition is defined as 20 or more remaining teeth. KARNOFSKY PERFORMANCE STATUS AND CHANGE IN Results OVERALL SURVIVAL OVER FIVE YEARS Examined patients had mean age of 66 years (range 38–82). Clinical R. McDonald1,L.Zhang1,G.Bedard1,E.Wong1,M.Popovic1, presence of oral candidiasis 51 %, dry mouth 82 %, mouth pain 13 %, L. Holden1,M.Tsao1,E.Barnes1,C.Danjoux1, E. Chow1 trismus 12 % and oral mucositis 25 % significantly affected the patients 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada and oral hygiene measures were adequate. The information concerning oral problems was least available. Background and Aims Conclusions The Karnofsky Performance Status (KPS) scale is used to assess patients Oral care for patients in palliative care units are important and need better based on functional impairment. KPS has been shown in many studies to mouth care. Setting up of oral care strategy is mandatory at a grass root be one of the most crucial and relevant predictive factors in the survival of level in health care systems. Increased information to the caregivers, cancer patients. The purpose of this study was to determine whether patients and staff about the presence and severity of oral problems is survival corresponding to the same KPS range has increased from 2007 necessary. Information about oral problems is important in all stages of to 2012. cancer treatment. S136 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0606 Background and Aims Palliative Care 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 FACTORS INFLUENCING PATIENT SATISFACTION WITH receiving myelosuppressive chemotherapy with a ≥20 % risk of FN. This CARE AMONG OLDER LATINOS WITH ADVANCED CANCER analysis evaluated the effects of age, weight, and treatment type (adjuvant I. Torres-Vigil1,A.delaRosa2,E.Pena3,A.Abdias3, E. Bruera4 vs metastatic disease) on the efficacy of lipegfilgrastim vs pegfilgrastim 1Graduate College of Social Work and Department of Palliative Care, using data from 2 studies (1 phase II, 1 phase III) in breast cancer patients University of Houston and The University of Texas MD Anderson Cancer receiving chemotherapy. Center,Houston, USA; 2Department of Palliative Care and Rehabilitation Methods Medicine, The University of Texas MD Anderson Cancer Center,Houston, Both studies randomized patients to subcutaneous lipegfilgrastim (3, 4.5, USA; 3Graduate College of Social Work and Department of Palliative or 6 mg, phase II; 6 mg, phase III) or pegfilgrastim (6 mg)≈24 h after Care, University of Houston, Houston, USA; 4Department of Palliative chemotherapy (60 mg/m2 doxorubicin/75 mg/m2 docetaxel) for 4 21- Care and Rehabilitation Medicine, University of Texas MD Anderson day cycles. Blood samples for absolute neutrophil counts (ANC) were Cancer Center,Houston, USA 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 Background and Aims lipegfilgrastim and pegfilgrastim 6-mg groups from both studies. Study Identifying the factors that influence patients’ satisfaction with care is endpoints included duration of severe neutropenia; time to ANC recov- crucial for informing quality improvement efforts for vulnerable popula- ery; depth of ANC nadir; and incidence of grade 4 neutropenia stratified tions. The aim of this study is to identify the demographic, psychosocial by age, weight, and type of treatment. and clinical factors associated with satisfaction among a cohort of older Results Latinos with advanced-cancer. Data for stratified efficacy endpoints are summarized in the Table. Methods Patients were interviewed to assess their satisfaction with care using a 12- Table 1. Efficacy End Point Stratified by Age, Weight, and Type of items version of the EORTC IN-PATSAT32. Independent variables mea- Treatment sured demographics (age, gender, income, education); psychosocial (ac- culturation, medical-mistrust, racism, fatalism, social support); quality-of- Pegfilgrastim 6 mg Lipegfilgrastim 6 mg life and symptom-burden (EQ-5D, FACT-G, ESAS, EGOG). Chi-square Parameter n Cycle 1 n Cycle 1 tests were conducted to identify associations between satisfaction-levels Duration of severe neutropenia, mean ± SD, daysa and independent variables. All patients 155 0.9±0.9 151 0.7±1.0 Results <65 y 144 0.9±0.9 139 0.7±1.0 From 68 baseline-interviews, 67 % of satisfaction scores were excellent- ≥ good, and 33 % were fair-poor. Males (P=0.013) and patients under age 65 y 11 0.7±0.9 12 0.9±1.4 70 (P=0.023) had greater satisfaction than females and those over 70. <60 kg 26 0.7±0.7 29 0.8±1.1 Acculturated or bicultural patients reported greater satisfaction than non- 60–80 kg 91 1.0±1.0 77 0.8±1.0 acculturated patients (P=0.036). High levels of mistrust (P=0.039) and >80 kg 38 0.8±0.9 45 0.5±1.0 fatalism (P=0.013) were associated with reduced satisfaction scores. Adjuvant 117 0.8±0.9 116 0.8±1.0 Patients with higher quality-of-life scores (P=0.001) and those reporting Metastatic 38 1.1±1.0 35 0.5±1.0 no problems with mobility, self-care, usual activities, pain, anxiety/ b depression had improved satisfaction (P≤0.05). Low functional-status Time to ANC recovery, mean ± SD, days and moderate-severe pain, fatigue, depression/anxiety, drowsiness, dys- All patients 155 7.4±3.4 151 5.8±3.5 pnea, poor-appetite and overall-wellbeing rated their satisfaction lower <65 y 144 7.4±3.4 139 5.8±3.6 than those with reduced symptom-burden (P≤0.05). ≥65 y 11 7.4±3.8 12 5.7±3.5 Conclusions <60 kg 26 6.7±3.3 29 6.0±3.5 Patient satisfaction with care varies significantly by sub-groups of older 60–80 kg 91 7.8±3.0 77 6.2±3.5 Latinos with advanced cancer. Consistent and significant associations between satisfaction and important quality-of-life and symptom-burden >80 kg 38 7.0±4.2 45 5.1±3.6 measures suggest that increased utilization of palliative care services may Adjuvant 117 7.4±3.5 116 5.9±3.7 improve satisfaction with care. Culturally-competent, age and gender Metastatic 38 7.6±3.0 35 5.7±3.1 appropriate interventions are needed to improve satisfaction among this Depth of ANC nadir, mean ± SD, × 109/Lc vulnerable population. 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 EFFICACY OF LIPEGFILGRASTIM VERSUS PEGFILGRAS Adjuvant 117 1.0±1.3 116 1.4±1.7 TIM IN PATIENTS WITH BREAST CANCER: SUBGROUP Metastatic 38 0.8±1.2 35 1.0±1.2 ANALYSIS BASED ON AGE, WEIGHT, AND TYPE OF TREATMENT aDays with grade 4 neutropenia (ANC <0.5×109/L). C. Volovat1,A.Buchner2,P. Bias2, U. Mueller3 bFirst day after start of chemotherapy with ANC ≥2.0×109/L after any 1Medical Oncology, Centrul de Oncologie Medicala, Iasi, Romania; day with ANC <2.0×109/L. 2Clinical, Teva Ratiopharm, Ulm, Germany; 3Clinical, Teva Pharmaceu- cLowest ANC value after start of chemotherapy in each cycle. ticals Inc, Ulm, Germany ANC absolute neutrophil count; SD standard deviation. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S137

Table 2. Incidence of Grade 4 Neutropenia MASCC-0468 Palliative Care Pegfilgrastim 6 mg Lipegfilgrastim 6 mg Cycle Cycle SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH Incidence of Grade 4 12341234 BRAIN METASTASES RECEIVING WHOLE BRAIN Neutropenia, % RADIATION THERAPY of Patientsa E. Wong1, M. Tsao1,L.Zhang1, R. McDonald1, G. Bedard1, L. Holden1, All patients 52.3 26.1 15.9 17.2 41.7 12.8 9.5 11.0 C. Danjoux1,E.Barnes1, M. Popovic1, E. Chow1 <65 y 52.8 25.9 14.2 16.3 41.7 12.3 9.5 11.9 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada ≥65 y 45.5 30.0 40.0 30.0 41.7 18.2 9.1 0 <60 kg 46.2 11.5 7.7 15.4 48.3 10.7 14.3 11.1 Background and Aims Patients with multiple brain metastases are often treated with whole – 60 80 kg 56.0 32.6 18.2 15.9 49.4 9.1 6.5 10.7 brain radiation therapy (WBRT). For these patients, symptom palli- >80 kg 47.4 21.1 16.2 21.6 24.4 20.5 11.6 11.6 ation as well as improvement of quality of life (QOL) and perfor- Adjuvant 50.4 24.1 14.7 14.7 44.8 13.0 8.8 10.7 mance status, are of upmost importance. The objective of this study is to determine the overall QOL and symptoms experienced by Metastatic 57.9 32.4 20.0 25.7 31.4 11.8 11.8 12.1 patients with brain metastases before WBRT, the changes seen fol- aANC <0.5×109/L. lowing WBRT, and the correlation between symptoms experienced ANC, absolute neutrophil count. and overall QOL. Methods Conclusions Patients receiving WBRT,who completed 14 symptom scores and overall Treatment with lipegfilgrastim limits the extent of neutropenia regardless QOL assessment for up to 3 months, were included. Wilcoxon signed of patient age, weight, or type of treatment. This post hoc analysis rank test was applied to determine significant symptoms and QOL demonstrates a trend for a lower rate of grade 4 neutropenia with changes. Spearman correlation was applied to determine the relationship lipegfilgrastim treatment that is consistent across all subgroups evaluated. between symptoms scores and QOL. Results Two hundred and seventeen patients were included. Appetite loss, weakness and nausea significantly increased from baseline, while MASCC-0618 balance, headache and anxiety significantly decreased. At baseline, Palliative Care 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 PHYSICIAN PERCEPTION OF CLINICAL BURDEN/STRESS with QOL changes. At month 2 FU, changes in pain, insomnia, ATATERTIARY LEVEL PALLIATIVE CARE PROGRAM concentration, balance and depression were significantly associated P. Walker1,N.Schuren1,E.Bruera1 with QOL changes. At month 3 FU, only change in nausea was 1Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer significantly associated with QOL changes. Center,Houston, USA Conclusions Clinicians should be aware of the symptom changes following WBRTand Background and Aims follow-up with patients as necessary. Certain symptoms may influence Little is known about the areas of difficulty or burden of clinical work for overall QOL to a greater extent than others and these symptoms should be Palliative Care physicians. palliated with other medications to improve QOL in patients with brain This study was conducted to determine which components of a Palliative metastases treated with WBRT. 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 MASCC-0085 pertained to the difficulty/burden/stress they experienced. An initial sur- Palliative Care 2 vey asked the physicians to rate the difficulty/burden of working on the Palliative Care Unit (PCU), Mobile Consult Teams, and the Out-Patient METRONOMIC ORAL COMBINATION CHEMOTHERAPY Center on a scale: 0=No Burden, 10=Worst Burden. A follow-up survey WITH CAPECITABINE AND CYCLOPHOSPHAMIDE IN asked physicians to rate stress caused by various areas of work on the PATIENTS WITH ANTHRACYCLINE-,TAXANE-AND PCU, 0=No stress, 10=Most stress. PLATINUM PRETREATED METASTATIC TRIPLE NEGATIVE Results BREAST CANCER Eleven full time Palliative Care physicians at MD Anderson Cancer Center (100 % of faculty with full clinical responsibility) responded to the initial G. Ajay1,R.Vinod1 survey. The PCU was rated the area of highest difficulty/burden (mean 7.4 1Medical Oncology, All India Institute of Medical Science, Delhi, India +/− 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) Background and Aims rated stress on the PCU. Dealing with Families and Caregivers rated most Triple negative breast cancer (TNBC) constitute 25 % of all breast stressful (mean 6.2 +/− 2.4 S.D.), followed by Rounding on Patients (mean cancer and have short progression free survival (PFS) and overall 5.3 +/− 2.0 S.D.), Family Meetings (mean 5.3 +/− 2.2 S.D.) and interaction survival (OS), is major concern in our country. The purpose of this with the Case Manager (mean 5.1 +/− 3.1 S.D.) study was to evaluate the efficacy and safety of an all-oral combi- Conclusions nation of metronomic cyclophosphamide plus capecitabine for wom- Further research is required to determine if these findings are generaliz- en with anthracycline, taxane, and platinum pretreated triple nega- able to other Palliative Care programs. tive MBC. S138 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0134 A retrospective single centre analysis of 60 patients with advanced Palliative Care 2 triple negative breast cancer. This analysis was carried out with the aim to determine efficacy in terms of response rate, control of SUPPORTING A PRISONER AT THE END OF LIFE tumor-related symptoms, outcome, and toxicity. All patients had chemotherapy resistant metastatic disease and had previously re- L. Boregowda1,L.Boregowda1 ceived three lines of chemotherapy included anthracycline, taxane, 1Palliative Medicine, Kidwai Memorial Institute of Oncology, Bangalore, and platinum . All patients received oral capcitabine 500 mg twice India in a day and oral cyclophosphamide at 50 mg/day without interrup- tion until re-evaluation or progressive disease. Background and Aims Results Providing appropriate palliative care support for a prisoner with ad- Between January 2008 and December 2013, 60 patients were enrolled vanced, progressive disease in a high security environment presents and 45 were included in the efficacy analysis. The median follow-up was practical, legal and ethical challenges for health care staff. The team in 12 months. ORR was 40 % and stable disease was achieved in 15 %, our Department took interest in treating him both as an outpatient and resulting in a 55 % clinical benefit response rate. Symptoms controlled inpatient for providing palliative care. was achieved in 58 % of cases. Median PFS was 6 months and overall Methods survival was 9 months. The 1- and 2-year OS rates were 51 and 21 %, Mr.X Sex: Male respectively. Toxicity was very mild and easily manageable Grade 3 Age: 56 Yrs adverse events comprised leukopenia (20 %), neutropenia (18 %) and Bio-hazardous (HIV + ve) transaminitis in 10 % of cases. Diagnosis: Carcinoma Lung (Right apical lobe) Conclusions Treatment received: Palliative care. Started on Oral Morphine 10 mg on The all-oral combination of metronomic CTX plus capecitabine is an 2nd December 2013 effective and convenient and well-tolerated regimen for MBC. 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 MASCC-0055 adjuvants. Palliative Care 2 Diagnosis: Carcinoma Lung (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013Cur- rently on: Oral Morphine 70 mg 4 hrly, with adjuvants. ENDOBRONCHIAL PALLIATIVE PHOTODYNAMIC Bio-hazardous (HIV + ve)Diagnosis: Carcinoma Lung (Right apical lobe) THERAPY FOR INOPERABLE CENTRAL LUNG CANCER Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 A. Akopov1, A. Rusanov1, N. Kazakov1,A.Gerasin1 December 2013 Currently on: Oral Morphine 70 mg 4 hrly, with adjuvants. 1Res Institute of Pulmonology, First State Pavlov Medical University, St. Age: 56 Yrs Bio-hazardous (HIV + ve) Diagnosis: Carcinoma Lung Petersburg, Russia (Right apical lobe) Treatment received: Palliative care. Started on Oral Morphine 10 mg on 2 December 2013Currently on: Oral Morphine Background and Aims 70 mg 4 hrly, with adjuvants. Malignant airway stenosis often causes severe life threatening symptoms, Sex: Male Age: 56 Yrs Bio-hazardous (HIV + ve) Diagnosis: Carcinoma primarily respiratory failure. Effectiveness of current treatment options Lung (Right apical lobe) Treatment received: Palliative care. Started on cannot be considered satisfactory. We analyze the possibility to extend Oral Morphine 10 mg on 2 December 2013 Currently on: Oral Morphine indications for photodynamic therapy (PDT) as a component of multidis- 70 mg 4 hrly, with adjuvants. ciplinary treatment for locally advanced and metastatic non-small cell Results lung cancer (NSCLC). I will provide an overview of the palliative care services provided to him Methods as both outpatient and inpatient at our hospital. I will present the chal- Two hundred seventy-three patients with inoperable stage III-IV lenges in providing good palliative care to maintain dignity and ensure NSCLC underwent endobronchial PDT in combination with chemo- comfort for a prisoner at the end of life. and targeted therapy (249), argon-plasma coagulation (59), stenting Conclusions (47), YAG laser (23), brachytherapy (7). Indications for PDT were This will illustrate the fascinating and satisfying aspect of my role as a obstructing central disease as well as local recurrence after surgical Palliative care consultant in providing good Palliative care to a prisoner. 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. MASCC-0132 Results Palliative Care 2 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 MUSCULAR METASTASES ARISING FROM SQUAMOUS had major PDT complications. Of the 273 patients 14 % achieved com- CELL CARCINOMA OF THE LUNG plete endobronchial response, 70 % - partial response, 16 % - no response. 97 % of patients had symptoms improvement. The 1 year survival rate for N. Chiu1, L. Chiu1, G. Bedard1, M. Poon1, M. Popovic1, E. Wong1, patients with stage III was 71 %, stage IV – 56 %, median survival was H. Lam1,E.Chow1 19 months. The best results were noted in patients with local relapse after 1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook previous resection. Health Sciences Centre University of Toronto, Toronto, Canada Conclusions PDT is safe and effective option for advanced obstructing endobronchial Background and Aims lesions. PDT appears to fit in well with the current multidisciplinary Lung cancer is the leading cause of cancer-associated death in the world approach to lung cancer. and is the second most commonly observed subcategory of cancer among Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S139 both men and women. Nonetheless, skeletal muscle metastases from Conclusions lung cancer are a rare occurrence. Due to the rare incidence of muscle We concluded that the weight stabilization and increased appetite we metastases arising from lung cancer, documentation of these types of observed in this study justify further studies of guarana in this patient cases in the literature may be of use to health-care professionals in population. 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 meta- MASCC-0061 static tumor to the right rectus femoris. Palliative Care 2 Results Investigations of the patient revealed extensive metastatic squamous cell PHASE II CLINICALTRIAL OF UNCARIATOMENTOSA carcinoma originating from the lung and involving the bones, liver, left (CAT’S CLAW) IN PATIENTS WITH ADVANCED SOLID adrenal gland, and the right rectus femoris muscle. The patient was treated TUMORS with palliative radiation for her painful bone metastasis. Specifically, she L. de Paula1,F. Fonseca1,F. Perazzo1,F. Melo Cruz1, D. Cubero1, received a single 8 Gy to the thoracic and lumbar spine, the pubic D. Trufelli1, S. Martins1,P.Santi1,E.AraújodaSilva1, A. Del Giglio1 symphysis, and the right pelvic bone. 1Clinical Oncology, ABC Foundation School of Medicine, Santo André, Conclusions Brazil We recommend that further studies of metastatic growth in skeletal muscles be done in order to in identify optimal treatment procedures Background and Aims for patients of various stages of disease progression. As more studies Cat’sclaw(Uncaria tomentosa) is a native amazonic plant that exhibits of relevant cases are documented, comparisons in treatment proce- anti-inflammatory and antitumor properties. dures should be made to identify more effective, individualized Methods therapies. 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’ MASCC-0018 quality of life, HADS questionnaire to assess their anxiety and depression Palliative Care 2 and Pittsburgh index (PSQI) to assess sleep quality. In addition, several biochemical and inflammatory parameters were analyzed. GUARANA (PAULLINIA CUPANA) IMPROVES ANOREXIA IN Results PATIENTS WITH ADVANCED CANCER We recruited 51 volunteers; their median age was 64 (33–85) years old, and 47 % were females. Their scores on the Karnofsky scale C.G.L. Palma1,F.Cruz1, A.T. Lera2,T.Lerner3, M.M. Oliveira3, 3 3 3 3 4 were equal to or less than 80 % for more than 65 % of the volunteers. T.M. Borta ,R.P. Barbosa ,G.M.Brito,C.A.Guazzelli,A.delGiglio Treatment caused an improvement in patients’ overall quality of life 1Clinical Oncologist, ABC Foundation School of Medicine, Santo André, 2 (p=0.0411) and social functioning (p=0.0341), as assessed by Brazil; Resident in Clinical Medicine, ABC Foundation School of Med- EORTC QLQ C-30, and a reduction of fatigue (p=0.0496) by icine, Santo André, Brazil; 3Academic, ABC Foundation School of Med- 4 Chalder Fatigue Questionnarie (figure 1). None of the biochemical icine, Santo André, Brazil; Chairman of the Department of Hematology or inflammatory parameters assessed exhibited significant changes. and Oncology, ABC Foundation School of Medicine, Santo André, Brazil No tumor response was detected according to RECIST criteria; how- ever, disease stabilized for more than eight months in four partici- Background and Aims pants. Medication was well tolerated by most patients. 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)inpatientswithcancerand weight loss. Methods Weincluded 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 tox- icity (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 complet- ed the study had weight gain above 5 % from their baseline, whereas 6 patients had at least a 3-point improvement in the Conclusions visual appetite scale. The M.D. Anderson Symptom Inventory We conclude that use of cat’s claw might be beneficial for patients with (MDASI) was used to evaluate several symptoms, and we ob- advanced cancer because it could improve their quality of life and reduce served a significant decrease in lack of appetite (p=0.02) and in fatigue. The mechanism of this action does not seem to be related to the somnolence (p=0.0142). anti-inflammatory properties of this plant. S140 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0111 Methods Palliative Care 2 We analyzed in 116 advanced cancer patients admitted to the ICU be- tween Jan 2010 and Dec 2012. We analyzed demographic, clinical and survival data and identified prognostic and predictive factors that could be FACTORS AFFECTING COMMUNICATION PATTERNS compared with short- and long-term survival. BETWEEN ONCOLOGY STAFFAND BEREAVED FAMILIES: A Results CROSS-SECTIONAL STUDY Of the 116 patients, the median age at ICU admission was 64 years T. Granot1,S.Perry2, N. Gordon3,S.Rizel1, S.M. Stemmer4 (59.5 % males, 40.5 % females). As the main cause of ICU admission 1Breast Cancer Unit, Davidoff Cancer Institute, Petah-Tikva, Israel; was acute respiratory failure (73 %), 102(87.9 %) patients were managed 2Psycho-Oncology, Davidoff Cancer Institute, Petah-Tikva, Israel; in mechanical ventilation, 99(85.3 %) patients in vasopressor and 3Research, Davidoff Cancer Institute, Petah-Tikva, Israel; 4Deputy of 31(26.7 %) patients in continuous renal replacement therapy (CRRT). Oncology Institute, Davidoff Cancer Institute, Petah-Tikva, Israel 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 Background and Aims <0.050) and the need for CRRT (HR:2.14, 95 % CI 1.24–3.70, P <0.007) Perceptions surrounding the role of the oncology staff in supporting were associated with ICU mortality However, Eastern Cooperative On- families of deceased patients have evolved with the transition to an cology Group (ECOG) performance status (HR 1.64, 95 % CI 1.03–2.62, interdisciplinary cancer-care approach. The goal of this study was to P <0.010) is associated poor prognosis and controlled disease status (HR investigate the interactions between oncology professionals and bereaved 0.372, 95 % CI 0.21–0.67, P <0.001) is good prognostic factor for 6- families. month survival after ICU admission. Methods Conclusions In a cross-sectional study, all staff members, at one Cancer Center, were To determine short-term survival, clinical factors presenting acute illness given a 5-point Likert scale questionnaire, including 39 statements relat- at ICU admission were higher associated ICU mortality than factors ing to communications with bereaved families. related to the malignancy itself. We have to assess the comprehensive Results approach considering cancer biology, disease control status in terms of One hundred seven (69 %) filled questionnaires (α=0.821). Re- long-term survival. spondents 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 pro- MASCC-0047 fessionally appropriate (82 %). 51 % indicated that they contact Palliative Care 2 >50 % of the families of their deceased patients. Contacting be- reaved families was considered to be within physicians (88 %), nurses (81 %), or social workers (87 %) responsibility. Barriers for AN EXPLORATORY STUDY OF THE ATTITUDES OF contacting families were emotional overload (68 %) and lack of PALLIATIVE CARE PRACTITIONERS TO THE USE OF time (63 %). 60 % indicated a need for additional communication PALLIATIVE CARE ASSESSMENT TOOLS IN KENYA tools, to aid them in bereavement activities. In a multivariate J. Weru1 analysis, profession (physician vs. nurse), primary workplace (in- 1Medicine, Aga Khan University Hospital Nairobi, Nairobi, Kenya patient vs. outpatient setting) and ethnicity (Jewish vs. Muslim) were significant variables regarding the importance of contacting Background and Aims bereaved families so actually contacting them. Other factors (age, According to WHO (2008) quality palliative care is possible if there is gender, experience, number of dying patients) were mostly early identification and impeccable assessment and treatment of pain and nonsignificant. other problems. From this definition, assessment of symptoms is an Conclusions important component of quality palliative care. Perspectives regarding bereavement actions differ significantly across Objectives medical professions, work settings, and ethnicities. Additional & Assess how attitudes of practitioners affect the use of assessment guidance/education regarding bereavement actions is warranted. tools & Assess practitioners’ attitude on utilization of assessment tools & Identify barriers to use of tools and determine methods which could MASCC-0128 increase their use. Palliative Care 2 Methods 1:1 interviews were conducted using a guideline, 10 participants who met the inclusion criteria, from 3 palliative care settings located in different PREDICTIONS FOR SHORTAND LONG TERM SURVIVAL parts of the country. Interviews at the practitioners’ places of work during AFTER ICU ADMISSION IN ADVANCED CANCER PATIENTS duty time. Data recorded and transcribed with issues isolated and grouped S.J. Heo1,K.S.Chung1,J.H.Sohn1,S.H.Lee1 together into themes. 1Department of Internal Medicine, Yonsei University College of medicine, Results Seoul, Korea Themes: practice, communication, practical concerns, resources and training, Culture, spirituality, patient and family wellbeing, symptoms Background and Aims management, tools applicability and availability. Intensive care unit (ICU) admission in advanced cancer patients remains Conclusions debated because of the poor short-term prognosis. Therefore, ICU admis- There is a need for better scientific evidence of palliative care assessment sion of these patients should be assessed on the possibility to administer tools clinical utility locally.Evidence need to be adduced showing that the specific anticancer treatment, tumor characteristics and the long-term use of tools enhance practice. Review of curricula for nurses, doctors and outcome. palliative care practitioners. Development of national palliative care tools Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S141 which are culture and language appropriate. Filling out assessment tools Methods bit by bit for completion with multiple visits. Assessments need to be A 65 year-old male with a CUP was referred to the Sunnybrook carried out at the key moments of a patient’s illness trajectory. Use of Health Sciences Centre in July 2013 with widespread bone metas- mobile telephony in assessment. tases 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 MASCC-0133 Due to the patient’s weak condition, orthopaedics felt that surgery Palliative Care 2 was not a suitable option; rather, radiotherapy for pain management was recommended. The dose of radiotherapy the patient was to SUSPECTED MALIGNANT SPINAL CORD COMPRESSION: receive was initially 30 Gy in ten fractions, but was reduced to CLINICAL SUSPICION IS VALID 20 Gy in five fractions in order to minimize the pain and suffering associated with trips by ambulance. J. MacKintosh1,A.Brady1,S.Carr1, D. MacKintosh1 Conclusions 1Palliative Care, Central Coast Local Health District, Long Jetty, The poor prognosis of CUP patients in certain risk categories makes Australia surgery an unfavorable option, especially in the treatment of patients with poor performance status. Management of pathological fractures second- Background and Aims ary to bone metastases through radiotherapy requires a balance in Malignant spinal cord compression (MSCC) is a genuine medical emer- assessing the goals of treatment, as well as the needs and conditions of gency and untreated can result in paralysis and bowel and bladder the patient. 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 clini- cians are aware of the need to start the assessment process on the basis of clinical suspicion in the absence of identifiable neurological deficits. MASCC-0116 To review outcomes for patients seen in the community with clinical Palliative Care 2 suspicion of MSCC (a known cancer diagnosis PLUS development of a new back pain or an increase in an existing back pain). Todevelop a protocol for emergency management of suspected MSCC in PALLIATIVE RADIOTHERAPY FOR BRAIN AND BONE the community. METASTASES FROM A PAPILLARY THYROID CARCINOMA Methods C. Yip1,N.Lao1, M. Popovic1, N. Pulenzas1 A retrospective audit of 399 medical records identified 27 patients with a 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada suspected MSCC. Results MSCC was confirmed by MRI in 60 % of patients with clinical suspicion Background and Aims of MSCC. Common sites of metastases from a primary papillary thyroid Conclusions carcinoma (PTC) are the lung and bone; conversely, metastases to Clinical suspicion of MSCC using the identified criteria is valid and the brain are extremely rare. Complications can arise from bone supports the use of a protocol enabling community based Palliative Care metastases, including pathological fractures. Pathological fractures Specialist Nurses to administer emergency treatment of dexamethasone can be treated aggressively with surgery or conservatively with 16 mg prior to transfer to the emergency department for imaging and radiotherapy. Surgical indication is greatly affected by the patient’s further assessment. Patients are instructed to continue dexamethasone life expectancy, which is greatly reduced with presence of brain 16 mg/day until the diagnosis has been either confirmed or refuted to metastases. minimise the risks of delayed diagnosis in the absence of neurological This case report discusses the optimal therapeutic approach for patients signs. with bone and brain metastases from a primary PTC. Methods A 78 year-old male was referred to the Sunnybrook Health Sciences MASCC-0117 Centre. The patient was diagnosed with PTC, with accompanying Palliative Care 2 brain, liver, and bone metastases. The patient suffered from head- aches and a pathological fracture of the right humerus secondary to a bone metastasis. PATHOLOGICAL FRACTURE FROM METASTATIC BONE Results DISEASE OFAN UNKNOWN PRIMARY CANCER It was decided that surgical management would put the patient at a C. Yip1, M. Popovic1,N.Lao1, N. Pulenzas1,E.Chow1 high risk of bleeding. Recovery from surgery would also be diffi- 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada cult, as he was wheelchair dependent and required almost 24-h care. The patient started radiation treatment of 20 Gy in five Background and Aims fractions to both the right humerus fracture and the whole brain. Cancer of an unknown primary (CUP) is a common malignancy that After treatment, the patient was reported to have felt relief from accounts for approximately 3–5 % of all cancer diagnoses. When patients pain. with low performance status suffer from pathological fractures secondary Conclusions to bone metastases, surgery is usually not indicated due to poor prognosis. This case demonstrates the potential difficulty of deciding a treat- Instead, pain management may become the primary concern. ment option for a patient with a poor prognosis due to potential The purpose of this present case report is to discuss the treatment of complications. Further studies done on this patient population would pathological fractures in patients with low performance statuses from a help clarify and improve treatment options available to such CUP. patients. S142 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0121 Most participants in phase two agreed that the workshop enabled them to Palliative Care 2 understand more about advance care planning and they could apply the knowledge in their professional practice. Conclusions PALLIATIVE RADIOTHERAPY FOR BRAIN AND BONE The project has increased the community’s awareness of, and interest in, METASTASES FROM A PAPILLARY THYROID CARCINOMA the available services when a person is facing a life-limiting disease and C. Yip1,N.Lao1, M. Popovic1, N. Pulenzas1,E.Chow1 encourage more openness in preparing for a good death. The project also 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada provided updated training to nurses and doctors to improve delivery of end-of-life care. 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 MASCC-0155 pathological fractures. Pathological fractures can be treated aggressively Palliative Care 3 with surgery or conservatively with radiotherapy. Surgical indication is greatly affected by the patient’s life expectancy, which is greatly reduced PALLIATIVE RADIOTHERAPY FOR BONE METASTASES with presence of brain metastases. FROM LUNG CANCER: EVIDENCE-BASED MEDICINE? This case report discusses the optimal therapeutic approach for patients A.M. Fairchild1 with bone and brain metastases from a primary PTC. 1Radiation Oncology, Cross Cancer Institute, Edmonton, Canada Methods A 78 year-old male was referred to the Sunnybrook Health Sciences Background and Aims Centre. The patient was diagnosed with PTC, with accompanying brain, Palliative radiotherapy (PRT) remains the gold standard for treatment of liver, and bone metastases. The patient suffered from headaches and a painful bone metastases (BM) from lung cancer (LC). The objectives pathological fracture of the right humerus secondary to a bone metastasis. were to review evidence-based recommendations for PRT for BM sec- Results ondary to LC and to analyze published surveys of global practice for It was decided that surgical management would put the patient at a high congruence. risk of bleeding. Recovery from surgery would also be difficult, as he was Methods wheelchair dependent and required almost 24-h care. The patient started English publications related to best practice PRT for BM from LC were radiation treatment of 20 Gy in five fractions to both the right humerus obtained via literature search (2003–2013). Additional consensus and fracture and the whole brain. After treatment, the patient was reported to clinical practice guidelines were obtained from the Standards and Guide- have felt relief from pain. lines Evidence Directory. Eligible surveys contained hypothetical case Conclusions scenarios requiring participants to declare whether they would administer This case demonstrates the potential difficulty of deciding a treatment PRTand if so, to what dose. option for a patient with a poor prognosis due to potential complications. Results Further studies done on this patient population would help clarify and There is no convincing evidence of differential outcomes based on improve treatment options available to such patients. 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 recom- MASCC-0243 mended for impending pathologic fracture or spinal cord compres- Palliative Care 3 sion (complicated BM). Twelve cases of LC and BM have been investigated in surveys with response rates from 15.7 to 63.3 % THE PROMOTION OF END-OF-LIFE SUPPORTIVE CARE TO (1998–2012). 8Gy/1 would be used by 13.7 % of respondents THE GENERAL PUBLIC 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 C. Chan1,C.K.Pang2 20Gy/5 or 30Gy/10 for a complicated BM presentation. 1Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Conclusions Kong China; 2Nursing, Princess Margaret Hospital, Hong Kong, Hong While PRTshould be appropriately customized to patients, dose should Kong China have a robust evidence base. Surveys regarding management of BM secondary to LC continue to show a large discrepancy between evidence Background and Aims and patterns of practice. The goal of this health promotion project was to promote public aware- ness and appreciation of the benefits of end-of-life supportive care. Methods Phase one of the project included 8 road-shows to disseminate the phi- MASCC-0253 losophy and the services available regarding end-of-life care to the com- Palliative Care 3 munity in Hong Kong. Five of the road-shows were organized in hospital lobbies and three in shopping malls. Participants were given sets of the KNOWLEDGE, ATTITUDES AND PRACTICES OF promotional materials (pamphlet and VCD) and completed a brief survey. ONCOLOGY NURSES TOWARDS COMPLEMENTARYAND Phase two of the project involved a 2-day training workshop for 58 home ALTERNATIVE MEDICINE FOR CANCER CARE IN QATAR care nurses and doctors on advance care planning and advance directives. Results A. Hassan1, A. Allam1,S.AlKindi2, G. Abu Zeinah3, S.A.A.D. Eziada1, The brief survey of 2,700 participants during the road-shows indicated A. Bashir1 that 87 % of participants did not know what an advanced care planning/ 1Oncology, Hamad General Hospital, Doha, Qatar; 2Internal Medicine, advance directive was, and 60 % of participants were interested in University Hospital Cleaveland, Ohio, USA; 3Internal Medicine, New knowing more about the end-of-life supportive service. York Presbyterian Hospital, New York, USA Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S143

Background and Aims MASCC-0165 Nurses play a vital role in the integration of CAM into cancer care. Palliative Care 3 knowledge of applications and interactions with the ability to offer advice on CAM is essential for nurses. PHASE ANGLE FOR PROGNOSTICATION OF SURVIVAL IN To investigate the attitudes, practices and knowledge of the use of CAM PATIENTS WITH ADVANCED CANCER in cancer care among oncology nurses at the National Center for Cancer Care & Research (NCCCR), Qatar. D. Hui1,S.Bansal1, M. Morgado1,R.Dev1, G. Chisholm2,E.Bruera1 Methods 1Palliative Care & Rehabilitation Medicine, University of Texas MD A cross-sectional cohort survey of nurses at NCCCR in the form of Anderson Cancer Center, Houston, USA; 2Biostatistics, University of questionnaire exploring attitudes, practices, knowledge and interest in Texas MD Anderson Cancer Center,Houston, USA CAM use in cancer care. Results Background and Aims One hundred fifty-six nurses participated in the study. Most of the nurses Accurate survival prediction is essential for decision-making in cancer were female 86 %. The majority of the nurses came from India, Pakistan, and therapies and care planning. Objective physiologic measures may im- Nepal 64 %, followed by Philippines 20 %. Most nurses were influenced by prove the accuracy of prognostication. In this prospective study, we Christianity 57 % and by Asian culture 71 % followed by Arabic culture determined the association of phase angle, hand grip strength (HGS), 29 % reflecting the countries of origin. Eighty-nine percent of the nurses and maximal inspiratory pressure (MIP) with overall survival in patients heard about CAM, 82 % of them recommended CAM to patients. The with advanced cancer. majority believes that CAM helps the patient’s condition 94 %. About Methods 96 % of nurses expressed interest in knowing more about CAM. The most Weenrolled hospitalized patients with advanced cancer who were seen by CAM modalities nurses knew about were herbal medicine 12 %, followed by palliative care for consultation. We assessed the phase angle, HGS, MIP, yoga and music therapy 10 % each. Most nurses (44 %) believe that CAM Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI), helps to improve the psychosocial and emotional wellbeing of patients. serum albumin and body composition. We conducted univariate/ Conclusions multivariate survival analysis, and examined the correlation between The knowledge of applications and interactions with the ability to offer phase angle and other prognostic variables. advice on CAM is essential in the nurses’ role in cancer care. CAM Results education and training will provide nurses with the knowledge to support Two hundred twenty-two patients were enrolled: average age 55, female and advocate its use for their patients. 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 MASCC-0245 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 Variables Hazard ratio (95 % CI) P-value QATAR: A POPULATION-BASED STUDY Phase angle (/degree) 0.86 (0.74–0.99) 0.04 A. Hassan1,A.Allam1, H. Mohsen2,P.Haddad2 PaP Score (/point) 1.07 (1.02–1.13) 0.008 1Oncology, Hamad General Hospital, Doha, Qatar; 2N/A, Weill Cornell Medical College, Doha, Qatar Albumin (/g/dL) 0.67 (0.50–0.91) 0.009 Fat free mass (/kg) 0.98 (0.96–0.99) 0.02 Background and Aims The consensus from International studies of patient preferences is that, Conclusions given adequate support, most people would prefer to die at home; Phase angle was a novel and independent predictor of survival in the however, hospitals remain the most common place of death. advanced cancer setting. This objective and non-invasive tool may be The purpose of this study was to assess place of death of cancer patients useful for bedside prognostication. 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 MASCC-0164 chart review of all patients. Palliative Care 3 Results A total of 1,224 cancer deaths occured during the period from 2006 to OUTPATIENT PALLIATIVE CARE AND ITS IMPACT ON 2012. The mean age was 58 yrs. Males constituted 55 % while 45 % were QUALITY OF END-OF-LIFE CARE IN PATIENTS WITH females. The most common cancer dignosis were GI tract 31 % followed ADVANCED CANCER by hematologic malignancies 14 %, breast and lung cancer 13 % each. Majority of the patients died in ICU 28 %, followed by Oncology ward D. Hui1,S.H.Kim1,J.Roquemore2,R.Dev1,G.Chisholm3,E.Bruera1 26 %; and acute palliative unit for 24 %. Those who died at home made up 1Palliative Care & Rehabilitation Medicine, University of Texas MD only 0.4 %. The majority of patients who died in ICU spent 0–2days Anderson Cancer Center,Houston, USA; 2Clinical Operations Informat- accounting for 34 %. The most common malignancy in ICU deaths were ics, University of Texas MD Anderson Cancer Center, Houston, USA; hematologic with 26 % followed by hepatobiliary 15 % and GI tract 14 %. 3Biostatistics, University of Texas MD Anderson Cancer Center,Houston, Conclusions USA 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 Background and Aims preferred place of death for most cancer patients, effective home care and Limited data is available on how the setting of palliative care (PC) referral hospice program are needed to enable patients to remain home in accor- can affect end-of-life care. We compared the quality of end-of-life care dance with their preference. between patients referred to outpatient and inpatient PC. S144 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods Cox-regression analysis. However, ECOG performance status (HR All adult patients who died of advanced cancer between 9/1/2009 and 1.64, 95 % CI 1.03–2.62, P <0.010) is associated poor prognosis 2/28/2010 and had a PC consultation were included. Weretrieved data on and controlled disease status (HR 0.372, 95 % CI 0.21–0.67, PC referral and quality of end-of-life care indicators. Weanalyzed the data P <0.001) is good prognostic factor for 6-month survival after using Chi-square tests, Mann–Whitney tests, and multivariate logistic ICU admission. regression. Conclusions Results To determine short term survival, clinical factors presenting acute Among 366 decedents, 169 (46 %) had their first PC consultation in illness at ICU admission, such as APACHE II score, the need of the outpatient setting and 197 (54 %) in the inpatient setting. CRRT, were higher associated ICU mortality than factors related to Outpatient PC referral was associated with a significant decrease the malignancy itself. However, we have to assess the comprehensive in emergency room visits (48 % vs. 68 %, P<0.001), hospital approach considering cancer biology, disease control status in terms admissions (52 % vs. 86 %, P<0.001), prolonged hospital stays of long term survival. (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 MASCC-0151 analysis, outpatient PC was independently associated with less Palliative Care 3 aggressive end-of-life care (Table). PATIENT OUTCOMES OFA PHARMACIST-PHYSICIAN Table. Factors Associated with Aggressive End-of-Life Care COLLABORATION IN A PALLIATIVE CARE OUTPATIENT PRACTICE Odds ratio (95 % CI) P-value J.D. Ma1, E.J. Roeland1, W.M. Mitchell1, R.S. Atayee1 Male 1.63 (1.06–2.50) 0.027 1Doris A. Howell Service, University of California San Diego Moores Hematologic malignancies 2.57 (1.18–5.59) 0.018 Cancer Center,San Diego, USA Palliative care outpatient referral 0.42 (0.28–0.66) <0.001 Background and Aims Conclusions We have previously reported the development and initial success of Patients referred to outpatient PC had improved end-of-life care a unique outpatient palliative care practice under pharmacist- compared to inpatient referral. Our findings support the need to physician collaboration. The study objective was to evaluate patient increase the availability of PC clinics and to streamline the process outcomes of a pharmacist-physician palliative care collaborative of early referral. practice. Methods New and follow up patient consultations were referred by an oncol- ogist or hematologist to a palliative care clinic at an academic, MASCC-0143 comprehensive cancer center. Patients were evaluated by a pharma- cist, in accordance with California code 4052 and under the super- Palliative Care 3 vision of a physician as detailed in a collaborative practice protocol. Pharmacists had independent prescriptive authority, with DEA li- PREDICTIONS FOR SHORTAND LONG TERM SURVIVAL censure and NPI status, to start, adjust, or stop pharmacologic AFTER ICU ADMISSION IN ADVANCED CANCER PATIENTS therapies, including Schedule II controlled substances for treatment S. Lee1, S.J. Heo1,K.S.Chung1 of pain and other physical symptoms. Pain scores, presence of 1Internal Medicine, Yonsei University College of Medicine, Seoul, Korea constipation, nausea/vomiting, and other physical symptoms were assessed. Background and Aims Results Intensive care unit (ICU) admission in advanced cancer patients remains A cohort of 84 new (45 women and 39 men) and 272 follow up debated because of the poor short-term prognosis. However, we should consultations was seen between March 2011 to March 2012. The most also assess on the specific anticancer treatment, tumor characteristics and common cancer type was gastrointestinal (n=21). the long-term outcome. Methods Visit N Pain score Patients with Patients without Presence of We analyzed in 116 advanced cancer patients admitted to the ICU at (Mean ± SD) a30% a30% constipation single institution between Jan 2010 and Dec 2012. Weexcluded palliative decrease in decrease in care only patients. Weanalyzed demographic, clinical and survival data of pain score pain score patients admitted at ICU and identify prognostic and predictive factors 1 (baseline) 84 7±2.7 N/A N/A 22 presented at ICU admission that could be compared with short- and long- 2 60 5.3±2.5* 29 31 12 term survival. 3 45 4.8±2.4* 25 20 12 Results The median age at ICU admission was 64 years. Eighty seven 4374.1±2.5*24133 (75 %) patients underwent active anticancer treatment in recent 5 30 3.5±2.5* 22 8 4 30 days. 102(87.9 %) patients were managed in mechanical ven- tilation, 99(85.3 %) patients in vasopressor and 31(26.7 %) pa- *p≤0.05 compared to baseline visit tients in CRRT. The ICU and 6-month survival rates were 51.7 %, 15.5 %, respectively. APACHE II score (HR: 2.86, 95 % CI: Conclusions 1.00–8.15, P <0.050) and the need for CRRT (HR:2.14, 95 % A pharmacist-physician collaboration in a palliative care outpatient prac- CI 1.24–3.70, P <0.007) were associated with ICU mortality by tice improved symptoms of pain and constipation. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S145

MASCC-0193 (9 %). Most patients are referred by SPCTs. Two hundred thirty-five Palliative Care 3 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 DANGEROUS ROTATIONS - SWITCHING FROM HIGH DOSE percent felt OOH handover should be undertaken by themselves or OXYCODONE TO MORPHINE SPCTs, suggesting joint working. Seventy-five percent felt patients D. MacKintosh1,A.Brady1,S.Carr1 should be referred when deteriorating, although GPs underestimated 1Palliative Medicine, Central Coast Palliative Care Service, Berkeley those not referred, stating reasons of patient stability. Four months fol- Vale, Australia lowing data collection, 57 % of patients had died, with 41 (19 %) dying with no handover at all. Background and Aims Conclusions Opioid switching in the management of cancer related pain continues to Most palliative patients were flagged to GP OOH, an improvement rely heavily on the use of published equianalgesic ratios despite widely on previous years. GPs and SPCTs are however encouraged to antic- acknowledged difficulties which includes serious toxicity.Although opin- ipate sudden deterioration in currently stable patients, to prevent ions differ, some degree of agreement has been reached on a suitable OOH crises. 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. Toassess the safety of switching from high dose oral oxycodone (480 mg/ MASCC-0168 – day 960 mg/day) to morphine using an equianalgesic ratio of 1:1.5 Palliative Care 3 (O:M). Methods INDICATIONS FOR INTEGRATED SUPPORTIVE CARE Retrospective case review. AMONG INDIVIDUALS WITH CERVICAL CANCER: AVIEW Results FROM A DEVELOPING COUNTRY Switching from high dose oral oxycodone to oral morphine was success- fully achieved with between 8 and 17 % of the predicted oral morphine A.T. Olagunju1,O.F. Aina1,F.O. Sarimiye2, T.O. Olagunju3 dose, equivalent to conversion ratios of 1:0.125 and 1:0.25 (O:M). 1Department of Neuropsychiatry (psychooncology), Lagos University Conclusions Teaching Hospital/College of Medicine University of Lagos, Lagos, The actual required conversion ratios were well below those predicted by Nigeria; 2Department of Radiotherapy and Oncology, University College agreed standards and blind adherence to a published dose equivalence Hospital Ibadan Nigeria, Ibadan, Nigeria; 3Department of Infectious ratio of 1:1.5 may have placed the patients at significant risk of serious Diseases and related cancers, Health Service Commission Lagos Nige- toxicity. Where, as in these cases, there has been dose escalation without ria, Lagos, Nigeria sustained improvement in analgesia, we recommend an initial ‘test dose’ of immediate release morphine of no greater than 10 % of the predicted Background and Aims morphine dose. An alternative is gradual reduction of the oxycodone Cervical cancer is not only a leading gynecologic cancer in the develop- while titrating morphine upwards; this approach, however while safe, is ing countries but disproportionately accounts for disease burden due to time consuming and does not address the need for urgent pain relief. 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. MASCC-0213 Methods Palliative Care 3 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. HANDOVER OF PALLIATIVE PATIENTS TO OUT OF HOURS Subsequently, Centre for Epidemiological Studies Depression Scale PRIMARY CARE Revised (CESD-R) was used to ascertain depressive symptoms in F. Murray-Brown1 participants. 1Palliative Care, Derriford Hospital, Plymouth, United Kingdom Results Majority of the subjects, 50(41.0 %) and 68(55.7 %) were in their fifth Background and Aims decade of life and unmarried respectively. Six (4.9 %) participants pre- Cancer patients spend 90 % of their last year of life at home. Two thirds of sented with early stage cancer, while close to two-thirds of the participants the week is out of hours (OOH). Britain’s Gold Standards Framework made up of 76(62.3 %) subjects had advanced stage cancer. The largest aims to provide consistent care for palliative patients, coordinated across proportion, consisting of about 7 in every 10 participants had pain, all community settings and delivered by practitioners aware of the per- 70(57.4 %) participants reported sexual dysfunction, and common sexual son’s medical condition and care plan. problems that were reported include loss of libido, dyspareunia and an Methods organism among others. In addition, physical complications like ulcer, This audit aimed to establish how many patients known to the Specialist weight loss and multiple complaints were seen in 56(45.9 %) participants. Palliative Care Team (SPCT) at St Lukes Hospice, Plymouth, England, Significant depressive symptoms based on CESD-R cut-off score of 16 were also known to Devon’s General Practice (GP) OOH coordinator, and above was elicited among close to half of the participants, DDocs, through the Electronic Palliative Care Coordination System 58(47.5 %). (EPaCCS). It also established, via a written questionnaire, GP attitudes Conclusions to referring palliative patients to OOH. Late presentation and significant burden of diverse symptoms were Results prevalent among individuals with cervical cancer. Health education, Of 382 SPCT patients, 90 % had cancer and 10 % had MND or chronic proactive health interventions to promote early presentation and diseases. Seventy-six percent were on EPaCCs. Information included supportive care to ensure qualitative care with best outcome are Diagnosis (72 %), Resuscitation Status (54 %) and Advance Care Plans implied. S146 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0236 spend more time supervising unskilled staff to ensure that patients receive Palliative Care 3 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 FREQUENCYAND OUTCOME OF NEUROLEPTIC ROTATION existential and spiritual care, and their experience with transferring palli- IN THE MANAGEMENT OF DELIRIUM IN PATIENTS WITH ative and spiritual care competency to nursing staff in specialist, non- ADVANCED CANCER hospital and community-based services. S. Shin1,D.Hui2,G.B.Chisholm3, J.L. Williams2,J.H.Kang4,I.Park1, Methods E. Bruera2 Data was gathered through a focus group interview with three expert 1Department of Internal Medicine College of Medicine, Kosin University, hospice nurses. Data was analyzed using a qualitative phenomenological- Busan, Korea; 2Department of Palliative Care and Rehabilitation Med- hermeneutical method. icine, The University of Texas MD Anderson Cancer Center, Houston, Results USA; 3Department of Biostatistics, The University of Texas MD Anderson The key spiritual care themes identified were: working with one’sheart, Cancer Center,Houston, USA; 4Department of Internal Medicine College managing emotions (fear and courage), Identifying spiritual needs, act- of Medicine, Gyeongsang National University, Jinju, Korea ing as door openers to existential and spiritual conversations, using intuition to seize the right moment and the right approach, Talking, Background and Aims listening, being silent, being with the patient in the ‘Room of Death’ The response rate to haloperidol as a first-line neuroleptic and the pattern Spiritual care was intuitively embedded in other care practices. of neuroleptic rotation after haloperidol failure have not been well defined The team observed that nursing staff became more courageous and in palliative care. To determine the efficacy of haloperidol as a first-line skillful in addressing patients’ spiritual and existential needs through neuroleptic and the predictors associated with the need to rotate to second situated ‘bedside’ supervision and reflective dialogue. neuroleptic. Conclusions Methods The findings suggest that developing work place learning strategies may We conducted a retrospective review of the charts of advanced cancer be an efficient way to transfer palliative and spiritual care competency to patients admitted to our acute palliative care unit between January, 2012 unskilled care workers in non-hospital and community based services. and March, 2013. Inclusion criteria were a diagnosis of delirium and first- Employers should support expert nurses to develop their roles as compe- line treatment with haloperidol. tency transmitters, rather than forcing them to take on generalist roles. 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 MASCC-0342 alive. Median initial haloperidol dose was 5 mg (IQR 3-7) and median Palliative Care 4 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 COMPARISON OF THREE SHORTENED QUESTIONNAIRES neuroleptic rotation (87 %). Significant factors associated with neurolep- FOR ASSESSMENT OF QUALITY OF LIFE IN ADVANCED tic rotation were inpatient mortality (59 % vs. 29 %, P=0.001), and white CANCER race (87 % vs. 62 %, P=0.014). Chlorpromazine was given to 37 (95 %) patients who failed haloperidol. Median initial chlorpromazine dose was L. Chiu1,N.Chiu1,E.Chow1,D.Cella2, J.L. Beaumont2,H.Lam1, 150 mg (IQR 100-150) and median duration was 3 days (IQR 2-6). M. Popovic1,G.Bedard1,M.Poon1, E. Wong1,L.Zeng1, A. Bottomley3 Thirteen (33 %) patients had reduced symptoms after the second 1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook neuroleptic. Health Sciences Centre University of Toronto, Toronto, Canada; Conclusions 2Department of Medical Social Sciences, Northwestern University Neuroleptic rotation from haloperidol was required in only 23 % of Feinberg School of Medicine, Chicago, USA; 3European Organisation patients with delirium and was associated with inpatient mortality and for Research and Treatment of Cancer,EORTC Headquarters, Brussels, white race. Belgium

Background and Aims Quality of life (QoL) assessment questionnaires can be burdensome to MASCC-0218 advanced cancer patients, thus necessitating the need for shorter assess- Palliative Care 3 ment instruments than traditionally available. The objective of this review is to compare three shortened QoL questionnaires in regards to their characteristics, validity, and reliability. TRANSFERRING SPIRITUAL AND PALLIATIVE CARE Methods COMPETENCY THROUGH WORKPLACE LEARNING - A A literature search was conducted to identify studies that employed or HOSPICE TEACHING TEAM’S EXPERIENCE discussed three abridged QoL questionnaires: the EORTC QLQ-C15- K.A. Tornoe1,L.J.Danbolt2,K.J.Kvigne3,V.M. Sørlie4 PAL, the FACT-G7, or the FACIT-PAL-14. Articles that discussed ques- 1Nursing, Lovisenberg Deaconal University College and Center for the tionnaire length, intended use, scoring procedure and validation were Psychology of Religion, Oslo and Ottestad, Norway; 2Innlandet Hospital included. Trust, Center for the Psychology of Religion, Ottestad, Norway; 3Nursing Results and Mental Health, Hedmark University College, Elverum, Norway; The 7 item FACT-G7 is the shortest instrument, while the EORTC QLQ- 4Nursing, Lovisenberg Deaconal University College, Oslo, Norway C15-PAL and the FACIT-PAL-14 contain 15 and 14 items, respectively. All three questionnaires have similar recall periods, item organization, Background and Aims and subscale components. Designed as core questionnaires, all three Unskilled care workers in nursing homes and home care increasingly deal maintain content and concurrent validity of their unabridged original with palliative care challenges, due to the international trend towards questionnaires. Both the EORTC QLQ-C15-PALand the FACT-G7 dem- downsizing specialized health care units. Registered nurses therefore onstrate good internal consistency and reliability, with Cronbach’salpha Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S147 of greater or equal to 0.7 deemed acceptable. The developmental study for 1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook the FACIT-PAL-14 was published in 2013 and subsequent validation Health Sciences Centre University of Toronto, Toronto, Canada; 2Department studies are not yet available. of Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; Conclusions 3Department of Radiation Oncology, Bank of Cyprus Oncology Centre, The EORTC QLQ-C15-PALand the FACT-G7 were found to be reliable Nicosia, Cyprus; 4Department of Clinical Oncology, Tanta University Hos- and appropriate for assessing health-related QoL issues—the former for pital Tanta Faculty of Medicine, Tanta, Egypt; 5Department of Orthopedic palliative cancer patients and the latter for advanced cancer patients Oncology, Federal University of São Paulo, São Paulo, Brazil; 6Department receiving chemotherapy. Conceptually, the FACIT-PAL-14 holds promise of Pharmacy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, to cover social and emotional support issues that are not completely France; 7Department of Surgery, Taipei Veterans General Hospital National addressed by the other two questionnaires; however, further validation Yang-Ming University, Taipei, Taiwan; 8Department of Gastroenterologic is needed. Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 9Department of Public Health and Institute of Epidemiology and Preventa- tive 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 MASCC-0338 12 Palliative Care 4 Territories, Hong Kong China; European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels, Belgium RADIOTHERAPY FOR A CERVIX CANCER PATIENT WITH Background and Aims EHLERS-DANLOS SYNDROME: A CASE REPORT Examining the patterns of synergy between concurrent symptoms L. Chiu1, N. Chiu1, M. Poon1, G. Bedard1, M. Popovic1, E. Wong1, through symptom cluster research can lead to increased understanding H. Lam1,E.Chow1,E.Barnes1 of symptom management in the oncology setting. The objective of this 1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook study was to compare the symptom cluster compositions of bone metas- Health Sciences Centre University of Toronto, Toronto, Canada tases patients undergoing radiotherapy and/or bisphosphonate treatment at baseline. Second, to examine whether symptom cluster composition in Background and Aims the patient cohort changed over time. Early stage cervix cancer can be treated successfully with radiotherapy or Methods surgery. Ehlers-Danlos syndrome Type IV is a rare connective tissue Principal component analysis (PCA) was used to extract symptom clusters disorder associated with vascular tear due to mutation in the gene for in data collected from patients with bone metastases using the EORTC type III procollagen. Due to the rare incidence of cervix cancer and QLQ-BM22. A total of 626 patients across 8 countries participated in this Ehlers-Danlos syndrome concurrently,documentation of more cases with study with questionnaires administered to the patients at baseline and follow- both diseases may be of use to health-care professionals in managing the up. Patients undergoing radiotherapy and/or bisphosphonates were isolated multiple risks involved and choosing the most appropriate treatment. from the sample and PCAwas used to identify clusters in these groups. Methods Results The current case report outlines the management of a patient with stage At baseline, bone metastases patients rarely had symptom clusters that IB2 cervical cancer and Ehlers-Danlos Type IV Syndrome. included both psychosocial and pain symptoms concurrently while the Results subset of radiotherapy and/or bisphosphonates patients did exhibit this The patient received 45 Gy in 25 fractions to the pelvis using a 4 field box trend. At follow-up, all patients, with the exception of bisphosphonate technique followed by a 2 field parametrial boost of 5.4 Gy in 3 fractions patients, had similar symptom cluster composition with all psychosocial with a 4 cm midline shield to treat her cervical cancer. Five cycles of items separated from pain symptoms. concurrent weekly cisplatin (40 mg/m2) were also given. As of 24 months Conclusions before completion of chemoradiotherapy, the patient had complete local Psychosocial items and symptom items of the QLQ-BM22 are more response to treatment with eradication of her cervical disease and no likely to coexist in symptom clusters of radiotherapy and bisphosphonates evidence of local or distant disease. patients than those of general bone metastases patients. Treatment from Conclusions baseline until follow-up seemed to influence most patients to reduce the Given the risk of excessive hemorrhage from surgery, this case report association of painful symptoms with worries about how their illnesses demonstrates that radical chemoradiotherapy was an effective and appro- would affect their life; bisphosphonates patients did not experience this priate treatment option for this patient with cervix cancer and Ehlers- effect from treatment. Danlos 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. MASCC-0354 Palliative Care 4

MASCC-0337 DEVELOPMENT OF EVIDENCE-BASED ORAL CARE Palliative Care 4 GUIDELINES FOR PATIENTS WITH ADVANCED CANCER A. Davies1,S.Hall1,M.P.Sweeney2,A.Dickman3, E. Sills4,S.Patel1 SYMPTOM CLUSTERS ANALYSIS IN BONE METASTASES 1Supportive & Palliative Care, Royal Surrey County Hospital/St. Luke’s PATIENTS USING THE EUROPEAN ORGANIZATION FOR Cancer Centre, Guildford, United Kingdom; 2Dental School, University RESEARCH AND TREATMENT OF CANCER QUALITY OF of Glasgow, Glasgow, United Kingdom; 3Pharmacy, Royal Victoria Hos- LIFE QUESTIONNAIRE BONE METASTASES MODULE pital, Blackpool, United Kingdom; 4Palliative Care, Woking Hospice, (EORTC-QLQ-BM22) Woking, United Kingdom L. Chiu1,E.Chow1,N.Chiu1,L.Zhang1,G.Bedard1,A.Fairchild2, Background and Aims V. Vassiliou3,M.A.AlmEl-Din4, R. Jesus-Garcia5,F. Forges6,L.M.Tseng7, Oral problems are common in patients with advanced cancer. However, M.F.Hou8,W.C.Chie9,T.Satoh10,B.Ma11 ,H.Lam1, A. Bottomley12 there are no evidence-based guidelines for the management of oral S148 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 problems in this group of patients. The aim of this project was to develop (n=47, 31 %). Patients referred for pain were more likely to have MD such guidelines. (OR=2.57, p=0.0109). Of the 82 patients with delirium that was re- Methods versed, 67 % (n=55) had MD. ATask Group of the Science Committee of the Association of Palliative Conclusions Medicine for Great Britain and Ireland was convened to produce guide- MD was found in 61 % of patients with a diagnosis of delirium by a PMS. lines for the management of oral problems in patients with advanced Patients with MD were frequently referred for pain. Universal screening cancer. The Task Group included Consultants in Palliative Medicine, a of cancer patients for delirium is recommended. 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 recommenda- MASCC-0308 tions were produced, and these were graded using the levels of evidence Palliative Care 4 endorsed by the National Institute for Health and Care Excellence (UK). Results THORACIC REIRRADIATION FOR LUNG CANCER: A The guidelines contain a series of recommendations about the assessment, LITERATURE REVIEW management and reassessment of common oral problems in patients with 1 2 1 advanced cancer including advice about routine oral hygiene measures. It C.S. Drodge , S. Ghosh , A. Fairchild 1 includes tables about recommended oral care products, and ones that Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; 2 should be avoided. It also discusses the role of various members of the University of Alberta, Cross Cancer Institute, Edmonton, Canada MDT, i.e. palliative care professionals and dental professionals. Conclusions Background and Aims It is hoped that these evidence based guidelines will reduce the use of Approximately half of all patients with lung cancer (LC) experience inappropriate interventions for oral care problems in patients with ad- locoregional failure after initial treatment. Historically, thoracic vanced cancer that are treated in the palliative care setting. The use of reirradation (ReRT) has been limited by toxicity concerns and lack of evidence-based interventions should lead to improved symptom control robust evidence. Our objective was to perform a systematic literature and quality of life for this group of patients. review regarding ReRT. Methods Search of the English-language literature related to best-practice thoracic ReRT (Medline and Embase; 2003–2013) was performed. Clinical prac- MASCC-0284 tice guidelines and consensus statements were also reviewed. Data was Palliative Care 4 abstracted regarding patient, tumour and radiotherapy characteristics; response rate; overall survival (OS); and toxicity. In addition to descrip- ’ MISSED DELIRIUM (MD) IN PATIENTS REFERRED TO tive analysis, Spearman s test explored relationships between RTdose and PALLIATIVE CARE IN A COMPREHENSIVE CANCER OS. CENTER Results Three hundred seventy-nine patients (89 % non-small cell; 11 % small 1 1 1 1 1 2 2 M. de la cruz ,J.Fan,S.Yennu,K.Tanco,S.Shin,J.Wu,D.Liu, cell LC) retreated with radical or palliative intent have been described by 1 E. Bruera 13 publications (1982–2014). Eighty-six percent were symptomatic at the 1 Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer time of ReRT; rate of symptom improvement was 69 %. Median OS was 2 Center,Houston, USA; Biostatistics, UT MD Anderson Cancer Center, 15 months (95 %CI: 3–58 months) for radical versus 3 months Houston, USA (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 Background and Aims dose (86 Gy; range 58–120 Gy) significantly correlated with OS, with Delirium is one of the most common neuropsychiatric complications in Spearman’s rho values of 0.85 (p=0.002), 0.72 (p=0.006), and 0.88 (p= advanced cancer patients with a frequency of up to 85 % before death and 0.001) respectively. Toxicity after ReRT was reported in 17 % is associated with increased morbidity,mortality,and family distress. This (esophagitis) and 12 % (pneumonitis), with RTcomplications contribut- study aims to determine the frequency of MD and its associated factors. ing to 2 % of deaths. Methods Conclusions Seven hundred seventy-one consecutive Palliative Care inpatient consults Despite heterogeneity of patient cohorts, RT techniques and duration of from August 2009- January 2010 were reviewed. Demographics, Memo- follow-up, ReRT appears to be a feasible option for recurrent thoracic rial Delirium Assessment Scale (MDAS), Edmonton Symptom Assess- disease. Treatment guidelines will be developed from this data to guide ment Scale (ESAS), primary referral symptom, ECOG, Palliative Medi- clinical decision-making. cine 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 MASCC-0290 team (PT) for other reasons besides delirium. Chi-Squared and Wilcoxon- Palliative Care 4 Mann–Whitney tests were used to examine differences among groups. Univariate regression analysis was done to assess associations for MD. EARLYPALLIATIVE CARE AND QUALITY OF DEATH IN Results PATIENTS WITH ADVANCED CANCER Two hundred fifty-two (33 %) had a diagnosis of delirium by the PMS. One hundred fifty-three (61 %) were missed by the PT. Hypoactive B. Hannon1,N.Swami1, A. Pope1,L.Le1,C.Zimmermann1 delirium was the most common subtype of delirium in MD (n=47, 1Psychosocial Oncology & Palliative Care, Princess Margaret Hospital, 63 %). Opioid related delirium was the most common etiology of MD Toronto, Canada Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S149

Background and Aims MASCC-0254 Early palliative care (PC) interventions have been shown to improve Palliative Care 4 the quality of life of patients with advanced cancer. However, it is unclear whether early PC can improve quality of death. We aimed to TIMELYREFERRAL OF CANCER PATIENTS FROM evaluate the quality of death and dying experienced by patients with ONCOLOGY-HEMATOLOGY TO PALLIATIVE CARE-QATAR advanced cancer who received early PC, as perceived by their EXPERIENCE informal caregivers. Methods A. Hassan1, M. Mufid M. El Mistiri1, R. Negmeldin1, S.A.A.D. Eziada1, Bereaved caregivers (N=128) of patients who had participated in A. Begum1,K.Aboudi1,A.M.R.A.Alkhalil1, H. Al Ayoubi1 a cluster randomized controlled trial of an early PC intervention 1Oncology, Hamad General Hospital, Doha, Qatar versus standard care (SC) at the Princess Margaret Cancer Centre, Toronto, between December 2006 and February 2011, were re- Background and Aims cruited 6 months to 5 years following the patient’s death. Care- Early palliative care access improves metrics perceived for high quality givers completed the Quality of Dying and Death (QODD) cancer care. In Qatar, the timing of referral to palliative care service was questionnaire. late, around 55 % stayed for a period of time of less than 30 days, while Results almost 15 % stayed for no more than 48 h from the time of referral. There were no differences between PC (N=72) and SC (N=56) Methods participants based on age, gender, relationship to patient, tumour This Project was held from March 2012 until September 2012 as a Clinical site or time since death. QODD total and subscale scores were Care Improvement initiative where the problem was clearly defined as a) moderate to high for both the PC and SC groups, with no the Cancer patients of National Center for Cancer Care & Research (NCCC statistically significant differences between groups (all p>0.25) R) are not referred from acute care to palliative care on time. b) ‘End of life (see Table). Although the SC group did not receive early PC, patients’ care was being provided at acute care rather than palliative setting, the majority received PC at some point during the patients’ illness which compromised patients’ quality of care & Quality of good death. An (N=45, 82 %). objective one-page scoring tool (adopted from NCCN Palliative Guidelines Referral Criteria) was developed & used to review medical records. Table - Caregiver demographics and QODD scores| Results More than 30 % of barrier for palliative care consultation & referral Early Palliative Care Standard Care stemmed from unawareness of referral criteria. The process value analysis (N=72) (N=56) did confirm that adding a subjective scoring tool to guide referral elim- N(%) N(%) inated 40 % waste in the process. We reduced the percentage of patients Age in years, Median (range) 62 (30–88) 59 (29–84) with score≥5 without palliative consultation from mean of 68 to 16 % ≥ Female 51 (70.8) 37 (66.1) & 7 without care in palliative setting from mean of 32 to 2 %. Aim was achieved & sustained. Relationship to patient Conclusions Spouse 48 (66.7) 37 (66.1) Our project proved that standardizing referral process & objective referral Son/daughter 13 (18.0) 12 (21.4) tools are needed to facilitate the transfer of care from one level to another. Sibling 4 (5.6) 3 (5.4) Other 7 (9.7) 4 (7.1) Tumour site MASCC-0322 Breast 8 (11.1) 8 (14.3) Palliative Care 4 Gastrointestinal 25 (34.7) 18 (32.1) Genitourinary 12 (16.7) 10 (17.9) PAIN RELIEF FROM PALLIATIVE RADIATION THERAPY IN A Gynecological 8 (11.1) 14 (25.0) PATIENT WITH CERVICAL SPINE BONE METASTASES Lung 19 (26.4) 6 (10.7) R. Jamani1,L.Zeng1,L.Probyn2,N.Lauzon1,L.Holden1, Months since death, Median (range) 39.5 (22.0–58.7) 39.4 (26.5–55.6) N. Thavarajah1,E.Wong1,E.Chow1 QODD scores, Mean (SD) 1Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, 2 Total score 61.2 (21.8) 60.8 (18.6) Canada; Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Symptom control subscle 55.8 (24.7) 55.9 (23.6) Canada Preparation subscale 73.0 (24.1) 68.3 (18.9) Background and Aims Connectedness subscale 77.6 (22.1) 77.3 (20.9) In up to 75 % of cases, prostate cancer metastasizes to the bone. When Transcendence subscale 53.6 (31.4) 47.4 (27.7) metastatic destruction occurs in the spine, it often leads to a loss of vertebral body structural integrity, thus leading to instability. As a result, QODD, Quality of Dying and Death questionnaire, range 0–100, higher patients often experience intense pain. Radiation therapy is known to scores are better; PC, Palliative Care; SD, Standard Deviation. 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 Conclusions bone metastases to the cervical spine. Although early PC improves quality of life among patients with advanced Methods cancer, in this study it did not influence the quality of death and dying. A 67 year-old male patient presented at the Rapid Response Radiotherapy The quality of death and dying may be more affected by receiving PC at Program (RRRP) at the Sunnybrook Health Sciences Centre with prostate all rather than by early involvement. adenocarcinoma and painful bone metastases. S150 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Conclusions Due to bone metastases to the cervical spine, the patient experienced This case demonstrates the effectiveness of radiotherapy as a method of basilar invagination, which resulted in limited neck motion and severe relieving pain and restoring mobility in certain cases, thus improving pain. The patient was prescribed a soft collar. The metastases were treated overall quality of life. 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. MASCC-0318 Palliative Care 4

USE OFA SOCIAL CAPITALQUESTIONNAIRE TO UNDERSTA ND NETWORKS OF CARE SUPPORT: OUTCOMES IN A DISADVANTAGED PALLIATIVE CARE POPULATION J. Lewis1,M.DiGiacomo1 1Faculty of Health, University of Technology Sydney, Sydney, Australia

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 ques- tionnaire 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 Figure 1: Axial CTimage through the C1 level on bone window (W3000, Results: Overall individual and community networks and relations of L600) pretreatment demonstrating a predominately lytic lesion in the support were limited. Specifically; informal caregiver networks and rela- right C1 lateral mass. tions 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 1Oncology, Denver Health, Denver,USA; 2Medicine, University of Colo- rado, Denver,USA

Background and Aims Underserved, ethnically diverse cancer patients have increased spiritual needs, including existential suffering. Dignity Therapy (DT), is a brief, Figure 2: Axial CT image through the C1 vertebra on bone window meaning-focused intervention to address existential suffering for those (W3000, L600) post-treatment demonstrating increased sclerosis of the facing advanced illness. Patients receive a transcript of the interview that lesion involving the C1 lateral mass. is a legacy gift to share with loved ones. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S151

Toassess the feasibility and patient satisfaction of DTin ethnically diverse MASCC-0371 oncology patients, where the interview is videotaped and the legacy gift is Palliative Care 4 in video for this low literacy population. Methods THE ROLE OF INTERVENTIONAL RADIOLOGY IN CANCER Intervention-only, pilot study of DT with video legacy gift. PATIENTS, A CROSS SECTIONAL STUDY English-speaking patients with stage IV cancer were recruited from a safety-net hospital. Contact with trained personnel included an F. Kose1,A.Besen2, M. Ulas3, L. Oguzkurt4, O. Ozyilkan1 introductory call, the videotaped interview and another meeting to 1Medical Oncology, Baskent University, Adana, Turkey; 2Medical Oncol- review/edit the video. Feasibility was measured by participation ogy, Van Training and Research Hospital, Van, Turkey; 3Internal Medi- and retention rates. Patient satisfaction was measured by post- cine, Baskent University, Adana, Turkey; 4Interventional Radiology, intervention survey. Baskent University, Adana, Turkey Results Seventeen eligible patients were approached for participation, 13 Background and Aims enrolled (76 % participation rate). So far, 9 have completed the The aim of this study is to evaluate the role of interventional radiology program, 4 have withdrawn (69 % retention rate). Demographics (IR) in clinical practice of oncology and define types and frequency of the for the 9 who completed included 5 females, 4 males; 5 Cauca- IR procedures performed in cancer patients. sian, 3 Hispanic and one African-American; ages from 31 to Methods 80 years. All participants agreed/strongly agreed that the program Medical charts of the cancer patients admitted to oncology clinic from was helpful, 7 participants (78 %) stated that the program made December 2012 to May 2013, were analyzed retrospectively. The data their lives more meaningful. Eight (89 %) agreed/strongly agreed including patient demographics, cancer characteristics, type of interven- with the statement that the program gave them a heightened sense tion and time to intervention were recorded. Interventional procedures of dignity and would probably or definitely recommend this to were classified as diagnostic, palliative care and treatment. other patients. Results Conclusions There were 1,120 new admissions to Medical Oncology department in the Video-DT is an innovative intervention, feasible to implement in an study period. There were 240 IR procedures performed in 147 patients underserved and ethnically diverse cancer patient population, with high (65 % male; mean age, 57 years). Stage IV disease constitutes 85 % of the levels of satisfaction. cases. The median time to intervention was 3.8 month. Number of inter- ventions for diagnosis, palliative care, and treatment were 27 (11.2 %), 211 (87.5 %), and 3 (1.3 %), respectively. Most frequently performed inter- vention was port catheter placement (29.5 %). Hepatobiliary-pancreatic MASCC-0345 tumors, thoracic malignancies, and breast cancer ranked first places which Palliative Care 4 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). THE EFFECT OF SYMPTOM MANAGEMENT PROGRAM Conclusions FOCUSING ON CHANTING ON PAIN OF TERMINAL CANCER Department of IR has an uprising place in the care of patients with cancer. PAT I E N T S We showed that over 20 % of patients required consultation with IR B. Trakoolngamden1, M.S. Benchamart2 department after cancer diagnosis. Most of the patients were stage IV 1Nursing, navamindradhiraj university, Bangkok, Thailand; 2Nursing, disease and need intervention for palliative care not curative intent. Navamindradhiraj university, Bangkok, Thailand

Background and Aims To test the effect of symptom management program focusing on praying MASCC-0297 on pain of terminal cancer patients and to compare the mean score of pre- Palliative Care 4 post pain tin the experimental and controlled groups. Methods DISTRICT DOCTORS’ SELF-CONFIDENCE AND CONCERNS The participants in this study were 60 terminal cancer patients who had IN PROVIDING END-OF-LIFE CARE FOR CANCER PATIENTS been diagnosed as cancer stage 3, 4 or had been cancer metastasis to multiple organs, buddhism and treated at Arokayasala Wat E. Vvedenskaia1 Khampramong, Skon Nakhon Province, Thailand. 1Palliative Care, State Medical University, Nizhny Novgorod, Russia Discussion The mean score of pain in the terminal cancer patients who received Background and Aims the Symptom Management Program focusing Chanting after 4 days The elderly made 29.9 % of population in 2013. 87.0 % of all adult cancer and 7 days were lower than that of the controlled group because of deaths occur at home. That is why palliative and end-of-life care for gaining more knowledge and received proper information as indi- cancer patients today is a challenge. The aim of the study was to assess vidual needed which assisting them having effectively and constant- district doctors’self-confidence in performance of 17 different end-of-life ly developing skills and ability of self-care in the pain palliation clinical skills and comfort with difficult end-of-life clinical decisions (e.g. causing from disease and complications. Likewise, the program treatment and hydration withdrawing, shifting in treatment approach from assisted to reduce pain in terminal cancer patients because of curative to comfort care) and also their interest in learning about end-of- chanting that can be affected to the patients who chanting for them life clinical and ethical topics. may develop spiritual well being and beneficial effects on the Methods immune system, central nervous system or endocrine system. The We used a tool ‘A Survey Instrument to Measure Physician Self- finally meditative relaxing aspects of chanter have beneficial effects Confidence and Concerns about End-Of-Life Clinical Skills and such as lowering blood pressure. Decision-Making’ designed by David E. Weissman and Bruce Ambuel This finding indicated that the Symptom Management focusing Chanting and surveyed more than 400 physicians who are responsible for providing Program could relief pain in terminal cancer patients. community medical care for the elderly. S152 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Background and Aims The results of our study showed that most of district doctors were Falls are a concern in patients who are frail, have advanced age or severe competent to perform patient management at the end of life only with underlying medical condition as a significant cause of morbidity and close (50 %) and minimal (32 %) supervision/coaching. All respondents reduced quality of life. It has been reported to occur in up to 50 % of had difficulties while responding to the questions regarding decision- palliative care patients in different settings. Our aim was to determine the making at the end of life. Almost all respondents (98 %) noted that such frequency of falls and identify its predictors and correlates in patients with issues, as symptom control, communication and decision-making at the advanced cancer. end of life should be included in the Medical Universities Curriculums. Methods Conclusions Wereviewed 1,984 consecutive patients with advanced cancer seen in the District doctors who provide care for cancer patients were not enough outpatient supportive care center and determined the frequency of patient competent to perform patient management at the end of life. Although reported falls within the last month prior to the visit. Demographics, education in palliative care has made clear progress within the country it Edmonton Symptom Assessment Scale (ESAS), medication use, func- is still to be incorporated fully into the fabric of medical education. tional 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 non- MASCC-0444 Hispanic white, 343 (17 %) had peripheral neuropathy, 237 (12 %) were Palliative Care 5 on psychotropic medications, and 1,140 (58 %) were on strong opioids. There were 211 (11 %) patient reported falls. Presence of brain metastasis, use EVALUATION OFAN EDUCATION PROGRAM FOR PATIENTS of assistive device, ECOG, ESAS depression, and weight prior to visit were WITH ADVANCED CANCER AND significantly associated with patient reported falls in the multivariate model. CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY Conclusions (CIPN) 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 C. Cranston1, R. Bhargava1,M.Chasen1 associated with brain metastasis, assistive device, functional status, ESAS 1Palliative Care, Elisabeth Bruyere, Ottawa, Canada depression and weight are useful in stratifying high risk patients. They also show that certain medications deemed as risk factors in other popu- Background and Aims lations were not associated with falls. 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. MASCC-0429 Methods Palliative Care 5 One-hour education session was developed to address safety, function, and various approaches to reduce distress in patients with advanced A PALLIATIVE REHABILITATION PROGRAM IMPROVES cancer having CIPN. Questionnaire Chemotherapy Induced Peripheral PATIENT FUNCTIONING Neuropathy Assessment Tool (CIPNAT)was used to evaluate effective- A. Feldstain1,M.Chasen2, R. Bhargava3,J.Pereira2 ness of these interventions, degree of distress and interference with 1School of Psychology, University of Ottawa, Ottawa, Canada; activities of daily living. A specifically designed novel tool was also used 2Palliative Care, Bruyère Continuing Care, Ottawa, Canada; 3Palliative to assess current knowledge of CIPN and the usefulness of the educa- Care, Bruyère Research Institute, Ottawa, Canada tional program. Results Background and Aims Seven participants have completed the study; (M: 4; F: 3). Diagnoses: After treatment, patients with active cancer face a considerable burden rectal, ovarian, breast cancers. Questionnaires revealed that all seven from the effects of both the disease and its treatment. Symptom burden patients had some prior knowledge of CIPN and they were using at least has been found to remain consistent until a few weeks before death, when some measures to protect skin and avoid accidents. Six reported learning it worsens. The Palliative Rehabilitation Program (PRP) is an interdisci- new measures from the education program. Interference and distress plinary program designed to ameliorate disease effects and to improve the continued for six; reduced for one patient. patient’s functioning. It strives for a more holistic approach by incorpo- Conclusions rating many aspects of wellness. The present study evaluated pre-post The educational program is beneficial, the patients learned new measures changes in functioning, symptoms, and well-being. to cope with CIPN thereby improving their own quality of life. Methods There were 171 patients with advanced cancer who enrolled in the 8- week interprofessional PRP; 108 completed the program. Measures of MASCC-0389 physical, nutritional, social, and psychological functioning were evaluat- Palliative Care 5 ed prior to beginning the program and at completion. Results Significant improvements were revealed in performance status THE FREQUENCY OF FALLS IN PATIENTS WITH ADVANCED (p<0.000), nutrition (p=0.003), symptom severity (p=0.021 to 0.000), CANCER FOLLOWED IN AN OUTPATIENT PALLIATIVE symptom interference with functioning (p=0.001 to 0.000), fatigue (p= CARE CENTER 0.008 to 0.000), and physical endurance, mobility, and balance or func- M. de la cruz1, N. Didwaniya1, K. Tanco1,S.Shin1,A.Reddy1,M.San tion (p=0.002 to 0.000). Miguel-Arregui1, G. Chisholm2, J. Williams1,E.Bruera1 Conclusions 1Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Patients living with advanced cancers who underwent the interprofes- Center,Houston, USA; 2Biostatistics, UT MD Anderson Cancer Center, sional PRP experienced significant improvement in functioning across Houston, USA several domains. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S153

MASCC-0436 Aims: To delineate important aspects of satisfaction with care on a PCU, Palliative Care 5 as described by inpatients, family-caregivers and healthcare professionals Methods Qualitative interviews and focus groups were conducted across four COMMUNICATION AND SATISFACTION WITH CARE ON Toronto PCUs, with a total of 46 patient/caregiver interviews and eight PALLIATIVE CARE UNITS staff focus groups. Interviews and focus groups were semi-structured to D. Seccareccia1,K.Wentlandt2, N. Kevork3,K.Workentin4,S.Blacker5, elicit comments about satisfaction with care and quality of care for D. Grossman6, C. Zimmermann7 inpatients and families on a PCU. Data were analyzed using a grounded 1Psychosocial Oncology, Sunnybrook Hospital, Toronto, Canada; theory method, with an inductive, constant comparison approach to 2Family and Community Medicine, Toronto General Hospital, Toronto, identify themes, and were coded to saturation. Canada; 3Psychosocial Oncology and Palliative Care, University Health Results Network, Toronto, Canada; 4Family Medicine, Toronto East General Themes identified as important to quality care and patient satisfaction were Hospital, Toronto, Canada; 5Cancer Services Planning and Perfor- grouped into seven domains: 1) team approach, whereby an interdisciplin- mance, St. Michael’s Hospital, Toronto, Canada; 6Family Medicine, ary staff delivers care and interacts effectively; 2) responsiveness, referring Baycrest, Toronto, Canada; 7Psychosocial Oncology and Palliative Care, to provision of immediate and attentive care; 3) palliative philosophy, Princess Margaret Hospital, Toronto, Canada prioritizing patients’ comfort and dignity; 4) competency, emphasizing specialized palliative care knowledge and staff professionalism; 5) family- Background and Aims centered care, supporting families and allowing family-caregivers to par- Background: Communication with patients is an important aspect of ticipate in care decisions; 6) efficient and equitable care, ensuring PCU satisfaction with care, but this has not been described specifically on provides adequate resources and access to consistent care; and 7) support- palliative care units (PCUs). ive setting, referring to unit’s physical atmosphere and mood. Aims: Toidentify elements of quality of care and satisfaction with care in Conclusions PCU inpatient settings, as described by inpatients, family caregivers and Key elements of quality care and patient satisfaction for PCUs have been healthcare professionals. identified. Further research will develop and validate a tool to evaluate Methods: Qualitative interviews and focus groups were conducted across patient and caregiver satisfaction with care on PCUs. 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 MASCC-0414 grounded theory method of analysis with an inductive, constant compari- Palliative Care 5 son approach to identify themes, which were coded to saturation. Results: Communication was identified as the most prevalent theme. Five DOES CUMULATIVE DOSE OF REPEAT WHOLE BRAIN subthemes described elements of communication that were deemed impor- RADIOTHERAPY CORRELATE WITH SURVIVAL: A POOLED tant by patients, caregivers and staff. These included: 1) developing rapport M U LT I C E N T R E A N A LY S I S with patients and caregivers to build trust and kinship; 2) clarifying the plan of care to establish realistic expectations; 3) keeping patients and families N. Logie1,R.Jimenez2,N.Pulenzas3, D. Ciafone4, E. Wong3,S.Ghosh1, informed about the patient’s illness and decisions about care; 4) listening C. Son5,H.Shih2,W.Wong4,E.Chow3,A.Fairchild1 actively to validate patients’ concerns and individual needs; and 5) creating 1Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; a safe space where conversations about death and dying can occur. 2Radiation Oncology, Massachusetts General Hospital, Boston, USA; Conclusion: Communication is a crucial component of satisfaction with care 3Radiation Oncology, Odette Cancer Centre, Toronto, Canada; on PCUs, as identified by patients, family caregivers and healthcare profes- 4Radiation Oncology, Mayo Clinic Arizona, Scottsdale, USA; 5Radiation sionals. Palliative care education should focus on both general communica- Oncology, University of Chicago, Chicago, USA tion skills, and specific techniques required when providing end-of-life care. Background and Aims For multiple brain metastases (BM), the primary treatment remains whole brain radiotherapy (WBRT). Patients with intracranial progression after MASCC-0439 initial WBRT may receive a repeat course. Early data suggests improve- Palliative Care 5 ment in overall survival (OS) if reirradiation dose is >20 Gy. We inves- tigated the relationship between dose and OS in patients receiving repeat WBRT for multiple BM. ELEMENTS OF SATISFACTION WITH CARE ON PALLIATIVE Methods CARE UNITS: A QUALITATIVE STUDY A pooled database included patients with any solid primary tumor; those K. Wentlandt1, D. Seccareccia2, N. Kevork3,K.Workentin4,S.Blacker5, receiving stereotactic radiosurgery, partial cranial RT, or surgery were D. Grossman6, C. Zimmermann7 excluded. Demographics, disease characteristics, and RT doses were 1Family and Community Medicine, Toronto General Hospital, Toronto, collected. Spearman correlation coefficients, along with OS using the Canada; 2Psychosocial Oncology, Sunnybrook Hospital, Toronto, Kaplan-Meier method, were calculated. Canada; 3Psychosocial Oncology and Palliative Care, University Health Results Network, Toronto, Canada; 4Family Medicine, Toronto East General Eighty-one patients (4 centres) met inclusion criteria: median age Hospital, Toronto, Canada; 5Cancer Services Planning and Perfor- 55 years, 64 % female (n=52), 48.1 % with lung and 39.5 % with breast mance, St. Michael’s Hospital, Toronto, Canada; 6Family Medicine, cancer. Median interval between courses was 8.2 months. Thirty-nine Baycrest, Toronto, Canada; 7Psychosocial Oncology and Palliative Care, WBRT schedules were used (7.95 Gy/4 to 48 Gy/24). 58.0 % (47/81) Princess Margaret Hospital, Toronto, Canada received 20Gy/5 initially, and 37.0 % (30/81) received 20Gy/10 subse- quently. Median survival from the first WBRT was 13.3 mos (95 %CI Background and Aims 11.2–15.4 mos) and from the second was 5.0 months (95 %CI 3.9– Background: Satisfaction with care is an important indicator of quality of care, 6.1 months). There was a significant positive correlation between dose but there is little research in this area specific to palliative care units (PCUs). and survival for both courses, with rho=0.32 (p=0.004) and rho=0.26 S154 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

(p=0.02), respectively.Cumulative dose did not correlate with OS except Background and Aims for survival from second WBRT for the subgroup with breast cancer Bone metastases are a common cause of pain among advanced cancer (rho=0.40; p=0.02). patients and often lead to increased morbidity. Palliative radiotherapy is Conclusions an accepted treatment for bone metastases in reducing pain and improv- For some patients experiencing recurrent BM, repeat WBRT may be the ing quality of life (QOL). The objective of this literature review was to only therapeutic option. Dose of each course correlated with survival but investigate change in pain and QOL following palliative radiotherapy for cumulative dose did not, except for those with breast cancer, suggesting painful bone metastases. other factors are more predictive. 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 MASCC-0422 English only but not restricted to any time period. Subject headings and Palliative Care 5 keywords utilized for the search included “palliative radiation”, “cancer palliative therapy”, “bone metastases”, “quality of life”, and “pain”. BREAKTHROUGH CANCER PAIN: A COMPARISON OF Articles determining change in pain and QOL in patients were included. SURVEYS WITH EUROPEAN AND CANADIAN PATIENTS Results Twenty-two articles were selected from a total of 1,730. The most 1 1 2 3 3 R. McDonald ,G.Bedard,P.Hawyley,A.Davies, A. Buchanan ,M. commonly used tool to evaluate pain and QOL was the Brief Pain 1 1 1 Popovic ,E.Wong,E.Chow Inventory. Thirteen articles reported pain relief and improved QOL com- 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada; pared to baseline in only those who responded to radiotherapy; these did 2 Palliative Medicine, British Columbia Cancer Agency, Vancouver, not report on quality of life for non responders. The remaining nine 3 Canada; Palliative Medicine, Royal Surrey County Hospital, Surrey, articles reported on QOL following radiotherapy in both responders and United Kingdom non responders. Eight articles demonstrated statistically significant im- proved QOL in responders compared to non responders. One article Background and Aims showed improvement in QOL in responders, and an irregular pattern Breakthrough cancer pain is defined as a transient exacerbation of pain during follow-up for non responders. that occurs spontaneously or in response to a trigger, despite stable and Conclusions controlled background pain. Breakthrough pain often causes significant Palliative radiotherapy for symptomatic bone metastases improves pain impairments for patients and can decrease quality of life. The objective of and quality of life in responders. 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 MASCC-0423 Canada was compared to the data published on breakthrough cancer pain Palliative Care 5 in Europe. A standard survey was utilized for both patient populations. Inclusion and exclusion criteria were the same for both patient RELATIVELYASYMPTOMATIC PRESENTATION IN AYOUNG populations. MAN WITH WIDESPREAD RENAL CELL CARCINOMA Results 1 1 1 1 1 1 Both groups of patients had similar number and duration of breakthrough R. McDonald , G. Bedard ,E.Wong,D.J.Lee,M.Popovic,E.Chow 1 pain episodes, and similar pain intensity and pain interference with their Radiation Oncology, Odette Cancer Centre, Toronto, Canada activities of daily living. European patients reported better analgesic efficacy and satisfaction with management, and a greater percentage of Background and Aims European patients reported being prescribed a transmucosal fentanyl Renal cell carcinoma is an uncommon form of cancer that only contributes formulation (19.5 % vs 2.9 %). More European patients (53 %) than to approximately 2 % of all cancer diagnoses. Often, renal cell carcinoma Canadian patients (32.5 %) took their rescue medication every time they presents asymptomatically which can result in advanced stage diagnosis in had a breakthrough pain episode. about 20 % of cases. Cancer screening initiatives and improved patient Conclusions education are crucial in identifying early stage cancer. The purpose of this Breakthrough cancer pain in both Canadian and European patients greatly case report is to provide an example supporting the initiation of robust impacts their daily living, and both groups of patients had similar expe- cancer screening tools for those at high risk of renal cell carcinoma. riences with breakthrough cancer pain. Currently, for many patients this Methods pain is not adequately managed. The role for new analgesic treatments in A 40-year-old male presented to a walk-in clinic in December 2013 with management of breakthrough cancer pain needs further study. 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 MASCC-0434 Center. Palliative Care 5 Results From the Rapid Response Radiotherapy Program, the patient was referred immediately to a medical oncologist who treated him the same day with QUALITY OF LIFE AFTER PALLIATIVE RADIOTHERAPY IN Sutent and Dexamethasone for suspected metastatic renal cell carcinoma. BONE METASTASES: A LITERATURE REVIEW A later biopsy confirmed this primary and further imaging revealed R. McDonald1,H.Lam2, G. Bedard1,E.Wong1,M.Popovic1,E.Chow1 widespread metastases in the bones, lungs, and brain. In addition, the 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Library patient was referred to Radiation Oncology for consideration of stereo- Services, Sunnybrook Health Sciences Centre, Toronto, Canada tactic body radiotherapy for his bone and brain metastases. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S155

Conclusions eventually paralysis if left untreated. In most cases, cancer will be This case highlights the importance of early cancer screening tools. diagnosed in early stages and very infrequently will it be first diagnosed Although promising progress has been made in terms of screening for with both bone metastases and SCC. renal cell carcinoma, no robust methods exist that can be employed for all The purpose of the present case report is to discuss the management of a high risk groups. 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 weak- MASCC-0441 ness and increased gait difficulty beginning roughly 24 h prior to Palliative Care 5 his visit. Results ACCOMPLISHMENTS OF STUDENTS WORKING IN THE At Sunnybrook, A CATscan showed probable diffuse metastatic disease RAPID RESPONSE RADIOTHERAPY CLINIC: ATEN YEAR and cord compression at T3 confirmed by a MRI of the spine. Surgical REVIEW decompression of the spine was performed followed by post-operative radiation therapy consisting of 20 Gy in five fractions to the T1-T5 1 1 1 1 1 R. McDonald ,N.Pulenzas, B. Lechner , G. Bedard , E. Wong , thoracic area for palliative consolidation. Subsequently,the patient started 1 1 1 1 1 1 L. Holden , M. Tsao ,E.Barnes,E.Szumacher,G.Fenton,E.Chow, hormonal therapy for his prostate cancer. 1 1 M. Popovic , C. Danjoux Conclusions 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada When treating SCC, two main treatment modalities exist: surgical de- compression followed by post-operative radiotherapy, or radiotherapy Background and Aims alone. Patients with SCC and without completed tissue diagnosis benefit In 1996, the Toronto-Sunnybrook Regional Cancer Center developed the from the option of surgical decompression and tissue diagnosis to prevent Rapid Response Radiotherapy Program (RRRP). The objective of this the possible radiation of a benign tumour. 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 MASCC-0402 examine whether the goals of the student program have been met. Palliative Care 5 Methods Students who worked in the RRRP from 2004 to 2013 were contacted to PARTICLE DISEASE VERSUS BONE METASTASES: A CASE complete a short survey regarding their overall experience with the REPORT program and their current endeavors. Student accomplishments were 1 1 1 1 1 collected from our database, as well as PubMed. L. Nicholas ,M.Poon, M. Popovic ,C.Yip,E.Chow 1 Results Odette Cancer Centre, Sunnybrook Hospital, Toronto, Canada 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 Background and Aims program. In total, articles were published, 93 of which can be found on Following arthroplasty, complications resulting from wear of the prosthe- PubMed. Other accomplishments include 40 book chapters, 232 oral, sis can arise. One such complication, particle disease, can be mistaken for poster, and invited presentations, and 99 awards cumulatively.Qualitative a lytic lesion resulting from metastases because of its rarity and similar data regarding student perspectives of their experience in the RRRP has appearance on x-ray imaging. Both particle disease and lytic lesions from also been analyzed. cancer can cause significant bone pain. Conclusions The purpose of this present case report is to discuss the assessment and Over the past 10 years, the RRRP has achieved its goal of providing possible diagnosis of particle disease in patients with prosthesis present- quality medical and research experience to students interested in the ing in oncology settings. health sciences. Through gaining the perspectives of past and present Methods students, we hope to continue to shape our program and provide unique In this report, we present the case of a 47 year-old woman who was opportunities to future students. 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 MASCC-0404 An x-ray of her hip and right femur was taken and showed what was Palliative Care 5 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 SPINAL CORD COMPRESSION AS A FIRST PRESENTATION particle disease. Therefore, the patient was referred to orthopaedic care OF CANCER: A CASE REPORT and was informed that she would require a revision of her total hip L. Nicholas1,M.Poon1, M. Popovic1,C.Yip1,E.Chow1 arthroplasty. 1Odette Cancer Centre, Sunnybrook Hospital, Toronto, Canada Conclusions Employing the use of a 3-phase bone scan and 18F-Fluoride PET/ Background and Aims CT can be an effective method to differentiate metastases and Bone metastases can cause extreme pain and skeletal-related events such particle disease. Oncologists should take extra care when assessing as fracture and spinal cord compression (SCC). Considered an oncologic patients with prosthesis and should explore the possible diagnosis of emergency, SCC can result in a loss of feeling, motor control, and particle disease. S156 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0411 Results Palliative Care 5 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 p- THE INCIDENCE OF “NO CPR DOCUMENTATION” IN values are less than 0.0001. In addition, some patients in 1 month/ PATIENTS REFERRED FOR PALLIATIVE RADIOTHERAPY IN 2 weeks before death were undergoing chemotherapy, targeted thera- THE RAPID RESPONSE RADIOTHERAPY PROGRAM py. The ratios of blood products (except albumin) transfused in ICU N. Pulenzas1, B. Lechner1, L. Zhang1, N. Thavarajah1, N. Lauzon1, were significantly higher than cancer center (P<0.0001), the same L. Holden1,P. Sheehan1, G. Bedard1, E. Wong1, R. McDonald1,E.Bain1, with various punctures and cavity mirror examinations. The propor- M. Tsao1,E.Barnes1,C.Danjoux1,E.Chow1 tions of patients, who refused invasive rescue, cardiopulmonary re- 1Rapid Response Radiotherapy Program Radiation Oncology, Odette suscitation or gave up the rescue on the day of death in cancer center Cancer Centre, Toronto, Canada were 31.68 %?19.88 % and 6.83 % respectively, but in ICU there wereonly3.64%,5.45%and5.45%. Introduction: The concept of having a do-not-resuscitate (DNR) order, Conclusions also known as a no cardiopulmonary resuscitation (CPR) code status, is The patients had less invasive examinations and treatments within used to spare unnecessary trauma resulting from CPR and extreme 6 months before death in cancer center than ICU, however, the excessive lifesaving measures. treatments still exist. Hospice care and doctor-patient communication Objective: To explore the prevalence of DNR orders in advanced should be further strengthened. cancer patients referred for palliative radiotherapy to the Rapid Re- sponse Radiotherapy Program (RRRP) at the Sunnybrook Odette Cancer Centre. Methods: Patients seen in the RRRP between January-April 2013 were MASCC-0433 assessed for code status documentation. Patients were recorded as having Paraneoplastic a DNR order if there was written documentation. Those with no DNR documentation were reported as no code status. EFFICACY OF TOLVAPTANINCANCERPATIENTSWITH Results: One hundred and forty-five patients had code status data col- HYPONATREMIA DUE TO SIADH: POST-HOC ANALYSIS OF lected. Median age was 71, and 78 (54 %) participants were female. SALT(STUDY OFASCENDING LEVELS OF TOLVAPTAN) Ninety-two patients (64 %) were living at home, 50 (35 %) were inpa- J. Blais1,F.Ahmad2,J.Chiodo3,L.A.Glaser4, R.J. Gralla5,W.Zhou6, tients, and 3 (2 %) were in supportive housing or a nursing home. One F.C. Czerwiec7 hundred and twenty-one patients (83.5 %) did not have a documented 1Global Medical Affairs, Otsuka Pharmaceutical Development and Com- DNR order, and 24 patients (16.5 %) had documented DNR status. mercialization Inc., Princeton, USA; 2Medical Information, Otsuka Patients with a DNR order were more likely to come from hospital America Pharmaceutical Inc., Princeton, USA; 3Medical Affairs, Otsuka (38 % of total inpatients), than from home (5 % of outpatients) America Pharmaceutical Inc., Princeton, USA; 4Medical Director,Coast- (p<0.0001). al Biomedical Research Inc, Santa Monica, USA; 5Professorof Medicine, Conclusions: Compared to previously collected data, the incidence of Albert Einstein College of Medicine, Bronx, USA; 6Biostatistics, Otsuka DNR documentation has increased. Continuation of promoting patient Pharmaceutical Development and Commercialization Inc, Rockville, education and awareness, improving care teams’ awareness of DNR USA; 7Global Clinical Development, Otsuka Pharmaceutical Develop- status and more effectively reaching outpatients are key areas of future ment and Commercialization Inc, Rockville, USA focus. Background and Aims Hyponatremia is common in cancer due to the underlying syndrome MASCC-0388 of inappropriate anti-diuretic hormone (SIADH). The 2 identical Palliative Care 5 RCT SALT studies evaluated hyper- or eu-volemic hyponatremia attributed to chronic heart failure, cirrhosis or SIADH. This post- hoc analysis evaluated the subset of SIADH patients with an etiology A RETROSPECTIVE STUDY OF CANCER PATIENTS’ of cancer to determine the efficacy of tolvaptan relative to the overall TREATMENTS IN SIX MONTHS BEFORE DEATH SIADH population. J. Rao1,Q.Fu1,Q.S.Wu2,S.Y.Yu1 Methods 1Oncology, Tongji Hospital Tongji Medical College Hua Zhong Univer- Patients with SIADH and an etiology likely attributable to cancer (n=28) sity of Science and Tec, Wuhan, China; 2Biliary & Pancreatic Surgery, were identified. The change from baseline in serum sodium AUC be- Tongji Hospital Tongji Medical College Hua Zhong University of Science tween tolvaptan and placebo were derived from an ANCOVAmodel.The and Tec, Wuhan, China percentage of patients having normalized serum sodium (>135 mEq/L) was analyzed and stratified by baseline disease severity. Background and Aims Results Whether cancer patients received treatments before death could be Baseline serum sodium levels in this cohort were 130 and 128 mEq/L for benefited or not, it has been a controversial topic and become a hotspot. tolvaptan and placebo, respectively. The mean change from baseline in The aim of this study is to investigate cancer patients’ treatment status in serum sodium AUC for tolvaptan versus placebo was 5.0 versus −0.3 (p= 6 months before death. <0.0001) at day 4, and 6.9 versus 1.0 (p<0.0001) at day 30, consistent Methods with the response seen in the total SIADH population (Figure). Serum A retrospective study of cancer patients’ treatments in 6 months before sodium normalization was observed in 6/12 and 0/13 patients at day 4, death, which from January 2010 to July 2013 in cancer center and ICU and 7/8 and 2/6 patients at day 30 (tolvaptan versus placebo respectively; (161 and 55 cases respectively) of Tongji Hospital, was conducted, and p<0.05). Common treatment emergent AEs for tolvaptan were consistent the differences of projects were compared by chi-square test. with previously reported results. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S157

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 dis- ease. 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 TREATMENTAND PREVENTION OF ACUTE CHEMOTHERAPY-INDUCED VOMITING (CIV) IN CHILDREN: A RETROSPECTIVE, MULTI-CENTRE REVIEW J. Flank1,J.Thackray2, D. Nielson3,A.August4, T. Schechter5, S. Alexander5,L.Sung5, L.L. Dupuis6 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; 2Pharmacy, Memorial Sloan-Kettering Cancer Center, New Conclusions York, USA; 3Nursing, Children’s Medical Center Dallas, Dallas, USA; Results of this post-hoc analysis support the use of tolvaptan for the 4Pharmacy, The Children’s Mercy Hospital, Kansas City, USA; treatment of hyponatremia due to para-neoplastic SIADH. Our conclu- 5Pediatrics, The Hospital for Sick Children, Toronto, Canada; sions are limited by the relatively small sample size. 6Pharmacy, The Hospital for Sick Children, Toronto, Canada

Background and Aims The addition of olanzapine to standard antiemetic prophylaxis improves MASCC-0050 chemotherapy-induced nausea and vomiting (CINV) control in adults. Paraneoplastic Published experience in children with cancer is lacking. This study describes the safety and efficacy of olanzapine for CIV control in children. ATYPICAL ORAL LICHEN PLANUS MAYPREDICT IMMUNE Methods SYSTEM RELATED MALIGNANCIES Children <18 years old who received olanzapine for acute CINV control H. Ahadian1, N. Mirjalili1, M.H. Akhavan Karbassi1 from December 2010 to August 2013 at 4 institutions were identified. 1Oral Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Data regarding patient characteristics, chemotherapy, antiemetic prophy- Iran laxis, olanzapine dosing, CIV control, liver function and adverse events were abstracted from the health record. Complete CIV control was Background and Aims defined as the absence of vomiting or retching throughout the acute Oral Lichen Planus (OLP) is a chronic immuno-inflammatory condi- phase. Toxicity was graded using CTCAEv4.03. tion that varies in appearance from keratotic lesions to erythematous Results and ulcerative ones. OLP mostly affects middle-aged females, and Sixty children (median age 13.2 years; range: 3.1–18) who received usually presents as asymptomatic reticular plaques. Asymptomatic olanzapine during 158 chemotherapy blocks were identified. Olanzapine lesions do not need any intervention but regular follow-ups. Howev- was most often (59 %) initiated due to a history of poorly controlled er, In case of pain or burning sensation paliative prescriptions are CINV. The median initial olanzapine dose was 0.09 mg/kg/day (range: treatments of choice. 0.026–0.210). Most children who received olanzapine daily for the entire Methods acute phase experienced complete acute CIV control (83/128; 65 %). A 28-year old man with the chief complaint of oral burning sensa- Grade 1–2 sedation was reported in 11/158 (7 %) of chemotherapy tion, for about 1 month, came to our clinic. Present illness history blocks. Of the 25 chemotherapy blocks where liver function tests were had no significant point, as well as his medical history. In clinical reported more than once, grade 1–3 elevations in ALTand/or AST were examinations, bilateral reticular white plaques of buccal and gingi- observed in 5. Bilirubin was unaffected. The median weight change in 31 val mucosa were significant. Since there was no amalgam filing in children who received olanzapine during more than one chemotherapy close contact with his mucosa, he was just instructed to use block was −1 % (range: −16–18). Teriamcinolone mouth-wash. After 2 weeks, symptoms showed Conclusions minimal response to the treatment. Switching to topical Olanzapine is likely to improve CIV control in children with little toxicity. Beclamethasone inhaler for next 2 weeks also resulted in moderate Prospective controlled evaluation of olanzapine for CINV prophylaxis in relief of the burning sensation. In the next session, due to poor children is warranted. S158 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0458 Methods Pediatrics 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 PERIPHERALLYINSERTED CENTRALVENOUS CATHETER CPGs for all topics in supportive care in childhood cancer (see figure 1). (PICC) IN PEDIATRIC ONCOLOGY UNIT: A DEVELOPING The Delphi method is a well-recognized process to achieve consensus WORLD EXPERIENCE among a group of experts (pediatric oncologists, pediatric oncology nurses A. Kumar1,V. Chinnabhandar1,S.P. Yadav1,A.K.Gupta1,A.Gupta2, and pediatricians involved in care for childhood cancer patients), based on N. Radhakrishnan1, D. Thakkar1, D. Tarangini1, A. Sachdeva1 anonymity, iteration, controlled feedback and statistical group response. 1Pediatric Hematology-Oncology and Bone Marrow Transplant Centre, Results Sir Ganga Ram Hospital, Delhi, India; 2Interventional Radiology, Sir In both rounds, 36 panellists (80 %) responded. The five topics with the Ganga Ram Hospital, Delhi, India highest score in round 2 were infection, sepsis, febrile neutropenia, pain and nausea/vomiting. Background and Aims Conclusions PICCs are attractive, economical alternative for prolonged administration We successfully used a Delphi questionnaire to prioritize childhood of chemotherapy in pediatric oncology kids. But there are few disadvan- cancer supportive care topics for the development of clinical practice tages also-infections, block, thrombosis etc. Here we describe our expe- guidelines. This is a first step towards uniform and evidence based Dutch rience with regard to patients demographics and complications. guidelines in supportive care in childhood cancer. Methods Figure 1. Outline of the Delphi method used in the questionnaire 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). Major- ity 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 PICCs- 6(8.2 %) -completed treatment, 14(20 %)- fever, with no proven sep- sis,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.

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, MASCC-0399 1 W.J.E. Tissing Pediatrics 1Department of Pediatric Oncology/Hematology, Beatrix Children’sHos- pital University Medical Center Groningen University of Groningen, CLINICAL EVALUATION ON TASTE PERCEPTION IN Groningen, Netherlands; 2Department of Pediatric Oncology, Emma HEALTHY CHILDREN AND IN PAEDIATRIC CANCER Children’s Hospital Academic Medical Center,Amsterdam, Netherlands PAT I E N T S Background and Aims A. Majorana1, E. Bardellini1,G.Conti2,M.G.Cagetti3,G.Campus4, Currently, nationwide Dutch guidelines for supportive care for children with G. Piana5, L. Strohmenger6, A. Polimeni7 cancer are over 10 years old and not evidence based. There is growing 1oral pathology, University of Brescia, Brescia, Italy; 2Maxillo Facial Surgery support and need for clinical practice guidelines (CPGs), which bridge the and Dentistry, University of Milano, Milano, Italy; 3Pediatric Dentistry, gap between research and clinical practice. However development of CPGs University of Milano, Milano, Italy; 4Pediatric Dentistry, University of is time consuming, therefore it is important to prioritise subjects for which Sassari, Sassari, Italy; 5Special Needs Dentistry, University of Bologna, the clinical importance is the greatest. The objective of this study was to Bologna, Italy; 6Community Dentistry, University of Milano, Milano, Italy; prioritise childhood cancer supportive care topics for development of CPGs. 7Pediatric Dentistry, University of Roma La Sapienza, Roma, Italy Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S159

Background and Aims Results INTRODUCTION: Taste sensitivity test provides information about the Out of the 258 spotted cases, 110 have been enrolled in the research program chemical characteristics of the substances coming in contact with the oral with the remaining being ineligible due to advanced disease or other terminal mucosa. The oral cavity is frequently associated with the typical side conditions that presented as tumors and referred to us for management. effects of anticancer therapy. Diagnosis and management of taste alter- Conclusions ations depend on knowledge of taste sensitivity among healthy children. This has initiated the palliative care activities being provided with very OBJECTIVES: The aim of this project is to analyse the different taste minimal resources and skills. sensitivity and the possible dysgeusia among healthy children and chil- A number of parents and their children have reported improved comfort dren undergoing chemo -radiotherapy. as far as the distressing symptoms are concerned. Methods This initiative registered marked improvement in quality of life to the suffering. 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 MASCC-0316 the Paediatrics Department of Brescia and Bologna (Italy). A taste Pediatrics 2 sensitivity test, performed using 8 solutions with 4 flavours at differ- ent concentrations, plus the placebo solution, was performed follow- UNDERSTANDING THE SUPPORTIVE CARE NEEDS OF ing a standardised protocol. The test was repeated at baseline and ADOLESCENTS WITH CANCER after 20–30 days for healthy children, and before, during and after the H.Y.L. Chan1, C.W.H. Chan1,W.Y.Ip1,D.Y.P.Leung1, M.K.Y.Lin2 therapy for cancer children patients. 1The Nethersole School of Nursing, The Chinese University of Hong Results Kong, Shatin, Hong Kong China; 2Palliative and Home Care Service, RESULTS: In healthy children, the mean of the threshold was 1.83 for Children’s Cancer Foundation, Kowloon, Hong Kong China 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 Background and Aims therapy): 1, 3 and 1.5 for bitter; 1.5, 3.75 and 2.25 for acid; 1, 2.875 In addition to the developmental tasks, adolescents with cancer are and 1.125 for sweet and 1.5, 3.25 and 2.375 for salty. confronted by additional stresses brought about by the disease and its Conclusions treatment. Yet, little is known about their needs and concerns in coping CONCLUSIONS : this study showed significative alterations in taste with all these challenges. The purpose of this study was to identify the perception (disgeusia) in children in cancer therapy, with a Gaussian way. 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 MASCC-0380 4.0 (PedsQLTM) for adolescents, the Brief Symptom Inventory-18 (BSI- Pediatrics 18) and the Medical Outcomes Study Social Support Survey (MOS-SSS) was used to assess their health-related quality of life, psychological MANAGEMENT OF CHILDREN WITH END STAGE DISEASE symptoms and social support respectively. IN A BURKITTS LYMPHOMATREATMENT PROGRAM IN Results WESTERN KENYAREGION 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 A.P. Were1,M.Liru2,C.Kasera2,L.John2,W.Aketch2, B. Weluchio3, physical functioning (1.39±1.05)in health-related quality of life was re- S.A. Obuya4,C.Tenge1 ported as the most overwhelming aspect, in particular on symptoms related 1AMPATH Program EMBLEM Project, Moi University, Eldoret, Kenya; to nausea (1.67±1.30) and pain/hurt (1.04±1.15), whereas somatization 2EMBLEM Project, Homabay District Hospital, Homabay, Kenya; was the most severe psychological symptom (4.00±4.41). They perceived 3EMBLEM Project, Webuye District Hospital, Webuye, Kenya; 4AMPATH the least support in emotional and information support (3.56±0.90). Program- EMBLEM Project, Moi teaching & Referral Hospital, Eldoret, Conclusions Kenya Findings of this study suggest that adolescents with cancer experienced a high level of symptom burdens and a lower level of emotional and Background and Aims information support. This heightened the importance of understanding Community mobilization and outreach activities to comb out all children their illness experiences and provided insights in developing psychosocial with Burkitts Lymphoma (BL) in western Kenya Region had not only intervention that address their needs. 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 MASCC-0094 but of rejection by peers and community members who do not understand Pediatrics 2 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 PREFERENCES AND SATURATION OF THE NEEDS OF whose appearances have been disfigured. PARENTS OF CHILDREN WITH ONCOLOGICAL DISEASES Methods This is an experience paper highlighting the plight of children that L. Sikorova1,R.Buzgova1, A. Filova1 presented with life challenging conditions in a BL treatment program in 1Faculty of Medicine Department of Nursing and Midwifery, University Western Kenya region. of Ostrava, Ostrava, Czech Republic Pain management, management of distressing symptoms is provided by a team of health workers that include physicians, nurses, social workers, Background and Aims physiotherapists and nutritionists who see these children both in the clinic If a child falls ill with an oncological disease, needs and priorities of and in the community during outreach activities. parents may change. The objective was to identify preferences of the S160 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 needs of parents of children hospitalized with an oncological disease Results and the perception of the needs of parents by nurses. Another objec- Results indicated a significant decrease in caregiving stress (especially tive was to determine whether the needs of parents were saturated in during the first 3 months after diagnosis), and improvement of mothers’ their opinion and how the saturation of their needs is perceived by functioning across the 12 months follow-up. Caregiving stress was pre- nurses. dicted by marital status and the ill child being the mother’s only child. Methods Multilevel analyses, controlled for socio-demographic and medical co- The sample included 100 parents of children with an oncological disease variates, showed that, over time, the decline in caregiving stress was (3–10 years old) who were hospitalized together with their children. The accompanied by a reduction in depressive symptoms and anxiety. The second sample consisted of 70 nurses. The Needs of Parents Question- amount of variance explained by caregiving stress was 53 % for depres- naire (NPQ) was used. Statistical evaluation–a median test, chi-squared sive symptoms, 32 % for anxiety, and 7 % for self-reported health. test and Fisher’s exact test. Conclusions Results The findings of the present study indicate that caregiving stress is an important Parents and nurses unanimously evaluated the need to be sure that factor related to maternal adjustment in pediatric oncology. This offers possi- the child will receive the best possible medical and nursing care bilities for developing interventions aimed at preventing caregiving stress, and even in their absence as the most important. They evaluated the strengthening parents’ confidence in their ability to provide good care. 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 MASCC-0185 of information about examinations (p=0.026) and quality education Pediatrics 2 of the child (p=0.004) were important for parents. Unlike nurses, parents much more frequently evaluated their needs as saturated REDUCTION OF CENTRALVENOUS and fulfilled. CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN Conclusions PEDIATRIC ONCOLOGY PATIENTS USING 70 % ETHANOL Nurses taking care of oncologically ill children and their parents should LOCKS: A RANDOMIZED CONTROLLED MULTI-CENTER focus more on the perception and saturation of psychological-social needs TRIAL of parents. 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 MASCC-0175 1paediatric oncology, Academic Medical Center, Amsterdam, 2 Pediatrics 2 Netherlands; paediatric haematology, Academic Medical Center, Am- sterdam, Netherlands; 3Medical Statistics and Bioinformatics, university of Leiden, Leiden, Netherlands; 4paediatric haematology/oncology, Uni- PROVIDING CARE TO A CHILD WITH CANCER: A versity of Groningen, Groningen, Netherlands; 5paediatric haematology/ LONGITUDINAL STUDY ON THE COURSE, PREDICTORS, oncology, Erasmus University of Rotterdam, Rotterdam, Netherlands; AND IMPACT OF CAREGIVING STRESS DURING THE FIRST 6paediatric haematology/oncology, VUMC University of Amsterdam, YEAR AFTER DIAGNOSIS Amsterdam, Netherlands; 7paediatric haematology/oncology, WKZ Uni- E. Sulkers1, W.E. Tissing2, A. Brinksma1,P.F. Roodbol3,W.A.Kamps2, versity of Utrecht, Utrecht, Netherlands; 8paediatric surgery, Academic R.E. Stewart4,J.Fleer4,R.Sanderman4 Medical Center, Amsterdam, Netherlands; 9datamanagement, Dutch 1UMCG School of Nursing and Health Department of Pediatric Childhood oncology group, The Hague, Netherlands; 10Department of Oncology/Hematology Beatrix Children’s Hospital, University of Gro- Medical Microbiology, Academic Medical Center, Amsterdam, ningen University Medical Center Groningen, Groningen, Netherlands; Netherlands; 11 paediatric haematology/oncology, Academic Medical 2Department of Pediatric Oncology/Hematology Beatrix Children’sHos- Center,Amsterdam, Netherlands pital, University of Groningen University Medical Center Groningen, Groningen, Netherlands; 3UMCG School of Nursing and Health, Uni- Background and Aims versity of Groningen University Medical Center Groningen, Groningen, The prevention of central venous catheter- (CVC-) associated blood- Netherlands; 4Department of Health Sciences Health Psychology Sec- stream infection (CABSI) in pediatric oncology patients is essential. tion, University of Groningen University Medical Center Groningen, Ethanol locks can eliminate biofilm embedded pathogens and have no Groningen, Netherlands known microbial resistance. Objective Background and Aims To determine whether 70 % ethanol locks can cause a 50 % reduction in Caring for a child with cancer is potentially stressful. Parents of children CABSI in pediatric oncology patients. with cancer are confronted with several extra demands (e.g. responsibility Methods for disease related tasks, dealing with role conflicts, and communication We conducted a randomized, double blind, multicenter trial in pediatric with the healthcare personnel). This may contribute to their already oncology patients (1–18 years) with newly inserted CVCs. Patients were existing stress. The aim of the present study was to describe the course, randomly assigned to receive 2 h ethanol locks (3 ml 70 %) or heparin predictors and impact of caregiving stress on the functioning of mothers locks (3 ml 100 IU/ml), maximum frequency once weekly. Primary of children with cancer during the 1st year post diagnosis. outcomes were catheter-associated bloodstream infection (CABSI), cath- Methods eter removal or death due to CABSI. Mothers (N=95, 86 % response rate) of consecutive newly diagnosed Results pediatric cancer patients (0–18 years) completed measures of caregiving We included 307 patients, 153 were allocated to ethanol and 154 to stress, depressive symptoms anxiety and self-reported health at diagnosis, heparin locks. In the ethanol group 16/153 (10 %) patients were diagnosed and 3, 6, and 12 months thereafter. with CABSI versus 29/154 (19 %) in the heparin group; incidence was Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S161

0.77/1,000 and 1.46/1,000 catheter days respectively (p=0.04), resulting MASCC-0091 in a number-needed-to-treat of 12 patients. Particularly Gram-positive Pharmacology CABSIs (ethanol, N=8; heparin, N=21, p=0.01) were reduced. Less CVCs were removed because of CABSI in the ethanol group (ethanol, ADJUVANT CHEMOTHERAPY OFADVANCED OVARY N=5; heparin, N=12, p=0.08). No patients died because of CABSI. CARCINOMA: SYSTEMIC REVIEW OF MODE OF During ethanol locks patients experienced significantly more transient ADMINISTRATION 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), I. Chang1,J.Y.Lee1,M.K.Kim2,B.G.Kim1,D.S.Bae1 no suspected unexpected serious adverse reactions (SUSAR) occurred. 1Obstetrics and Gynecology, Samsung Medical Center Sungkyunkwan Conclusions University of Medicine, Seoul, Korea; 2Obstetrics and Gynecology, This is the first RCT to show that ethanol locks can prevent CABSI in Samsung Changwon Hospital Sungkyunkwan University of Medicine, pediatric oncology patients, in particular CABSI caused by Gram- Changwon-Si, Korea positive bacteria. Implementation of ethanol locks in daily practice should be considered. 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 MASCC-0167 databases was conducted for studies. Pharmacology Results Nine randomized trials were identified that evaluated adjuvant chemo- TARGETING OF RAC1-SIGNALING FOR THE PREVENTION therapy in women with advanced ovary carcinoma in terms of mode of OFANTHRACYCLINE-INDUCED CARDIO- AND administration. Among them 8 was eligible for evaluation of survival HEPATOTOXICITY results and hazard ratio was 0.80 (95 % CI 0.71~0.90). Besides survival differences, toxicity results were compared, too. Intraperitoneal (IP) che- C. Henninger1,J.Ohlig2, A. Bopp1,F. Wartlick1,M.Merx2, G. Fritz1 motherapy has low or moderate evidence regarding thrombocytopenia, 1Toxicology, Heinrich-Heine-University Düsseldorf, Düsseldorf, leucopenia, febrile neutropenia, gastro intestinal problem from analysis. Germany; 2Cardiology Pneumology and Angiology, University Hospital Conclusions Düsseldorf, Düsseldorf, Germany The benefits of IP chemotherapy need to be weighed against the toxicity of treatment. Background and Aims Patients should be informed of the benefits and risks of IP chemotherapy. Ras-homologous (=Rho) small GTPases regulate numerous functions Additional analysis would be helpful. More clinical trials are warranted to associated with malignant disease. Pharmacological inhibition of Rho further define the role of IP chemotherapy in subgroups of patients and to GTPases counteracts tumor progression and potentiates the antitumor clarify the role of IP chemotherapy. efficacy of various anticancer drugs in preclinical models. Yet, conse- quences of inhibition of Rho signalling on normal tissue damage pro- voked by anticancer drugs is unknown. We aimed to elucidate the influ- ence of inhibition of Rac1 on stress responses and cell death of normal MASCC-0040 cells/tissues following treatment with the anthracycline derivative doxo- Pharmacy rubicin (Doxo). Methods ADHERENCE TO ANTIEMETICS THERAPY IN ASIAN HEAD Rat cardiomyoblasts (H9c2) and human liver cells (HepG2) were pre- AND NECK CANCER PATIENTS treated with lovastatin (Lova) or Rac1-specific small-molecule inhibitors (EHT1864, NSC23766). Following Doxo exposure, DNA damage re- A. Chan1,M.Shwe1,Y.X.Gan2,X.H.Low1,K.Yap1,D.Lim3 sponse (DDR) and cytotoxicity were monitored. Moreover, the influence 1Pharmacy, National University of Singapore, Singapore, Singapore; of Lova and NSC23766 on Doxo-induced early and late cardio- and 2Pharmacy, National Cancer Centre Singapore, Singapore, Singapore; hepatotoxicity was analyzed in vivo (B6 mice). In addition, we investi- 3Medical Oncology, National Cancer Centre Singapore, Singapore, gated the influence of hepatic knock-out of the rac1 gene on doxorubicin- Singapore induced stress responses. Results Background and Aims Both Lova and EHT1864 blocked the DDR and promoted the survival of In Asia, head and neck cancers are highly prevalent. Currently, there H9c2 and HepG2 cells following Doxo treatment1,2. Pharmacological is little prevalence data in the literature describing non-adherence to inhibition of Rac1 and liver-specific rac1 ko reduced the level of DNA outpatient antiemetic regimens for prophylaxis of chemotherapy- damage induced by Doxo3,4. Notably, Lova and NSC23766 also protect induced nausea and vomiting (CINV) among Asians. Hence, this the mouse heart from anthracycline-induced damage5,6. The data show study was designed to evaluate the impact of adherence to delayed that inferfering with Rac1-signaling protects against anthracycline- antiemetics (3–4 days after cisplatin-based chemotherapy) on CINV induced normal tissue damage. control in head and neck cancer patients after cisplatin-based chemo- 1Huelsenbeck et al. (2012) JBC 278, 38590-99; Wartlick et al. (2013) therapy and (b) identify patient-related factors associated with BBA 1833, 3093-04; 3Henninger et al. (2012) TAAP 261, 66-73; 4Bopp nonadherence to delayed antiemetics. et al. (2013), CDDIS 4,e558; 5Hulsenbeck et al. (2011) CDDIS 2:e190; Methods 6unpublished This was a single-center, prospective, observational study conducted Conclusions between September 2008 and May 2013. Adult head and neck cancer Targeting of Rac1 signaling attenuates the cardiotoxic and hepatotoxic patients planning to receive cisplatin-based chemotherapy were recruited side effects of Doxo-based anticancer therapy. in this study. A standardized diary was used to collate clinical events. S162 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Primary endpoints included overall significant nausea, overall vomiting MASCC-0386 and complete response to antiemetics. Pharmacy Results Two hundred thirty-five patients were included in the analyses. The CLINICAL PHARMACY SERVICES IN UNITS : IMPACT ON majority (75.7 %) was male and Chinese (81.7 %), manifested nasopha- THE PHYSICIAN ORDERS IN A CANCER CENTER ryngeal 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 G. Marliot1,E.Tresch2,I.Sakji1, G. Lefebvre3, I. Rodrigues3,S.Delbey1 patients (63.8 %) self-reported nonadherent use of delayed antiemetics. 1Clinical Pharmacy Department, Centre Oscar Lambret, Lille, France; Patients who were nonadherent to antiemetics had a higher incidence of 2Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille, overall vomiting (31.4 % vs. 16.5 %, p=0.013), but similar incidence of France; 3Oncology Supportive Care Department, Centre Oscar Lambret, significant nausea (56.4 % vs. 52.9 %, p=0.61) than those patients who Lille, France were adherent to their antiemetics. After adjusting for potential con- founders, patients receiving radiotherapy were more adherent to their Background and Aims – antiemetics (OR=8.4; CI 95 %=2.4 29, p=0.001). Since the computerization of physician orders, 2 intern pharmacists have Conclusions been associated with order verifications and have made rounds with the Asian head and neck cancer patients are poorly adherent to their pre- medical team in two units. Our work was to evaluate the impact of this scribed antiemetic regimens, which results in poor control of clinical pharmacy service. chemotherapy-induced vomiting. 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 MASCC-0328 groups : ‘accepted’, ‘refused’ or ‘replaced’. These proportions were Pharmacy compared using Khi-2 test. An analysis of the evolution of the conformity of the orders was performed comparing the two quarters THE EFFECTS OF DENOSUMAB ON CALCIUM PROFILES IN of the study. ADVANCED CANCER PATIENTS WITH BONE METASTASES Results In 6 months, 23,608 orders were verified. For each month, the conformity 1 2 2 3 1 B. Lechner , C. DeAngelis , N. Jamal , U. Emmenegger ,N.Pulenzas, of orders was significantly higher in the units with an intern pharmacist. 2 1 1 1 A. Giotis ,P. Sheehan ,M.Tsao, E. Chow In the 2 populations (units with/without intern), the conformity of the 1 Rapid Response Radiotherapy Program Department of Radiation On- orders was significantly higher in the 2nd quarter.The improvement in the cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, To- conformity of the orders between the 2 quarters is significantly more 2 ronto, Canada; Department of Pharmacy, Odette Cancer Centre important in the units with intern. 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 hypocalce- mia 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 hypocal- cemia 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 intra- Conclusions venous calcium and hospitalization for hypocalcemia. Median num- The development of clinical pharmacy services in the units was ber of injections before hypocalcemia was 1 (range 1 to 14). The connected to a rate of conformity of orders significantly higher median time from first hypocalcemic value to normocalcemia was than in units without interns. That can be explained by a com- 33 days. munication increased between oncologists, pharmacists and nurses, Conclusions resulting in an optimization of the orders. Moreover, the best Nine of 52 (17.3 %) of patients had at least one incidence of grade≥2 knowledge of the patients and their clinical status can also ex- hypocalcemia, suggesting that cautionary measures should be taken to plain an increased relevance of the emitted pharmaceutical avoid hypocalcemia in patients receiving denosumab. interventions. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S163

MASCC-0292 Methods Pharmacy This study is based on a review of medical databases (Pub Med CEN- TRAL, MEDLINE, Cochrane Library) of the last 30 years. All articles included in the present analysis were in English. VENOUS THROMBOEMBOLISM: WHAT PHARMACISTS Results KNOW? WHAT DO THEY NEED? Research has demonstrated significant difference in overall survival J.B. Rey1,P.Kreit2, D. Parent3,J.Sicard4,D.Hettler5,N.Jovenin6, favoring the non-smoking group among patients with lung cancer. There P. Nguyen7,J.L.Ducrocq8 is also evidence that tobacco smoking exacerbates and prolongs radio- 1Faculté de Pharmacie, Université de Reims, Reims, France; therapy induced complications. Continuing smoking is associated with 2-, Pharmacie, Vanault les Dames, France; 3Département de Pharmacie, adverse effects during anticancer treatment. Smoking increases tumor Institut Jean Godinot, Reims, France; 4-, Pharmacie Principale, Chalons progression and resistance to chemotherapy due to nicotine-induced en Champagne, France; 5OMEDIT, ARS Champagne-Ardenne, Chalons resistance to apoptosis by modulating mitochondrial signaling. Continu- en Champagne, France; 6-, Réseau ONCOCHA, Reims, France; ing smoking is also related with inferior outcomes during treatment with 7Laboratoire d’Hématologie, CHU de Reims, Reims, France; 8Medical novel targeted therapies such as erlotinib. Quitting smoking after lung affairs, Léo Pharma, Voisins le Bretonneux, France cancer diagnosis is associated with better performance status. Patients who continued to smoke despite being diagnosed with cancer report more Background and Aims severe pain. Venous thromboembolism is frequent in cancer. Low molecular weight Conclusions heparins (LMWH) are recommended for prevention/treatment of throm- Continuing smoking after cancer diagnosis is related with reduced treat- bosis in cancer. Community pharmacists are very often faced with pa- ment efficacy and reduced survival, risk for more secondary malignancies tients’ questions (dosage, tolerance, treatment duration). The aim of this and deterioration in quality of life. study was to assess the community pharmacists’ knowledge regarding ‘thrombosis in cancer’. Methods A web-questionnaire (built by a multidisciplinary group) was open be- MASCC-0570 tween October and November 2013 to community pharmacists in Population Research Champgne-Ardenne region. Collected data were 1) pharmacy’sgeneral organization for cancer patients’ management, 2) management of ambu- WHY PATIENTS WITH CHOLANGIOCARCINOMA ARE latory patients with ‘thrombosis and cancer’ and 3) pharmacists‘ knowl- DOOMED TO PALLIATIVE CARE: RETROSPECTIVE STUDY edge assessment through a simple case report: after an initial 10-days OF DIAGNOSIS AND TREATMENT hospital prescription, what should a patient receive as anticoagulant treatment?’ I. Kuznecovs1, S. kuznecovs1, D. Baltina2 Results 1Cancer Research, Institute of Preventive Medicine, Riga, Latvia; One hundred eighty (38 %) community pharmacists answered the ques- 2Epidemiology, Oncology Center,Riga, Latvia tionnaire. Among those, in 65 %, the number of patients with cancer was 6–15/pharmacy. In 70 % the number of patients with thrombosis and Background and Aims cancer was 1-10/pharmacy. Morbidity and mortality from biliary tract cancer is increasing worldwide. In 93 %, the pharmacists had no specific competency in oncology and/or The purpose of this study was to investigate and assess the clinical supportive care. Moreover, 96 % were not aware of the existence of features, diagnosis and therapy of the patients, treated for cholangiocar- national/international recommendations regarding ‘thrombosis in cancer’. cinoma at the Latvian Oncology Center. At last, only 49 % gave the correct answer to the case report (LMWH). Methods The most expressed needs were information, continuous education, and Retrospective study of 17 cholangiocarcinoma patients’ medical records information booklets for patients. between January 2001 and December 2007at the Latvian Oncology Conclusions Centre. Statistical calculations were performed using MedCalc 12.4.0.0. This regional questionnaire will be extended to all French regions. Con- for Windows. tinuous education sessions are being put in place. Another questionnaire Results will be launched at the end of 2014 to assess education sessions’ efficacy. 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 MASCC-0281 severe weight loss. All patients with jaundice had only extrahepatic tumor Population Research 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 INFLUENCE OF SMOKING CESSATION IN EFFECTIVENESS industry, diabetes, a history of the use of isoniazid. Extrahepatic tumors OF CHEMOTHERAPY IN LUNG CANCER PATIENTS were diagnosed by computed tomography and magnetic resonance. Sev- M. Kiagia1,I.Gkiozos1,G.Krommidas1,A.Charpidou1, S. Tsagkouli1,K. en of 17 patients (41.2 %) had stage III disease, ten (58.8 %) - stage IV. Syrigos1 Only in single case tumor was evaluated as resectable, and radical surgical 1Oncology Unit GPP, Sotiria General Hospital, Athens, Greece approach was used left liver lobe hemihepatectomy.In the rest of the cases palliative treatment was indicated. Background and Aims Conclusions Despite the established causal relationship between tobacco smoking and In patients with bile duct tumors complete tumor resection achieving a cancer many cancer patients continue to smoke after diagnosis. This negative resection margin is the only potentially curable method. Comor- partly reflects the ignorance of the beneficial effects of smoking cessation bidities, advanced age and very poor performance status significantly even after diagnosis. The aim of the study is to demonstrate the impact of limited tumor resectability. Are patients with cholangiocarcinoma continuing or quitting smoking in patients with diagnosed cancer. doomed to palliative care? S164 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0490 Conclusions Population Research In the Medicare BC population, the comorbidities studied were more prevalent in patients on less aggressive chemotherapy and less prev- alent in those on more aggressive treatment. Further studies are CO-MORBIDITIES IN ELDERLYBREAST CANCER PATIENTS warranted to examine the potential risk of FN/IF hospitalization TREATED WITH CHEMOTHERAPY related to the AoC. R. Sosa1, J. Molony2,S.Li2,R.Barron3,P. Morrow4, W.Stryker5,J.Liu2, A. Collins2, J. Acquavella6 1Division of Hematology and Oncology, Vanderbilt University, Nashville, USA; 2Chronic Disease Research Group, Minneapolis Medical Research MASCC-0021 Foundation, Minneapolis, USA; 3Global Health Economics, Amgen Inc., Population Research Thousand Oaks, USA; 4Amgen Global Development, Amgen Inc., Thou- sand Oaks, USA; 5Center for Observational Research, Amgen Inc., San SKIN CANCER KNOWLEDGE AND SUN PROTECTION Francisco, USA; 6Center for Observational Research, Amgen Inc., Thou- BEHAVIORS IN MEDICAL AND NON-MEDICAL UNIVERSITY sand Oaks, USA STUDENTS IN KARACHI, PAKISTAN R. Rafaqat1 Background and Aims 1Medicine, dow medical college, Karachi, Pakistan Comorbidity may influence how providers decide the aggressiveness of chemotherapy (AoC) for patients and likely impacts the risk of febrile Background and Aims neutropenia (FN)/infection (IF) hospitalizations. We characterized the To examine skin cancer knowledge and sun protection behaviors in relationship between the AoC and comorbidity in elderly breast cancer Medical and Non-Medical university students in Karachi, Pakistan (BC) patients on chemotherapy from Medicare claims data. Methods Methods We surveyed 768 students (16–27 years) at two large public sector The BC study population was identified from the 20 % Medicare sample with universities (401 Medical Students and 367 Non-Medical Students) in Parts A and B coverage who initiated their first course of chemotherapy Karachi, Pakistan. Survey data were collected regarding skin cancer between 06/01/2007-to-11/30/2011. The AoC was approximated by the num- knowledge and sun protection behaviors. Differences between the 2 ber of different IVagents reported on claims during the first course of therapy groups were compared with chi-squared test. and classified into low (1 agent), medium (2 agents), and high (3+ agents). Results Comorbidity, prior hospitalizations and age were defined in the 6 months Of all the respondents, sun exposure as a risk factor for skin cancer before chemotherapy initiation. Counts and proportions were estimated. was identified by 77.7 %, genetics by 44 %, ultraviolet radiation by Results 87.1 %, multiple skin moles by 19.1 % and fair complexion by Weidentified 16,829 BC patients. Compared with those treated with only 27.7 %. Knowledge of risk factors was greater among the Medical 1 agent, those treated with 2 and 3+ agents were younger and less likely to Students as compared to the Non-Medical Students. Of the total, have CVD, GI disease, CKD, arthritis, history of anemia, prior IF hospi- 56 % of the participants ‘always’ wears sun-protective clothing, talizations, and prior hospital stay≥7 days; these results were more 41.4 % ‘always’ wears hat/dupatta, 13.2 % ‘always’ seeks shade, pronounced in patients treated with 3+ agents (table). 10.5 % ‘always’ wears sun glasses, and 27.9 % ‘always or most of times’ apply sunscreen with sun protection factor of≥15. The most Ta b l e Distribution of Demographics Comorbidities by Aggresiveness of frequent method of sun protection was found to be wearing sun- Chemotherapy in Elderly Breast Cancer Patients protective clothing, which was significantly more common among

Characteristics All patients Aggressiveness of Chemotherapy the Medical Students (64.1 % vs. 47.1, p). Low, n (%) Medium, n (%) High, n (%) Conclusions To t a l N u m b e r 16,829 4,613 6,109 6,107 University programs for increasing knowledge of skin cancer risk are Demographics warranted. Changing attitude and behaviors regarding exposure and Age, years 65–69 5,200 (30.9) 812 (17.6) 1,983 (32.5) 2,405 (39.4) protective measures is increasingly important. 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) Female sex 16,624 (98.8) 4,572 (99.1) 6,037 (98.8) 6,015 (98.5) MASCC-0334 * Comorbidities Population Research 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) Diabetes 3,640 (21.6) 1,058 (22.9) 1,287 (21.1) 1,295 (21.2) SUPPORTIVE CARE ORGANIZATION: A NATIONAL Chronic renal disease 926 (5.5) 387 (8.4) 298 (4.9) 241 (3.9) MEDICAL SURVEY Chronic obstructive 1,991 (11.8) 485 (10.5) 832 (13.6) 674 (11) lung disease 1 2 3 4 5 6 Arthritis 2,239 (13.3) 740 (16) 756 (12.4) 743 (12.2) F.Scotté,F. Farsi , N. Jovenin , M.E. Bugat , M. Namer ,C.Herve, Thyroid disease 2,581 (15.3) 654 (14.2) 997 (16.3) 930 (15.2) J.M. Tourani7,R.Bugat4, C. Tournigand8,P.Leroy9,I.Krakowski10 Anemia 2,174 (12.9) 834 (18.1) 733 (12) 607 (9.9) 1Medical Oncology AND Supportive Care in Cancer Unit, Georges Other cancer 1,272 (7.6) 362 (7.8) 588 (9.6) 322 (5.3) 2 Primary cause of hospitalization* Pompidou European Hospital, Paris, France; Oncology Department, 3 Infectious disease 590 (3.5) 227 (4.9) 196 (3.2) 167 (2.7) Leon Berard Cancer Center,Lyon, France; Oncology Department, Jean 4 CV disease 539 (3.2) 206 (4.5) 167 (2.7) 166 (2.7) Godinot Institute, Reims, France; Oncology Department, Claudius Other 5,206 (30.9) 1,043 (22.6) 2,108 (34.5) 2,055 (33.6) Regaud Institute, Toulouse, France; 5Oncology Department, Clinique * LOS of any hospitalization, days Mougins, Mougins, France; 6Ethics Department, Paris Descartes Uni- 0 11,031 (65.5) 3,324 (72.1) 3,820 (62.5) 3,887 (63.6) 7 1–3 2,905 (17.3) 371 (8) 1,205 (19.7) 1,329 (21.8) versity, Paris, France; Oncology Department, Centre Hospitalier 8 4–6 1,377 (8.2) 381 (8.3) 533 (8.7) 463 (7.6) Universitaire La Miletrie, Poitiers, France; Oncology Department, Hen- 9 =7 1,516 (9) 537 (11.6) 551 (9) 427 (7) ri Mondor Hospital, Creteil, France; Supportive Care in Cancer Unit, Georges Pompidou European Hospital, Paris, France;10oncology De- *Defined based on 6 months prior to chemotherapy initiation partment, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S165

Background and Aims Results The French Supportive Care in Cancer (SCC) organization was evaluated Interviews were conducted with 1,562 patients. The majority had a in 2010, i.e. individual physicians (MDs). favorable opinion (measured on a numerical scale) of their management MDs awareness was promoted in a new national survey. and 34 % knew the term SCC, most frequently described as complemen- Methods tary care to specific treatments (55 %). The offer to benefit from the SCC The French Speaking Association for SCC (AFSOS) conducted an ob- organization was proposed to 19 % of patients (represented by 54 % at servational study to evaluate practices, organizations and information diagnosis, 35 % after complication) and supportive treatment was pre- delivered to patients (pts) on SCC. A 30 points questionnaire was sent scribed for 63 %, mostly by their oncologist (74 %). When prescribed, to 2,263 physicians caring for cancer patients (oncologists (MO), radio- 64 % of patients received information on side-effects (usually verbally therapists, haematologists, gastroenterologists). (96 %)). Epoetin was prescribed for 25 % and analgesics for 73 %. The Results term “Palliative Care” was previously heard mentioned by 80 % frequent- MDs returned 711 questionnaires (31 %) with a majority of MO (47 %) ly considered as care to improve quality of life during cancer treatment and a SCC organization was identified in 81 % of structures (71 % in (59 %). The top 3 supportive care offers were psychology (61 %), 2010), primarily developed in CCC (96 %; p<0.05) specifically through nutrition (55 %) and announcement organization (55 %). Professional out-patient departments (66 %). In 78 % of centres, patient care was resources outside the hospital were: General Practitioners (84 %), Nurses organised as a combination of hospitalisation and consultation dedicated (58 %), Pharmacists (52 %). to supportive care (55 % in 2010). Cross-disciplinary co-ordination Conclusions meetings dedicated to supportive care were developed in 40 % of struc- Information on supportive organization as well as treatment must be tures but unchanged compared to 2010 (39 %). Homecare was developed developed to further enhance SCC. 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 MASCC-0352 (94 %). Supportive care was enhanced at diagnosis and in adjuvant Procedures settings compared to 2010. Adverse event information was better deliv- ered in 2013 specifically for erythropoiesis stimulating agents (72 % vs MINIMALLY INVASIVE PALLIATIVE PROCEDURES IN 54 % in 2010). ONCOLOGY:A REVIEW OFA MULTIDISCIPLINARY Conclusions COLLABORATION SCC organization and information to pts were enhanced from 2010 to 2013 in public and private centres, with disparities. The most developed P. Hawley1, L.L. Chu2,P. Munk3,P. Mallinson3 were social care, nutrition management, cancer announcement and 1Pain & Symptom Management/Palliative Care, BC Cancer Agency, homecare organization. Vancouver, Canada; 2Yr 2 Medicine, University of British Columbia, Vancouver,Canada; 3Musculoskeletal Interventional Radiology, Vancou- ver General Hospital, Vancouver,Canada

MASCC-0336 Background and Aims Population Research Minimally Invasive Palliative Procedures (MIPPs) are sometimes consid- ered 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 SUPPORTIVE CARE ORGANIZATION: A NATIONAL PATIENT MIPPs for advanced cancer patients with severe pain unresponsive to VIEW conventional analgesics. The twice-monthly conference discusses refer- F. Scotté1,C.Herve2, N. Jovenin3,F.Farsi4, M.E. Bugat5,R.Bugat5, rals for pain control procedures and reviews imaging, with palliative care, M. Namer6, J.M. Tourani7, C. Tournigand8,P. Leroy9,I.Krakowski10 musculoskeletal interventional radiology, radiation oncology, medical 1Medical Oncology AND Supportive Care in Cancer Unit, Georges oncology and anesthesia experts in attendance. Pompidou European Hospital, Paris, France; 2Ethics Department, Paris This study aimed to determine the benefit to patients from the procedures Descartes University, Paris, France; 3Oncology Department, Jean recommended by the case conference and assess the impact of the case Godinot Institute, Reims, France; 4Oncology Department, Leon Berard conference on management. Cancer Center,Lyon, France; 5Oncology Department, Claudius Regaud Methods Institute, Toulouse, France; 6Oncology Department, Clinique Mougins, A retrospective review of electronic charts of all cancer patients referred Mougins, France; 7Oncology Department, Centre Hospitalier to the case conference between December 20, 2011 and June 25, 2013. Universitaire La Miletrie, Poitiers, France; 8Oncology Department, Hen- Results ri Mondor Hospital, Creteil, France; 9Supportive Care in Cancer Unit, There were 103 referrals, resulting in 69 procedures performed among 63 Georges Pompidou European Hospital, Paris, France; 10Oncology De- patients. Procedures included cementoplasty, cryoablation, nerve blocks, partment, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France etc. Over 80 % of procedures provided analgesic benefit. Pain scores fell across all categories post-procedure. Mean worst pain scores fell from 8.1 Background and Aims ±1.4 to 4.6±2.8 (P<0.001). The Medical Doctor’s perspective of supportive care in cancer (SCC) in Patient function, mobility, and symptoms measured by the Edmonton France was previously assessed based on two national surveys. However, Symptom Assessment System also improved post-procedure. At time of the opinion of patients has never been evaluated. abstract submission, 37/63 (58.7 %) patients had died. Mean survival Promote patient awareness via a national survey. post-procedure was 200 days. The documented rate of major adverse Methods events attributable to MIPPs was 2/69 (2.9 %). The French Speaking Association for SCC (AFSOS) conducted an ob- Conclusions servational study from October 2013 to January 2014, to evaluate prac- MIPPs are valuable treatment options in patients with severe cancer pain tices, organizations and information delivered to patients on SCC. A 40 despite use of appropriate step three WHO ladder medications. The case point questionnaire was performed by physicians using a face-to-face conference facilitates excellent communication and sharing of expertise, method and analyzed with a Chi2 test. ensuring optimal patient care. S166 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0201 settings. The current systematic review and meta-analysis aims to deter- Procedures mine the factors influencing HTO presence in patients receiving prophy- lactic radiotherapy. Methods SAFETYAND EFFECTIVENESS OF PERIPHERALLY A systematic search of the literature was conducted on Ovid INSERTED CENTRALVENOUS CATHETERS IN MEDLINE, EMBASE and CENTRAL. Studies were included if they TERMINALLYILL CANCER PATIENTS reported the percentage of patients developing heterotopic ossifica- K. Park1,H.G.Lim2 tion after receiving a specified dose of prophylactic radiotherapy. 1Hematology-Oncology, KEPCO Medical Center, Seoul, Korea; Weighted linear regression analysis was conducted for continuous 2Radiology, KEPCO Medical Center,Seoul, Korea or categorical predictors. Results Background and Aims Extracted from 528 articles, a total of 5,464 patients were included, Terminally ill cancer patients were limited or no peripheral venous access spanning 85 separate study arms. Most patients (55.2 %) were from the due to edema or long term intravascular therapy including chemotherapy, United States, had radiation performed on the hip (97.7 %), and had so intravenous access has been often provided by central venous access. radiation prescribed postoperatively (61.6 %) and at a dose of 700 cGy The purpose of this study was to investigate the safety and efficacy of the (61.0 %). After adjusting for radiation site, there was no statistically peripherally inserted central venous catheter (PICC) in terminally ill significant relationship between the percentage of patients developing cancer patients. HTO and radiation dose (p=0.1) or whether radiation was administered Methods preoperatively or postoperatively (p=0.1). Patients with previous HTO A retrospective review was conducted on patients who underwent PICC formation were more likely to develop recurrent HTO than those without at hospice-palliative unit of KEPCO medical center between January previous HTO formation (p=0.04). There was a statistically significant 2013 and December 2013. All PICCs were inserted by interventional negative relationship between HTO development and the cohort mean radiologist. year of treatment (Figure 1; p=0.007). 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. Conclusions Decreases in rates of HTO over time in this patient population may be a function of more efficacious surgical regimens and prophylactic radiotherapy. MASCC-0465 Procedures

A SYSTEMATIC REVIEWAND META-ANALYSIS OF MASCC-0331 RADIOTHERAPY FOR THE PROPHYLAXIS OF Psychooncology HETEROTOPIC OSSIFICATION EVALUATION OF BURNOUTAND WORK SATISFACTION OF M. Popovic1,A.Agarwal1,L.Zhang1,C.Yip1, H.J. Kreder2, MEDICAL ONCOLOGISTS IN TURKEY M.T. Nousiainen2, R. Jenkinson2,M.Tsao1,H.Lam1, M. Milakovic1,E. Wo n g 1,E.Chow1 T. A k m a n 1, T. Yavuzsen2, O. Tanriverdi3,F. Cay Senler4, S. Komurcu5, 1Rapid Response Radiotherapy Program, Odette Cancer Centre O. Ozyilkan6, H. Ellidokuz7 Sunnybrook Health Sciences Centre University of Toronto, Toronto, 1Medical Oncology, Izmir Tepecik Research and Training Hospital, Izmir, Canada; 2Division of Orthopaedics, Sunnybrook Health Sciences Centre Turkey; 2Medical Oncology, Dokuz Eylul Medical Faculty, Izmir,Turkey; University of Toronto, Toronto, Canada 3Medical Oncology, Sitki Kocman University Faculty of Medicine, Mugla, Turkey; 4Medical Oncology, Ankara University Faculty of medi- Background and Aims cine, Ankara, Turkey; 5Medical Oncology, Bayindir Hospital, Ankara, Following surgery, the formation of heterotopic ossification (HTO) can Turkey; 6Medical Oncology, Baskent University Faculty of Medicine, limit mobility and impair quality of life. Radiotherapy has been proven to Adana, Turkey; 7Basic Oncology, Dokuz Eylul University faculty of provide efficacious prophylaxis against HTO, especially in high-risk medicine, Izmir,Turkey Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S167

Background and Aims Table 3. MBI subscales and MSQ according to socio-demographic feature Burnout is defined as a syndrome characterized by depersonalization(D), in physicians emotional exhaustion(EE), and sense of low personal accomplishment(PA). Many different personal or environmental factors DEEPAMSQ may lead to decrease in work satisfaction and burnout. Our aim is to Gender determine the work satisfaction and level of burnout in medical oncologists(MO). Female Methods Male All MO working in different areas were invited to fill in the ques- p* NS 0,0024 0,009 NS tionnaire in the internet. In the questionnaire forms, first part includ- Work experience ed questions on sociodemographic properties and in the second part, – there was the Turkish version of Maslach Burnout Inventory(MBI) 1 5year and in the third part Minnesota Work Satisfaction Scale. 129 ques- > 5 year tionnaires were evaluated. p* < 0,001 NS <0,001 <0,001 Results Academic title Sociodemographic properties of MO who had participated to the study were given (Table 1). Burnout sub-groups and average of Present Minnesota scores, burnout and work satisfaction results were given Absent (Table 2). Burnout and work satisfaction was found significantly p* 0,01 NS 0,023 0,001 lower in young oncologists with no academic titles, PA and work satisfaction were significantly higher as the age increased Work stress management (Table 3). Present Absent p* < 0,001 NS <0,001 <0,001 Table 1. The socio-demographic features of Medical Oncologist Willing to do job Ye s N(%) Mean ± SD No Age 129 (100) 37,8±5,9 p* NS <0,001 < 0,001 <0,001 Wo r k i n g Ye a r 1 –587(67,4) > 5 42 (32,6) * Independent samples t-test EE: emotional exhaustion, D: depersonalization, PA: personal Gender Female 71 (55) accomplishment Male 58 (45) Conclusions Marital status Married 112 (86,8) This study is the first and widest ranged national study which burnout and work satisfaction of MO has been evaluated in Turkey. We have deter- Single 17 (13,2) mined that burnout was seen more in MO with female gender, younger Academic title Present 41 (31,8) age, no academic title and the work satisfaction was lower significantly in Absent 88 (68,2) accordance with the literature. More wide ranged studies and training Work stress management Present 13 (10,1) about burnout to MO are necessary in our country. Absent 96 (74,4) Institutional training Present 26 (20,4) MASCC-0294 Absent 103 (79,8) Psychooncology Willing to do job Yes 111 (91,5) MULTIDIMENSIONAL FATIGUE SYMPTOM INVENTORY-SHORT FORM: A SYSTEMATIC REVIEW OF ITS PSYCHOMETRIC PROPERTIES K. Donovan1, K. Stein2,M.Lee3,C.Leach3,O.Ilozumba3, Table 2. The mean of MBI and MSQ P.B. Jacobsen.3 1Psychosocial and Palliative Care, H. Lee Moffitt Cancer Center and Mean ± SD* Research Institute, Tampa, USA; 2Research, American Cancer Society, 3 MBI Atlanta, USA; Population Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA EE 16,38±5,6 D 5,97±2,97 Background and Aims PA 21,28±3,34 Fatigue is among the most common problems experienced by cancer patients. The Multidimensional Fatigue Symptom Inventory-Short Form MSQ 68,25±11,76 (MFSI-SF), a 30-item self-report measure, assesses five empirically- derived dimensions: general, physical, emotional and mental fatigue Mean ± SD (mean ± standard deviation), EE: Emotional exhaustion, D: and vigor. We reviewed and evaluated the MFSI-SF’s psychometic prop- depersonalization, PA: personal accomplish erties based on its use in published research studies. S168 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods MASCC-0582 We identified 70 studies published between 1998 and 2013. Alpha Psychooncology coefficients and test-retest correlations were summarized to characterize internal consistency reliability and test-retest reliability, respectively. Cor- PSYCHOLOGICAL DISTRESS IN PATIENTS WITH relation coefficients between subscales and other published measures PANCREATIC CANCER COMPARED TO OTHER ADVANCED were summarized to characterize concurrent, convergent and divergent CANCERS validity. The mean difference statistic (d) was calculated to characterize sensitivity to change and discriminative validity. P. Fitzgerald1,Y.Yeung1,M.Li1,G.Rodin1 Results 1Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Mean alpha coefficients for subscales ranged from 0.83 to 0.93 and mean Centre, Toronto, Canada 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 Background and Aims between MRFI-SF vigor and other measures of vitality/vigor was .64. Pancreatic cancer is reported to have higher prevalence of depression and Correlations with depression and anxiety measures were small to large and anxiety compared to other cancers. While a possible shared underlying in the expected direction (range=0.10–0.80). Effect sizes for sensitivity to pathophysiology has been proposed to explain this association, past change and discriminative validity ranged from very small to very large. studies have been small in size and have not accounted for the potential Conclusions roles of differing prognosis and physical symptom burden when compar- The MFSI-SF has been widely used to assess fatigue. Its psychometric ing psychological distress between pancreatic and other cancers. properties include high internal consistency and moderate test-retest Methods reliability. Its concurrent validity is moderate to high; there is good Cross-sectional analysis of patient responses on the psychosocial distress evidence for its convergent and divergent validity. Evidence for its sensi- screening tool (D.A.R.T.) at Princess Margaret Cancer Centre, Toronto over tivity to change and discriminative validity is positive. These findings 2 year period. Pancreatic cancer patients (n=184) were compared to other encourage continued use of the MFSI-SF in fatigue research studies. 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 (SDI- 21). Univariate tests investigated for differences between groups on study MASCC-0407 measures, and subsequent poisson regressions investigated for independent Psychooncology relationships between depression, anxiety and pancreatic cancer. Results Pancreatic cancer patients had significantly elevated depressive LONGITUDINAL DEPRESSION SCORES FOR PATIENTS WHO (p<0.001) and anxiety (p<0.001) scores compared to other advanced HAVE UNDERGONE A PALLIATIVE REHABILITATION cancers: 26 % of pancreatic patients had clinically significant depressive PROGRAM symptoms, versus 15 % of patients with other advanced cancers A. Feldstain1, S. Lebel1,M.Chasen2 (p<0.005), with corresponding anxiety results being 16 % and 9 % 1School of Psychology, University of Ottawa, Ottawa, Canada; respectively (p=0.01). Regression analyses indicated that pancreatic can- 2Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, cer diagnosis remained a significant predictor of elevated depressive and Canada anxiety scores (p<0.0002 and p<0.0001, respectively), and this was independent of physical symptom severity. Background and Aims Conclusions Patients with advanced cancer who have completed anti-cancer treatment Pancreatic cancer patients have significantly elevated depression and need a coordinated plan to encourage healthy lifestyle changes in order to anxiety scores compared to other advanced cancers, and this is indepen- alleviate subsequent late-effects. Palliative rehabilitation is one such dent of physical burden. avenue but depression affects program adherence each year. The Pallia- tive 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 MASCC-0246 during and after the PRP. Psychooncology Methods Patients underwent a thorough interdisciplinary assessment and 2-month SAVORING AS A DAILYLIFE PROCESS MEDIATES THE interdisciplinary intervention. The Problem Checklist (PCL) was admin- ASSOCIATION BETWEEN HEALTHPROMOTION AND istered to assess patient’s subjective impression of depression as a prob- DEPRESSIVE AND PHYSICAL SYMPTOMS IN PEOPLE lem and the Hospital Anxiety and Depression Scale (HADS) was admin- NEWLYDIAGNOSED WITH CANCER istered for a quantitative depression score; both at initial assessment (T1), upon completion of the PRP (T2), and 3-months following completion W. K . H o u 1,K.M.Lau1,S.M.Ng1,S.T.Cheng1 (T3). Twenty patients completed all three time points. PCL was analyzed 1Department of Psychological Studies, The Hong Kong Institute of Edu- descriptively. HADS was analyzed using a repeated-measures for longi- cation, Hong Kong, Hong Kong China tudinal changes in depression. Results Background and Aims The number of patients endorsing “depression” as a problem decreased Limited is known about the daily life processes in the association between from baseline. Patients who underwent to PRP reported alleviation of health promotion and outcomes in cancer patients. This study aimed to their depression symptoms at the end of the program and continue to examine the nature of associations among cancer-specific health engage- benefit after 3 months, F(1)=13.41, p=0.002. ment control strategies, savoring, and psychological and physical symp- Conclusions toms in Chinese people with colorectal cancer (CRC). Our pilot data suggest that patients who have undergone the PRP expe- Methods rience relief from their symptoms of depression throughout the program, A total of 157 newly diagnosed CRC patients were recruited and admin- and continue to benefit 3 months after completion. istered (1) back-translated items on control strategies (i.e., active Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S169 processes counteracting physical health problems) (Wrosch et al., 2003), MASCC-0566 (2) back-translated savoring the moment subscale of Savoring Belief Psychooncology Inventory (i.e., enjoyment of pleasant experiences in the moment (Bryant, 2003), and (3) the Chinese version of Hospital Anxiety and Depression MINDFULNESS-BASED STRESS REDUCTION PROGRAM IN Scale (Ho et al., 1993) and Memorial Symptom Assessment Scale- NEWLYDIAGNOSED PATIENTS WITH EARLYSTAGE Physical Symptom Subscale (Cheng et al., 2009). BREAST CANCER Results The 157 participants ranged in age between 25 and 90 years (M=65.97, A. Koumarianou1, Z. Tsovou2,K.Syrigos3,C.Darviri2 SD=12.02); 65 (41 %) were female and 114 (73 %) were married. Twenty- 1Fourth Department of Internal Medicine, Attikon University Hospital, four (15 %) participants reported receiving no formal education. Forty-one Athens, Greece; 2Postgraduate Course Stress Management and Health (26 %) participants were diagnosed with rectal cancer, 81 (52 %) with Promotion, Athens University, Athens, Greece; 3Medical Oncology Unit colon cancer, and 35 with other cancers (22 %). Structural equation Third Department of Internal Medicine “Sotiria” General Hospital, modeling using Mplus 6.1 revealed that savoring significantly mediated Athens University, Athens, Greece 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). Background and Aims Conclusions Breast cancer diagnosis and its treatment may induce intense psycholog- Tomaximize holistic health in cancer patients, symptom management and ical stress, particularly during the first year of diagnosis. The purpose of health behavior change intervention should be integrated with well-being this study was to investigate whether the application of mindfulness- intervention that targets daily life psychological functioning. based 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 MASCC-0489 Newly diagnosed breast cancer patients with early stage disease were Psychooncology randomly assigned to no intervention (control group; n=30) or to an 8- week MBSR program including diaphragmatic breathing, progressive muscle relaxation and guided imagery (intervention group; n=35). Vali- EFFECTS OF SLEEP DYSFUNCTION ON SELF-REPORTED dated questionnaires including Perceived Stress Scale, Health Locus of MEMORY PROBLEMS IN ADULTCANCER SURVIVORS IN Control Scale, Rosenberg Self-esteem Scale, Self-esteem Questionnaire THE UNITED STATES: A CROSS-SECTIONAL STUDY and cortisol levels in the saliva were assessed at the beginning and the end P. Jean-Pierre1, M. Grandner2 of the study. Participants’ demographic and clinical data were included in 1Psychology, University of Notre Dame, Notre Dame, USA; 2Psychiatry, the statistical analyses. University of Pennsylvania, Philadelphia, USA Results Our study shows a significant stress reduction in patients included in the Background and Aims intervention group, improvement in relation to their eating choices (p= Cancer survivors generally struggled with many treatment adverse effects 0.012), their general satisfaction (p=0.008), sleep satisfaction (p=0.001), such as self-reported memory problems (SRMP). Despite its importance perceived social support (p=0.003), quality of diet (p=0.049) and phys- to memory function, studies on the effects of sleep dysfunction on ical activity (p=0.001). We found no differences in the levels of self- memory in cancer survivors are lacking. esteem or cortisol among the two groups but patients in the intervention Methods group had lower median levels of cortisol. We examined data from 151 cancer survivors, age 41–46 years, Conclusions who completed the 2007–2008 National Health and Nutrition Ex- Our MBSR program proved to promote psychosocial adaptation in newly amination Survey. We excluded people with history of brain diagnosed patients with early stage breast cancer. We deem that these cancer/stroke since these conditions are expected to result in cog- results encourage for further studies aiming to address the psychosocial nitive difficulties. Population-weighted binary logistic regression well-being, relevant for health outcomes, in breast cancer patients. 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 (7–8h)or MASCC-0589 long (>=9 h); and insomnia as combined, and with different Psychooncology subtypes (i.e., initial = difficulty falling asleep, middle = difficulty maintaining sleep, and late = waking too early). Each type of TARGETS FOR PSYCHOSOCIAL SUPPORT: FAMILYAND insomnia was classified as none, mild (<15 days/month) and se- WORK IN BREAST CANCER PATIENTS vere (>=15 days/month). The combined insomnia variable catego- rized individuals as insomnia if they had severe insomnia of any G. Kuznecova1, S. Kuznecovs1,L.Gromcakova1,I.Kuznecovs1, type (early, middle, late). G. Kuznecova1 Results 1Supportive Care, Institute of Preventive Medicine, Riga, Latvia Insomnia predicted SRMP (p<0.0001). Specifically,severe initial insom- nia (p=0.006), mild and severe middle insomnia (p=0.007 and Background and Aims p<0.0001), and late mild-insomnia (p=0.037) predicted SRMP. Only Breast cancer is a chronic disease that may often have a relapse. The aim long-sleep had a negative associated with SRMP (p=0.019). A compar- of the present study was to identify priorities and targets for psychosocial ative analysis with 2,001 age-matched participants without a cancer support. In the focus were work and family in women with breast cancer. history no effects of sleep on SRMP (p>0.05). Methods Conclusions Monitoring was spent from the 1997 to 2013 in Latvia. There were 1,308 Insomnia and long sleep predicted SRMP only in participants with a women in the age of 28–75 years old with breast cancer. The Occupa- cancer history,suggesting sleep might be a pathway through which cancer tional Psychosocial Monitoring Questionnaire was used to detect the impact memory function. cause and level of victimization. S170 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results Conclusions Leading factors promoting occurrence of relapses and reduction of a life Comparison of groups at different points in the cancer trajectory found were conflicts at work, overtime hours, shift work, work in a night shift. elevated levels of distress from diagnosis through 3 months post treat- Findings reveal that 54 % (32 % in 1997) of women with relapse in cancer ment. Distress significantly decreased at 6 months post treatment. These treatment and recurrence of the disease perceived themselves as victims findings will be used for a future intervention study although validated of the conflicts at work. The positive influence of returning to labor that distress screening should occur for breast cancer survivors from activity on life expectancy was established only in 8 % of cases. The diagnosis forward. 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 MASCC-0477 and latent uncooperative altitudes in family caused development of Psychooncology relapses of disease and reduction of life expectancy. Conclusions IMPLEMENTING AND SUSTAINING SCREENING FOR Leading psychosocial factors, such as emotional distress at work and in DISTRESS IN 14 COMMUNITY ONCOLOGY CLINICS: A family attitudes which could be provoking in occurrence of breast cancer, GOOD NEWS STORY! continue to render essential influence on development of relapses of breast cancer and life expectancy of women. C. Mayer1, D. Damore-Petingola1, M. Conlon2,K.George1 1Supportive Care Oncology Research Unit, Health Sciences North North East Cancer Center,sudbury, Canada; 2Epidemiology Outcomes & Eval- uative Research, Health Sciences North North East Cancer Center,sud- bury, Canada MASCC-0413 Psychooncology 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 DISTRESS IN BREAST CANCER SURVIVORS: chemotherapy is delivered in community hospitals permitting patients to SELF-REPORTED ISSUES IN ACUTE SURVIVORSHIP receive treatment closer to home. This presentation will describe how J. Lester1,K.Crosthwaite2,R.Stout2,R.Jones3,C.Shapiro4,C. screening for distress was implemented in rural and remote community Holloman5,B.Andersen1 oncology clinics from 2009 to 2011 and how the initiative continues to be 1Department of Psychology, The Ohio State University Comprehensive sustained. Cancer Center, Columbus, USA; 2Division of Nursing, The Ohio State Methods University James Cancer Hospital & Solove Research Institute, Colum- Using principles of participatory action research, the clinics were bus, USA; 3College of Nursing, The Ohio State University, Columbus, asked to implement a screening for distress program. Patients com- USA; 4Division of Medical Oncology, The Ohio State University Com- pleted the Edmonton Symptom Assessment Symptom scale and the prehensive Cancer Center,Columbus, USA; 5Department of Mathemat- Canadian Problem Checklist at every cycle of chemotherapy. Nurses ics, The Ohio State University Comprehensive Cancer Center,Columbus, were responsible to review patient scores, assess for further clinical USA intervention and refer patients to other health care professionals as necessary. Background and Aims Results Distress is prevalent in breast cancer survivors with psychosocial or During the implementation of the project, 607 patients were eligible physical issues. Their concerns may go unnoticed unless distress to be screened. Eighty-percent (n=505) of the patients who received screening is performed and further assessment and discussion occurs. at least one cycle of chemotherapy were screened once or more for Research about distress is most helpful when performed in a desig- distress. The overall screening rate was 80.7 % with a range of 39.7– nated group and time period using validated, clinically-relevant 100 %. Of the 27 % (n=163) of patients who scored 7 or higher on instruments. ESAS, 41 % (n=67) were identified as having some of their symp- The aim of this study was to observe self-reported distress in breast cancer toms reduced by their next completed screen. Over 2,000 screens survivors during acute survivorship to inform a future survivorship have been completed since the implementation phase and most intervention. clinics are screening at 80 % or higher. Methods Conclusions A descriptive, cross-sectional design compared the level and sources Changing the clinical practice of oncology clinicians to screen patients for of distress from breast cancer survivors (n=100) across four time cancer distress requires a well-developed knowledge translation plan with periods in acute survivorship. Measures included distress thermom- continuous outcome evaluation. eter & 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 MASCC-0537 applied to determine significant relationships to specific pairs of Psychooncology time periods. Results SUPPORTING ONE ANOTHER THROUGH CANCER: THE Participants scored in range of cutoff score (≥4) during time periods of DYADIC PATIENTAND FAMILYCAREGIVER RELATIONSHIP active treatment, end of treatment, & 3 months post. At 6 months post treatment, distress levels were significantly lower (M=3.6, sd=3.2). C.J. McPherson1,A.Devereaux1,M.M.Lobchuk2,W.Petrcich3 Significant differences between groups were noted on total problem list 1Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; score (P=0.007), and emotional (P=0.01) and physical (P=0.003) sub- 2Faculty of Nursing, University of Manitoba, Winnipeg, Canada; scale scores. 3Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Canada Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S171

Background and Aims Methods Families play an important role in supporting patients with can- CRC patients were divided into 4 groups (n=20 each): 1. Patients who cer to cope with the disease, its treatment and symptoms. Re- did not undergo surgical resection of CRC. 2. Patients who underwent search indicates that mutually supportive interactions between surgical resection but did not start adjuvant chemotherapy. 3. Patients patients and their caregivers can have a positive effect on phys- receiving adjuvant chemotherapy. 4. Patients who completed chemother- ical health and well-being of both members of the dyad. How- apy. Healthy volunteers comprised the control group (n=20). Depression ever, few studies have examined how patient and caregiver per- and anxiety were analyzed using the Hospital Anxiety and Depression sonality characteristics intersect within the patient-caregiver rela- Scale (HADS). Cytokine serum levels were measured by CBA. tionship to determine the care given and received. Using an Results attachment theory perspective, the aim was to examine the syn- Approximately 60 % of CRC patients manifested a combination of severe ergistic effects of patient and caregiver attachment styles on anxiety and depression. Regardless of surgical resection, patients who did supportive interactions within the caregiving relationship, and not start chemotherapy had increased levels of the pro-inflammatory dyadic adjustment. cytokines IL-1, IL-6, IL-8, and TNF-α, but lower IL-10 concentrations. Methods Compared to these patients, those who were receiving or completed One hundred and three adult patients receiving outpatient cancer care and chemotherapy had lower pro-inflammatory cytokine levels. Correlation their primary family caregivers completed a survey that comprised vari- analysis revealed a positive association of anxiety and/or depression with ous measures including dyadic adjustment (Relationship Assessment IL-1, IL-6, IL-8, and TNF-α, and a negative correlation with IL-10 for Scale Generic; RAS-G), attachment style (Experiences in Close Relation- CRC patients. ships Modified scale; ECR-M16) and supportive interactions (Shared Conclusions Care Inventory; SCI-R). These results suggest that pro-inflammatory cytokines are involved in the Results pathophysiology of anxiety and depression in CRC patients. A better The Actor-Partner Interdependence Model (APIM) was used was understanding of these intricate relationships may contribute to the de- used to examine caregiver and patient ECR-S scores on SCI-R velopment of therapeutic strategies to assist in alleviating anxiety/ taking into account interdependence within the patient-caregiver depression symptoms in cancer patients. relationship. The findings revealed that patient and caregiver attach- Supported by FAPESP ment styles contributed significantly (P>.05) to supportive interac- . tions. Attachment styles that were characterised as avoidant and anxious were negatively associated with supportive interactions (communication, reciprocity and decision-making) and dyadic adjustment. MASCC-0507 Conclusions Psychooncology The findings underscore the importance of understanding how individual styles of responding in relationships can facilitate or hinder supportive COMPARISON OF ZOLPIDEM AND LORAZEPAM EFFECT ON interactions and dyadic adjustment in cancer. Attachment theory provides INSOMNIA IN HEMATOPOIETIC STEM CELLS TRAN a framework for interventions aimed at those at risk for unsupportive SPLANT RECIPIENTS exchanges. M. Tavakoli-Ardakani1 1clinical pharmacy, School of pharmacy, Tehran, Iran

Background and Aims MASCC-0260 Hematopoietic Stem Cells Transplantation (HSCT) is associated with Psychooncology 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 PRO-INFLAMMATORY CYTOKINES CORRELATE WITH Zolpidem and Lorazepam effect on insomnia in HSCT recipients. ANXIETYAND DEPRESSION IN PATIENTS WITH Methods COLORECTAL CANCER In a randomized, single blind trial, 35 inpatients, aged 18–65, from 2009 G. Silva Bisson1, D.O. Miranda2, L.R. Azevedo3, T.A.S. Lima4, till 2011 in HSCT ward of Taleghani hospital with insomnia were allo- F.M. Peria5,M.Flória-Santos1 cated into Zolpidem or Lorazepam group. Epworth Sleepiness Scale 1Department of Maternal-Infant and Public Health Nursing, University of (ESS) questionnaire and Hospital Anxiety and Depression scale São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil; (HADS) were completed at baseline, weekly, and end of 1 month treat- 2Postgraduate program in Public Health Nursing, University of São Paulo ment. Medication was initiated with 5 mg Zolpidem or 1 mg Lorazepam. at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil; 3Postgraduate Side effects of drugs were assessed by clinical observations. program in Basic and Applied Immunology, School of Medicine of Ribeirão Results Preto University of São Paulo, Ribeirão Preto, Brazil; 4Undergraduate ESS score showed no significant difference between groups (p=0.17). student, University of São Paulo at Ribeirão Preto College of Nursing, SMI score significantly decreased at the end of fourth week in zolpidem Ribeirão Preto, Brazil; 5Division of Clinical Oncology, School of Medicine group (p=0.047). At the end of first week, zolpidem decreased latancy of of Ribeirão Preto University of São Paulo, Ribeirão Preto, Brazil 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 sig- Background and Aims nificant patients had normal sleep in zolpidem group and there was no Colorectal cancer (CRC) is a leading cause of cancer mortality world- anxious or depressed patient in both groups. Rate of side effect were wide. Anxiety and depression are the most prevalent psychological similarinbothgroups. disorders in CRC, impairing patients’ quality of life. Nevertheless, mech- Conclusions anisms underlying these disorders are poorly understood. This study Based on this study, It is better to use zolpidem for long sleep onset time aimed to investigate whether serum cytokine levels correlate with anxiety and lorazepam for disrupted sleep in HSCTrecipients during first 2 weeks and depression in CRC patients. of insomnia. After that, zolpidem is preferred. S172 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0482 successfully connected from multiple settings. Several satisfaction sur- Psychooncology veys 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 accept- FACTORS AFFECTING THE EFFECTS OF REMINISCENCE ability, with high levels of satisfaction (Figure 1) and group cohesion THERAPY IN CANCER PATIENTS WITH RECURRENCE (Figure 2) across participants. Cascade participants reported that: the K. Ueno1,T.Kataoka2,H.Okamura2 ‘online format was easy to use’ (100 % ‘agreed’), ‘I learnt new skills’ 1nursing, Japanese Red Cross Hiroshima College of Nursing, Hiroshima, (94 %), ‘I enjoyed talking to other parents’ (94 %) and ‘the homework Japan; 2Graduate school of Biomedical & Health Sciences, Hiroshima helped me’ (84 %). 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 interven- tion. 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 Wefound 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. 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, MASCC-0533 ADAPT, SURVIVE: LIFE AFTER CANCER’): AN ONLINE Psychooncology PSYCHOLOGICAL INTERVENTION FOR PARENTS AFTER THEIR CHILD’S CANCER TREATMENT PERCEPTIONS OF THE “VENTURING OUT PACK PROGRAM” AS TANGIBLE SUPPORT FOR YOUNG ADULTS C.E. Wakefield1, U.M. Sansom-Daly1,E.L.Doolan2,R.J.Cohn1 WITH CANCER 1School of Women’s and Children’s Health, University of NSW, Sydney, Australia; 2Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia L. Wazneh1, A. Tsimicalis2, C.G. Loiselle3 1Ingram School of Nursing (RN MSc(A)), Faculty of Medicine McGill Background and Aims University, Montreal, Canada; 2Ingram School of Nursing Introduction: Few cost-effective psychological interventions are avail- (RNPHD)Associate Professor, Faculty of Medicine McGill University, able for parents of young cancer survivors aged <15 years. Our team Montreal, Canada; 3Christine and Herschel Victor/Hope & Cope Chair developed an online program called ‘Cascade’ (Cope, Adapt, Survive: in Psychosocial Oncology School of Nursing and Dept. of Oncology life after CAncEr’), which aims to improve parental quality of life. Associate Professor at Faculty of Medicine McGill University (PHD) Cascade is delivered live by a psychologist over three 2 h videoconfer- Senior Scientist Lady Davis Institute Jewish General Hospital, Faculty of encing modules, with 3–5 parents/group. Medicine McGill University/Jewish General Hospital, Montreal, Canada Methods: 177 eligible parents were invited, 50 of whom opted in (24 parents randomly allocated to Cascade, 26 allocated to a waitlist control). Background and Aims To date, 21 parents have completed Cascade, 22 have completed the Within the cancer community, young adults (YAs) with cancer have been waitlist, 3 have dropped out and 4 are awaiting group allocation. 90 % increasingly recognized as a distinct group with unmet supportive care of participants have completed every module, and parents have needs. “Venturing Out Beyond Our Cancer” is a non-profit community Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S173 agency committed to providing YAs with tangible support services to MASCC-0096 address their cancer-related needs. One of these services called the Psychooncology 2 “Venturing Out Pack (Vo-Pak) Program” provides backpacks containing resources to help YAsthroughout their cancer journey. EXPRESSIVE WRITING IN CANCER PATIENTS: To explore: (a) the needs of YAs newly diagnosed with cancer; (b) the EXPERIMENTAL EVIDENCE FOR ITS FEASIBILITYAND extent to which Vo-Pak helps them meet their practical, psychosocial and EFFECTIVENESS informational needs; and (c) how the Vo-Pak could be further enhanced. Methods B. Muzzatti1,A.Surbone2, M.A. Annunziata1 A qualitative descriptive study was conducted with a purposive sample of 12 1Unit of Oncological Psychology, Centro di Riferimento Oncologico - YAs treated for cancer at a university-affiliated tertiary hospital. Semi-structured National Cancer Institute, Aviano (PN), Italy; 2Medicine, University of interviews were audio-recorded, transcribed, coded and thematically analyzed. New York, New York, USA Results Overall, YAs positively perceived the Vo-Pak as a welcoming ready-to-use Background and Aims timely package. The Hospital Comfort Kit was seen as a “hands on” resource Expressive writing (EW) is a brief supportive intervention aimed at that reduced their illness-related uncertainty. The Venturing Out Kit was helping people in managing stressful or traumatic events. Its effectiveness construed as a catalyst for connecting with similar others and offering them and feasibility have been tested regarding different settings. “guilt-free” complimentary outings. The Friends of Lara Information Kit was In this work, experimental studies testing the effectiveness of expressive commended for its relevance as a dispatcher to important support resources. writing in oncological settings have been reviewed to evaluate EW feasibility Conclusions with cancer patients, and its effectiveness both overall and in specific domains. Enhancing the Vo-Pak program by promoting it and increasing awareness Methods of its purposes is critical in meeting the needs of YAs with cancer. More A computer-based literature search was performed in PubMed and systematic dissemination of programs such as this one would add to the PsychINFO to identify pertinent articles published between January overarching goal of providing comprehensive person-centered cancer 2000 and August 2013. The search was restricted to articles written in care to an underserved segment of the cancer population. 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 MASCC-0017 many different investigated domains, little evidence has been found for Psychooncology 2 the EWeffectiveness. This seemed to be limited to a reduction in hospital stay, better reported physical health, and improvement in perceived sup- port (including mental health services). EW was welcomed by most PSYCHOLOGICAL INTERVENTION UTILIZING participants who described it as useful in reflecting about cancer and its EDUCATIONAL MATERIALS AS A MEAN FOR IMPROVING meanings and as having positive effect on their own emotional mood. PSYCHOSEXUAL HEALTH OF BREAST CANCER WOMEN Conclusions S. Abasher1 When analyzed in isolation, most of the reviewed studies sounded encour- 1Education and Psychology College, King Faisal University, Alhassa, aging. However, considering all published articles together, the available Saudi Arabia literature suggests caution in proposing EWas an approved method to help cancer patients in managing their own emotions. As culture may greatly Background and Aims influence patients’ ability to use EW and its consequent effectiveness, This study is to provide psycho-educational materials as an intervention results will be also presented with reference to different cultural settings. 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; MASCC-0200 educational group (n=30), intervention group (n=29), or control group Psychooncology 2 (n=30). Tobe eligible for the study,women were married, sexually active with their husbands, and inhabitant in Khartoum state during the imple- MENTAL HEALTHLITERACY IN EARLY-STAGE ASIAN mentation of the study. Twoscales were been filled by all the participants BREAST CANCER PATIENTS: ABILITY TO RECOGNIZE as measurements for this study and those are: Watts Sexual Function PSYCHOSOCIAL DISTRESS AND PREFERENCES OF Questionnaire (WSFQ) which measure and provides a total sexual func- TREATMENTS tion score and subscale score for desire, arousal, orgasm and satisfaction. Hospital Anxiety and Depression Scale (HADS) is the other measure- Y.T. Cheung1, Y.Y. Ong1, T.R.D. Ng1, M. Shwe1, H.K. Ho1,Y.P.Tan2, ment that used in this study. G. Fan2, W.S. Yong3,P.Madhukumar3,M.Wong4,W.S.Ooi4,W.Y.Chay4, Results R.A. Dent4, S.F. Ang4,R.Ng4, J.A. Lee5, M.T. Cham5, C.W. Chan6, Significant difference has been found in regard to HADS and WSFQ pre A. Molassiotis6, A. Chan1 and post test analysis for the experiential group. Women assigned to the 1Pharmacy, National University of Singapore, Singapore, Singapore; educational materials group had significant higher posttest scores on both 2Psychosocial Oncology, National Cancer Centre Singapore, Singapore, HADS and WSFQ scales than women assigned to psychosexual inter- Singapore; 3Surgical Oncology, National Cancer Centre Singapore, Sin- vention program. gapore, Singapore; 4Medical Oncology, National Cancer Centre Singa- Conclusions pore, Singapore, Singapore; 5Breast Department, KK Women’sandChil- The study concluded that, as patients cease to visit the hospital regularly dren’s Hospital, Singapore, Singapore; 6School of Nursing, The Hong until their first follow-up, it is in generally difficult for health-care Kong Polytechnic University, Hong Kong, Hong Kong China providers to detect problems and hence to intervene. Information giving in form of educational materials goes beyond the period of treatment as Background and Aims many patients continue to have problems and need to be preparing for Psychosocial distress in breast cancer patients is often under diagnosed handling them. and undertreated due to lack of recognition of symptoms and knowledge S174 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 about treatments available. This study was designed to evaluate the feelings towards such interventions. From the perspective of the nurses, the mental health literacy (MHL) of Asian breast cancer patients, through interventions were regarded as useful for newly diagnosed gynecological assessing their ability to recognise symptoms of anxiety, fatigue, depres- cancer patients. They believed the interventions were feasible and practical sion and cognitive disturbance, and their knowledge of help-seeking to be incorporated into routine practice in Hong Kong clinical settings. options and professional treatments. Conclusions Methods The findings indicated that the psycho-educational intervention pro- This is an ongoing, cross-sectional, multi-centered study. Chemotherapy- gramme was desired and appreciated by the gynecological cancer pa- receiving early-stage Asian breast cancer patients completed four tools to tients, and it was feasible to be delivered in Hong Kong. measure their levels of anxiety, depression, fatigue and cognitive distur- bances. With the aid of cancer-specific vignettes, a modified question- naire (Jorm et.-al 1997) was administered to evaluate patients’ MHL. Descriptive statistics were used to summarise the data. MASCC-0101 Results Psychooncology 2 Fifty-four patients were analyzed (77.7 % Chinese, age: 52.7±8.5 years). Clinically-significant anxiety (15.1 %), fatigue (27.8 %) and cognitive MAKING THE CASE FOR PSYCHOSOCIAL ONCOLOGY disturbances (25.9 %) were prevalent, compared to depression (5.6 %). ACTIONS IN ROMANIA: EVIDENCE FROM REPEATED Majority of the patients could recognize the symptoms of fatigue accu- CROSS-SECTIONAL DATA rately (75.9 %), but less than half of them could identify the symptoms of C. Dégi1, E. Kallay2,I.Lukacs1, M. Cimpianu1,C.Burz3 anxiety (35.2 %), depression (48.1 %) and cognitive disturbances 1 (48.1 %). Patients were more receptive to help from oncologists Sociology and Social Work, Babes Bolyai University, CLUJ-NAPOCA, Romania; 2Department of Psychology, Babes Bolyai University, CLUJ- (29.6 %) and their family members (24.1 %), as compared to other mental 3 health specialists such as psychiatrists (5.6 %) and psychologists (5.6 %) NAPOCA, Romania; Medical Oncology - Chemotherapy, Oncology “ ” for the management of their psychosocial distress. Approximately half of Institute Prof. Dr.Ion Chiricuta , CLUJ-NAPOCA, Romania the patients indicated embarrassment and fear as their main barrier to seeking professional treatment. Background and Aims Conclusions Seven years after acceding to the European Union and endorsement of Asian breast cancer patients’ MHL was inadequate. Interventions and several cancer control agendas (e.g. including EPAAC) the Romanian management strategies could be implemented to educate Asian breast National Cancer Program, as there is not an integrated plan yet, does not cancer patients on recognising the symptoms of psychosocial distress and include or cover psychosocial cancer care. In this situation we aim to evidence-based treatment that are specific to mental disorders. analyse prevalence of diagnosis non-disclosure, cancer distress and qual- ity of life in Romanian cancer patients prior and post EU accession. Methods APSCO - Assessment of Psycho-Social and Communication needs in Oncol- ogy - is the first extensive questionnaire based study in Romania on psycho- MASCC-0013 social aspects of cancer. APSCO has a repeated cross-sectional design using Psychooncology 2 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 EVALUATING A PSYCHO-EDUCATIONAL INTERVENTION 2013, and 420 in 2006. Instruments included: BDI, STAI-T, and FACT-G. PROGRAMME FOR GYNECOLOGICAL CANCER PATIENTS Results IN HONG KONG Preliminary data show that prevalence of cancer diagnosis non-disclosure halved in Romania between 2006 and 2013 (16.9 % vs. 8.2 %). However, K.M. Chow1, C.W.H. Chan1,J.C.Y.Chan1 psychosocial distress is highly elevated and symptoms are relatively un- 1The Nethersole School of Nursing, The Chinese University of Hong changed, especially depression (47.5 % vs. 42.2 %) and anxiety (46.7 % vs. Kong, Hong Kong, Hong Kong China 47.2 %). All aspects of quality of life (Ms=63.37 vs. 70.63) — including physical, social, emotional and functional well-being - show clinically Background and Aims meaningful shifts but still under normative levels indicated by FACIT. A diagnosis and treatment of gynecological cancer have adverse effects Conclusions on the sexual functioning, quality of life and psychological outcomes of Our results about moderate to high cancer distress and undermet well- the patients. Psycho-educational interventions are recommended to be being needs among Romanian cancer patients, burdened by tendencies of provided for them to improve their outcomes. non-disclosure, support current efforts to put psychosocial cancer care on This study aims to explore the experience, opinions and feelings towards Romania’s priority health agenda. a psycho-educational intervention programme from the intervention re- Study was supported by CNCS – UEFISCDI grant PN-II-RUTE-2012-3- cipients and health-care providers. 0011 and UBB no. GTC 34020/2013. Methods This study adopts a qualitative semi-structured interview approach. Sam- ples were newly diagnosed gynecological cancer patients with surgery as MASCC-0006 the first-line treatment in Hong Kong. They were randomly assigned to Psychooncology 2 the intervention group to receive a psycho-educational intervention pro- gramme, or to the attention control group. Interviews were arranged to ANTIPSYCHOTIC DRUGS: PRO-CANCER OR gather views on the interventions from the participants in the intervention ANTI-CANCER? group and nurses working at the study site. Content analysis was per- formed to analyze the data. G. Fond1 Results 1pav hartmann, INSERM U955, Créteil, France A total of 13 participants and three nurses were interviewed. From the perspective of the participants, the programme was regarded as helpful for Background and Aims their psychological status by providing emotional and informational sup- Important data was recently published on the potential genotoxic or port. The design of the programme was appropriate and they had positive carcinogenic effects of antipsychotics, as well as on their cytotoxic Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S175 properties on cancer cells, that must be considered by psychiatrists in the MASCC-0210 benefit/risk ratio of their prescriptions. Psychooncology 2 Aim of the study: To answer whether or not antipsychotics, as a class or only some specific molecules, may influence cancer risk among treated THE DEGREE OF PSYCHOLOGICAL DISTRESS IN GASTRIC patients. CANCER PATIENTS Methods Eligibility criteria: All studies (in vitro, animal studies and human studies) P. Heras1,V.Natsis1,T.Sirbilantze1, K. Grigoriou1, A. Papadopoulos1, concerning effects of antipsychotic drugs on cancer development were V. Niarou1 included. 1Hellenic Medical Society for the Study of Psychosomatic Problems, Results Hellenic Medical Society for the Study of Psychosomatic Problems, Results can be summarized as follows: (1) patients with schizophre- Athens, Greece nia 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 Background and Aims properties among rodents, (3) phenothiazines seem to have antipro- The diagnosis and treatment of gastric cancer (gc) may be associated with liferative properties that may be useful in multidrug augmentation increased psychological distress and can subsequently increase the risk of strategies in various cancer treatments, but their bad tolerance may developing a range of negative health outcomes. Despite this, remarkably decrease usage amongst non-psychotic patients, and (4) clozapine little is known about the degree of psychological distress experienced by appears to have a separate status given that this molecule shows gc patients. antiproliferative effects implied in agranulocytosis as well as a po- Methods tential increased risk for leukemia. In a cross-sectional study, 25 patients with gc and 31 patients with other Conclusions hematological malignancies completed the Brief Symptom Inventory Benefit/risk ratio regarding cancer risk is in favor of treating patients (BSI/BSI-18) and the Problem Common Checklist (PCL) during outpa- with schizophrenia with antipsychotic drugs. The practicing clinician tient registration. Sociodemographic characteristics were collected from should be reassuring on the subject of cancer risk due to antipsychot- patients’ clinical files. ic drugs. Results acknowledgments : this work was supported by INSERM, AP-HP,Foun- A higher percentage of gc patients reported elevated distress across each dation Fundamental and by Investissement d’avenir under the ANR subscale of the BSI and BSI-18 when compared to those diagnosed with reference ANR-IDEX-0004-02 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 MASCC-0208 percentage of males endorsing high depression levels when compared Psychooncology 2 to females (35 % vs 23.4 %, p<0.04). Conclusions Despite the small number of patients examined in our study, gc patients SLEEP DISTURBANCES AND DEPRESSION IN PATIENTS demonstrated elevated levels of psychological distress in comparison to WITH PANCREATIC CANCER those ones diagnosed with other hematological malignancies. P. Heras1,V.Natsis1,T.Sirbilantze1,V.Niarou1,M.Hera1 1Hellenic Medical Society for the Study of Psychosomatic Problems, Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece MASCC-0206 Psychooncology 2 Background and Aims Aim of this study is to estimate the degree of sleep disturbances, as well as PREVENTING ANXIETYAND DEPRESSION IN BREAST the possible contributing factors in patients with pancreatic cancer. CANCER: A RANDOMIZED CONTROLLED TRIAL Methods Thirty-two patients were concluded in our study. Fourteen were P. Heras1,V.Natsis1,T.Sirbilantze1 female and 18 male with mean age of 61 (range: 55–74). These 1Hellenic Medical Society for the Study of Psychosomatic Problems, patients underwent through a clinical psychiatric interview according Hellenic Medical Society for the Study of Psychosomatic Problems, to the diagnostic criteria of ICD-10. The degree of sleep disturbances Athens, Greece during the month prior to the patients’ evaluation was assessed through the Athens Insomnia Scale (AIS) and psychopathology was Background and Aims assessed through the Montgomery Asberg Depression Rating Scale To examine the effects of counseling and relaxation intervention on (MADRS) psychological symptoms displayed on patients with breast cancer be- Results tween the post –operative period and that after the 2-month review There was a strong correlation between the score of AIS and the one of Methods the MADRS for all 32 patients (r:0,40, p<0.01). 13 of our patients Thirty-two patients were randomized and completed the baseline Hospital complained of insomnia. These patients scored higher on the MADRS Anxiety and Depression Scale (HADS) and General Health than the ones without sleep difficulties. (z:-3.032, p=0.002) Questionnaire-28 (GHQ-28) questionnaires. The intervention consisted Conclusions of a relaxation and a counseling session performed by a senior doctor. The results of our study suggest that sleep disturbance (insomnia) in Follow up questionnaires were completed after 2 months. Demographic patients with pancreatic cancer is a probable indicator of depression. and tumor data were examined and compared independently. Furthermore, these data suggest that insomnia in these patients is one of Results the factors mediating the association between depression and impairment Complete data were available on 30 patients. There were no significant in their functioning differences in demographic, social support or tumor characteristics S176 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 between the two groups. Multivariable analysis showed that only the Methods intervention and baseline score were significant predictors of outcome. Weselected 47 patients diagnosed with pc from 2004 to 2013. Weasked them The intervention was associated with a significant reduction of the total to complete a questionnaire containing type D personality scale (DS14), HADS score (p=0.002). The reduction was evident in both anxiety and Impact of Cancer Questionnaire (IOC) and SF-36 and 80 % responded. moderate depression subscales (p=0.001 and p=0.02). The intervention Results was also associated with a significant reduction in total GHQ-28 score Twenty-two percent survivors were classified as type D. They reported a and with three of the four subscale scores (somatization, anxiety and clinically and statistically significant worse general health (57.9 vs 75.4), personality development-all p<0.02) However, no significant difference social functioning (73.2 vs 89.1), mental health (62 vs 81), more emo- was found in the fourth subscale of major depression. tional role limitations (67.2 vs 89.1) and less vitality (54.6 vs 73) than Conclusions non-type D patients. Additionally, they reported a statistically and clini- The relaxation and counseling intervention performed by a specially cally relevant higher impact of cancer on body changes, negative self- trained doctor reduces psychological symptoms in patients with a diag- evaluation, negative outlook on life, life interferences and health worry. nosis of breast cancer. 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 diagno- MASCC-0209 sis. The type D scale has proven to be a useful screening tool in pc Psychooncology 2 survivors to identify subgroups at risk for impaired health status and impact of cancer. STRESSFUL LIFE EVENTS BEFORE THE DEVELOPMENT OF PANCREATIC CANCER MASCC-0212 P. Heras1,V.Natsis1,T.Sirbilantze1 Psychooncology 2 1Hellenic Medical society for the study of Psychosomatic Problems, Hellenic Medical society for the study of Psychosomatic Problems, THE RELATION OF GENERAL SELF-EFFICACY WITH Athens, Greece STRESS, THE SYMPTOMS AND THE QUALITY OF LIFE IN PATIENTS WITH BREAST CANCER Background and Aims The aim of this study was to describe stressful events before development P. H e r a s 1,V.Natsis1,K.Grigoriou1, T. Sirbilantze1,K.Kritikos1, of pancreatic cancer. A. Hatzopoulos1 Methods 1Hellenic Medical Society for the Study of Psychosomatic Problems, Retrospective chart review study of all first time hospitalized patients for Hellenic Medical Society for the Study of Psychosomatic Problems, pancreatic cancer treated at the General Hospital of Nafplio during 3 year Athens, Greece period of time. During the first year that followed the diagnosis, patients were assessed using standardized instruments. (Holmes and Rache stress scale). Background and Aims Results The symptoms that are related with breast cancer (bc), may increase the Twenty-nine pancreatic cancer patients were hospitalized. Stressful life psychological and corporal suffering and change the quality of patients’ events before the diagnosis of pancreatic cancer were found in 44 %. life. This prospective study evaluates the symptoms, the general self- Death of significant other was present in 13 %, separation/divorce 16 % efficacy,stress and the quality of patients’ life. Additionally,it investigates patients, change of job in 29 %, serious illness/operation in 16 % and the correlation of general self-efficacy with other parameters, in the initial moving house in 13 % of patients, serious problems in family 22 %, at measurement and the actual modification 2 months after the diagnosis. work 17 %, major journey 16 %. Methods Conclusions We selected 90 patients with bc. The general self-efficacy was examined We found that a large part of our patients had stressful life events before with the “General Perceived Self-Efficacy Scale” (GSE). The quality of pancreatic cancer, so we can conclude that it is an important factor, which life was measured with the “Linear Analoque Scale Assessment” can facilitate development of disease. (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 com- pleted initially at the time of the diagnosis and then 2 months later. MASCC-0211 Results Psychooncology 2 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 THE PREVALENCE OF TYPE D PERSONALITYAMONG symptoms (3.24±2.62). The actual modification at the time of diag- PROSTATE CANCER SURVIVORS nosis and 2 months later show important negative correlation be- P. Heras1,V.Natsis1,T.Sirbilantze1,M.Hera1 tween the general self-efficacy and stress (p<0.0005). Moderate 1Hellenic Medical Society for the Study of Psychosomatic Problems, negative correlation was observed between general self-efficacy and Hellenic Medical Society for the Study of Psychosomatic Problems, the symptoms (MDASI severity of symptoms:p=0.003, intervention Athens, Greece of symptoms:p=0.002),while low positive correlation was found be- tween self-efficacy and energy LASA scale(p=0.048). Background and Aims Conclusions Type D personality is defined as the joint tendency towards negative affec- The results of this study show that the sense of general self-efficacy, like tivity. We aimed to investigate the prevalence of type D personality among stress and the corporal symptoms and the energy of the patients are crucial prostate cancer (pc) survivors and to obtain insight into its effect on health factors for patients with bc and thus, the ministrants of health should status, impact of cancer and health care utilization and social inhibition. consider these psychological and corporal dimensions. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S177

4 MASCC-0207 Cancer Care Centre, Sydney, Australia; Medical Oncology, St George Psychooncology 2 Hospital Cancer Care Centre, Sydney, Australia

Background and Aims QUALITY OF LIFE IN PATIENTS WITH BREAST CANCER A This study explored how patients diagnosed with advanced cancer cope YEAR AFTER ADJUVANT CHEMOTHERAPY with an uncertain disease trajectory with the aim of identifying health care P.Heras1,V.Natsis1, K. Grigoriou1, T. Sirbilantze1, A. Hatzopoulos1, services and practices that can best address this complex and growing K. Kritikos1 patient group’s needs. 1Hellenic Medical Society for the Study of Psychosomatic Problems, Methods Hellenic Medical Society for the Study of Psychosomatic Problems, Twenty-seven patients with advanced cancer and with a prognosis of Athens, Greece 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 Background and Aims audio- taped and transcribed verbatim. Data analysis was based on This report is based on the assessment of the health-related quality of life Grounded Theory using the constant comparison method. in patients with breast cancer (bc) 1 year after adjuvant chemotherapy. Results This assessment focused on the three main dimensions of physical, Results indicate that patients cope by avoidance, remaining posi- mental and social health tive, maintaining as normal a life as possible, minimising the Methods impact of the disease on their daily lives, comparing themselves Data collection was carried in 2007–2013 with the use of the self- favourably with others in a similar situation and focusing on the administered “instrument health survey SF-36”, which consists of outcome of treatment to control disease progression. Most did not 36 questions constituting 8 scales of physical and social-mental wish to discuss prognosis or have detailed information on disease health. The sample consisted of 100 patients with bc a year after progression. 6 cycles of adjuvant chemotherapy. The majority of patients were Conclusions womenagedover65years(47%)andbetween56and64years Participants in this study represent an emerging cancer patient pop- old (25 %). ulation who are receiving palliative therapies. While they have in- Results curable cancer, they self-report as clinically well, they describe a The rating of the scales of the review SF-36 gave the following good quality of life and the trajectory of their disease, while unpre- results:“physical functioning”:70.8 (SD=18.6),“physical dictable, may extend over many months to years. Our study suggests role”:63.7(SD=38.6),“physical pain”:48.5(SD=4.7),“general that a flexible model of care is needed to support the needs of people health”:62.2(SD=14.1),“vitality”:73.3(SD=22.3),“social functioning”: who may still be receiving anti cancer therapies and remain well. A 68.3(SD=26.6),“emotional role”:64.2(SD=36.2),“mental traditional palliative care service may not be suitable for this emerg- health”:78.4 (SD=18.8). Linear regression analysis showed that 6 ing patient group. 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= MASCC-0139 0.000),“mental health”(B=0.653,t=3.231, p=0.003) were related to Psychooncology 2 patients’ satisfaction with the quality of life, while in addition, “phys- ” − − “ ical functioning (B= 0.380, t= 2.986, p=0.005) and social REVERSIBILITY OF COGNITIVE IMPAIRMENTAMONG ” − − functioning (B= 0.425, t= 3.282, p=0.002) showed an inverse re- ASIAN EARLYSTAGE BREAST CANCER PATIENTS lationship with age. RECEIVING CHEMOTHERAPY:A ONE YEAR Conclusions LONGITUDINAL STUDY Patients with bc a year after adjuvant chemotherapy appear to assess their 1 1 1 2 1 1 3 socio-mental health (average 71.0) as more important than their physical T. N g ,Y.T.Cheung,S.Y.Tan,M.Shwe,H.K.Ho, W.K. Chui ,G.Fan , 3 4 4 5 5 5 health (average 61.3). This finding raises the issue of non-concurrence of Y. P.Tan, W.S. Yong ,M.Preetha, M. Wong ,W.S.Ooi, W.Y. Chay , 6 5 5 5 7 7 1 the individual assessment of patients between the objective (physical R. Dent ,S.K.Lo,Y.S.Yap,R.Ng, M.T. Cham ,J.A.Lee, A. Chan 1 functioning, physical role, physical pain, general health) and the subjec- Department of Pharmacy, National University of Singapore, Singapore, 2 tive (vitality, mental role, social functioning, mental health) dimension of Singapore; Department of Pharmacy, National Cancer Centre Singa- 3 health related quality of life. pore, Singapore, Singapore; Department 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, Duke- MASCC-0156 NUS Graduate Medical School Singapore, Singapore, Singapore; 7Breast Psychooncology 2 Department, KK Women and Children’s Hospital, Singapore, Singapore

Background and Aims LIVING WITH ADVANCED CANCER AND AN UNCERTAIN Background: There is a lack of long-term evaluation on cognitive impairment DISEASE TRAJECTORY:AN EMERGING PATIENT among Asian early-stage breast cancer (ESBC) patients after chemotherapy. POPULATION IN PALLIATIVE CARE? Aim: Toevaluate the reversibility of cognitive impairment in Asian ESBC L. Lobb1, J. Lacey2, J. Kearsley3,W.Liauw4, L. White1,A.Hosie1 patients 1 year post-chemotherapy. 1Palliative Care, Calvary Health Care Sydney, Sydney, Australia; Methods 2Palliative Care, Calvary Health Care Sydney and St George Private This was a multicenter, prospective longitudinal study conducted in Hospital, Sydney, Australia; 3Radiation Oncology, St George Hospital Singapore. Newly diagnosed Asian ESBC patients were recruited. S178 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Cognitive function was assessed using a subjective tool, FACT-Cog, and MASCC-0562 an objective computerized tool, Headminder® at four time points: Prior to QualityofLife chemotherapy,at midpoint, end of chemotherapy (T3) and 1 year after the completion of chemotherapy (T4). Headminder® evaluated four cogni- ITALIAN VERSION OF THE M.D. ANDERSON SYMPTOM tive domains namely attention, memory, processing and response speed. INVENTORY HEAD AND NECK MODULE: LINGUISTIC Statistical tests were conducted to compare (i) the FACT-Cog scores and VALIDATION (ii) proportions of patients suffering cognitive impairment in various domains between T3 and T4. A. Greco1,E.Orlandi2,A.Mirabile3,P.Steca1,M.Sala1,E.Russi4, Results S. Takanen5, A. Rimedio6,D.Alterio7, C. Fallai2, P. Bossi3,B.Gunn8, One hundred and five patients were analyzed. Among the 59 patients who D. Rosenthal9 completed follow-up at T4, median FACT-Cog score was lower at T3 than 1Psychology, University of Milan-Bicocca, Milano, Italy; 2Radiotherapy, T4 (T3: 129.5 vs T4: 133.0, p=0.819) but the difference was not statis- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 3Head tically significant. However, through objective assessment, more patients and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei had impairment in the memory (T3: 32.8 % vs T4: 7.0 %, p=0.001) and Tumori, Milano, Italy; 4Radiotherapy, AO S Croce e Carle, Cuneo, Italy; response domains (T3: 18.0 % vs T4: 1.8 %, p=0.004) at T3 than T4. All 5Radiotherapy, Policlinico Umberto I - University “Sapienza” of Rome, patients experiencing impaired attention at T3 (29.5 %) returned to Rome, Italy; 6Ethical Committee, AO S Croce e Carle, Cuneo, Italy; normal by T4. 7Radiotherapy, Istituto Europeo Oncologia, Milano, Italy Conclusions Both subjective and objective cognitive functioning tests suggest that Background and Aims reversibility of chemotherapy-induced cognitive impairment is possible Head and neck cancer (HNC) patients can experience symptoms due 1 year after chemotherapy. Larger sample size and longer follow up are to the tumor itself or to the treatment and this experience may required to validate these findings. decrease their health-related quality of life (HRQoL). The construct of HRQoL, progressively accepted as an important outcome param- eter, is used, along with others, in medical research to support clinical decisions. HRQoL applicability and cultural adaptation must MASCC-0109 be tested for each population. Aim of this study is to linguistically Psychooncology 2 validate the Italian translation of the M.D. Anderson Symptom Inventory – Head and Neck Module (MDASI-HN). Methods THE EXPERIENCE OF HAVING CANCER WHILE RAISING Following forward and backward translation of the items of the English MINOR CHILDREN MDASI-HN into Italian, it was administered along with a cognitive C. Rashi1,T.Wittman1,C.Loiselle2 debriefing to HNC patients able to read and understand Italian language. 1Nursing, McGill University, Montreal, Canada; 2Psycho-oncology, Jew- Individual and group responses are presented using descriptive statistics. ish General Hospital, Montreal, Canada Results From May 2013 through September 2013 56 patients with HNC an- Background and Aims swered to the MDASI-HN followed by completion of the accompanying Cancer poses unique and pressing challenges to patients who are also cognitive debriefing. Ninety-nine percent of the individual MDASI-HN juggling the demands of raising minor children. The purpose of this items were completed. Average time to complete the MDASI-HN was qualitative study was to gain a rich understanding of parents’ cancer 8.5 min (range 3–15). Results suggested overall ease of completion, experience and explore recommendations to address cancer-related and relevance, and comprehensibleness of this translated self-report instru- family challenges. ment in this Italian patient population. Methods Conclusions Five mothers and seven fathers were recruited from a university affiliated The Italian version of the MDASI-HN is linguistically valid; future cancer care center in Montreal, Quebec. Researchers conducted face-to- research should explore dimensionality, reliability, convergent, discrimi- face, audio-recorded, semi-structured interviews. Content, transcribed nant, and predictive validity of this patient-reported instrument, in order verbatim, underwent thematic analysis. to use the scale properly in outcomes research and in clinical setting. 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 MASCC-0621 strategies, including maintaining child routines, selective disclosure of QualityofLife cancer-related information, projecting strength and positivity, and adapting to physical impairments while parenting. The second category PSYCHOLOGICAL INTERVENTION AND ITS EFFECTS ON captures how parents tap into an already existing social network to meet THE QUALITY OF LIFE IN WOMEN WITH BREAST CANCER, transportation, child care, meal care, and psycho-emotional support AND WITH MODERATE DEPRESSION needs. The last category involves seeking to match parents’ needs with cancer care resources, including the health care providers needing to H. Fernández Suárez1, B. Blum Grynberg1 listen to patient and family needs, coordination of appointments, timing 1Facultad de Psicologia, Universidad Nacional Autónoma de México, of services offered, and the need for instrumental support. Mexico City, Mexico Conclusions The findings reveal interrelated facets of the patients’ experience: coping Background and Aims with an illness affecting the self and the family, (re)activating an already Women with breast cancer, depression and chemotherapy have a very cohesive personal social network and interacting and navigating a com- poor quality of life while being medically treated for cancer. The objective plex health care system. Participants identified key elements that may of this study was to assess quantitatively and qualitatively the effects of allow more person/family-centered interventions and the development of psychological intervention on the quality of life of women with breast programs to meet their unique needs. cancer and moderate depression. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S179

Methods MASCC-0513 From a sample of 142 patients diagnosed recently with non- QualityofLife metastatic breast cancer, ten patients with moderate symptoms of depression participated in a prospective study. Four of these patients THE GENERIC AND STOMA-SPECIFIC QUALITY OF LIFE OF received 12 sessions of cognitive behavioral therapy. The ten patients CANCER AND NON-CANCER PATIENTS WITH A answered the FACT-B and the Beck Depression and Anxiety Inven- COLOSTOMY,ILEOSTOMY OR UROSTOMY tory before, during and after chemotherapy. Non parametric statistical analysis were carried out. When the medical treatment was over, 6 F. Jansen1,C.F.vanUden-Kraan2, A. Braakman3, B.I. Witte4, patients were interviewed (4 who had received psychological support I.M. Verdonck-de Leeuw2 and2whohadnot). 1Dept. of Otolaryngology-Head and Neck Surgery, VU University Med- Results ical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ The quantitative study showed that women with psychological sup- Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU port (group 1) had a better quality of life, greater emotional and University Medical Center, Amsterdam, Netherlands; 3, Dutch Ostomy functional well-being, and less depression. Interviews showed that Association, Maarssen, Netherlands; 4Dept. of Epidemiology and Bio- their quality of life was improved during medical treatments, and statistics, VU University Medical Center,Amsterdam, Netherlands 4 months after they were concluded. A significant decrease of phys- ical well-being during chemotherapy was observed in patients who Background and Aims only were assessed (group 2) Several studies in cancer and non-cancer patients with a colostomy, ileostomy Conclusions or urostomy have reported limitations in patient-reported quality of life The psychological intervention brought about benefits, since patients who (QoL). However, few studies have focused on differences in the generic received it had a statistically significant better quality of life than those and stoma-specific QoL between patients with a stoma due to cancer and who did not receive it. Other variables contributing to these results were: patients with a stoma due to benign causes such as inflammatory diseases. adherence to the model of the psychological intervention, the therapist- Objectives patient relationship, the way of implementing the psychological support, Tocompare the generic and stoma-specific QoL between cancer and non- and the patients’ spirituality. cancer 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 MASCC-0579 domain scores of the RAND-36 and total stoma-QoL score of cancer QualityofLife stoma patients were compared with non-cancer stoma patients using linear regression analyses. Results PATIENTS AND THEIR ADVOCATES ASK FOR INTEGRATIVE In total, 668 patients were included: 379 cancer patients (80 % colorectal, ONCOLOGY IN SUPPORTIVE CARE 17 % bladder and 3 % other) and 289 non-cancer patients (38 % Colitis A. Fonfa1 Ulcerosa, 22 % Crohn’s disease and 40 % other) with a colostomy (55 %), 1Patient Advocacy, Annie Appleseed Project, Delray Beach, USA ileostomy (31 %) and/or urostomy (16 %). Adjusted for gender, age, type of stoma and time elapsed since stoma-operation, cancer stoma patients scored Background and Aims higher (better) on stoma-QoL (β=2.1) and all RAND-36 domains (9.1 Supportive cancer care lends itself perfectly to the blend of complemen- <β≤19.5) except on mental health, compared to non-cancer stoma patients. tary and conventional therapies and treatments. With the MASCC mis- Conclusions sion of “enhancing the lives of people coping with cancer”, patient Cancer patients reported a better generic and stoma-specific QoL than advocates focus on exactly the same goals, hoping for the best possible patients with a stoma due to non-cancer causes. Potential explanations outcomes. will be sought by comparing qualitative data, reported by cancer and non- Methods cancer stoma patients, on factors influencing QoL and the influence of Since 1999 Annie Appleseed Project volunteers have gathered and shared their stoma on daily life. information about the less toxic, non-toxic and natural approaches that constitute complementary therapies. We will share the latest, most up- dated studies and concepts in our poster. Results MASCC-0545 2013 brought more studies, few at level 1, but a preponderance of QualityofLife information nonetheless. More evidence than ever showed the value of ginger for nausea; yoga for energy, relaxation, balance and strength; fish THE EORTC QLQ-BN20 FOR ASSESSMENT OF QUALITY OF oils for cachexia and as radio-protectant, curcumin for radiation protec- LIFE IN PATIENTS RECEIVING TREATMENT OR tion, and more. PROPHYLAXIS FOR BRAIN METASTASES: A LITERATURE The 2013 meeting of the Society for Integrative Oncology, attended by REVIEW two board members of Annie Appleseed Project, featured a variety of talks demonstrating the value of integrating these two areas — there is A. Leung1,K.Lien1,L.Zeng1,J.Nguyen1,A.Caissie1, S. Culleton1, now truly no reason for separation between conventional and L. Holden1,E.Chow1 complementary. 1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Conclusions Centre University of Toronto, Toronto, Canada At most patient/advocacy group meetings we do hear talks on comple- mentary treatments, we believe it is absolutely time for full inclusion in Background and Aims medical meetings. Therefore we will show a poster full of study refer- Brain metastases occur in approximately 20–40 % of all cancer patients ences and well-accepted therapies already in use by up to 80 % of those during the course of disease. As treatment for brain metastases is pallia- with cancer. tive rather than curative, quality of life (QoL) is emphasized over S180 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 prolonged survival. The European Organisation for Research and Treat- MASCC-0469 ment of Cancer (EORTC) QLQ-BN20 is a QoL assessment tool specific QualityofLife to brain neoplasms. We aim to provide a review of the current use of the EORTC QLQ-BN20 for patients with brain metastases. DISEASE BURDEN OF CANCER PATIENTS SUFFERING Methods FROM ANEMIA AND THEIR CAREGIVERS IN THE US, ITALY, All studies using the EORTC QLQ-BN20 for QoL assessment in patients AND FRANCE receiving treatments related to brain metastases were included. Study information including treatment type, assessment periods, patient enrol- N. McGarvey1, P. Corey-Lisle2,E.Donahue3, M.P. Desrosiers4, ment and information pertaining to the QLQ-BN20 were extracted. G.C. Bohac5,S.Hunter6,S.Hubbard3 Results 1Community Health Sciences, UCLA Fielding School of Public Health, A total of 13 studies were identified, five of which were randomized trials Los Angeles, USA; 2Global Health Economics, Amgen Inc., Thousand assessing prophylactic whole brain radiation for patients with small-cell Oaks, USA; 3Clinical Operations, United Biosource Corporation, Lex- lung cancer. The QLQ-BN20 was used in conjunction with the core QLQ- ington, USA; 4Clinical Operations, United Biosource Corporation, C30 questionnaire in all but one of the studies and together these comprised Dorval, Canada; 5Hematology/Oncology, Amgen Inc., Thousand Oaks, the entire QoL assessment for 11 of the 13 studies. Neurocognitive function USA; 6Global Biostatistical Science, Amgen Inc., Thousand Oaks, USA assessments supplemented QoL in four studies and accompanying perfor- mance status indices used with the QLQ-BN20 varied. Compliance issues Background and Aims were commonly cited. QoL changes during study periods varied as im- Chemotherapy-induced anemia (CIA), prevalent in cancer patients, provements, deteriorations and stabilizations were all observed. may contribute to patient fatigue, declining functional capacity and Conclusions health-related quality of life (HRQoL), potentially increasing the QoL assessments should be conducted using disease-specific tools. Fu- need for caregiver assistance and caregiver burden. The study aims ture studies should minimize patient burden in order to maximize data to explore the burden of disease among patients with CIA and their collection and accrual. A common set of QoL endpoints for patients with caregivers. brain metastases should be created. 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 MASCC-0588 receiving myelosuppressive chemotherapy and their caregivers from QualityofLife March 2012 through July 2013. Patients and caregivers completed sur- veys with questions on socio-demographics, time spent providing care- giving assistance, perceived burden, work productivity, anemia-related QUALITY OF LIFE AND UNMET NEEDS OF PATIENTS WITH symptoms, hospitalization, fatigue, and HRQoL. Descriptive statistical BRAINTUMORS:ADYADICPERSPECTIVE analysis was conducted. C. lucchiari1, A. Botturi2, G. Pravettoni3 Results 1Health Sciences, Università degli studi di Milano, Milan, Italy; 2Neuro- A total of 182 patients and their caregivers were enrolled. Patients oncology, Istituto Nazionale Neurologico “Carlo Besta”, Milan, Italy; (74.7 % female and 50.5 % ≥65 years) had a mean Hb level of 10.4 g/ 3Health Sciences, Università degli Studi di Milano, Milan, Italy 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 Background and Aims assistance with instrumental activities and 7.9 h with activities of daily During the last 10 years, numerous studies have highlighted the need to living. Caregivers reported a Zarit Burden mean score of 10.02. Addi- consider Quality of Life (QOL) issues in the treatment of brain cancer. tionally, caregivers reported impacts to work productivity (among However, gaps in scientific knowledge are still present, since we have employed, mean overall work impairment=31 %) and activity (mean poor data about the whole experience of patients and about their needs. activity impairment=23.43 %) in the past week. The present study was aimed at evaluating quality of life mood state and Conclusions unmet needs, in order to describe the psychological adjustment process. Data supports that patients with CIA and their caregivers are experiencing Since the proxies are particular important in the context of brain tumors, moderate disease burden. Research of this kind aids health care providers, we also aimed to study the proxies’ perspective. patients, and caregivers in making more informed decisions related to Methods patient and caregiver needs. We obtained data from 85 patient-proxy couples during chemotherapy treatment. Weused 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 MASCC-0456 Our date depict a difficult adjustment process to the illness, even though QualityofLife positive elements emerged. Indeed, patients reported a satisficing self- perceived quality of life. Further, depression symptoms seem to affect a REVIEW OF RADIATION INDUCED NAUSEA AND VOMITING minority of our patients. Our data also suggest that proxies might not be IN THE RAPID RESPONSE RADIOTHERAPY PROGRAM always considered reliable information carriers, since the perspectives of patients and proxies may be greatly different. N. Pulenzas1,B.Lechner1, N. Thavarajah1,E.Chow1 Conclusions 1Department of Radiation Oncology, Odette Cancer Centre, Toronto, Brain tumors may heavily affect patients’ QoL and psychological Canada wellbeing. However, some element of the context may improve the adjustment to the disease. In particular, when a good emotional sharing Introduction: Radiation induced nausea and vomiting (RINV) develops between proxies and patients is achieved, this process seem to be signif- in approximately 50–80 % of patients, and severity is dependent on icantly improved. This issue deserves further studies in order to obtain factors such as treatment volume, chemotherapy, and pre-existing nausea significant clinical recommendations. and vomiting (N/V). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S181

Objective: To review research conducted by the Rapid Response Radio- MASCC-0615 therapy Program (RRRP) on RINV. QualityofLife Methods: Past studies in the RRRP that investigated the effective- ness and optimal timing of 5-hydroxytryptamine-3 (5-HT3) recep- HORMONE REPLACEMENT THERAPYAND ENDOMETRIAL tor antagonists (RA) in the prophylaxis or rescue of RINV were CANCER RECURRENCE: META-ANALYSIS OFAVAILABLE reviewed. DATA Results: RINV has an acute phase, during and immediately after radiation, and a delayed phase in the days following treatment. The M. Teramoto1, Y.Eboras1,M.Cadungog2 most commonly prescribed anti-emetic in practice was 5-HT3RA, 1Department of Health Sciences, Drexel University, Philadelphia, USA; which is highly recommended in practice. The international patterns 2Department of Obstetrics & Gynecology, Christiana Care Health Ser- of awareness of guidelines and standard of practice varied across vices, Newark, USA radiation oncologists and trainees. Prospective studies that used 5- HT3 RAs for the prophylaxis of RINV resulted in low control rates Background and Aims of N/V, most markedly in the delayed phase. A prospective study Hormone replacement therapy (HRT) after the treatment of endo- used the Functional Living Index of Emesis (FLIE), and developed metrial cancer could alleviate menopausal symptoms often experi- a daily diary to assess N/V. However this study had a very low enced by cancer survivors. Meanwhile, evidence is limited regard- compliance rate due to no follow-up calls and complicated ing the safety of HRTafter endometrial cancer. The aim of this study instructions. is to examine whether HRT is associated with an increased risk of Conclusion: There is no current standardized assessment for RINV endometrial cancer recurrence. that is applicable to palliative cancer patients. Complete control of Methods nausea has historically been lower than vomiting, suggesting that it A meta-analysis was performed on the studies published in the past that is a more difficult symptom to prevent. Further investigation should investigated HRT and recurrence of endometrial cancer. A pooled odds focus on the use of other 5-HT3 RAs, or use in combination with ratio (OR) with 95 % confidence interval (CI) was calculated to determine other medications. 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 MASCC-0457 between cancer survivors receiving HRT and those not receiving QualityofLife 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 REVIEW OF BRAIN METASTASES RESEARCH IN THE RAPID endometrial cancer recurrence. RESPONSE RADIOTHERAPY PROGRAM (RRRP) Conclusions Based on available data, it does not appear that HRT is associated 1 1 1 1 N. Pulenzas ,B.Lechner, N. Thavarajah ,E.Chow with an increased risk of endometrial cancer recurrence. Hence, 1 Department of Radiation Oncology, Odette Cancer Centre, Toronto, HRT could be used to alleviate menopausal symptoms in patients Canada after the treatment of endometrial cancer, helping them maintain quality of life without adverse consequences on their survival. On Background and Aims the other hand, due to limited research, physicians should carefully Introduction: Brain metastases develop in approximately 20-40 % of consider possible benefits and risks associated with HRT for each patients, and are frequently treated with whole brain radiation therapy patient. (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. MASCC-0554 Objective: To review and discuss the past research conducted in the QualityofLife RRRP on brain metastases patients. Methods COVER MAKEUP IS HELPFUL AND IMPORTANT FOR Methods: A retrospective review was conducted of research from the PAT I E N T S ’ GOOD DAILYLIVING RRRP involving brain metastases from 2004 – present. Results T. Wa k e d a 1,Y.Heike2,Y.Kikuchi1,T.Ogawa1 Results: Research in the RRRP has focused on QOL, prognostic factors, 1Breast Surgery, Tokyo University Hospital, Tokyo, Japan; 2Exploratory and use of corticosteroids. Past studies have used a wide variety of tools to oncology research & clinical trial center,National Cancer Center,Tokyo, assess QOL in this patient population. Japan Conclusions Conclusions: The effect of WBRT on QOL is widely variable, Background and Aims ranging from decreased QOL to improvement. There is not a Cancer therapy causes appearance changes related to patients’ Quality of current standardized QOL questionnaire that has been created and Life (QoL), it is well-known that alopecia caused by chemotherapy validated in the brain metastases population. Research in the RRRP depresses the patients and wigs should be needed. Recently, National is lacking in other treatment options for brain metastases such as Cancer Center in Japan showed that patients were suffered from various stereotactic radiosurgery (SRS), likely due to the palliative nature appearance changes, not only alopecia but also surgical wound, pigmen- of our patients. Future research should focus on creating a standard tation by chemotherapy and so on. And it is noteworthy that not a few QOL instrument, measuring QOL following SRS, and better deter- patients said that the appearance problems were more painful than phys- mining prognostic factors of brain metastases patients before ical symptom such as nausea and cancer pain. Our previous interview treatment. survey also showed that skin changes decreased patients’ QoL, e.g. ‘I S182 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 cannot go swimming with this wound’ and ‘Idon’t want to see anyone maintaining and improving HRQOL is often the main focus of palliative with this pigmented face’. Therefore, we introduced ‘cover makeup’ to treatment. This study aims to determine factors that may influence skin changes caused by cancer to contribute to the patients’ QoL. HRQOL, which may in turn influence treatment and care of bone metas- Methods tases patients. Cover makeup was performed for the applicants with the skin-like color cream Methods that our group had developed based on the patients’ demand, that is easy to use, Three hundred and ninety six patients completed the European Organisa- good covering and strongly water-resistant (available for swimming). tion for Research and Treatment of Cancer Quality of Life Questionnaire Results Bone Metastases Module (EORTC-QLQ BM22) at baseline. EORTC Most patients were satisfied with their skin changes concealed almost QLQ-BM22 data and sociodemographic and medical factors were ana- perfectly (See pictures). Some patients could retrieve even their confi- lyzed by univariate analysis of variance (ANOVA). Items of significance dence thanks to cover makeup. 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 func- tional interference (FI) scales. KPS>80 and prostate primary were pre- dictive 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 QualityofLife Conclusions Our results suggest that cover make up is helpful and important for ’ PROGNOSTIC VALUE OF PRE-TREATMENTAND CHANGES patients good daily living. Now we perform the service of cover makeup IN HEALTH-RELATED QUALITY OF LIFE FOR SURVIVAL IN advice for any patients other than cancer sufferers upon receiving numer- PATIENTS WITH MULTIPLE BRAIN METASTASES TREATED ous inquiries. WITH WHOLE BRAIN RADIOTHERAPY E. Wong1, M. Tsao1,L.Zhang1, R. McDonald1, G. Bedard1, L. Holden1, C. Danjoux1,E.Barnes1, M. Popovic1, E. Chow1 MASCC-0467 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada QualityofLife Background and Aims Health-related quality of life (HRQOL) is commonly assessed. The FACTORS INFLUENCING HEALTH RELATED QUALITY OF objective of this study was to determine the prognostic survival value of LIFE IN CANCER PATIENTS WITH BONE METASTASES HRQOL and its domains in patients with brain metastases. E. Wong1,E.Chow1,L.Zhang1,G.Bedard1,K.Lam1,A.Fairchild2, Methods V. Vassiliou3, M.A. Alm El-Din4, R. Jesus-Garcia5,A.Kumar6,F. Forges7, Patients with brain metastases treated with whole brain radiotherapy who L. Tseng8,M.Hou9,W.Chie10,A.Bottomley11 completed a HRQOL questionnaire were included. HRQOL and its 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada; domains were classified as improved, no change or deteriorated. Overall 2Radiation Oncology, Cross Cancer Institute, Edmonton, Canada; survival (OS) was calculated from baseline to date of death or censored at 3Radiation Oncology,Bank of Cyprus Oncology Centre, Nicosia, Cyprus; last follow-up date. Univariate and multivariate cox proportional hazard 4Clinical Oncology, Tanta University Hospital, Tanta, Egypt; 5Orthopedic model of OS was conducted with demographic factors, baseline and Oncology, Federal University of Sao Paulo, Sao Paulo, Brazil; changes in HRQOL and its domains. 6Radiation Oncology, Regional Cancer Center, Trivandrum, India; Results 7Pharmacy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, Twohundred sixty-nine patients at baseline and 179 patients at follow-up France; 8Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; were included. Median OS at baseline was 3.8 months (95 % CI: 3.2– 9Gastroenterologic Surgery, Kaohsiung Medical University Hospital, 4.6 months), while for patients with month 1, 2, and 3 follow-ups was Kaohsiung, Taiwan; 10Public Health and Institute of Epidemiology and 4.8 months (95 % CI: 4.0–6.9), 7.1 months (95 % CI: 5.1–9.5) and Preventative Medicine, National Taiwan University, Taipei, Taiwan; 9.5 months (95 % CI: 6.1–11.5), respectively. Patients of older age, lower 11 Quality of Life, European Organisation for Research and Treatment of Karnofsky Performance Status, primary cancer site of gastrointestinal and Cancer,Brussels, Belgium genitourinary in comparison to breast were more predictive of poorer survival outcome. At baseline, patients with lower overall HRQOL, Background and Aims especially lower physical functioning and motor dysfunction domains, Health related quality of life (HRQOL) is a multidimensional concept that were found to have a poorer survival outcome. Changes in overall is especially important for cancer patients with bone metastases, as HRQOL and its domains were not significantly related to OS. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S183

Conclusions T32 was used for assessing psychometric properties of patients’ satisfac- Pre-treatment HRQOL has prognostic survival value in patients with tion with provided care and the relevant issues such as the quality of brain metastases. Our study was limited by small sample size and high hospital doctors and nurses, as well as selected aspects of the care attrition rates. Prognostic survival value of changes in HRQOL following organization and hospital environment to evaluate Iranian cancer inpa- treatment should be investigated in a larger sample size. tients’ 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 MASCC-0079 (EORTC IN-PATSAT32, EORTC QLQ C30 and sociodemographic ques- tionnaires). Data were analyzed by using statistical software (SPSS) to PSYCHOMETRIC PROPERTIES OF THE PERSIAN VERSION determine factors associate with patients’ satisfaction. OF SATISFACTION WITH CARE QUESTIONNAIRE AMONG Results IRANIAN CANCER PATIENTS: VALIDATION OF THE EORTC Details of the age distribution of the sample shows 77.6 % of patients were IN-PATSAT32 MODULE bellow 65 years old and 79.7 % were married. Younger patients mentioned higher scores while their marital and occupation status did not influenced M. Ahmadi1, M. Asadilari2 their satisfaction. Results show a significant correlation between patients’ 1school of health, tehran university of medical sciences, Tehran, Iran; overall satisfaction and their quality of life (rho=0.263 and p<0.001). 2school of health, Iran university of medical sciences, Tehran, Iran Patients’satisfaction mean scores for all scales were higher than 56 except for the scales of information provision. All individual scales of satisfaction Background and Aims with care contributed significantly to the overall satisfaction score (P<0· The aim of this study was to assess the psychometric properties of the 001). Crude mean scores show higher level of satisfaction in developed Persian version of EORTCIN-PATSAT32 questionnaire when applied to a areas and average level for Iran and a lower level for morocco. sample of Iranian cancer patients to prepare a valid and reliable instru- Conclusions ment to evaluate satisfaction with care to identify the points where These findings highlight the areas of care services which requiring improvements can be implemented into the cancer care organizations. attention to improve. Methods The survey was conducted over 380 patients. We evaluated covergent, discriminant, and divergent validity of the Persian version of EORTC-in- patsat32 questionnaire using multitrait scaling analysis and using CFA to assess the construct validity. Then we tested the reliability by intraclass MASCC-0064 correlation coefficient. For assessing the test-retest reliability and the questionnaire responsiveness to change, a consecutive sample of 70 TITLE: COMMUNITYACUPUNCTURE PILOT STUDY: patients was asked to complete the form twice within 2 weeks interval. UTILIZATION AND CLINICAL OUTCOMES IN AN Results INTEGRATIVE ONCOLOGY HOSPITAL MODEL OF CARE Results show well-acceptance and high sensitivity of the questionnaire to K. Anderson1, K. Anderson1, T.E.R.I. Applegate1,B.Valentine1 be used in Iran. Low obtained floor effect and high ceiling effect represent 1Naturopathic Medicine, Cancer Treatment Centers of America, Tulsa, USA the power of the instrument in detecting differences between groups with heterogeneous levels of satisfaction. Multitrait scaling analyses support Background and Aims considerable convergent and discriminant validity.Divergent validity was Acupuncture utilization has increased and there is good evidence to satisfactory resulted from low correlation between EORTC in-patsat32 support it’s use with cancer patients to manage side effects often resulting module scales and the EORTC-C3o scales (Spearman Rho<0.30). Con- from conventional therapy. firmatory factor analysis (CFA) suggested five components explaining Community acupuncture is a delivery model that with a low cost to 71.1 % of variance. The test-retest reliability was excellent (intraclass implement, is easily accessible and allows for a greater number of patients correlation coefficient ranged within 0.859 to 0.958). to receive treatment on a more frequent basis than the traditional one Conclusions room treatment model design. The Persian version of the EORTC-in-patsat32 module is a reliable and Methods valid instrument to measure cancer patients’ satisfaction with care re- Data were employed from cancer patients at SRMC from March- ceived during their hospitalization period and can be utilized in clinical September 2013 through survey analysis determining patient’s frequency cancer research in Iran. and satisfaction with treatment, QOL scoring metrics and clinical out- comes. Patients eligible for group acupuncture were returning patients that were ambulatory and able to stay comfortably seated in a chair. The MASCC-0080 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. MEASURING SATISFACTION OF CARE IN CANCER Results PATIENTS ADMITTED TO DIFFERENT ONCOLOGY Wesaw 73 unique patients with 152 visits total in the pilot study. Wetreated DEPARTMENTS IN TEHRAN-2013: EORTC IN-PATSAT32 AND a variety of symptoms including fatigue, xerostomia, anxiety, allergies, SATISFACTION IN IRANIAN PATIENT WITH CANCER smoking cessation, nausea, peripheral neuropathy, pain and headaches. M. Ahmadi1,M.Asadilari2 The average number of patients that attended each day was about 5, with 1school of health, tehran university of medical sciences, Tehran, Iran; an average of 2.5 patients in each class. With group acupuncture we treated 2school of health, Iran university of medical sciences, Tehran, Iran 100 % more patients and had availability to treat 400 % more when compared to the traditional setting. Patient satisfaction scores were 99 %. Background and Aims Conclusions The worldwide increasing trend of cancer incidence highlights the im- Community acupuncture has good application to improve patient care, portance of paying a special attention on cancer patients’ determinants of allowing frequent treatments and meeting the space and staffing chal- health, quality of life and satisfaction with care. The EORTC IN-PATSA lenges often present in a hospital environment. S184 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0174 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 THE IMPACT OF NUTRITIONAL STATUS ON cause debilitating, persistent problems, affecting overall health and well- HEALTH-RELATED QUALITY OF LIFE IN CHILDREN being. TREATED FOR CANCER This study aims to compare and contrast the development, characteristics A. Brinksma1, R. Sanderman2, P.F. Roodbol3, E. Sulkers3, J.G.M. and validity of two of the most widely used QOL assessment tools in Burgerhof4, E.S.J.M. de Bont5, W.J.E. Tissing5 patients with prostate cancers: the EORTC QLQ-PR25 and FACT-P. 1Department of Pediatric Oncology and Hematology/School of Nursing Methods and Health, University of Groningen University Medical Center Groning- A literature search was conducted on Ovid EMBASE (1947 to 2013 en, Groningen, Netherlands; 2Department of Health Sciences Health Week 28), Ovid MEDLINE (1946 to July Week 1, 2013), and the Psychology Section, University of Groningen University Medical Center Cochrane Central Register of Controlled Trials (June 2013) to identify Groningen, Groningen, Netherlands; 3School of Nursing and Health, studies that described the development, characteristics, validity, reliability, University of Groningen University Medical Center Groningen, Groning- and use of either the EORTC QLQ-PR25 or the FACT-P. en, Netherlands; 4Department of Epidemiology, University of Groningen Results University Medical Center Groningen, Groningen, Netherlands; The EORTC QLQ-PR25 is a 25-item questionnaire that assesses urinary 5Department of Pediatric Oncology and Hematology, University of Gro- symptoms, bowel symptoms, sexual activity and function, and the side- ningen University Medical Center Groningen, Groningen, Netherlands effects of treatment. In reliability and validity field testing, this module surpassed Cronbach’s alpha coefficient standard of 0.70 for most items Background and Aims and displayed good responses to performance status (PS) change over It is generally assumed that malnutrition in childhood cancer patients is time. The FACT-P is a 12-item questionnaire that assesses pain, bowel associated with lower levels of health related quality of life (HRQL). How- function, micturition, and sexual function. Validity and reliability testing ever, this association has never been tested. Therefore, we aimed to quantify was subsequently conducted; Cronbach’s alpha criterion of 0.60 was met the impact of nutritional status on HRQL in children treated for cancer. and the module demonstrated sensitivity to changes in PS. Methods Conclusions At diagnosis, and at 3, 6, and 12 months nutritional status and HRQL Both questionnaires present several strengths as well as limitations in were assessed using the child- and parent-report versions of the PedsQL measuring the QOL of prostate cancer patients. Each tool may be selected 4.0 Generic Core scale and the PedsQL 3.0 Cancer Module in 104 accordingly based on study design and needs. 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 MASCC-0059 PedsQL scores compared with well-nourished children on the domains physical (−13.3), and social functioning (−7.0), cancer summary scale REVIEW OF PALLIATIVE CARE INTERVENTIONS IN (−5.9), and nausea (−14.7). Overnourished children (BMI/FM>2SDS) report- GYNAECOLOGICAL CANCER PATIENTS MANAGED ATA UK ed lower scores on emotional (−8.0) and cognitive functioning (−9.2), and CANCER CENTRE. CAN LESSONS BE LEARNT FOR FUTURE cancer summary scale (−6.6); whereas parent-report scores were lower on PRACTICE? 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), S.C. Henry1, A. Derbyshire2,B.Lee3,R.J.W.Henry2 emotional (−7.4) and social functioning (−6.0) (child-report), pain (−11.6), and 1General Medicine, Western General Hospital., Edinburgh., United nausea (−7.8) (parent-report). Parents reported worse social functioning and Kingdom; 2Gynaecology, Dorset cancer Centre, Poole, United Kingdom; more pain in children with weight gain (>0.5 SDS). 3Palliative Care., Dorset cancer Centre, Poole, United Kingdom Conclusions Undernutrition and weight loss were associated with worse physical and Background and Aims social functioning; whereas overnutrition and weight gain affected the Timing is everything in maximising symptom control. Are there lessons emotional and social domain of HRQL. Measures that improve nutrition- to be gained from analysis of previous clinical interventions by the al status will contribute to enhanced health outcomes in children treated Palliative care Physicians helping to manage patients with for cancer. 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 ap- MASCC-0075 proach which requires appropriate planning and communication to ensure effective symptom control. Can study of past practice help plan and produce future improvements? LITERATURE REVIEW OF THE DEVELOPMENT, CHAR Methods ACTERISTICS AND VALIDITY OF THE EORTC QLQ-PR25 Retrospective review of the Palliative Care Service Database with regard to AND THE FACT-PFOR ASSESSMENT OF QUALITY OF LIFE historical involvement dealing with patients with advanced Pelvic cancers. IN PROSTATE CANCER PATIENTS Analysis of case notes with regard to type, timing and effectiveness of D. Chu1,M.Popovic1,E.Chow1,D.Cella2, J.L. Beaumont2,H.Lam1, clinical interventions set against Patient’s cancer journey. J. Nguyen1,J.DiGiovanni1, N. Pulenzas1, G. Bedard1,A.Bottomley3 Results 1Rapid Response Radiotherapy Program Odette Cancer Centre, Results will be analysed, tabulated and discussed in written and Sunnybrook Health Sciences Centre University of Toronto, Toronto, diagramatic form as a poster presentation. Canada; 2Department of Medical Social Sciences, Northwestern Univer- Conclusions sity Feinberg School of Medicine, Chicago, USA; 3Quality of Life, Euro- Neutral, positive and negative findings will be distilled into definitive pean Organisation for Research and Treatment of Cancer Headquarters, conclusions. Brussels, Belgium Recommendations for potential changes in clinical practice will be made. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S185

MASCC-0146 Background and Aims Health related quality of life (HRQoL) is an important outcome in treat- ment of cancer. The standard treatment for muscle invasive bladder cancer THE ASSOCIATION OF SYMPTOM PROFILES WITH (MIBC) is radical cystectomy (RC). Cancer diagnosis, surgical procedure HEALTH-RELATED QUALITY OF LIFE IN ADULTCANCER and loss of body-function considerably affect patients’ daily lives and SURVIVORS AND NON-CANCER GENERAL POPULATION: MIBC patients have reported significantly worse body functioning com- THE 2010 NATIONAL HEALTHINTERVIEW SURVEY pared to the general population. Proactive physical rehabilitation in RC I. Huang1,Z.Li1,E.Shenkman2,K.Krull3 with enhanced postoperative mobilisation and their impacts on patient- 1Health Outcomes and Policy, University of Florida, Gainesville, USA; reported outcome (PRO) have not been reported in a randomised design. 2Health Outcomes and Policy, University of Florida, Memphis, USA; Methods 3Epidemiology and Cancer Control, St. Jude Children’s Research Hospi- In total 107 patients were randomised to a physical- based intervention tal, Memphis, USA (nI=50) or standard treatment (ns=57). The intervention consisted of patient-tailored home-based exercises and step training preoperatively Background and Aims and progressive postoperative mobilisation and exercises. HRQoL and We aimed to compare symptom profiles and health-related quality of inpatient satisfaction was measured as defined by the European Organi- life (HRQOL) between survivors of adult cancer and non-cancer sation of the Research and Treatment of Cancer (EORTC). Efficacy was populations using data from the 2010 National Health Interview defined as the differences in HRQOL-scores between intervention and the Survey (NHIS). standard group at the 4-month follow-up Methods Results Reports from cancer survivors (N=604) and a non-cancer general adult This study demonstrated that both pre- and post-rehabilitation could sample (N=6,166) who were randomly selected to complete the Quality significantly improve HRQoL- scores in dimensions closely related to of Life module during the 2010 NHIS were used for analyses. Symptoms early recovery (e.g., dyspnoea, constipation and abdominal flatulence (p≤ were categorized by items measuring vision, hearing, motor/movement, 0.05). In contrast, the standard group reported significantly less symp- pain, learning/memory problems, anxiety, depressive symptoms, and toms concerning sleeping patterns (p≤0.04) and minor but clinically fatigue. Physical and mental HRQOL was measured using the NIH relevant differences in role-function and fatigue. The intervention did PROMIS Global Health Scale. Regression analysis was performed to not compromise inpatient satisfaction. investigate the association of physical/mental HRQOL with survivors Conclusions versus non-cancer population by accounting for the influence of symp- In RC there have been uncertainties concerning the impact of physical toms and important covariates on HRQOL. interventions in relation to PRO. This study provides evidence that Results exercise based rehabilitation can positively impact HRQoL-aspects with- Cancer survivors reported significantly higher prevalence of individual out compromise inpatient satisfaction suggesting physical interventions symptoms than the non-cancer sample (p-values<0.05), except for anx- can proactively reduce loss of HRQoL. iety. 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). Pres- MASCC-0092 ence of individual symptoms was significantly associated with lower physical and mental HRQOL (p-values<0.05). However, regression EFFICACYAND TOXICITY OF IFOSFAMIDE AND CISPLATIN analyses suggest that the significant associations between cancer survi- FOR THE TREATMENT OF RECURRENT OVARIAN CANCER vorship and physical/mental HRQOL was chiefly explained by the prev- alence of individual symptoms, older age, and a greater number of J.Y.Lee1,M.Kim2,B.G.Kim1,D.S.Bae1 chronic conditions (p-values<0.05). 1Obstetrics and Gynecology, Samsung Medical CenterSungkyunkwan Conclusions University of Medicine, Seoul, Korea; 2Obstetrics and Gynecology, Compared to the general population, more cancer survivors suffer from Samsung Changwon HospitalSungkyunkwan University of Medicine, multiple symptoms, which is associated with poor HRQOL. Interventions Changwon-si, Korea on symptoms especially for survivors with older ages and more chronic conditions might improve HRQOL. 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) MASCC-0066 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 EARLYREHABILITATION CAN IMPACT ON outcome was response rate (RR) and toxicity. Other measurements were HEALTH-RELATED QUALITY OF LIFE OUTCOME IN duration of response, time to progression (TTP), and overall survival (OS). RADICAL CYSTECTOMY:A RANDOMISED CONTROLLED Results TRIAL All 47 patients with 160 cycles were assessed for response and toxicity. B. Jensen1, J.B. Jensen2, A.K. Petsersen3,S.Laustsen4, I. Søndergaard2, The overall RR was 31.9 %; there were 3 complete responses (6.4 %) and M. Borre2 12 partial remission (25.5 %). Grade 3 and 4 hematologic toxicities 1Department of Urology and Centre of Research in Rehabilitation, Aar- included neutropenia (23.6 %), anemia (12.8 %) and thrombocytopenia hus University Hospital, Aarhus N, Denmark; 2Department of Urology, (10.7 %). Nonhematologic toxicities were mild. There were no drug- Aarhus University Hospital, Aarhus N, Denmark; 3Department of Phys- related toxic deaths. The median duration of response, TTP and OS were iotherapy and Centre of Research in Rehabilitation, Aarhus University 5.1, 4.8, and 17.0 months, respectively. In initial platinum-sensitive Hospital, Aarhus N, Denmark; 4Department of Thoraco -and Vascular group, RR and OS were 44.4 % and 20.4 months, while in initial diseases and Centre of Research in Rehabilitation, Aarhus University platinum-resistant group these were 15.0 % and 8.7 months, respectively Hospital, Aarhus N, Denmark (P=0.027 and P=0.002). S186 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Methods Ifosfamide combined with cisplatin is a well-tolerated regimen with The research sample consisted of 225 patients from the oncology depart- modest activity in recurrent EOC. In addition, this regimen is especially ment of the University Hospital in Ostrava, no longer receiving anti- significant in patients with an initial platinum-sensitive disease. cancer 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. MASCC-0169 Results The average age of patients was 65.1 years. Anxiety was determined in 77 PROFILE OF QUALITY OF LIFE AND THE INTERPLAYOF patients (33.9 %) and depression in 107 patients (46.6 %). The average ANXIETY DISORDERS AMONG INDIVIDUALS WITH total global health status/QoL score was 41.8 (95 % CI: 39.7–43.9). The BREAST CANCER functional scale QLQ-30 showed a low average score in the role func- tioning domain (39.2, SD=29.7) and higher scores in the emotional A. Olagunju1,O.Fatiregun2,J.D.Adeyemi3 functioning domain (69.5, SD=22.9) and the cognitive functioning do- 1Department of Neuropsychiatry (psychooncology), Lagos University main (72.8, SD=21.8). By correlation the relation between the lower QoL Teaching Hospital/College of Medicine University of Lagos, Lagos, and the occurrence of anxiety was determined (r=0.43; p<0.001), de- Nigeria; 2Neuropsychiatry, Federal Neuropsychiatric Hospital Yaba, La- pression (r=0.39; p<0.001), cognitive functioning (r=0.48; p<0.001), gos, Nigeria; 3Neuropsychiatry, Lagos University Teaching Hospital/ role functioning (r=0.45; p<0.001) and emotional functioning (r=0,46; College of Medicine University of Lagos, Lagos, Nigeria p<0.001). The relation between QoL, HADS and the age of a patient was not determined. Background and Aims Conclusions Quality of life (QOL) is stimulatingly recognised as a useful measure of The presence of anxiety, depression, negative evaluations of cognitive, outcome in cancers. This study investigates the influence of anxiety emotional and role functioning of oncological patients is connected with a disorders on QOL in cohorts with breast cancer in a developing context. lower evaluation of QoL. 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 adminis- MASCC-0026 tered to assess QOL across functioning and symptom domains. This was followed by interview with the anxiety subscale of Hospital Anxiety and BODY IMAGE-RELATED ISSUES FOR BREAST CANCER Depression rating Scale (HADS) to ascertain presence of anxiety disorders. SURVIVORS WITH LYMPHEDEMA Results B. Rhoten1, E. Radina2,M.Adair3,V. Sinclair3, S. Ridner3 The mean age of participants was 49.6±11.2 years, 76.5 % were married, 1School of Nursing, Vanderbilt University, Nashville, USA; 2College of and majority of them were employed (59.5 %). In terms of clinical factors, Education Health and Society,Miami University,Oxford, USA; 3School of the mean duration of illness was 8.46 months, Chemotherapy (50.0 %) Nursing, Vanderbilt University, Nashville, USA was the commonest mode of treatment and most of the subjects (97.5 %) were compliant with treatment. More than half of them (54 %) presented Background and Aims at the late stages (stage 3 and 4). Overall, more than a quarter of the Lymphedema affects approximately 40 % of breast cancer survivors. It participants (26.5 %) had anxiety based on HADS score of 8 and above. can develop at any time after breast cancer treatment, thus remaining a Anxiety disorders correlated positively with lower mean scores on all the threat for the rest of a survivor’s life. Subsequently, survivors with breast cancer QOL functional scale domains, however with higher mean lymphedema often have a loss of confidence in body image as a result scores on the symptom scale (p<0.05). of this chronic condition. Aim: To present focus group findings related to Conclusions body image in breast cancer survivors with lymphedema (BCS-LE). In this study, varied degrees of impairment in functioning and worse Methods experience of symptoms were observed; with anxiety disorders constitut- Individuals age 18 years or older with a history of Stage II lymphedema ing determinant of QOL. Multidisciplinary-based management of breast subsequent to breast cancer living in the Nashville area were recruited to cancer having full complement of supportive care is implied. participate in four focus groups at Vanderbilt University School of Nurs- ing. Discussions were audio recorded and transcribed verbatim. Tran- scribed data were analyzed by three independent reviewers using MASCC-0093 ATLAS.ti software. A fourth non-biased outside consultant independently reviewed the transcripts and codes resulting in additional conformation of thematic categories. ASSOCIATION BETWEEN QUALITY OF LIFE AND MENTAL Results STATE OF HOSPITALIZED PATIENTS WITH ONCOLOGICAL Most participants were middle aged, Caucasian, postmenopausal women DISEASE IN PALLIATIVE CARE with private insurance coverage. Sixty-seven percent (n=14) spoke about R. Bu?gová1,L.Sikorová1, D. Jaro?ová1 some aspect of body image. Two body image-related themes emerged. More 1Department of Nursing and Midwifery, Ostrava University, Ostrava, than half of participants (n=9, 64 %) had a sense of uneasiness in public. Czech Republic Subthemes included embarrassment and avoidance. A second theme men- tioned by 57 % of participants (n=8) was difficulty with apparel. Subthemes Background and Aims included limited clothing options and difficulty wearing clothes. The emphasis on the quality of life (QoL) and mental well-being of a Conclusions patient is an important principle of the palliative care. The aim of the BCS-LE have body image-related concerns including a sense of uneas- research was to determine the occurrence of anxiety and depression in iness in public and difficulty with apparel. These types of body image hospitalized oncological patients no longer receiving anti-cancer treat- concerns affect survivors’ every day lives. Intervention studies that ad- ment and their influence on QoL. dress these issues are needed to enhance the quality of life of BCS-LE. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S187

MASCC-0144 Methods This team has contributed to the management of 50 AYAwith cancer. Each patient could benefit from an individual evaluation of his unique social, PALLIATIVE RADIOTHERAPY IN LOCALLYADVANCED educational or psychological support needs, and then multidisciplinary HEAD AND NECK CANCER: A QUALITY OF LIFE STUDY case discussion before treatment. Medical management had been focused C. Singh1, S. Gupta1 on supportive care, especially fertility preservation. Inclusion in clinical 1Department of Radiotherapy and Clinical Oncology, S.M.S. Medical trial has been systematically discussed. College and Hospital, Jaipur,India Results Seventy-four percent (37/50) of patients who have been discussed in Background and Aims interdisciplinary meeting benefited from a specific AYA supportive care To evaluate feasibility of a novel, short duration, palliative radiotherapy meeting schedule for advanced inoperable head and neck cancer in terms of 32 % (16/50) was included in a clinical trial palliation of cancer related symptoms and occurrence of acute toxicities. 76 % (38/50) had social worker need The study also analysed improvement in head and cancer specific quality 70 % (35/50) had special education teacher need of life (QoL) after completion of radiotherapy. Psychologist and art-therapist was necessary for respectively 58 % (29/ Methods 50) and 52 % (26/50) of the cases. 40 patients with inoperable head and neck cancer, not fit for radical Conclusions treatment were included in the study. They received 40 Gy in 10 Implementation of interdisciplinary team dedicated to AYAis feasible and fractions with two fractions per week. Treatment related toxicity provide useful expertise for the management of social, educational and was assessed using common toxicity criteria. Functional assess- psychological needs. ment of cancer therapy QoL tool was administered before starting More inclusions in clinical research are needed to reach pediatric or adult and after completion of radiotherapy. The mean value before and rate. after treatment was compared. The AYA’s perspective should be interesting. That’s why we developed a Results questionnaire regarding our activities to gather opinion of AYAs. 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 % MASCC-0279 patients required nasogastric tube placement during treatment. QoL as- QualityofLife3 sessment showed improvement in general well-being (summation of physical, social and functional status) but no significant change was FREQUENCY,INTENSITYAND CORRELATES OF SPIRITUAL observed in head and neck specific score after treatment. Reduction of PAIN AMONG ADVANCED CANCER PATIENTS ASSESSED IN pain was observed in 90 % patients. A SUPPORTIVE CARE OUTPATIENT CENTER (SCOC) Conclusions Short duration palliative radiotherapy is comparable option for advanced M. Delgado-Guay1, H. Moreno1,G.Chisholm1, J. Williams1, S. Frisbee- inoperable head and neck cancer to achieve significant palliation and is Hume1, E. Bruera1 well tolerated with good patient compliance. There was improvement in 1Palliative Care and Rehabilitation, The University of Texas MD Ander- quality of physical, social, functional well-being. son Cancer Center,Houston, USA

Background and Aims Regular assessments of spiritual distress/spiritual pain in the SCOC MASCC-0214 setting are limited or no available. We modified the Edmonton Symptom QualityofLife3 Assessment Scale(ESAS-sf) adding two items following the same scale(0=best, 10=worst) to evaluate: Spiritual Pain(SP) and Financial- Distress(FD). MULTIDISCIPLINARY TEAM FOR ADOLESCENTS AND Methods YOUNG ADULTS(AYA,15–25 YEARS-OLD) WITH CANCER We reviewed 282 consults of AdCa evaluated at our SCOC between ASSESSMENT: OSCAR LAMBRET CANCER CENTER (COL) October-2012 and January-2013. Symptoms were assessed using IN LILLE EXPERIENCE ESAS-sf. We determined the frequency, intensity and correlates of self- G. Carbonnelle1, C. Lervat2,N.Penel3, A.S. Defachelles2,F.Ait-kaci4,J. reported SP(pain deep in your soul/being that is not physical) among Jacquot4, M. Mangenot4,M.Delbarre2, H. Sudour-Bonnange2 these AdCa. 1urologic and digestive oncology, Centre Oscar Lambret, Lille, France; Results 2pediatric oncology, Centre Oscar Lambret, Lille, France; 3medical Mean age (range): 60 years (22–92). 53 % were male. One hundred oncology, Centre Oscar Lambret, Lille, France; 4supportive care, Centre eighty-nine (65 %) were White, 45 (15 %) African-American, and Oscar Lambret, Lille, France 34(12 %) Hispanic. 123/282 (44 %) AdCa had SP: mean (95 % Confidence-Interval) 4(3.5–4.4). Background and Aims AdCa with SP had worse Pain [mean(95 %CI) 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] As stressed by many recent publications, Initial management and long- (p=0.03), depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p<0.0001], anxiety term follow-up of AYAwith cancers require specific and inter-disciplinary [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p<0.0001], drowsiness [4.2(3.7, 4.7) vs. supportive care; including psycho-social care. The French National Can- 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= cer Institute (INCa) had funded the implementation of some interdisci- 0.0136], and FD [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p<0.0001]. SP correlated plinary teams dedicated to AYAwith cancer. In this context, we created a (Spearman) with Depression r=0.45, p<0.0001; Anxiety r=0.34, multidisciplinary team including 1 general practitioner, 2 pediatric oncol- p<0.0001; Drowsiness r=0.26, p<0.0001, and FD r=0.44, p<0.0001. ogists, 1 medical oncologist, 1 social worker, 1 special education teacher, Multivariate-analysis showed association with FD [OR (95 % Wald CI) 1 psychologist and 1 art-therapist. 1.204(1.104–1.313), p<0.0001] and Depression [1.218(1.110–1.336), We describe here the activity done in the first 12 months. p<0.0001]. The odds of patients with SP at baseline being also SP at follow S188 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 up were 182 % higher (OR=2.82) than for patients for SP-negative at MASCC-0225 baseline (p=0.0029). SP at follow up correlates with depression(r=0.35, QualityofLife3 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). COMPARISON OF THE EORTC QLQ-LC13 AND THE FACT-L Conclusions FOR ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH SP was reported in more than 40 % of AdCa. It correlates with physical LUNG CANCER and psychological distress. The use of ESAS-sf allows identifying AdCa with SP evaluated in a SCOC. More research is needed. J. Digiovanni1, M. Popovic2,E.Chow2,D.Cella3, J. Beaumont4, S. Gretz4, J. Nguyen4,D.Chu4,N.Pulenzas4, B. Lechner4,H.Lam4, A. Bottomley4 1Rapid Response Radiotherapy Program, Odette Cancer Centre, Toronto, Canada; 21Rapid Response Radiotherapy Program, Odette Cancer Centre, MASCC-0282 Toronto, Canada; 3Department of Medical Social Sciences, Northwestern QualityofLife3 University Feinberg School of Medicine, Toronto, Canada; 4Rapid Response Radiotherapy Program, Odette Cancer Center, Toronto, Canada FINANCIAL DISTRESS (FD) AND ITS ASSOCIATIONS WITH PHYSICAL AND EMOTIONAL SYMPTOMS AND QUALITY Background and Aims OF LIFE AMONG ADVANCED CANCER PATIENTS (ADCA) Introduction: Quality of life (QOL) remains an important endpoint in lung cancer research. M. Delgado-Guay1, J. Ferrer2,A.Rieber3,W.Rhondali4,J.Ochoa1, Purpose: To compare and contrast the development, characteristics, H. Cantu1, G. Chisholm1, J. Williams1, S. Frisbee-Hume1, E. Bruera1 validity and reliability of two widely used QOL assessment tools in lung 1Palliative Care and Rehabilitation Medicine, The University of Texas cancer: the European Organisation of Research and Treatment of Cancer MD Anderson Cancer Center,Houston, USA; 2Geriatrics and Palliative Quality of Life Questionnaire Lung Cancer (EORTC QLQ-LC13) and the Medicine, The University of Texas Health Science Medical School, Hous- Functional Assessment of Cancer Therapy-Lung (FACT-L). ton, USA; 3General Oncology Medicine, The University of Texas MD Methods Andeson Cancer Center,Houston, USA; 4Hospices Civils de Lyon, Centre Methods: A literature search was conducted using Ovid MEDLINE, de Soins Palliatifs Centre Hospitalier de Lyon Sud., Lyon, France EMBASE, and CENTRAL to identify studies that detailed the use of the EORTC QLQ-LC13 or the FACT-L. Background and Aims Results Financial problems are frequent and severe for AdCa and care- Results: FortheQLQ-LC13,thedevelopmentprocessledtoa13-item givers. There is limited data on the effects of FD on overall suffer- instrument that assessed coughing, haemoptysis, dyspnoea and pain, as ing and quality of life(QOL) of AdCa. In this prospective cross well as the side effects of treatment. International field-testing confirmed sectional study, we examined the frequency of FD and its correlates the multi-item dyspnoea scale met the minimal standards for reliability in AdCa. (Cronbach’s α>0.70), while the pain items did not form scale with Methods reliability estimates acceptable for group comparisons. Currently, the We interviewed 149 AdCa, 77 at a Comprehensive Cancer Center(CCC) EORTC QLQ-LC13 is being updated to reflect newer treatments. Con- and 72 at a General Public Hospital(GPH). AdCa completed self-rated versely, in version 4 of the FACT-L, general QOL concerns and nine lung FD(subjective experience of distress attributed to financial problems) cancer-specific items, such as shortness of breath and breathing, weight numeric rating scale(0=best, 10=worst) and validated questionnaires loss, cough, hair loss, and smoking, are assessed. Validity and reliability assessing symptoms(ESAS), psychosocial-distress(HADS), and testing was done using a linear test for trend which showed a highly QOL(FACT-G). reliable Trial Outcome Index (TOI) of α =0.89. Results Conclusions Median age (Interquartile range:IQR): 60 years(55–65). 74/149 (50 %) Conclusion: Inclusion of QOL assessments in clinical trials for lung were female. 78/149 (52 %) were married. 48/77 (62 %) at CCC vs. 13/ cancer is important in evaluating patient-reported outcomes for various 72(18 %) at GPH were white (p<0.0001); 21/77 (27 %) vs. 32/72 (38 %) treatments. Both QOL reported herein have been appropriately validated; were African American (p<0.0001), and 7/77 (9 %) vs. 27/72 (38 %) thus, choice is dependent on the specific needs of the investigation. 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 % MASCC-0301 (95 %CI=76–93 %)] at CCC vs. 65/72 [90 % (81–96 %)] p=0.45. QualityofLife3 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 physical- COPING WITH A LIFE-THREATENING MALIGNANCYAND distress, distress about physical-functioning, social/family distress and ITS TREATMENT: SIMILARITIES AND DIFFERENCES IN emotional distress by 45 (31 %), 46 (32 %), 64 (43 %), and 55 (37 %) YOUNGER AND OLDER ACUTE MYELOID LEUKEMIA AdCa respectively (all significantly worse for GPH). AdCa reported that (AML) SURVIVORS 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 FACT- V. Ghodraty Jabloo1,H.Breunis2, S. Alibhai2,M.Puts1 G(r=−0.23, p=0.005); HADS-Anxiety(r=0.27, p=0.001), ESAS- 1Nursing, University of Toronto, Toronto, Canada; 2Medicine, University Anxiety(r=0.2, p=0.01), and ESAS-depression(r=0.18 p=0.03). Health Network, Toronto, Canada Conclusions FD was very frequent in both groups but intensity was double among Background and Aims GPH patients. FD was associated with worse anxiety, depression and Few studies have examined coping in AML patients while this disease poor-QOL. More research is warranted. onset is usually sudden and unexpected, and treatment requires intense Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S189 regimens with significant toxicities. Therefore, our aim was to examine Table 1. Concepts and Items in Final Questionnaire coping with the diagnosis and treatment of AML and 6-month recovery in younger (<60) and older (>60) AML patients. Concept 1: Relationship with Health Care Providers - 9 items Methods Examples of Individual Items: A qualitative prospective study was conducted with participants of an ongo- Please rate how well you think your oncologist treated your cancer. ing larger study on quality of life and fatigue. Thirty-one participants were My oncologists listened to my concerns. recruited (19 younger and 12 older). Participants were interviewed at 6 months after diagnosis and had just completed treatment as well as 6 months My oncologists took good care of me. later. Semi-structured interviews were conducting using a topic guide, tran- My oncologist spent right amount of time with me. scribed verbatim and analysed using the grounded theory approach. My nurses listened to my concerns. Results My nurses took good care of me. Both younger and older adults experienced several health problems Concept 2: Medical Information - 11 items immediately following treatment completion including fatigue and weak- Examples of Individual Items: ness, and this was still present in many participants 6 months after treatment completion. In all patients the AML diagnosis and treatment My health care providers gave me useful information about my cancer. led to a reduction in their daily activities; for younger patients with work My health care providers gave me useful information about potential side effects of and family responsibilities this was more bothersome compared to older infusion treatment. patients who often reduced their activities due to other health conditions When I asked for information from a health care provider,I received it in a timely and had fewer demands as most were retired. Most patients were hesitant manner. to initiate long-term plans and were afraid of disease relapse. Fear of My health care providers explained the purpose of medical tests and procedures I relapse was slightly higher in younger patients. underwent. Conclusions My health care providers discussed home health services forcare after this course of AML and its treatment had a significant impact on coping and this lasts at infusion treatment. least up until 6 months after treatment completion in both older and Concept 3. Communication Regarding Medical Treatment - 6 items younger patients. Examples of Individual Items: In general, the health care providers involved in my care worked together to MASCC-0233 coordinate my care. QualityofLife3 In general, my oncologist discussed decisions regarding my treatment with me. In general, I felt in control of decisions regarding my infusion treatment. DEVELOPMENT OFA PATIENT-REPORTED OUTCOME Concept 4. Cancer Care and Environment - 2 items QUESTIONNAIRE TO MEASURE SATISFACTION WITH In general, the atmosphere where I received by infusion treatment was comfortable. ONCOLOGY CARE In general, the numberof other patients receiving infusion treatments when I did was S.D. Mathias1,M.D.Fisher2,J.J.Stephenson3,Y.M.Yim4 acceptable. 1Patient Reported Outcomes, Health Outcomes Solutions, Winter Park, Concept5.AccesstoHealthCareProviders-10items USA; 2Health Economics & Outcomes Research, HealthCore Inc, Wil- Examples of Individual Items: 3 mington, USA; Research Operations, HealthCore Inc, Wilmington, USA; In general, I found the time I spent traveling to receive my infusion treatment was 4Health Economics & Outcomes Research, Genentech Inc, South San acceptable. Francisco, USA In general, I found the time I spent in the waiting room before my infusion treatment was acceptable. Background and Aims In general, I found the total amount of time I spent in the infusion treatment center Patient satisfaction is a multidimensional concept, consisting of emotional acceptable. support, communication, side effect management, accessibility, and coor- In general, my health care providers were available by phone, if needed. dination and continuity of care. In oncology, care has shifted from com- In general, scheduling an appointment was easy. munity cancer clinics to larger hospital-based networks. Patient satisfac- tion with care received in various treatment settings is largely unknown. Concept 6. Financial Burden - 2 items To evaluate the content, clarity, and relevance of a new patient-reported Overall, what has been your average monthly out-of-pocket cost related to your outcome questionnaire assessing satisfaction with cancer treatment setting. infusion treatment only? Methods How much of a financial burden were the out-of-pocket infusion treatment costs to Questionnaire items were drafted based on a literature review and clinical you and your family? input. Patients receiving treatment for non-Hodgkin’s lymphoma, breast, Concept 7. Overall Satisfaction - 4 items lung, or colon cancer with≥1 infusion treatment in the previous 3 months Examples of individual items: completed a draft questionnaire and participated in a telephone cognitive Overall, how satisfied have you been with the care you received during your infusion debriefing interview to evaluate its face and content validity. treatments? Results Overall, how satisfied have you been with the center where you received your Ten patients were enrolled (mean age: 54.4±12.0 years, 3 male, 3 non- infusion treatments? white, 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 Conclusions period, and response options clear, relevant, and appropriate. Feedback This study confirmed the content, clarity, and relevance of the question- informed revisions, including exclusion and rephrasing of instructions naire in a sample of recently or actively-treated cancer patients. The final and some questions. The final questionnaire contains 44 items, including questionnaire will be valuable in exploring satisfaction of different set- 7 concepts, with a 3-month recall period (Table 1). tings for receipt of cancer care. S190 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0274 Methods QualityofLife3 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 COMPARISON OF THE EORTC QLQ-BR23 AND THE FACT-B - Expanded (FACIT-Sp-Ex) that assesses spiritual domains of Peace, FOR THE ASSESSMENT OF QUALITY OF LIFE IN PATIENTS Meaning, Faith, and the under-researched Relational factor. FACING BREAST CANCER: A LITERATURE REVIEW Results J. Nguyen1, M. Popovic1,E.Chow1,D.Cella2, J.L. Beaumont2,D.Chu1, Survivors reporting high life enjoyment at baseline (n=435) reported J. DiGiovanni1,H.Lam1, N. Pulenzas1, A. Bottomley3 elevated Peace despite fatigue (?=.46), nausea, (?=.41), and pain 1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook (?=.11), all p<.05. Importantly, these findings were only evident for the Health Sciences Centre University of Toronto, Toronto, Canada; high Peace/high symptom group combinations. The same significant 2Department of Medical Social Sciences, Northwestern University pattern was evident for those reporting elevated Meaning despite nausea Feinberg School of Medicine, Chicago, USA; 3Quality of Life Depart- (?=.35), pain (?=.28), and fatigue (?=.25). Results were not significant ment, European Organisation for Research and Treatment of Cancer for Faith or Relational domains. Findings were further supported by low Headquarters, Brussels, Belgium reports of Depression severity (13.7 %) and Anxiety (15.0 %) alongside high reports of symptoms (93–95 %), compared to controls and norms. Background and Aims Conclusions Quality of life is an established prognostic indicator and study endpoint in Findings support our previous outcomes in a larger, more homogenous breast cancer. Two widely used assessment modules in this patient pop- group. Survivors with cancer suffering chronic symptoms appear to make ulation are the European Organisation for Research and Treatment of the most of their lives, experiencing elevated peace and/or meaning, Cancer Quality of Life Questionnaire Breast Cancer Module (EORTC lending support to Park and Folkman’s (1997) model of meaning in the QLQ-BR23) and the Functional Assessment of Cancer Therapy-Breast context of stress and coping. Peace appears the most neglected construct (FACT-B). as a clinically significant influence in QOL in oncology warranting This study compares the development, characteristics, and validity of the further exploration. 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, MASCC-0248 EMBASE, and the Cochrane Central Register of Controlled Trials QualityofLife3 to identify studies that discussed the development, validation, reli- ability, use and characteristics of the EORTC QLQ-BR23 and the HOME CHEMOTHERAPY FOR BONE MARROW CANCER FA C T- B . PAT I E N T S – A QUALITATIVE STUDY OF HOW PATIENTS Results EXPERIENCE TREATMENTAT HOME Both the EORTC QLQ-BR23 and the FACT-B were developed through patient interviews, literature searches, and expert opinion. Both question- B. Overgaard1,J.C.Froelund1 naires subsequently underwent formal item reduction, resulting in 23 1Hematology Ward, Vejle Hospital, Vejle, Denmark 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 37- Background and Aims item FACT-B. Each questionnaire was well received and was found to be The project is about patients with bone marrow cancer who receive both reliable and valid. Scoring, item format, organization and response chemotherapy at home. The treatment is physically and emotionally options differ between the two questionnaires. stressful for the patients. Patients receiving chemotherapy have also Conclusions reported diminished quality of life. There are similarities and differences between the two questionnaires. Therefore it is relevant to develop alternative models of health service Ultimately, decision-making between the questionnaires should be based delivery, and the belief that treatment at home has fewer detrimental on the purpose and design of the study or clinical evaluation. effects have led to the development of home treatment. Keywords: breast cancer, quality of life, EORTC, FACT 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 MASCC-0198 been inspired by the French philosopher Poul Ricoeur’stext QualityofLife3 interpretation. Results The results show that the patients prefer home treatment with chemother- INVESTIGATING THE CLINICAL RELEVANCE OF apy over hospital treatment, that the patients are less fatigue and stressed, SPIRITUALWELLBEING DOMAINS IN QUALITY OF LIFE and thus that home treatment has less adverse impact on the patients’ daily ASSESSMENT lives, that the patients have more energy left over for social relationships I. Olver1, H. Whitford1 and, accordingly, home treatment increases the patients’ quality of life. 1Research, Cancer Council Australia, Sydney, Australia Furthermore the patients emphasize the importance of having an experi- enced nurse providing the treatment, as that provides a sense of security. Background and Aims Conclusions The bio-psycho-social-spiritual model attests spiritual wellbeing im- The conclusion is that home treatment with chemotherapy can be a safe proves quality-of-life (QOL) assessment accuracy, providing clinical alternative to hospital treatment, provided there is a close cooperation utility. Given our mixed attempts to replicate the clinical significance of among patients, nurses and physicians. Home treatment with chemother- spiritual wellbeing assessment, we assessed 883 female cancer survivors apy could be considered as an alternative or addition to the traditional from a larger study. hospital treatment for patients with bone marrow cancer. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S191

MASCC-0215 decision-making. Two commonly used QOL assessment tools for brain QualityofLife3 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 COMPLEMENTARYAND ALTERNATIVE MEDICINE IN THE tools in patients with brain tumors. PRIMARY BRAIN TUMOR POPULATION AND ITS Methods ASSOCIATION WITH HEALTH-REPORTED QUALITY OF A literature search was conducted using the Cochrane Central Register of LIFE Controlled Trials, Ovid EMBASE and Ovid MEDLINE to identify stud- D.M. Randazzo1, M.L. Affronti1, E. Lipp1,F.McSherry2, J.E. Herndon II2, ies that discussed the development, characteristics, validity and reliability C. Flahiff1, E. Miller1, S. Woodring1,M.Freeman1,P.Healy2, of the EORTC QLQ-BN20 or the FACT-Br. J. Minchew1, S. Boulton1, A. Desjardins3, T. Ranjan3, G. Vlahovic4, Results H.S. Friedman1,K.Peters3 Both assessment tools have been validated for use with primary brain 1Surgery, Duke University Medical Center,Durham, USA; 2Biostatistics tumor patients, however, the FACT-Br has also been validated for use with and Bioinformatics, Duke University Medical Center, Durham, USA; patients who have brain metastases from other primary sites. The QLQ- 3Neurology, Duke University Medical Center,Durham, USA; 4Medicine, BN20 assesses the subscales of future uncertainty, visual disorder, motor Duke University Medical Center,Durham, USA dysfunction, and communication deficit while the FACT-Br evaluates the subscales of physical, social/family,emotional, and functional well-being. Background and Aims Conclusions Complementary and Alternative Medicine (CAM) refers to a non- Both the EORTC and FACT organizations provide valid measurement mainstream approach to health care. This holistic field of healthcare is options for patients with brain tumors. Questionnaire selection should be growing, not only among the general public, but also in oncology. Use of based on the suitability of the tool for particular clinical or research needs. CAMs occurs in the brain tumor population, but little is known about its effect on health-related quality of life (HRQoL), an increasingly impor- tant outcome in clinical trials. The purpose of this study to identify the percentage of brain tumor MASCC-0181 patients using CAMs, what modalities they are using, and whether or QualityofLife3 not there is a significant difference in their HRQoL. Methods HEAD AND NECK CANCER - PATIENTS’ EXPERIENCES A database of primary brain tumor patients (PRoGREss) from the Preston BEFORE, DURING AND AFTER TREATMENT WITH Robert Tisch Brain Tumor Center will be used to examine retrospectively RADIOTHERAPY CAM usage. Data collected via the modified International CAM Question- naire (I-CAM-Q) will assess CAM usage such as botanicals, supplements, J. Gornitzka1, C.W.Saevarsson1,L.Sigaard1 meditation, massage, yoga, Osteopathy, and Reiki. Assessment of HRQoL 1Department of Oncology, University Hospital Odense, Odense, is routinely collected in concert with standard medical care and includes Denmark FACT-Br, FACIT-F, and Godin-Leisure surveys. Regression analyses will examine the impact of CAM usage on HRQoL with adjustment for other Background and Aims potential confounders such as histologic grade and recurrence status. Patients have compact and accelerated treatment courses. This study focuses Results on patients’ experiences related to this. The purpose is to investigate head To date, 2,639 primary brain tumor patients have consented for PRoGREss. and neck cancer patients’ experience of treatment course with radiotherapy. Data in regards to CAM usage will be analyzed and presented at a later date. Methods Conclusions Seventeen patients (age range 56–90, mean 65) who had completed Brain tumor patients are using CAMs and association with HRQoL will radiotherapy were interviewed in three focus groups focusing different be determined. Because of the increased interest and the limited avail- aspects related to the treatment course. ability of data with CAMs in oncology, more research is needed. Results Before treatment Physical impact of disease: Hoarseness, Sore throat, Loosing teeth MASCC-0179 Psychosocial impact of disease: QualityofLife3 Switching between hope and fear - Hope concerning treatment, Fear of dying The need of sharing information with relatives COMPARISON OF THE EORTC QLQ-BN20 AND THE FACT-BR During treatment QUALITY OF LIFE QUESTIONNAIRES FOR PATIENTS WITH Physical impact of treatment: PRIMARY BRAIN TUMORS: A LITERATURE REVIEW Side effects after 2 weeks C. Ronald1,N.Lao1, M. Popovic1,E.Chow1,D.Cella2,J.Beaumont2, Psychosocial impact of treatment: H. Lam1, N. Pulenzas1,G.Bedard1, C. DeAngelis1,A.Bottomley3 Busy time – like having a job or go to school everything is scheduled, 1Rapid Response Radiotherapy Program, Odette Cancer Centre Accelerators and fixation can be daunting but must be accepted Sunnybrook Health Sciences Centre University of Toronto, Toronto, Need of relatives who have overview and practical coping Canada; 2Department of Medical Social Sciences, Northwestern Univer- After treatment sity Feinberg School of Medicine, Chicago, USA; 3Quality of Life Group, Late physical effects: European Organisation for Research and Treatment of Cancer Head- Fatigue, Reduced appetite, Dry mouth, Bad swallowing function, Mod- quarters, Brussels, Belgium ified voice, Lack of taste and smell Late psychosocial effects: Background and Aims Continued uncertainty For advanced brain tumor patients, quality of life (QOL) has been The new normal life recognized as a significant treatment outcome which can assist shared Social interactions are a challenge S192 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions Background and Aims Unpleasant symptoms from throat and mouth changes from being signs Bone metastases are a common occurrence in patients with advanced of disease to late effects that need coping. cancer. Complications of bone metastases can include pain, pathological In the beginning patients psychological status switch between hope and fractures, spinal cord compression, and immobility. Palliative radiothera- fear to a more permanent uncertainty at the end of the treatment. py (RT) is an effective treatment option for symptomatic bone metastases. Initially, the patient needs assistance from close relationships to cope The Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook information and for practical help. Later social interactions are Health Sciences Centre provides timely RT for palliative cancer patients, challenged. 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 MASCC-0417 A literature search was performed to identify studies investigating bone QualityofLife4 metastases in cancer patients referred to the RRRP from 2000 to 2013. All publications pertaining to patients with metastatic bone disease were USING A PERSONALIZED MEASURE (PATIENT GENERATED included. INDEX (PGI)) TO IDENTIFY WHAT MATTERS TO PEOPLE Results WITH CANCER Studies in the RRRP have focused on topics including QOL in patients with bone metastases, the incidence and methods to prevent pain flare 1 1 1 2 1 A. Aburub ,A.Rodri’guez ,S.Ahmed, B. Gagnon ,N.Mayo following RT, optimal treatment regimens for bone metastases, and var- 1 Faculty of Medicine School of Rehabilitation Sciences, McGill Univer- ious patient population subgroups. 2 sity Health Centre, montreal, Canada; Department of Medicine and Conclusions Oncology, McGill University Health Centre, montreal, Canada Avast amount of research has been completed and is currently ongoing in the RRRP regarding bone metastases. Substantial work has been accom- Background and Aims plished over the years in the RRRP to aid in the development of a bone Quality of life (QOL) concerns are not often queried, let alone document- metastases-specific QOL module, establish standard definitions for RT ed, during a typical clinical encounter yet the information is important to response and pain assessment, determine ideal RT treatment schedules, guide care. The Patient Generated Index (PGI), a personalized measure and prevent or treat pain flare in patients with bone metastases receiving designed to both ask and document QOL concerns could potentially be a RT. 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 gath- MASCC-0344 ered from standardized measures of cancer QOL. Populations & Health Services Methods The data came from a Terry Fox funded study of people with advanced THE RELATIONSHIP BETWEEN CAREGIVING BURDEN AND cancer (mean age 64±12 years; 59 % men). THE QUALITY OF LIFE AMONG FAMILYCAREGIVERS OF Results CANCER PATIENTS The most common tumors were pancreas (23 %), lung (17 %), and colorectal 1 2 2 3 3 (12 %). 192 completed the PGI at baseline and 139 participants 1 year later. S. Rha , J. Lee ,Y.Park,S.Song,C.Lee 1 2 At study entry, the most frequent areas affecting QOL were fatigue (39 %), Medicine, Yonsei University, Seoul, Korea; Nursing, Eulji University, 3 sleep (23 %), pain (22 %), appetite (18 %), and emotional function (15 %). Daejeon, Korea; Yonsei Cancer Hospital, Severance Hospital, Seoul, PGI QOL rating was substantially lower (mean 37±25) than ratings from Korea generic measures, EQ-5D (mean 66±17) and SF-6D (mean 65±14), cancer specific measures, the McGill QOL Index – Existential Subscale Background and Aims (mean 81±15) and single items, mean 64±28). The correlation between Current cancer care engage family members as caregivers of cancer the PGI and other QOL measures was low <0.3, the other measures inter- patients which creates considerable caregiving burden and influence to correlated somewhat higher, <0.55. their quality of life (QOL). The purpose of this study was to describe the Conclusions influence of caregiving burden on QOL among family caregivers of QOL is by definition a personal construct and as such is best cancer patients controlling for determinants of caregiving burden and captured using a personal measure rather than a standardized one- the QOL. size-all measure. Methods A total of 212 caregivers had participated in this descriptive study. Instruments included the Korean version of the Zarit Burden Inter- view (K-ZBI) and WHOQOL brief (WHOQOL BREF). Caregivers’ MASCC-0325 demographics as well as cancer patients’ disease and treatment QualityofLife4 related information were inquired to identify determinants of care- giving burden and QOL. Descriptive statistics, t-test, ANOVA and Pearson correlation, and multiple regression were used to analyze REVIEW OF BONE METASTASES RESEARCH IN THE RAPID the data. RESPONSE RADIOTHERAPY PROGRAM (RRRP) Results B. Lechner1, N. Pulenzas1, N. Thavarajah1,E.Chow1 Caregiving burden explained 30.6 % of variance of the total WHOQOL 1Rapid Response Radiotherapy Program Department of Radiation On- (β=−0.590, p<.001). Higher caregiving burden was experienced by cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, To- caregivers residing with patients (β=.197, p=.041), caring patients with ronto, Canada functional deterioration (β=.280, p<.001), and older patients (β=.155, Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S193 p<.034). Caregivers' educational level (receiving college education) was item to total score correlations estimated the contribution of each item to the only contributing caregiver related factor for the total WHOQOL the score. Rating scale efficacy was evaluated by comparing mean subject (β=.141, p=.026). measures for each category of the rating sale. Results Fig 1: WHOQOL-BREF mean scores 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 QualityofLife4

Conclusions MINIMAL CLINICALLYIMPORTANT DIFFERENCES IN THE Caregiving burden was the most influential, negatively affecting EORTC QLQ-BN20 IN PATIENTS WITH BRAIN METASTASES factor for the QOL, whereas caregivers' educational level contrib- uted to better QOL. Assessment of caregiving burden with special E. Wong1,L.Zhang1,G.Bedard1,R.McDonald1, M. Tsao1, C. Danjoux1, attention to caregivers residing with patients, caring patients with E. Barnes1, L. Holden1,M.Popovic1, E. Chow1 functional decline and older patients would identify caregivers in 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada need of support. Caregivers’ educational level needs to be consid- ered in the evaluation of the QOL. Supportive care which could Background and Aims ease caregiving burden and improve the QOL for at risk caregivers Quality of life (QOL) is an important treatment endpoint in ad- is recommended. vanced 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 MASCC-0452 important difference (MCID) for the European Organisation for QualityofLife4 Research and Treatment of Cancer Quality of Life Questionnaire Brain Module (EORTC QLQ-BN20) in patients with brain metastases. RASCH ANALYSIS OF THE EORTC QLQ-BM22 MODULE TO Methods ASSESS HEALTH-RELATED QUALITY OF LIFE IN PATIENTS Patients undergoing radiotherapy for brain metastases completed the WITH BONE METASTASES EORTC QLQ-BN20 and QLQ-C30/C15 at baseline and 1 month E. Wong1, A.H. Pakpour2, D.M. Lawson3, M. Popovic1,E.Chow1, follow-up. MCIDs were calculated for both improvement and dete- A. Bottomley4 rioration using anchor and distribution based approaches. The an- 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada; 2Public chor of overall QOL (as assessed by question 30 on the QLQ-C30 Health, Qazvin University of Medical Sciences, Qazvin, Iran; orquestion15ontheQLQ-C15)wasusedtodeterminemeaningful 3Chiropractic, D’Youville College, Buffalo, USA; 4Quality of Life, Euro- change. pean Organisation for Research and Treatment of Cancer, Brussels, Results Belgium A total of 99 patients were included in the MCID calculation. Average age was 61 years and the most common primary cancer Background and Aims sites were lung and breast. Statistically significant meaningful dif- The European Organisation for Research and Treatment of Cancer Qual- ferences were seen on two scales. A decrease of 6.1 (0.8 to 11.4) ity of Life Scale Bone Metastases Module (EORTC QLQ-BM22) is a units and 13.8 (0.2 to 27.4) units were required to represent clini- quality of life tool used in conjunction with the general EORTC QLQ- cally relevant deterioration of seizures and weakness of legs. C30. The objective of this study was to apply the Rasch mathematical Distribution-based MCID estimates tended to be closer to 0.5 SD model, which determines the performance of individual items, to the on the EORTC QLQ-BN20. EORTC QLQ-BM22. Conclusions Methods Understanding MCIDs allows physicians to determine impact of treat- From 2010 to 2014, 565 subjects from 8 countries were included. Internal ment on patients’ QOL and sample sizes for clinical trials. Future studies consistency was estimated with Cronbach’s α forsubjectsanditems. should be conducted to validate in a larger population of patients with Mean square estimates (MSEs) determined suitable fit of the items, and brain metastases. S194 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0408 Methods Rehabilitation 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 PREDICTORS OF WEIGHT CHANGE ON COMPLETION OF board approval, surveys with consent forms were e-mailed to subjects and AN INTERPROFESSIONAL PALLIATIVE REHABILITATION subjects received follow-up e-mail reminders. PROGRAM Results A.M. Burns1,A.Feldstain2, R. Bhargava3,M.Chasen1 One hundred eighty-eight (18.13 %) usable surveys were returned. 62.8 % 1Palliative Care, Bruyère Continuing Care, Ottawa, Canada; 2School of of therapists reported treating individuals with a history of cancer while Psychology, University of Ottawa, Ottawa, Canada; 3Palliative Care, only 17.8 % were treating the cancer patients on regular basis. Most Bruyère Research Institute, Ottawa, Canada common patients were with breast cancer (75 %); common treatments were: home exercise programs and breathing exercises (both 77.1 %), Background and Aims range of motion exercises (68.6 %), chest clearance techniques (64.6 %), Weight change is often of concern to patients with advanced cancer strengthening and education (both 60.4 %), and stretching (56.3 %), having anorexia cachexia syndrome (ACS). This study aims to examine Monitoring methods were: heart rates (58.3 %), blood pressure (54.2 %), the predictors of weight change including fatigue, anxiety and appetite in pain scale and O2 saturation levels (47.9 %), Functional outcome measures patients enrolled in an 8 week interprofessional Palliative Rehabilitation were: 6 min walk test (41.7 %), quality of life (20.8 %), SF-36 (18.8 %), Program (PRP). and Functional Independence Measure (14.6 %). Methods Conclusions Patients enrolled in the PRP were asked to complete several assessment Wefound that, only very few physiotherapists are practicing exclusively in measures prior to and following participation in an 8-week interprofes- cancer care setting in South India. Intervention types were satisfying while sional program that included individualized nutritional counseling inter- monitoring and functional outcome measures were inconsistently used. ventions. The Patient Generated Subjective Global Assessment (PG- SGA), Hospital Anxiety and Depression Scale (HADS), and the Multidimentional Fatigue Inventory (MFI) completed by the patients MASCC-0397 enables the team to assess nutrition, anxiety and general fatigue Rehabilitation respectively. Results DESIGNING A SELF-MANAGEMENTAPPLICATION Participants included 26 patients with heterogeneous advanced cancers SUPPORTING (EARLY)REHABILITATION IN PATIENTS (12 female, 14 male). The mean age of the sample was 63.69 (SD= AFTER TOTAL LARYNGECTOMY 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= I.M. Verdonck-de Leeuw1,I.C.Cnossen1, C.F. van Uden-Kraan1, 0.012). Change in malnutrition (PGSGA: mean=−2.12, SD=4.90) was a S.E. Eerenstein1,R.deBree1,C.R.Leemans1 significant predictor of weight change, (mean=−0.01, SD=3.12, p= 1Otolaryngology - Head and Neck Surgery, VU University Medical 0.015). Changes in anxiety (HADS: mean=−1.62, SD=2.70) and general Center,Amsterdam, Netherlands fatigue (MFI subscale: mean=-1.04, SD=4.09) were not significant predictors. Background and Aims Conclusions Patients after total laryngectomy (surgical removal of the larynx for An interdisciplinary Palliative Rehabilitation Program that includes nutri- advanced laryngeal cancer) have to deal with altered speech, swallowing tional guidance and counseling can help patients decrease malnutrition, gain and breathing function, with a major impact on daily life. weight, potentially improve functional outcome and overall quality of 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 MASCC-0496 assessment with patients (N=9) by means of a focus group interview. In Rehabilitation four group meetings, a multidisciplinary team of care professionals (N= 11) discussed the intervention content and structure. A plan of require- ments was formulated and translated into an intervention prototype “In AN EXAMINATION OF PHYSICALTHERAPY PRACTICE Tune without Cords”. Usability of the prototype was tested by end-users PATTERNS IN THE REHABILITATION OF INDIVIDUALS (N=6). Speech therapists (N=10) participated in cognitive walkthroughs. WITH CANCER IN INDIA Results K. Guru1, U. Manoor2,S.Supe3 Based on patients’ needs assessment and group meetings with care 1Physiotherapy, Srinivas College of Physiotherapy & Research Center, professionals, six main intervention topics were identified: 1) mobility Mangalore, India; 2Radiation Oncology, Bangalore Hospital, Bangalore, exercises for neck and shoulders, 2) speech rehabilitation, 3) voice India; 3Radiation Physics, Kidwai Memorial Institute of Oncology, Ban- prosthesis care, 4) tracheostomy care, 5) nutrition, and 6) smell rehabil- galore, India itation. Usability tests identified some points for improvement in the user interface that resulted in adjustments. Speech therapists were contented Background and Aims about the completeness of information offered and the way the informa- Physiotherapists contribute significantly to the maintenance of functional tion was offered (multimedia). Considerations appointed during the cog- independence and quality of life among cancer patients through early nitive walkthroughs concerned the level of tailoring possible and remarks intervention and community follow up. Very little has been documented about exercises, animations and movies offered. All intended to imple- about the extent Physiotherapists are involved in the care and manage- ment the intervention in regular care when available. ment of individuals with functional deficits related to cancer in India Conclusions although physiotherapists are mandatory to promote and maintain phys- Study results give insight into the characteristics needed to design a self- ical function. The aim was to examine and describe current practice management application for patients after total laryngectomy. A patterns of Physiotherapists in cancer rehabilitation in India. multicentre feasibility study is ongoing. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S195

MASCC-0379 Conclusions Rehabilitation 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 IMPLANT-PROSTHETIC REHABILITATION OF 26 need a strong osteointegration, resistant to overload. The tantalum surface POST-ONCOLOGICAL ORAL AND MAXILLOFACIAL of Zimmer Trabecular Metal® was chosen for its capability to promote PAT I E N T S bone ingrowth into the porous material. S. Jamshir1,E.Brauner1, G. Guarino1,S.DiCarlo1, G. Pompa1 1Oral and Maxillo-Facial sciences, Sapienza University of Rome, Rome, Italy MASCC-0462 Background and Aims Rehabilitation After oral cancer treatment, a prosthetic rehabilitation is usually necessary to restore oral functions and aesthetics. The removal of the tumor deter- FUNCTIONAL OUTCOMES OF NEUROFIBROMATOSIS mines loss of soft and hard tissues and results in terms of rehabilitation are PATIENTS WHO RECEIVED INPATIENT REHABILITATION challenging to achieve. INTERVENTIONS Aim of this study is to evaluate osteointegration and marginal bone loss of titanium implants with surfaces enhanced with tantalum (Zimmer Trabecular A. Ngo1,E.Bruera2, G. Chisholm3,Y.Guo1 Metal®) 2 years after loading, in patents with compromised bone anatomy 1Section of Physical Medicine and Rehabilitation, University of Texas MD of the jaws, due to resection and/or reconstruction for oncological reasons. Anderson Cancer Center, Houston, USA; 2Section of Palliative Care, Methods University of Texas MD Anderson Cancer Center, Houston, USA; Twenty-six patients were rehabilitated through implant-retained 3Department of Biostatistics, University of Texas MD Anderson Cancer overdentures supported by two or four implants. All patients had at least Center,Houston, USA one completely edentulous arch and 14 received radiotherapy. Implants were loaded 3 months after placement. Background and Aims Results 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 Weretrospectively 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

THE EXPERIENCE OFADVANCED CANCER PATIENTS ATTENDING AN INTERDISCIPLINARY CANCER NUTRITION REHABILITATION PROGRAM FOR THE TREATMENT OF Patients were reappointed at 6, 12 and 24 months after loading. After CACHEXIA 24 months the mean probing depth in non-irradiated patients (12) was M. Parmar Calislar1,Y.H.Luan2, K. Gartshore1 2.1 mm, the mean crestal bone loss was 0.41 mm; in irradiated patients 1Ingram School of Nursing & Oncology, McGill University & Jewish the mean probing depth was 2.7, the mean crestal bone loss was 0,53 mm. General Hospital, Montreal, Canada; 2Ingram School of Nursing, McGill No implant was lost. University, Montreal, Canada S196 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims Results Cancer cachexia is a debilitating metabolic syndrome causing consider- Two studies were selected after screening 3,243 articles in the able physical, emotional, and psychosocial effects on patients. Ambula- databases. The first was a physical therapy based exercise inter- tory cancer nutrition rehabilitation (CNR) programs have been vention in breast cancer patients which lead to improvement in established for the management of cancer cachexia through a compre- limb girth measurement & QoL. While in the second a study hensive interdisciplinary approach; though limited evidence on the expe- physical therapy based exercise intervention led to improvement rience of patients attending such services exists. Improved understanding in QoL and functional capacity in head and neck cancer patients on of the experience of patients attending such programs is needed to further chemo-radiotherapy. tailor interventions for this population, and to promote the integration of Conclusions supportive interventions throughout the trajectory of cancer care. The aim There is a lack of physical therapy based exercise interventions in India of this research study was to explore the experience of patients with with only two studies done till now. The need of the hour is to focus on advanced cancer and cachexia attending a CNR program. more research in this area. Methods This study was guided by a qualitative descriptive design, and pur- posive sampling was used to recruit ten cancer patients with at least one clinic visit to a CNR program in an urban university-affiliated MASCC-0099 cancer center. Semi-structured interviews were audio-recorded, tran- Rehabilitation 2 scribed, and coded. Thematic analysis was conducted concurrently with the data collection. REHABILITATION IMPROVES URINARY IRRITATIVE Results PROBLEMS: REPCA – A RANDOMISED STUDYAMONG Three themes were described by participants: (1) “Being Known to PROSTATE CANCER PATIENTS Health Care Professionals” including individualized and accessible care and the element of human connection; (2) “Patient Empower- K.B.D. Karin B. Dieperink1, C.J. Christoffer Johansen2, S.H. Steinbjørn ment” capturing the process of knowledge acquisition to facilitate Hansen1,L.W.LisWagner3, K.K.A. Klaus K. Andersen4, L.R.M. Lisbeth self-management in care; (3) “Satisfaction with Care” highlighting Rosenbek Minet5, O.H. Olfred Hansen1 the integration of cancer rehabilitation services within the broader 1Department of Oncology, University Hospital Odense, Odense, system. Denmark; 2Survivorship, Danish Cancer Society Research Center, Co- Conclusions penhagen, Denmark; 3University of Southern Denmark, Clinical Insti- Overall, participants described a positive experience with tailored tute, Odense, Denmark; 4Statistics Bioinformatics and Registry, Danish interdisciplinary interventions, and were interested in participating Cancer Society Research Center,Copenhagen, Denmark; 5Department of in cancer nutrition rehabilitation when integrated into their general Rehabilitation, University Hospital Odense, Odense, Denmark oncology care. Background and Aims Prostate cancer is the most frequent male malignancy in the Western world. Following improvements in survival, clinical attention has been MASCC-0539 to counteract treatment-related adverse effects. Rehabilitation 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 PHYSICALTHERAPY BASED EXERCISE INTERVENTIONS cancer. FOR CANCER SURVIVORS IN INDIA-A SYSTEMATIC Methods REVIEW In a single-center oncology unit in Odense, Denmark, 161 prostate cancer S. Samuel1, S. Kumar V1,A.Maiya1,D.Fernandes2 patients treated with radiotherapy and androgen deprivation therapy were 1Physiotherapy, School Of Allied Health Sciences, Manipal, India; randomly assigned to either a programme of two nursing counselling 2Radiotherapy, Kasturba Medical College, Manipal, India sessions and two instructive sessions with a physical therapist (n=79), or to usual care (n=82). Primary outcome was EPIC-26 urinary irritative Background and Aims sum-score. Studies show that Physical therapy based exercise interventions help in Before radiotherapy,pre-intervention 4 weeks after radiotherapy,and after combating disease & treatment related factors like fatigue, impaired joint a 20-week intervention, measurements included self-reported disease- range of motion, lymphedema,retained secretions,etc. which decrease the specific QoL (EPIC-26, including urinary, bowel, sexual, and hormonal Quality of Life (QoL) in patients with cancer. With the growing burden of symptoms), general QoL (SF-12), mental adjustment styles (Mini-MAC), Cancer in India there is a great need to know the state of research in pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor exercise interventions for cancer survivors in India. electromyography. Intension-to-treat analyses were made with adjusted Aims linear regression. 1. To identify types of cancer in which physical therapy based exercise Results The intervention improved, as compared to controls, urinary irritative interventions have been researched in India. ’ 2. sum score 5.8 point (Cohen s d=0.40; P=.011), urinary sum-score (d= To identify different forms of physical therapy based exercise inter- 0.34; P=.023), hormonal sum-score (d=0.19; P=.018), the SF-12 Phys- ventions that have been studied among cancer survivors in India. ical Component Summary (PCS) d=0.35; P=.002, and stabilized the 3. To identify different outcomes of physical therapy based exercise fighting spirit P=.025. Patients with moderate or severe impairment interventions in cancer survivors in India. gained most. Pelvic floor muscle strength measured by electromyography Methods declined in both groups, P=.0001. Search in scientific databases PubMed, IndMed, Scopus, CINAHL, Conclusions PEDro, Cochrane Library and EMBASE using search terms in com- Rehabilitation in irradiated PCa patients improved urinary and hormonal bination with Boolean operators, inclusion & exclusion criteria was symptoms, SF-12 physical QoL and remained positive adjustment styles undertaken. stable. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S197

MASCC-0131 Methods Rehabilitation 2 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 REHABILITATION AND ADULTATTACHMENT IN WOMEN is necessary to assess all existing physical, psychological or mental WITH NEWLYDIAGNOSED GYNAECOLOGICAL CANCER impairments potentially reducing the employee’s ability to meet the K.A. Holt1, D. Gilsaa Hansen2, A. Elklit3,P.T. Jensen1, O. Mogensen1 requirements of the job as well as potential special needs of the employee 1Research Unit of Gynaecology and Obstetrics, Institute of Clinical at work. Specific programs like the vocationally and medically oriented Research University of Southern Denmark, Odense, Denmark; 2Research rehabilitation process (MBOR-concept) are supposed to prepare the Unit of General practice, Institute of Public Health University of South- patient for occupational reintegration. ern Denmark, Odense, Denmark; 3Danish Research Unit of Psycholog- Results ical Trauma, Institute of Psychology University of Southern Denmark, Different players in the German system of social services can be in charge Odense, Denmark to give financial support depending on the individual situation. Conclusions Background and Aims Due to the prevalence of cancer, the demographic changes and the longer Knowledge about rehabilitation of gynaecological cancer and the devel- period until retirement the need to keep all employees in their jobs as long opment of individually adjusted rehabilitation initiatives are needed. as possible is obvious. Ways to reintegrate cancer survivors into working Research has shown that adult attachment is important and influence on life by different means of occupational rehabilitation are one important humane experiences with chronic disease, health behaviour, symptom instrument to reach this goal. 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. MASCC-0126 The aim is to explore adult attachment among women newly diagnosed Rehabilitation 2 with gynaecological cancer, depression, post-traumatic stress disorder (PTSD) and quality of life (QLQ) with a 5-month follow up. THE PROGRESSION OF MORBIDITIES (NECK-SHOULDER Methods RANGE OF MOTION, CONSTANT SHOULDER SCORE, A longitudinal study including 151 women, aged 20–75 years, treated QUALITY OF LIFE AND LYMPHEDEMA) IN surgically for endometrial, cervical or ovarian cancer with data collection POST-RADIATION ORAL CANCER PATIENTS May 2012–November 2013. Attachment style and mental symptoms are measured using the Revised Adult Attachment Scale, Major Depression S. Liao1,T.Chang2, K. Tsai3 Inventory and Harvard Trauma Questionnaire. EORTC QLQ-C30 and 1Department of Physical Medicine and Rehabilitation, Changhua Chris- specific symptom surveys are used to measure quality of life. Data were tian Hospital, Changhua, Taiwan; 2Department of Radiation Oncology, collected during the rehabilitation consisted of two nurse consultations Changhua Christian Hospital, Changhua, Taiwan; 3Department of Oral and two telephone conversations. and Maxillofacial Surgery, Changhua Christian Hospital, Changhua, Results Ta i w a n The results indicate occurrence of PTSD/depression among women close to surgery, spotted as a substantial psychological burden at the time for Background and Aims establishing the cancer rehabilitation in the clinical practice. The prelim- The oral cancer is the 1st cancer happened in middle-age man in Taiwan. inary analysis on attachment dimensions showed significant correlation Radiation fibrosis syndrome and lymphedema were the common side effects for depression at baseline. The 5 months follow up showed reduction of in oral cancer patients, and will deteriorate cancer patients’ quality of life PTSD and no cases of depression among women with endometrial cancer. (QOL). The aim of this study is to identify the time-course of neck-shoulder Conclusions range of motion (ROM), Constant shoulder score, QOL and lymphedema The attachment dimensions contribute to rehabilitation with focus on Methods individual approach for the rehabilitation. 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 includ- MASCC-0120 ing ROM, Constant shoulder score, maximal interincisal distance (MID), Rehabilitation 2 VAS pain scale, lymphedema scale, face distance for lymphedema, and EORTC QLQ (QLQ C30, H-N 35) when the patients receiving radiother- apy, finished radiotherapy, and every 3-month follow-up. BACK TO WORK – MANAGEMENT OF OCCUPATIONAL Results REINTEGRATION IN THE GERMAN SYSTEM OF SOCIAL Twenty-two patients were completed 1st and 2nd follow-up, and 12 SERVICES patients was completed 3rd follow-up. 18 patients (88 %) were advanced C. Kerschgens1 cancer (stage IVa). The mean age was 58(9.8) years, the number of 1Oncology, Vivantes Rehabilitation, Berlin, Germany removed lymph nodes was 40(18), the radiation dose was 6,540 cGy. The flexion/extension/rotation of neck, right shoulder adduction, pain Background and Aims scale, lymphedema and Constant shoulder score significantly improved The way back to work after cancer treatment is an important step towards after radiation. The lymphedema was happened in all patients. The score participation in social life. On the other hand, disabling factors after cancer of nausea, appetite, pain, sense, speech, and weight loss were the worst treatment regarding physical, psychological and mental well-being might when finished radiation, then gradually improved. The symptom of dry reduce the ability to meet occupational requirements. This is an important mouth was progressed after radiotherapy. factor after long-term disease which becomes especially apparent when Conclusions having to cope with pre-existing work-related stress, especially in jobs with The lymphedema happened in all advanced oral cancer patients even after fast developing technologies. The German system of social services offers surgery 6 months. The morbidities of oral cancer has significant improve- different means of support which take these factors into account. ment after radiotherapy except the symptom of dry mouth. S198 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0012 institutional review board approved the study protocol. At baseline and Rehabilitation 2 6 weeks after initiating chemotherapy, we measured incremental shuttle- walk distance (ISWD), hand grip strength (HG), serum prealbumine (SPA),body weight (BW), and appendicular skeletal muscle mass EARLY-PHASE DIFFERENCES IN HEALTH-RELATED QOL, (ASM) assessed by bioimpedance analyzer (Tanita BC-190). Cancer PSYCHOLOGICAL STATUS, AND PHYSICAL FUNCTION cachexia was diagnosed by the international consensus criteria (Fearon BETWEEN HLA-HAPLOIDENTICAL AND OTHER K, Lancet Oncol. 2011). ALLO-HSCT RECIPIENTS Results S. Morishita1, K. Kaida2, S. Yamauchi1, T. Wakasugi1, K. Ikegame2, Among 30 patients (11 women and 19 men) enrolled from Jan. 2013 to N. Kodama3,H.Ogawa2,K.Domen3 Jan. 2014, median age was 74 (range, 70–82) years. Platinum-based 1Department of Rehabilitation, Hyogo College of Medicine Hospital, combination and single agent chemotherapy were administered in 14 Kobe, Japan; 2Division of Hematology Department of Internal Medicine, and 16 patients, respectively. At baseline, sarcopenia and cancer cachexia Hyogo College of Medicine, Kobe, Japan; 3Department of Rehabilitation were observed in 21(72.4 %) and 17 (56.7 %) patients. During the first Medicine, Hyogo College of Medicine, Kobe, Japan 6 weeks, decline in ISWD (mean difference of -40 m, Wilcoxon signed- rank test p=0.0029)andBW(−0.85 kg, p=0.0032) were observed, while Background and Aims there was no statistically significant changes in HG (−0.96 kg, p= The purpose of this study is to investigate the differences with respect to 0.0986), SPA(+1.4 mg/dL, p=0.1295), and ASM (+0.47 kg, p=0.1950). quality of life (QOL), psychological status, and physical function be- Conclusions tween allo-HSCT patients receiving from HLA haploidentical donor Majority of elderly patients with advanced NSCLC were sarcopenic and (HID) and other donors in the early phase after HSCT. cachectic at baseline. Their walking capacity and BW declined during Methods chemotherapy. (Clinical Trials Registry No. UMIN000009768) 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 MASCC-0015 Outcome Study 36-item Short Form Health Survey. Psychological status Rehabilitation 2 was measured by Hospital Anxiety and Depression Scale. Physical func- tion was assessed using tests for hand-grip strength, knee-extensor strength, and the 6-min walk test. REHABILITATION BY NURSING CONSULTATIONS Results T. Nielsen1,M.KjerholtMette2, O.T.S. Toftdal-Sørensen Ole2 The HID group showed a significantly increased physical functioning, general 1Department of Hematology, Region Sjaelland Sygehus Nord Roskilde, health, and social functioning subscale score for QOL (P<0.01), greater Roskilde, Denmark; 2Department of Hematology, Region Sjaelland decline in handgrip and knee-extensor muscle strength (P<0.05), and a trend Roskilde-Koege Hospital, Roskilde, Denmark towards lower depression score (P=0.051), compared to the other donors group. Multivariate analysis confirmed total corticosteroid dose was associat- Background and Aims ed with decreased handgrip strength before and after HSCT (P<0.05). The Danish Model of Quality indicates that rehabilitation at an early state Conclusions must be conducted in the ward. The National Board of Health has Thus, the donor type affected QOL, psychological status, and physical published “Cancer Plan III” with a number of recommendations for function in allo-HSCT patients; these findings may provide insight into rehabilitation and palliation. Nursing consultations with educated nurses customized rehabilitation strategies for HSCT patients. 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 MASCC-0329 as Action Research Project. Rehabilitation 2 Aim: & To detect rehabilitation problems at an early stage CHANGES IN PHYSICAL CAPACITY,NUTRITIONAL STATUS, & Toqualify rehabilitation during and after treatment for hematological AND SKELETAL MUSCLE MASS OF ELDERLYPATIENTS disease WITH ADVANCED NON-SMALL CELL LUNG CANCER & To promote the health of individuals at all aspects of the patients life RECEIVING CHEMOTHERAPY in order to prevent disabilities and improve health during and after T. N a i t o 1, T. Okayama2,T.Ohashi2,Y.Masuda2,M.Kimura3, treatments H. Murakami1,H.Kenmotsu1, T.Taira1,A.Ono1, H. Imai1,T.Oyakawa1, Methods T. I s h i i 2, M. Mitsuda2, E. Morita2, K. Mori4, T. Takahashi1, A. Tanuma2 • Patient oriented: Narrative approach, follow up by the same nurse, fluent 1The division of thoracic oncology, shizuoka cancer centar, Shizuoka, booking Japan; 2Division of Rehabilitation Medicine, shizuoka cancer centar, • Organizational level: Consultation room with possibility to book pa- Shizuoka, Japan; 3Department of Clinical Oncology, Osaka Medical tients according to their preferences, electronic documentation Center for Cancer and Cardiovascular Diseases, Osaka, Japan; • Professional level: Nursing education according to narrative approach, 4Clinical trial coordination office, shizuoka cancer centar,Shizuoka, Japan nurses with independent responsibility for follow up Results Background and Aims Nursing consultations meant an earlier focus on rehabilitation and earlier The number of elderly patients with non-small cell lung cancer (NSCLC) intervention. Focuses in the consultations were patient oriented. To book is increasing worldwide. The aim of this study is to explore the changes of patients according to their preferences was a big challenge, because the physical and nutritional status in elderly patients with advanced NSCLC nurses had to organize their work themselves rather than the nursing receiving chemotherapy. leader did so. To use narrative approach was a success. Methods Conclusions Patients aged>=70 years with advanced NSCLC (stage III-IV) scheduled These results will be background organization of rehabilitation during and to commence first-line chemotherapy were prospectively enrolled. The after treatment for hematological disease in the future. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S199

MASCC-0324 people who did not want surgery, the others could not tolerate radical Rehabilitation 2 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 THE ASSOCIATION BETWEEN BASELINE WALKING interval time was 1.5 months and mean number of DSA procedure was 5 CAPACITYAND FUNCTIONAL PROGNOSIS OF ELDERLY times. PATIENTS WITH ADVANCED NON-SMALL CELL LUNG Results CANCER Short term effects were obvious. Twelve hours after DSA, urine color in T. Okayama1,T.Naito2,T.Ohashi1, Y. Masuda1, M. Kimura3,T.Ishii1, 24 serious bleeding cases returned to yellow. Hematuria ceased in all M. Mitsuda1,E.Morita1,T.Oyakawa2,H.Murakami2,H.Imai2, patients including one centenarian 1 week later. Long term effects were H. Kenmotsu2,T.Taira2,A.Ono2, K. Mori4,T.Takahashi2, A. Tanuma1 not as good as short. Complete response in 6 and partial response in 21 1Division of Rehabilitation Medicine, shizuoka cancer centar, Shizuoka, patients were achieved. The 1, 3 and 5 year survival rates were 93.88 %, Japan; 2Division of Thoracic Oncology, shizuoka cancer centar,Shizuo- 81.63 % and 53.06 %, respectively. ka, Japan; 3Department of Clinical Oncology, Osaka Medical Center for Conclusions Cancer and Cardiovascular Diseases, Shizuoka, Japan; 4Clinical trial Interventional chemoembolization is the preferred treatment for inopera- coordination office, shizuoka cancer centar,Shizuoka, Japan ble patients diagnosed as invasive urothelial carcinoma of bladder, espe- cially complained about persistent hematuria. This therapeutics is a fast, Background and Aims safe, effective and bladder-preserving approach, rather than palliative The number of elderly patients with non-small cell lung cancer (NSCLC) treatment. In order to achieve immediate and reliable efficacy, permanent is increasing worldwide. However, there is little evidence about their embolic agents are suggested to administer if angiography show extrav- functional capacity. The aim of this study is to elucidate the impact of asation of contrast or abundance of tumor blood vessels. Notice Lipiodol baseline walking capacity on activity of daily living (ADL) in elderly emulsion cannot be injected unless vesical artery super-selective cathe- patients with NSCLC. terization. In addition injection speed must be under control in case non- Methods target embolization by reflux. 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 shuttle- MASCC-0612 walk distance (ISWD) before chemotherapy. ADL was assessed by Surgical Oncology Barthel index (BI). To assess the functional prognosis, we defined dis- ability free survival (DFS) as the time between the date of the first FEASIBILITY OF DIGITAL PHOTO ANALYSIS FOR assessment and the date of 10 points decline of BI, which was calculated OBJECTIVE MEASURE OF POSTURAL CHANGES AFTER by Kaplan-Meier method. SURGICAL MANAGEMENT OF HEAD AND NECK CANCERS Results Among 30 patients (11 women and 19 men) enrolled from Jan. 2013 to K. mannion1,B.A.Murphy2,S.H.Ridner3,J.Deng3,M.S.Dietrich4, Jan. 2014, median age was 74 (range, 70–82) years and BI was 100 points K. Stevens5 in all patients. Platinum-based combination and single agent chemother- 1Otolaryngology, Vanderbilt University Medical Center,Nashville, USA; apy were administered in 14 and 16 patients, respectively. Median base- 2Oncology, Vanderbilt University Medical Center, Nashville, USA; line ISWD was 285 (range, 80–640) m. Patients with high (ISWD>= 3School of Nursing, Vanderbilt University Medical Center, Nashville, 285 m) walking capacity tended to have longer DFS than those with low USA; 4Biostatistics, Vanderbilt University Medical Center, Nashville, (ISWD<285 m) walking capacity (median DFS, >13.2 vs. 6.9 months, USA; 5School of Medicine, Vanderbilt University Medical Center,Nash- log-rank test p=0.0804). ville, USA Conclusions Baseline walking capacity might predict functional prognosis of elderly Background and Aims patients receiving chemotherapy against advanced NSCLC. (Clinical Introduction: The postural changes in head and neck cancer(HNC) Trials Registry No. UMIN000009768) 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 phys- ical therapy discipline to determine the feasibility of use in objective MASCC-0255 measurement of posture changes in head and neck cancer patients. Surgical Oncology Methods Anterior, posterior, and lateral photographs of patients previously treated with head and neck cancer resection and reconstruction were captured in OUTCOMES OFARTERIAL INTERVENTIONALTHERAPY front of a posture grid. Trial analysis of these photographs with available FOR INVASIVE UROTHELIAL CARCINOMA OF THE software programs were carried out, before analyzing all patients with the BLADDER software program deemed to be most utile. X. An1, J.B. Wang1 Results 1Neoplasms and Interventional Radiology, Shanghai First People’sHos- Twety-nine patients were evaluated with Biotonix posture analysis pital School of Medicine Shanghai Jiao Tong Universit, Shanghai, China software. Four postural elements were identified as accurately measureable and applicable in head and neck cancer patients: head Background and Aims to shoulder angle on lateral view, shoulder asymmetry on anterior and To evaluate efficacy of internal iliac arterial interventional chemotherapy posterior views, and head deviation from the vertical plane on ante- and embolization for invasive bladder urothelial carcinoma. rior view. Tight fitting clothing, removing footwear, and placing Methods reflective stickers on physical landmarks prior to photography in- 49 cases of invasive bladder cancer were recruited, including 30 patients creased the accuracy of the photo analysis. The horizontal and verti- with serious hematuria after ineffective conservative therapy. Except 16 cal planes can be used as normal for evaluation of shoulder position S200 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 and lateral deviation of the head on anterior/posterior views. Normal MASCC-0173 values for deviation of the head from the vertical plane on lateral Surgical Oncology views are not well established. Conclusions DEVELOPMENTAND EVALUATION OFA NURSE Software photo analysis will be useful in evaluation postural changes in COUNSELLING PROGRAM »WOMAN-PRO II« TO IMPROVE HNC patients; however, this will require standardization of techniques for SELF-MANAGEMENT OF POSTSURGICAL SYMPTOMS IN photo capture and the establishment of grading systems WOMEN WITH VULVAR NEOPLASIA S. Raphaelis1,H.Mayer1,B.Senn2 1Department of Nursing Science, University of Vienna, Vienna, Austria; 2 MASCC-0299 Institute for Applied Nursing Science, University of Applied Sciences Surgical Oncology FHS St. Gallen, St. Gallen, Switzerland

Background and Aims CARBON NANOTUBES AS INNOVATIVE DRUG DELIVERY In women with vulvar neoplasia, even minor surgical interventions cause SYSTEMS IN CANCER RECURRENCE PREVENTION AFTER multiple symptoms with illness-related uncertainty considered among the SPARING TYPE SURGERY:MURINE MODEL most prevalent. After hospital discharge, affected women face complex EXPERIMENTAL STUDY symptom self-care tasks. Therefore, counseling on this issue is a crucial M.S. Nowacki1,M.Wisniewski2, K. Werengowska-Ciecwierz2, A.P. intervention to be addressed in clinical practice. However, there is no Terzyk2, T.Kloskowski3,A.Marszalek4, M. Bodnar4, M. Pokrywczynska3, literature concerning supportive interventions for these patients. The aim K. Pietkun3,T.A.Drewa5 of this study is to develop a counseling program on symptom self- 1Tissue Engineering Department, Ludwik Rydygier Collegium Medicum management and to compare its efficacy with standardized care by overall in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, symptom prevalence and different aspects of illness-related uncertainty. Poland; 2Physicochemistry of Carbon Materials Research Group, Methods Nicolaus Copernicus University in Torun, Torun, Poland; 3Tissue Development and evaluation of the counseling program are guided by the Enginering Department, Ludwik Rydygier Collegium Medicum in Byd- Medical Research Council framework. Thus, intervention development draws goszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; on existing literature and new qualitative research in the field of vulvar neoplasia. 4Department of Clinical Pathomorphology, Ludwik Rydygier Collegium Program evaluation takes place in a randomized controlled trial. Ninety women Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Byd- with vulvar neoplasia are recruited from six hospitals in Switzerland, Austria, goszcz, Poland; 5Tissue Enginering Department/Urology Department - and Australia and randomized into either standardized care or the counseling Nicolaus Copernicus Hospital in Torun, Ludwik Rydygier Collegium program. Patients in the intervention-group receive five consultations at Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Byd- predefined points in time from diagnosis until 6 months after treatment. Data goszcz, Poland collection is conducted concurrently at these specific checkpoints. Results Background and Aims Results of the intervention development phase indicate that counseling should Nanotechnology gives a new hope and possibility for obtaining the new be provided by an advanced practice nurse and should include information on precisely prepared and targeted drug delivery systems. The aim of our decision making, specific symptoms, and available health care services. The work was to evaluate the usefulness of carbon nanotubes combined with randomized controlled trial started 2013 and is ongoing until 2015. cisplatin as a new, self-developed experimental concept of innovative Conclusions hemostatic dressings preventing local cancer recurrence in murine exper- This study will provide first insights in the efficacy of counseling for imental study. women affected by this rare disease and will indicate future priorities for Methods their symptom-management. We have used 35 4 -week’s old, male BALB/c-Nude mouse’s. All experiments conducted due the study were approved by the rele- vant Local Ethical Committee. Animals were divided into five groups: CDDP (M-) CDDP (M+), CONTROL (M-) consisted of MASCC-0276 10 mouses, and CONTROL (M+) consisted of 5 mouses. The 5 × Surgical Oncology 106 786-o cells were injected under the kidney fibrous capsule. When tumors reached the operative size, the NSS were performed. MULTIPLE MYELOMA AS SECOND PRIMARY MALIGNAN In CDDP (M-) and CONTROL (M-) the resection were performed CIES IN A PROSTATE CANCER PATIENT: A CASE REPORT with surgical parenchymal margin (M-) and in CDDP (M+) and CONTROL (M+) the margin was left (margin positive M+). In X. WU1,M.Popovic1 CDDP (M-) and CDDP (M+) groups we use the innovative carbon 1Department of Radiation Oncology, Sunnybrook Health Sciences Centre nanotubes filled with cisplatin. In CONTROL (M-) and CON- University of Toronto, Toronto, Canada TROL (M+) groups we use carbon nanotubes not filled with any chemical agent. Background and Aims Results Introduction: Multiple myeloma is the most common primary bone In the CDDP (M-) group we haven’t observed any local tumor recur- malignancy and one of the most common hematologic malignancies that rences. In Group CDDP (M+) one animal were diagnosed with local can produce a paraprotein. In the literature, it has never been reported as tumor recurrence. In four of animals from CONTROL (M-) group and in second primary malignancy after prostate cancer. all of animals from CONTROL (M+) the recurrent tumor formation were Objective: To explore differential diagnoses of multiple lytic bones observed. lesions and a soft tissue mass in a patient diagnosed with a 10-year history Conclusions of prostate cancer treated with hormone therapy. The preliminary results shows that carbon nanotubes can probably play in Methods the future a significant role in the systemic surgical oncology An 82-year-old male was referred to the Rapid Response Radiotherapy development. Program at Sunnybrook Health Sciences Centre for palliative Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S201 radiotherapy. Due to the patient’s history of prostate cancer, complicated Objectives: The purpose of the present case report is to discuss the bone metastases was the most likely differential diagnosis. diagnosis of a patient with moth-eaten destruction in the left distal femur Results as primary synovial sarcoma. Right arm and shoulder were swollen and limited range of motion. Methods Prostate-specific antigen (PSA) was undetectable. A plain film and A 20-year-old female was referred to the Liaoning Cancer Hospital & MRI scan showed a lytic lesion in the proximal humerus and scapula Institute, China. She had presented with some pain in the lower left thigh with an extensive soft tissue component. The morphologic appearances of for 6 months. bony lesions did not support metastatic disease of prostate cancer. A CT- Results guided biopsy of the soft tissue component of the lesion was ordered and She had a slightly swollen left knee joint and slight limited motion this patient was instead diagnosed with multiple myeloma. secondary to pain in the left leg. Alkaline phosphatase (ALP) was Conclusions undetectable. Medical imaging reported the presence of a possible the Multiple myeloma can be a second primary malignancy in a prostate left distal femur osteosarcoma (plain films, CTand MRI scan (low T1 and cancer patient. This report exemplifies the need for further investigation high T2). Bone scan showed bone abnormalities in the left distal femur of primary malignancies in metastatic sites when clinical, imaging and and the left proximal tibia. Surgical pathology confirmed a primary laboratory findings do not completely correlate. 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 MASCC-0277 Synovial sarcoma arises primarily in the soft tissues, but also rarely in Surgical Oncology bone. This is the first reported case of primary synovial sarcoma in the distal femur. OPTIMIZATION OFA SURGICAL APPROACH FOR VALIDATION STUDIES IN THE SPINE X. Wu1, M. Popovic2 1Department of Surgery, Sunnybrook Health Sciences Centre University MASCC-0484 of Toronto, Toronto, Canada; 2Department of Radiation Oncology, Survivorship Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada PAT I E N T S ’ EXPECTATIONS OF ONCOLOGISTS AND PRIMARY CARE PROVIDERS (PCPS) IN ADDRESSING Background and Aims REPRODUCTIVE AND SEXUAL HEALTH Introduction: Different surgical approaches exist for shrinking tumors in W.Cheung1,Y.Wang1 cancer patients while minimally invading the surrounding bone and 1Medical Oncology, British Columbia Cancer Agency, Vancouver, connective tissue. Canada Objective: To study a safety surgical approach for shrinking the tumor volume. Background and Aims Methods The risk of infertility and sexual dysfunction from cancer therapy is Porcine cervical vertebrae were used to optimize a surgical approach to mini- inadequately discussed at the time of cancer diagnosis. We surveyed mize invasion. Vertebrae C3 and C4 were drilled to position using a radiofre- young cancer patients to 1) ascertain their expectations of physicians in quency ablation device (RFA) in both levels. RFAheated the treatment vertebrae addressing these concerns and 2) characterize how patients’ expectations until 70 °C, while there was no heating for vertebrae serving as controls. modify the likelihood of having discussions about reproductive and Results sexual health. X-ray and MRI data showed no sign of bone fracture; rather, only drilling Methods marks could be appreciated. The animals had no difficulty in normal daily Patients aged 20 to 39 diagnosed with solid tumors and alive at >/= activities after surgery. 2 years after diagnosis were surveyed to determine their views about Conclusions oncologists’ and PCPs’ responsibilities for reproductive and sexual The surgical approach proved successful in evaluating the initial safety of health. Using logistic regression, we explored for associations between the RFA device. expectations and whether or not patient-physician conversations had occurred. Results MASCC-0268 A total of 453 patients were included: median age was 35 years, Surgical Oncology 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 %, PRIMARY SYNOVIAL SARCOMA OF THE DISTAL FEMUR: A respectively). However, only 55 % and 7 % of individuals actu- RARE CASE REPORT ally engaged in conversations about these issues. In multivariate X. Zhang1,X.W.WU2,M.P. Popovic2 models, higher patient expectations of oncologists’ involvement in 1Department of Bone and Soft Tissue Tumor,Liaoning Cancer Hospital & reproductive and sexual health did not correlate with greater Institute, Shenyang, China; 2Department of Radiation Oncology, likelihood of having a discussion (OR 1.22 p=0.49 and OR Sunnybrook Health Sciences Centre University of Toronto, Toronto, 0.99 p=0.98, respectively). Conversely, increased patient expecta- Canada tions 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 Background and Aims p=0.15). Introduction: Synovial sarcoma is a malignant mesenchymal spindle cell Conclusions tumor which comprises 5–10 % of all soft-tissue sarcomas. Intraosseous Patients prefer to address their reproductive and sexual health concerns presentation is very rare and has only been documented in 11 cases. with their PCPs. Whereas most discussions appear to be driven by S202 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 physician factors, fertility conversations with PCPs can be facilitated by MASCC-0602 increased patient engagement. Survivorship

COMPARISON OF HEAD AND NECK CANCER-RELATED LYMPHEDEMA PREVALENCE USING A PATIENT-REPORTED MASCC-0536 OUTCOME MEASURE AND CLINICIAN-REPORTED OUTCOME MEASURES Survivorship J. Deng1,S.H.Ridner1, M.S. Dietrich1,N.Wells1, B.A. Murphy2 1 2 ASSOCIATION BETWEEN ABDOMINAL FAT DISTRIBUTION School of Nursing, Vanderbilt University, Nashville, USA; Vanderbilt- AND CLINICAL OUTCOMES IN POSTMENOPAUSALWOMEN Ingram Cancer Center,Vanderbilt University, Nashville, USA WITH OPERABLE STAGE BREAST CANCER Background and Aims 1 1 2 1 3 1 S. Dalal ,D.Hui, S. Yeung , I. Ihenacho ,R.Ogunti,M.DeLaCruz, Recent data support that head and neck cancer (HNC) patients fre- 1 3 1 1 4 M. Vidal ,D.Bedi,R.Dev,E.Bruera,J.Litton quently experience secondary lymphedema post cancer treatment. 1 Palliative Care, UT MD Anderson Cancer Center, Houston, USA; HNC patients may have lymphedema externally (e.g., located at the 2 Emergency Medicine, UT MD Anderson Cancer Center, Houston, face and neck) and internally (e.g., involving the pharynx and lar- 3 USA; Diagnostic Radiology, UT MD Anderson Cancer Center,Houston, ynx). However, evaluation and measurement of lymphedema in HNC 4 USA; Breast Medical Oncology, UT MD Anderson Cancer Center, population is challenging. Houston, USA We report prevalence of external lymphedema involving the neck and face using a patient-reported outcome (PRO) measure as compared to Background and Aims clinician-reported outcome (CRO) measures. Visceral fat is considered more pathogenic than subcutaneous fat, and Methods may contribute to the negative impact of obesity on breast cancer out- A cross-sectional design was used. Study measures included: 1) comes. This retrospective study was done to examine the association demographic/medical data; 2) the Lymphedema Symptom Intensity & between abdominal fat distribution and key outcomes. Distress Survey-Head & Neck (LSIDS-H&N) Soft Tissue Swelling Sub- Methods scale (PRO); 3) CTCAE Criteria and Foldi’s Scale (CROs). Cross- Postmenopausal women with stage I-III breast cancer who received tabulation was used. neoadjuvant chemotherapy (NC) were included. Abdominal fat Results areas were quantified from pre-chemotherapy computed tomography One hundred three HNC patients completed the study.Thirty-five percent images. Visceral to subcutaneous fat ratio (VSR) was used as metric of patients reported swelling at least one anatomical site. Using the for abdominal fat distribution, and categorized into quartiles. The CTCAE and Foldi’s scale, 36 % and 47 % of patients were found to have association between VSR quartiles, BMI (WHO classification) and lymphedema. There were substantial agreements identified between the key outcomes (pathologic complete response [pCR], relapse-free PRO and CROs. [RFS], disease-specific [DSS] and overall survival [OS]) were ex- Conclusions amined, adjusting for relevant factors (age, race, stage, nuclear The findings indicate that strong concordance between patient reported grade, lymphatic and vascular invasion, hormone receptor status, and clinician reported soft tissue swelling secondary to lymphedema. and NC). Longitudinal studies are needed to determine if a PRO is capable of Results identifying lymphedema at an early stage when therapeutic interventions Of 1,233 patients, 63 % white; 32 % were overweight and 44 % obese. may be more effective. 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. MASCC-0559 Survivorship Visceral: Odd Ratio Hazard Ratio (95 % CI)# subcutaneous (95 % CI)* Relapse-free Disease- Overall fat ratio Pathologic survival specific survival A PHASE II EXERCISE RCT FOR AML PATIENTS quartile complete survival response UNDERGOING INDUCTION CHEMOTHERAPY PPPP 1 1 1 1 · First 1111 S.M.H. Alibhai , S. Durbano , N. Timilshina ,H.Breunis, 2 3 3 4 · Second J. Brandwein ,G.Tomlinson,P.Oh, N. Culos-Reed 1 · Third 0.62 0.04 1.85 0.02 1.99 0.002 General Medicine, University Health Network, Toronto, Canada; (0.39– (1.11– (1.28– 2Medicine, University of Alberta, Edmonton, Canada; 3Medicine, Uni- 0.98) 3.10) 3.11) 4 · Fourth 0.47 0.003 1.78 0.01 2.00 0.009 2.03 0.002 versity Health Network, Toronto, Canada; Kinesiology, University of (0.28– (1.15– (1.89– (1.29– Calgary, Calgary, Canada 0.78) 2.78) 3.38) 3.19) Background and Aims Adjusted Logistic* & Cox Proportional Hazards# Regression Models Curative treatment for acute myeloid leukemia (AML) begins with induction chemotherapy (IC), which requires 4–6 weeks of admis- Conclusions sion and is associated with extended bed rest and toxicities, lead- Our study found higher visceral to subcutaneous fat ratio to be associated ing to worsening quality of life (QOL), fatigue, and physical with worse breast cancer outcomes. The predisposition to accumulate fat fitness. Preventive exercise at the time of IC may ameliorate these viscerally versus subcutaneously may be a novel prognostic factor inde- declines. However, this approach has not been rigorously tested in pendent of BMI, absolute fat stores and tumor characteristics. this population. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S203

Our objective was to determine the efficacy of a supervised mixed- types of cancer) and lower QoL. Lower age and breast cancer (versus modality exercise program during IC on QOL, fatigue, and fitness. prostate and testicular cancer) were associated with a more positive Methods attitude towards self-management, while higher income, treatment Adult patients (age 18–80) with AML scheduled to receive IC with chemotherapy or (chemo)radiotherapy (versus surgery alone), who were medically cleared for exercise underwent randomization prostate and testicular cancer (versus hematologic, skin and breast (2 exercise: 1 control). Fitness, QOL, and fatigue measures were cancer) and lower QoL were associated with a more positive attitude completed at baseline and post-IC. The mixed-modality, moderate- towards eHealth. intensity program was offered 4–5 days per week, 30–45 min per Conclusions session. The perceived need for SC among cancer survivors was high, and in Results general survivors had a positive attitude towards self-management and 83 participants were enrolled. Baseline characteristics were similar in eHealth. Need and attitude were associated with socio-demographics, both groups. Recruitment was good (56 %), retention excellent clinical variables, and QoL. Therefore, a personalized approach seems (96 %), and participants were adherent 53 % of the time. QOL warranted to improve and innovate SC targeting cancer survivors. 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 MASCC-0514 exercise group alone (between-group differences p=0.005, p<0.001, Survivorship and p=0.03, respectively). Conclusions TRANSLATION AND VALIDATION OF THE SUPPORTIVE A supervised, mixed-modality exercise program for patients with CARE NEEDS SURVEYAND CANCER-SPECIFIC MODULE IN AML undergoing IC is feasible, safe, and effective at managing side HEAD AND NECK CANCER PATIENTS effects including fatigue and declines in fitness and function. A phase F. Jansen1, A.M. Braspenning1, C.F. van Uden-Kraan2,B.I.Witte3, 3 RCT will definitively define the role of supervised exercise in this 1 2 population. C.R. Leemans , I.M. Verdonck-de Leeuw 1Dept. of Otolaryngology-Head and Neck Surgery, VU University Med- ical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU MASCC-0510 University Medical Center,Amsterdam, Netherlands; 3Dept. of Epidemi- Survivorship ology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands CANCER SURVIVORS’ PERCEIVED NEED FOR SUPPORTIVE Background and Aims CARE AND THEIR ATTITUDE TOWARDS Information on the supportive care needs of head and neck cancer (HNC) SELF-MANAGEMENTAND EHEALTH patients is scarce. Patient Reported Outcome measures are increasingly F. J a n s e n 1, C.F. van Uden-Kraan2,V.vanZwieten1,B.I.Witte3, being used in clinical practice to assess supportive care needs of patients. C.R. Leemans1, I.M. Verdonck-de Leeuw2 However, a valid and precise measure to assess supportive care needs 1Dept. of Otolaryngology-Head and Neck Surgery, VU University Med- among HNC patients was recently not available. ical Center, Amsterdam, Netherlands; 2Dept. of Clinical Psychology/ Objectives Dept. of Otolaryngology-Head and Neck Surgery, VU University/VU To translate and validate the Supportive Care Needs Survey Short Form University Medical Center,Amsterdam, Netherlands; 3Dept. of Epidemi- (SCNS-SF34) on the (extent of) need for supportive care and to develop ology and Biostatistics, VU University Medical Center, Amsterdam, and validate a head and neck cancer (HNC) module. Netherlands Methods The SCNS-SF34 was translated according to the EORTC guidelines and Background and Aims validated in 127 HNC patients. The HNC-module was developed by a Cancer survivors often experience unmet supportive care (SC) needs. To multidisciplinary team and was examined on completeness (i.e. content improve accessibility to SC, self-management and eHealth are promoted. validity) using report forms of nursing consultations during aftercare. Objectives Spearman’s rank correlations were used (SCNS-SF34 and the HNC- To explore the perceived need for SC among cancer survivors and their module in relation to several questionnaires (HADS, EORTC QLQ- attitude towards self-management and eHealth and to assess its’ associ- C30/H&N35, SHI en SWAL-QOL)) to study convergent validity. The ation with socio-demographics, clinical variables, and quality of life discriminatory validity of age, gender and (time since) treatment were (QoL). studied using Mann–Whitney or Kruskall-Wallis. Hypotheses were for- Methods mulated a priori. An online questionnaire on the perceived SC need, and attitude towards Results self-management and eHealth was completed by 212 cancer survivors Preliminary findings showed that≥75 % of convergent validity hypothe- from an online panel. ses and none of the discriminant hypotheses were confirmed. Comple- Results mentary to the HNC-module, pain in the mouth, problems with smelling/ Participants reported some to strong SC needs, with highest needs report- tasting, coughing, shortness of breath, limited mouth opening and eating ed on the physical domain (66 %), followed by the lifestyle (54 %), social were reported. (43 %), psychological (38 %) and life questions (24 %) domain. In Conclusions general, cancer survivors had a positive attitude towards self- The SCNS-SF34 and HNC-module showed good convergent validity; the management and eHealth. Higher SC needs were associated with male discriminant validity regarding age, gender and (time since) treatment gender, lower age, treatment with chemotherapy or (chemo)radiotherapy was limited. For completeness of the HNC-module some items need to be (versus surgery alone), hematologic cancer (versus skin, breast and other added or modified. S204 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0614 Methods Survivorship 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, IMPROVING REACH AND UPTAKE OF PSYCHOSEXUAL reported exercise behavior, planned exercise behavior, symptom distress SUPPORT:ASSESSMENT OF INTERVENTION PREFERENCES and depression. The t test, ANOVA, and Pearson’s correlation were used OF BREAST CANCER SURVIVORS REGARDING SEXUAL to examine the association. CONCERNS Results C. Lawsin1, A. Ballard1,H.Dhillon1,K.Hobbs2,P.Butow3 Twohundred and four patients were included in this study. About 67.6 % 1Psychology, The University of Sydney, Sydney, Australia; 2Oncology, (n=138) patients reported taking regularly exercise. Those who were Westmead Hospital, Sydney,Australia; 3Psychology,University of Sydney, older age, with less number of children younger than 18 years, higher Sydney, Australia level of perceived importance and preference of exercise and with unem- ployment status tend to take regular exercise. Perceived the importance of Background and Aims exercise and preference with doing exercise were associated with the Changes to sexuality can lead to psychological distress for cancer survi- higher level of the planned exercise behavior including all the exercise vors impacting the long-term quality of life for both them and their intention, attitude, subjective norm, and perceived behavior control. partners. Psychosocial and pharmaceutical interventions have proven Higher level of depression was only associated with lower level of beneficial in reducing this burden; however, due to resource limitations, subjective norm. psychosocial and pharmaceutical interventions are not accessible by most Conclusions cancer survivors and their partners. Healthcare providers should understand the cancer survivors’ exercise Objectives: The current study assessed how best to provide psycho- preferences before conducting exercise program to enhance exercise. sexual support and potential barriers to uptake amongst a sample of 141 Education about the importance of exercise and Understand patients’ Australian breast cancer survivors (ave age=50.2). exercise preferences are the key factors to enhance and maintain regular Methods exercise. Participants completed an online survey distributed via national support groups and cancer research registries. Results Participants reported that they primarily sought psychosexual support MASCC-0616 from either a book/article (34 %) or the Internet (30 %) rather than their Survivorship oncologist (17 %). While most participants utilized some type of medic- inal intervention (77 %) many wanted further information regarding SELF-MANAGEMENT PRACTICES AMONG CHINESE available medical treatments and how treatment can affect relationships BREAST CANCER SURVIVORS: IDENTIFICATION OF FOCI (Table 1). When asked how participants would like to receive this support, FOR EMPOWERING CANCER SURVIVORS TO LIVE WITH the most popularly ranked modality was online education programs CANCER AS A CHRONIC ILLNESS (27 %) followed by books (17 %). Contrary to expectations, only 32 % indicated they would like to participate in interventions with their partner. J. Sit1,H.Cheng2,C.Chan1,W.So1 Similar to previous studies, embarrassment (28 %) and lack of privacy 1The Nethersole School of Nursing, The Chinese University of Hong (22 %) were the most commonly cited barriers to uptake of psychosexual Kong, Shatin, Hong Kong China; 2School of Nursing, The Hong Kong support. Polytechnic University, Hunghom, Hong Kong China Conclusions Findings highlight the desire for cancer survivors to received additional Background and Aims psychosexual support, in a private manner. Participants’ preferences offer Cancer can be managed as a chronic illness in the survivorship phases of encouraging support that web-based interventions can reach survivors in the cancer care continuum. With ongoing survivorship, cancer survivors need of psychosexual support while addressing feelings of embarrass- often engage more actively in self-care and self-management to promote ment and enhancing privacy. 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 MASCC-0622 study aimed to explore the self-management practice of Chinese breast Survivorship cancer survivors in the survivorship phases of the cancer care continuum. Methods Qualitative approach with in-depth semi-structured interviews was PLANNED EXERCISE BEHAVIOR AND ITS RELATED employed. Twenty-nine participants were selected by purposive sampling FACTORS IN COLORECTAL CANCER SURVIVORS from local cancer self-help organizations. Individual Interviews were S. Shun1,Y.H.Lai1 audio-taped and transcribed verbatim. Interview data were analysed using 1Department of nursing, College of Medicine/National Taiwan University, qualitative content analysis. Taipei, Taiwan Results Six categories emerged from the data include managing the residual Background and Aims symptoms; dietary and activity regulations for establishing balance of Although exercise has been recognized as an important factor associated Yin-Yang and Qi; managing life roles; maintaining harmony between the with recurrence with colorectal cancer, the regular exercise participation self and the nature; re-establishing a sense of normalcy; and seeking for is low in cancer survivors. Planned exercise behavior should be under- peer support. Findings also showed how culture beliefs shaped an indi- stood before conducting exercise program. The aims were to (1) explore vidual’s self-management practice. current planned exercise behavior (i.e., intention, attitude, subjective Conclusions norm and perceived behavior control), and (2) identify its associated Findings were consistent with the Chinese holistic views about health factors in colorectal cancer survivors. which emphasized the harmony between the body, mind and spirit. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S205

Greater understanding of the cultural beliefs that underpinned the self- with at least one follow-up record were included. OS was calculated from management practice could enhance oncology nurses to develop cultural the date of consultation for palliative radiotherapy to date of death or sensitive collaborative care intervention to empower breast cancer survi- censored at last follow-up date. Symptom changes at follow up were vors to assume an active role in managing their follow-up care. 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 MASCC-0419 Two hundred and one patients were included. The median age of Survivorship 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: CHANGES IN MARITAL STATUS IN SOUTHERN ITALIAN 4.3–7.0), 7.1 months (95 % CI: 5.2–9.5) and 8.8 months (95 % CI: CANCER SURVIVORS: ROLE OF CULTURE AND RELIGION 5.8–11.5) for patients with month 1, 2, and 3 follow-ups, respectively. The most common symptom changes following WBRT were: wors- P. Tralongo1,S.Roccaro1,S.Iemmolo1,V.Pumo1,A.DiMari1, ened fatigue, appetite loss and weakness. At follow-up, worsening in M. Iacono1, E. Puzzo1,S.RamettaGiuliano1,A.Surbone1 nausea, appetite loss, headache, concentration, fatigue and balance 1Medical Oncology, Umberto I Hospital, Siracusa, Italy were found to be significantly related to OS. Worsened difficulty concentrating, fatigue, nausea and headaches were most predictive Background and Aims of a poorer survival outcome. Psycho-social issues in cancer survivorship include changes in roles and Conclusions relations within couples. Deterioration of these symptoms at follow up predicts short sur- To assess how couple’s dynamics in cancer survivors are affected by vival. Appropriate palliative care arrangements should be made cultural and religious values. accordingly. 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 MASCC-0473 cancer; 25 % were man and women with gastric or pulmonary or Survivorship urogenital cancers, lymphomas and melanomas. Using an ad hoc, previ- ously validated, questionnaire, consenting responders were asked about SURVIVAL OF PATIENTS WITH MULTIPLE BRAIN METAST changes in couple relationship. ASES TREATED WITH WHOLE BRAIN RADIOTHERAPY Results E. Wong1, M. Tsao1,L.Zhang1, R. McDonald1, G. Bedard1, L. Holden1, Ninety-nine percent respondents were married on average for over C. Danjoux1,E.Barnes1, M. Popovic1, E. Chow1 20 years; only 1 % for less than 5 years. Ninety-five percent couples 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada 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 Background and Aims were Catholic: 11 % never attended Church, while 74 % did on main For patients with multiple brain metastases, the standard of care is occasions. whole brain radiotherapy (WBRT). The objective of this study was to Conclusions report the outcomes of patients with brain metastases who were No correlation between cancer and changes in marital status were found treated with WBRT. in Southern Italian long-term survivors. This unusually positive adapta- Methods tion within couples reflects cultural and religious values and norms. Other Patients with brain metastases referred to the Rapid Response Radiother- contributing unexplored family dynamics deserve further studies. apy Program at the Sunnybrook Health Sciences Centre from 2004 to 2012 and treated with WBRTwere included. Overall survival (OS) was calculated from the start of radiation treatment. Univariate and multivar- MASCC-0481 iate cox proportional hazard model of OS was conducted with demo- Survivorship graphic and medical parameters. Results Nine-hundred-ninety-one patients were included. The mean age was PROGNOSTIC SIGNIFICANCE OF CHANGES IN SYMPTOM 65.6 years and the most common primary cancer sites were the lung SEVERITY WITH SURVIVAL FOLLOWING WHOLE BRAIN and breast. The median duration of follow-up was 2.6 months (range: RADIOTHERAPY IN PATIENTS WITH MULTIPLE BRAIN 0.1–94). The actuarial median OS time was 2.7 months (95 % CI: 2.5– METASTASES 2.9). Patients of older age (>60), lower performance status (Karnofsky E. Wong1, M. Tsao1,L.Zhang1, R. McDonald1, G. Bedard1, L. Holden1, Performance Status (KPS)<80), male gender, treated with a dose of C. Danjoux1,E.Barnes1, M. Popovic1, E. Chow1 20 Gy in 5 fractions, and patients from hospital or arrived by ambulance 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada were more likely to have a shorter survival. Age ≥65, KPS<80 and patients from hospital were the most predictive factors of impending Background and Aims death. Predicting life expectancy of patients with brain metastases is a challenge. Conclusions The objective of this study is to determine the significance of changes in Patients with brain metastases who are treated with WBRTsurvive a symptoms severity following whole brain radiotherapy (WBRT) in median of 2.7 months following their treatment. Age, performance predicting overall survival (OS) in patients with brain metastases. status, gender, radiation doses, patient location (home vs. hospital) Methods are significant prognostic factors for survival. Such factors can be From 1999 to 2013, patients who received WBRT and completed a considered when recommending further treatment or palliative care symptoms questionnaire in an outpatient palliative radiotherapy clinic for patients. S206 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0472 least 5 years and/or are undergoing only maintenance or preventive Survivorship therapies) completed the Short Form 12 Health Survey Questionnaire, the State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale. CORRELATING SYMPTOMS WITH SURVIVAL IN PATIENTS Results WITH MULTIPLE BRAIN METASTASES Both physical (p<.001) and mental (p<.001) functioning were worse E. Wong1,M.Tsao1,L.Zhang1,R.McDonald1,G.Bedard1, L. Holden1,C. than those of the Italian general population. Of the people tested, 4.1 % Danjoux1, E. Barnes1, M. Popovic1,E.Chow1 were a probable case of state anxiety, and 20 % were depressed. Physical 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada functioning was associated with age (p=.041). Mental functioning was associated with gender (p=.033). Anxiety was associated with gender Background and Aims (p=.013) and perceived social support (p=.038). Depression was associ- Having a clear prognosis for patients with brain metastases can allow ated with gender (p<.001), perceived social support (p<.001) and the health care practitioners (HCPs) to determine appropriate palliative man- presence of other health issues (p=.002). No associations between the agement and patients to make informed treatment decisions and plan for four tested dimensions and education, occupational status, marital status, the future. The objective of this study was to determine prognosis of diagnosis (lymphoma vs. other cancers), or length of the survivorship symptoms experienced by patients with multiple brain metastases with were found. their survival outcome. Conclusions Methods These data support ongoing interest in quality of life, anxiety and depres- Patients with brain metastases treated with whole brain radiotherapy sion of long-term cancer survivors and suggest the need for further study in an outpatient palliative radiotherapy clinic and completed of multidimensional functioning in this population. 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 MASCC-0095 was conducted on 14 symptoms. Survivorship 2 Results From 1999 to 2013, 1,662 patients were included. The median OS was IMPACT OF CANCER IN ITALIAN LONG-TERM CANCER 5.1 months (95 % CI: 4.6–5.8). The most common symptoms were: SURVIVORS: RELIABILITYAND CONVERGENT VALIDITY fatigue, insomnia, pain and appetite loss. Through univariate analysis, OF THE IMPACT OF CANCER SCALE, VERSION 2 fatigue (p<0.0001), nausea (p=0.025), appetite loss (p<0.0001), coordi- nation (p=0.011), concentration (p=0.0008), balance (p=0.013) and M. Annunziata1, B. Muzzatti1,C.Flaiban1,A.Surbone2 depression (p<0.0001) were significantly related to OS. Through multi- 1Unit of Oncological Psychology, Centro di Riferimento Oncologico - variate analysis, fatigue and appetite loss were most predictive of short National Cancer Institute, Aviano (PN), Italy; 2Medicine, University of survival. New York, New York, USA Conclusions HCPs should be aware of the shorter prognosis associated with patients Background and Aims exhibiting one or more of these symptoms at consultation for palliation Impact of Cancer, Version 2 (IOC-V2; Ganz et al., 2008) is a question- management of brain metastases. As a result, HCPs can tailor care naire specifically developed to assess quality of life in cancer survivors. It accordingly to maximize patient’s remaining quality of life, help patients is composed of 37 items grouped in 8 different factors: Altruism and make informed decisions and planning, and ultimately improve patient- empathy, Health awareness, Meaning of cancer, Positive self-evaluation, centered care. 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 MASCC-0118 Italian translation of IOC-V2 are provided. Survivorship 2 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 QUALITY OF LIFE, ANXIETY,AND DEPRESSION IN maintenance/preventive therapies) were administered a culturally sensi- LONG-TERM CANCER SURVIVORS: PRELIMINARY tive translation of the IOC-V2 together with the Short Form 36 Health EVIDENCE FROM AN ITALIAN SURVEY Survey Questionnaire, the EORTC Quality of Life Questionnaire Core S. Surbone1, B. Muzzatti2,M.A.Annunziata2 30, the Post-Traumatic Growth Inventory. For each IOC-V2 factor, inter- 1Medicine, University of New York, New York, USA; 2Unit of Oncologica nal consistency was assessed calculating Cronbach’s alpha; temporal Psychology, Centro di Riferimento Oncologico - National Cencer Insti- stability was assessed calculating Spearman’s correlations between two tute, Aviano (PN), Italy subsequent administrations; whereas convergent validity was obtained correlating IOC-v2 factors with the subscales of the other administered Background and Aims tools with similar content. Since long-term survivorship is now a reality for an increasingly number Results of people diagnosed with cancer, understanding their quality of life (QoL) The internal consistency exceeded 0.70 in each factor excepting Health can inform health care policy as well as help in clinical practice. This awareness and Positive self-evaluation. Temporal stability exceeded 0.60 in study aims to assess QoL (physical and mental functioning), anxiety, and each subscales, excepting Health awareness, Positive self-evaluation, and depression for this specific population, and their association with the main Appearance concerns. Finally, the eight factors showed a moderate or sub- clinical and socio-demographic variables. stantial convergent validity with the other scales assessing similar constructs. Methods Conclusions One-hundred and three Italian long-term cancer survivors (defined as Despite their preliminary nature, present data encourage further studies to persons who have been free from cancer and cancer treatments for at validate the Italian version of the Impact of Cancer Scale, Version 2. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S207

MASCC-0097 Results Survivorship 2 Self-reported work disability was 39.6 % among Romanian cancer pa- tients. Patients perceived work (M=4.38, SD=2.43, max. 7) and health were primarily influenced by illness intrusiveness, compared to relations, UTILIZATION OF SPERM BANKING IN YOUNG MEN recreation, diet or financial situation. Perceived work inability was cor- UNDERGOING CHEMOTHERAPY FOR TESTIS CANCER related with being too tired (r/s=.51,ps<0.0001), trouble meeting needs M. Brames1, S. Case-Eads1, L. Einhorn1 along burden of present physical condition (0.44 and 0.40), forced to 1Medicine, Indiana University Melvin and Bren Simon Cancer Center, spend time in bed (0.43) and feelings of hopelessness (0.35). 56.7 % Indianapolis, USA reported high levels of work satisfaction (including work at home), significantly correlated with work ability (0.67), being able to enjoy life Background and Aims (0.46) and doing things for fun (0.41). Experience of job loss prior to Testicular cancer, the most common carcinoma in 15–35-year-olds, cancer diagnosis had an elevated negative impact on work-related accounts for 1 % of male malignancies. Eighty percent with metas- aspects. tases achieve disease-free status with chemotherapy +/− surgical Conclusions resection. Standard chemotherapy is BEP (bleomycin, etoposide, Addressing work and cancer issues from the moment of diagnosis can cisplatin) or EP for 3–4 courses. Forty percent of patients receiving help to plan survivorship care and to fully determine the impact of cancer chemotherapy have permanent oligospermia, even azoospermia. Im- on work in Romania. paired spermatogenesis is related to chemotherapy. Sperm banking, Grants: UEFISCDI PN-II-RUTE-2012-3-0011; UBB GTC 34020/2013 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 MASCC-0105 why. Survivorship 2 Methods Charts screened for eligibility. Patients completed 5-point questionnaire. PRELIMINARY EVALUATION OF HEAD AND NECK Questions: Did you bank sperm prior to chemotherapy? If yes, have you EXTERNAL LYMPHEDEMA AND FIBROSIS GRADING utilized the stored sperm? Did it result in multiple births? If you did not CRITERIA bank sperm, what was the deciding factor? a) not offered b) time con- straints c) cost d) not interested e) other.Eligiblity: > 18 years, 1 year post- J. Deng1, S.H. Ridner1, M.S. Dietrich1,A.C.Fleischer2,N.Wells1,B.A. chemotherapy. Murphy3 Results 1School of Nursing, Vanderbilt University, Nashville, USA; 2Department One hundred fifty-nine questionnaire completions. Ages: 18–63. One of Radiology & Radiological Sciences, Vanderbilt University, Nashville, hundred five (66 %) did not bank sperm, 30 not offered, 24 of those USA; 3Vanderbilt-Ingram Cancer Center,Vanderbilt University, Nashville, had advanced disease. 11 patients constrained due to cost, the rest de- USA clined, most stating they had children and not interested in further progeny. 54 banked sperm. 13 utilized banked sperm with 9 successful Background and Aims pregnancies, including 3 multiple births. Our previous publication compared four available tools for evaluating Conclusions skin/soft tissue lymphedema and fibrosis and concluded that no validated Sperm banking should be offered to testicular cancer patients when tools are available for clinicians to clearly document head and neck feasible and reasonable. This study will help identify barriers to routine external lymphedema and fibrosis. To address this gap, we conducted a utilization of sperm banking pre-chemotherapy. study to develop the Head and Neck External Lymphedema and Fibrosis (HN-LEF) Grading Criteria. The study aimed to provide an initial eval- uation of the HN-LEF Grading Criteria. Methods MASCC-0100 A cross-sectional design was used. Study measures: 1) lymphedema/ Survivorship 2 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. Reli- WORK-RELATED CHALLENGES FOR CANCER PATIENTS ability estimates used simple agreement and Kappa statistic. Validity DURING TREATMENT IN ROMANIA assessed via Spearman correlations of HN-LEF grades with ultrasound C. Dégi1 measurements. 1Sociology and Social Work, Babes Bolyai University, CLUJ-NAPOCA, Results Romania 1) A total of 60 head and neck cancer (HNC) patients signed in- formed consent and 54 of them completed the study. 2) Interrater Background and Aims reliability: 91.0 % agreement with Kappa statistic=0.81 (p<0.001) Cancer and work emerged as an international field of research but still on the presence of some types of lymphedema or fibrosis; 85.1 % there are little data available so far from the non-Western European agreement regarding the grade of lymphedema and fibrosis (Kappa= countries. We aim to address correlates of work ability and work satis- 0.70, p<0.001). 3) Intrarater reliability: 96.1 % agreement for type of faction during cancer treatment. lymphedema and fibrosis; and 91.4 % agreement for grade. 4) Pat- Methods terns of increasing skin thickness under the ultrasound examination Data were extracted from APSCO, the first extensive questionnaire based with the types and severities of lymphedema are apparent (particu- study in Romania, which has a repeated cross-sectional design using larly in the neck and cheek regions). proportionate quota sampling in order to be representative for all cancer Conclusions centres. A mixed and various sample of 784 oncology patients was The study provided initial reliability and validity data for a clinician- assessed in 2013. Work-related items from the IIRS, BDI, Rahe’s life reported tool evaluating lymphedema and fibrosis in the HNC population. events, and FACT-Gwere selected. Further measurement research of the tool is warranted. S208 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0016 Methods Survivorship 2 A qualitative prospective longitudinal design was employed. Non- probability purposive sampling allowed the recruitment of 10 par- ticipants. The principal data collection method used was a digital SELF-RATED HEALTHSUPERSEDES PATIENT audio taped semi-structured interview along with drawings pro- SATISFACTION WITH SERVICE QUALITYAS A PREDICTOR duced by the participants. Data was analysed using latent content OF SURVIVAL IN PROSTATE CANCER analyses. D. Gupta1, K. Patel2,C.Lis1 Results 1Outcomes Research, Cancer Treatment Centers of America, Schaum- Three ‘dynamic’ themes, physical, psychosocial and existential experi- burg, USA; 2Radiation Oncology, Cancer Treatment Centers of America, ences were revealed that interact and influence each other in a complex Zion, USA and compound whole. These experiences are present at different degrees and throughout the entire trajectory of care. Patients have a number of Background and Aims specific concerns and challenges that cannot be compartmentalised into We previously reported higher satisfaction with service quality to be unitary or discrete aspects of their daily lives. associated with better survival in prostate cancer. However, we cautioned Conclusions that patients with greater satisfaction with service quality might be the An understanding of the patient’s experience of their illness at all stages of ones with better self-rated health (SRH), a well-established prognosticator the disease trajectory, is essential to inform service providers’ decision of cancer survival. We investigated whether SRH can supersede patient making if the delivery of care is to be client centred. Dynamic and satisfaction as a predictor of survival in prostate cancer. fluctuating changes in the patient’s personal experience of the cancer Methods journey require dynamic, energetic and timely input from health care Nine hundred seventeen prostate cancer patients (mean age 63 yrs) treated professionals. 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 associ- MASCC-0030 ation between patient satisfaction and survival. Survivorship 2 Results Majority of patients (n=517) had stage II disease. Seven hundred eighty- BARRIERS TO LYMPHEDEMA SELF-CARE seven (85.8 %) patients were “completely satisfied”. Three hundred nineteen (34.8 %) patients had “excellent” SRH. There was a weak but B. Rhoten1, E. Radina2,M.Adair3,V. Sinclair3, S. Ridner3 significant correlation between satisfaction and SRH (Spearman rho= 1School of Nursing, Vanderbilt Univeristy, Nashville, USA; 2College of 0.20; p<0.001). On univariate analysis, “completely satisfied” patients Education Health & Society, Miami University, Oxford, USA; 3School of had a significantly lower risk of mortality (HR=0.46; 95 % CI: 0.25– Nursing, Vanderbilt University, Nashville, USA 0.85; p=0.01). Similarly,patients with “excellent” SRH had a significant- ly lower risk of mortality (HR=0.25; 95 % CI: 0.11–0.58; p=0.001). On Background and Aims multivariate analysis, SRH was found to be a significant predictor of Approximately 40 % of breast cancer survivors develop lymphede- survival (HR=0.35; 95 % CI: 0.14–0.89; p=0.03) while patient satisfac- ma. Self-care is essential in managing this chronic condition. Adher- tion was not (HR=0.64; 95 % CI: 0.33–1.2; p=0.17). ence to self-care has been less than optimal. To improve outcomes, it Conclusions is important to identify and address barriers to lymphedema self-care. SRH supersedes patient satisfaction with service quality as a predictor of The aim of this presentation is present focus group findings survival in prostate cancer. SRH should be used as a control variable in concerning barriers to self-care in breast cancer survivors with analyses involving patient satisfaction as a predictor of clinical cancer lymphedema. outcomes. 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 MASCC-0081 audio recorded and transcribed verbatim. Data were analyzed by three Survivorship 2 independent reviewers using ATLAS.ti software. A fourth non-biased outside consultant independently reviewed the transcripts and codes providing additional conformation of themes. AN EXPLORATION OF THE EXPERIENCES OF NEWLY Results DIAGNOSED ORAL CANCER PATIENTS OVER THEIR The majority of participants were middle aged, post-menopausal, urban CANCER ILLNESS TRAJECTORY dwelling, Caucasian females with private insurance. All had stage II B. Noonan1,J.Hegarty1,M.O’Mahony1 lymphedema. Three themes regarding barriers to lymphedema self-care 1School of Nursing and Midwifery, University College Cork, Cork, were garnered from the focus groups. The first theme was lack of social Ireland support. Subthemes included feeling abandoned, criticized, and misun- derstood. A second theme was lack of resources for self-care activities. Background and Aims Subthemes included lack of tangible self-care support and lack of self- The main goal of treatment for oral cancer is to guarantee long-term care supplies. The third theme was self-advocacy by default: the need for tumour free survival with as little functional and cosmetic damage. knowledgeable and proactive healthcare workers. Subthemes included Despite progress in developing treatment strategies, cancers of the oral the need to proactively plan for lymphedema complications, educate cavity continue to have high mortality rates. healthcare workers, and for adequate treatment from the healthcare The aim of this study was to uniquely explore the dynamic changes in the system. physical, psychological, social and existential experiences of newly di- Conclusions agnosed patients with oral cancer at the time of diagnosis and at the end of Intervention studies are needed to improve social support, resources for treatment. self-care activities, and self-advocacy skills in this patient population. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S209

MASCC-0029 Cochrane). Inclusion/Exclusion criteria developed. Two reviewers inde- Survivorship 2 pendently reviewed selected research papers. A quality Assessment (QA) score devised and utilized. Studies with QA scores <50 % deemed inadequate and excluded. ROLE OF C-REACTIVE PROTEIN IN ADULTSOLID TUMOR Results PROGNOSTICATION Two hundred seventy-one articles selected for final review. Forty- S. Shrotriya1, D. Walsh1, A. Nowacki2, N. Bennani-Baiti1, A. Aktas1, five percent prospective studies; 52 % retrospective. Seven had an B. Estfan3 adequate QA score (80–100 %); 264 intermediate QA score (≥50 % 1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic but <80 %). Elevated CRP predicted prognosis in 90 % (245/271) of Taussig Cancer Institute, Cleveland, USA; 2Quantitative Health Sciences, studies; 80 % of 245 by multivariate analysis, 20 % univariate Cleveland Clinic Taussig Cancer Institute, Cleveland, USA; 3Solid Tumor analysis. High CRP level was not prognostic in 10 % (26/271). Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA Over half (52 %) of all articles were either in gastrointestinal malignancies (GI) or renal cell carcinoma (RCC). High CRP pre- Background and Aims dicted prognosis in 90 % (127 of 141) of the articles in these two C-reactive protein (CRP), a non-specific marker of inflammation may tumor groups. Most reports in other solid tumors supported CRP as help cancer prognostication. CRP is secreted by liver due to interleukin-1 a prognostic indicator. (IL-1), IL-6 and tumor necrosis factor (TNF). It has been linked to shorter Conclusions survival in some cancers. Weexamined associations between CRP levels 1. Elevated CRP was prognostic in 90 % of studies in solid tumors. and prognosis in solid tumors. 2. Most studies were in GI malignancies and RCC; a high CRP Methods predicted prognosis in 90 % of both Retrospective study of electronic medical records (EMR). Multiple CRP 3. levels at a tertiary cancer center reviewed from 2006 to 2012. Hemato- High CRP predicted prognosis in other tumors (lung, pancreas, logical cancer diagnoses excluded. Survival was defined as the time from hepatocellular and bladder). cancer diagnosis to date of death. CRP reported as median (Quartile 1, 4. CRP may help determine treatment response and tumor recurrence. Quartile 3). CRP reference range 0–10 mg/L. Results N=4931 with solid tumors identified. Forty-nine percent males. Eighty- three percent Caucasian; 15 % African American. Common cancers — Breast 24 %, Prostate 21 %, Lung 13 %, Colorectal 12 %, Bladder 10 % MASCC-0069 and others. Sixty-six percent had high CRP level; 34 % were normal. Survivorship 2 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 UNMET NEEDS AND THEIR ASSOCIATED FACTORS AMONG sites: 88 % Esophageal cancer, 81 % pancreas, 78 % colorectal and CHINESE HEAD AND NECK CANCER SURVIVORS AT ONE bladder each, 74 % liver and 72 % kidney and lung each. High CRP YEAR AFTER TREATMENT: WHAT DOES IT IMPLYTO level experience shorter survival as compared to normal CRP level HEALTHCARE PROFESSIONALS? (p<0.001). Conclusions W. K . W. S o 1, O.W.M. Fung2, J.C.Y. Chan2, K.C. Choi2, C.W.H. Chan1, 2 3 3 4 4 5 1. Higher median CRP in most solid tumors. S.Y.Chair ,R.W.M.Wan,S.S.S.Mak,W.M.Ling, W.T. Ng ,B.W.L.Yu, 2. C.K. Pang5 Higher CRP associated with shorter prognosis across primary sites. 1 3. The Nethersole School of Nursing, The Chinese University of Hong Inverse relationship between absolute CRP values and survival. Kong, Hong Kong, China; 2The Nethersole School of Nursing, The 4. High CRP ? an adverse prognostic indicator in most solid tumors. Chinese University of Hong Kong, Hong Kong, Hong Kong China; 3Department 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; 5Department of Surgery, Princess Margaret Hospital, Hong Kong, Hong MASCC-0028 Kong China Survivorship 2

Background and Aims C-REACTIVE PROTEIN A PROGNOSTIC INDICATOR IN Studies have reported that patients with head and neck cancer (HNC) ADULTSOLID TUMORS: A SYSTEMATIC REVIEW experience distress throughout the cancer trajectory and a significant S. Shrotriya1,D.Walsh1, N. Bennani-Baiti1,S.Thomas1 proportion continue to endure distress after treatment. Examining unmet 1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic supportive care needs (SCNs) among these survivors can help healthcare Taussig Cancer Institute, Cleveland, USA professionals to tailor-make strategies to suit their needs. This study aimed to examine the most common SCNs among Chinese Background and Aims HNC survivors at one year after treatment and identify factors that are Serum C-reactive protein (CRP) is an acute phase reactant and a associated with various needs. stable downstream marker of inflammation. We conducted a sys- Methods tematic literature review to examine the relationship between A total of 285 eligible subjects were recruited from the out- elevated CRP and prognosis in solid tumors. The role of CRP patient clinic of three public hospitals in Hong Kong. Data were in prediction of treatment response and tumor recurrence was also collected from a survey consists of three parts: 1) demographic determined. and clinical information, 2) the Chinese version of the Short-Form Methods Supportive Care Needs Questionnaire (SCNS-SF34-C) and 3) the Related MeSH (Medical Subject Heading) terms used to search electronic supplementary module ‘access to healthcare and ancillary support databases (PubMed, EMBASE, Web of Science, SCOPUS, EBM- services. S210 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results MASCC-0242 The most prevalent SCNs among HNC survivors were related to Survivorship 3 health system and information. Multivariate regression analysis found that age, marital status, education, time spent travelling from A QUALITATIVE EXPLORATION OF PERCEIVED SUPPORT home to hospital, time since treatment, co-existing disease, number CARE NEEDS AMONG BREAST CANCER SURVIVORS of symptoms and attitude towards life were significantly associated with various domains of SCN-SF34-C and the supplementary K. Cheng1,E.Lim1,L.Ge1, C. Chan2, W.H. Wong3,C.Koh3 module. 1Nursing, National University of Singapore, Singapore, Singapore; Conclusions 2Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong Healthcare professionals should consider the type of information request- China; 3Nursing, National University Hospital, Singapore, Singapore ed by these survivors. More attention should be paid to those who are younger age, obtained higher education levels, have more symptoms and Background and Aims more pessimistic to address their multiple needs. There is little research investigating individual breast cancer survivors’ experience of supportive care service and perceived unmet needs follow- ing the completion of primary cancer treatment. This qualitative study explores the experiences of women who were in the first 5 years post- MASCC-0335 breast cancer treatment, and describes their perceived unmet needs. Survivorship 3 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 VALUE OFADVANCED PRACTICE PROVIDER (APP) LED interview, with the aim of achieving maximum variation on the basis of health TRANSITION TO SURVIVORSHIP VISITS (TSV) AT information and system score. Interviews were audio recorded and fully STANFORD CANCER INSTITUTE (SCI) transcribed verbatim. Data was analysed using inductive content analysis. K. Bugos1,J.Foran1, K. Pose2, J. Petree1, C. Williamson1, B. Miralda1, Results K.G. Bailey1,D.W.Blayney3,M.L.Telli3 The median age of participants was 55 years and was on average 2 years 1Nursing, Stanford University Medical Center, Stanford, USA; post treatment. Five themes, which subsumed a number of categories, 2Lymphoma, Stanford University Medical Center, Stanford, USA; were constructed: ‘Continuity of care’, ‘Interactions with health care 3Medicine, Stanford University Medical Center, Stanford, USA team’, ‘Emotion issues and needs’, ‘Needs beyond providing and sharing of information’,and‘Viable option for post-treatment care’. The majority Background and Aims of breast cancer survivors who have completed primary breast cancer Cancer survivorship care is becoming an essential care standard. treatments have decreased contact with health care professionals, and The timing and elements of the care are still being determined. would hope to receive continuing information and emotional support Since 2012, SCI offered APP led TSV for survivors of breast cancer, from the health care professionals in dealing with their health problems acute leukemia, lymphoma and Hodgkin’s disease. Eligibility criteria are and coping with the transition. They also expressed a need for multi- complete remission following intensive chemotherapy, surgery and delivery modes of supportive services including home-based and e-health radiation. options as they have infrequent clinical follow-up and full time work. TSV includes Lickert-scale previsit assessments of common survivor Conclusions symptoms. Multifaceted and multi-delivery modes of supportive services are impor- Our aim is to evaluate patients’ perception, knowledge and confidence tant for women following the completion of primary cancer treatment. 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. MASCC-0393 The anonymous responses were collected from November 5, 2012 to Survivorship 3 February 11, 2014. Results DEVELOPING AND PILOTING AN EHEALTHAPPLICATION Of the 104 unique patients, 80 surveys were analyzed. FACILITATING SURVIVORSHIP CANCER CARE Results are : A standard assessment form helped in communicating symptoms (78/ I.M. Verdonck-de Leeuw1, C.F. van Uden-Kraan1, S. Lubberding1, 80=98 %). F. Jansen1,P.Cuijpers2,C.R.Leemans1 The majority of SCP recipients (78/80=98 %) found the SCP increased 1Otolaryngology - Head and Neck Surgery, VU University Medical their knowledge about past treatment and future health recommendations Center, Amsterdam, Netherlands; 2Clinical Psychology, VU University, (75/78=96 %). Amsterdam, Netherlands Patients gained confidence about health care providers’ responsibility for each aspect of the patients’ health care (68/73=93 % confident or very Background and Aims confident). An eHealth application integrating use of patient-reported outcomes, Satisfaction with the care received was high (78/80=98 %). provision of personalized advice and information on symptoms and Most would like future survivorship visits (52/73−=71 %). supportive care, may help cancer survivors in obtaining optimal support- Specific to breast cancer survivors, the majority were<6 months from ive care. The aim is to develop and test an eHealth application, treatment end (66/70=94 %) and rated the optimal time to receive SCP as OncoKompas, through a user-centred design approach. 1–3 months from treatment end (49/70=70 %). Methods Conclusions Weconducted a qualitative needs assessment among patients (N=30)and Based on patient survey results, APP-led TSVadd a valuable component care professionals (N=11). Based on the results, OncoKompas 1.0 was to patient care at SCI developed. Usability of a prototype was tested by patients (N=18) and and SCP increase knowledge about past treatment and future health care professionals (N=20) in a cognitive walkthrough. Patients (N=62) recommendations. participated in a multi-centre pilot study to assess feasibility. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S211

Results MASCC-0152 Needs assessments revealed that an eHealth application was appealing to Survivorship 3 most patients and care professionals. Patients requested OncoKompas to provide tumour specific information and supportive care options in their SELF-REPORTED CHRONIC DISEASE IN THOSE WITH own environment. Requirements for usage were: easy to use, non- HISTORY OF CANCER – THE INFLUENCE OF SEX AND obligatory, and an addition to care as usual. Usability tests identified SOCIOECONOMIC STATUS some weaknesses in the user interface. Care professionals appointed some considerations concerning the extensive scope and unclear final respon- B. Koczwara1,M.Miller2, R.J. Woodman3,J.Coveney4, J. Dollman5, sibility.They were pleased about the positive “approach”, complete list of C. Mackenzie6,N.M.Berry7 supportive care, and design. The feasibility study showed that patients 1Medical Oncology, Flinders Centre for Innovation in Cancer,Adelaide, appreciated the increased insight in their well-being, the offered possibil- Australia; 2Nutrition and Dietetics, Flinders University, Adelaide, ities to improve their well-being, as well as the opportunity to immedi- Australia; 3Medicine, Flinders University, Adelaide, Australia; 4Public ately get started with the tailored advice and supportive care options Health, Flinders University, Adelaide, Australia; 5School of Health Sci- provided. ences, University of South Australia, Adelaide, Australia; 6Southgate Conclusions Institute, Flinders University, Adelaide, Australia; 7Public Health Clini- Study results were used to design, build and implement a useful eHealth cal Systems, Department of Health and Aging, Adelaide, Australia application. OncoKompas seems to be especially appreciated by patients who recently completed their treatment or continue to experience im- Background and Aims paired quality of life. 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 MASCC-0273 differs according to sex, and whether it is further influenced by Survivorship 3 differences in SES. Objectives To examine prevalence of self-reported CD in those with cancer accord- IMPACT OF PARTICIPATION IN A COMMUNITY EXERCISE ing to sex and SES. PROGRAM ON PHYSICAL AND PSYCHOLOGICAL HEALTH Methods OF CANCER SURVIVORS We reviewed CD and lifestyle behaviours from a state-wide telephone J. Kamath1,S.Victoria1 survey conducted between January 2010 and March 2012 comparing 1Psychiatry, University of Connecticut, Farmington, USA adults who self-reported previous cancer diagnosis and randomly selected age and sex matched controls who did not. Analysis was stratified by sex Background and Aims and adjusted for socioeconomic status (SES). Patients with cancer experience numerous physical and psychological Results difficulties, including fatigue, depression, anxiety,and insomnia. Many of Twothousand one hundred three cases and 4,185 controls were included. these comorbidities have been associated with inflammation and altered In men, cancer cases had an increased odds of reporting a previous hypothalamic-pituitory-adrenal axis function. Evidence suggests that diagnosis of cardiovascular disease (OR1.39, 95 %CI 1.16, 1.67), high structured exercise can have a significant positive impact on physical/ blood pressure (OR 1.30, 95 %CI 1.11, 1.53), high cholesterol (OR 1.35, psychological comorbidities and improve quality of life of cancer survi- 95 %CI 1.15, 1.59) and diabetes (OR1.24, 95 %CI 1.01, 1.52) which vors. The YMCA of USA in collaboration with the LIVESTRONG remained significant, after controlling for SES with the exception of high foundation has piloted a specialized 12 week exercise program at several blood pressure. In women, cancer cases had increased odds of having sites across the United States. To date, benefits of such community reported high cholesterol (OR1.23, 95 %CI 1.07, 1.43), diabetes (OR translation of exercise programs to cancer survivors have not been 1.28, 95 %CI 1.04, 1.58) and osteoporosis (OR 1.31, 95 %CI 1.08, 1.58) investigated. which was no longer significant after adjusting for SES. Objectives: To determine impact of exercise program participation as Conclusions measured by validated physical, psychological, quality of Life, and The prevalence of self-reported CD’s was significantly higher amongst immune/endocrine assessments at specific time points. those with history of cancer compared to controls but in women this was Methods largely a result of differences in SES. A total of 200 cancer survivors participating in the LIVESTRONG exercise program at the YMCA are being enrolled in the study. Partici- pants 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 fa- tigue, depression/anxiety, sleep, pain, cogntive function, other physical MASCC-0138 comorbidities (e.g. lymphedema), quality of life, as well as assessments Survivorship 3 of cytokine and salivary cortisol levels. Results DEVELOPMENT OFAN INTERACTIVE PORTAL FOR A total of 22 cancer survivors have undergone study assessments. Partic- BREASTAND LUNG CANCER SURVIVORS: ipants are primarily breast cancer survivors but also include other cancers. DETERMINATION OF REQUIREMENTS AND EVALUATION Demographic/clinical characteristics and outcomes of physical, psycho- OF CONTENT, VISUAL DESIGN AND USABILITY logical, immune/endocrine assessments of completed participants will be presented. W. Kuijpers1, W.G. Groen1, H.S.A. Oldenburg2, M.W.J.M. Wouters2, Conclusions N.K. Aaronson1, W.H. van Harten1 The present investigation is first of its kind evaluating benefits of a 1Psychosocial research and epidemiology, The Netherlands Cancer In- community exercise program to cancer survivors using comprehensive stitute, Amsterdam, Netherlands; 2Surgical Oncology, The Netherlands physical, psychological and biomarker assessments. Cancer Institute, Amsterdam, Netherlands S212 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims osseous metastatic disease. However, in August 2013, when she present- In the Netherlands Cancer Institute an interactive portal will be introduced ed with increasing dyspnea and a significant weight loss, a CT scan to empower cancer survivors. Possible features of this portal were deter- showed multiple pulmonary lesions, which was confirmed to be adeno- mined by a literature review. We aimed to develop the portal using a carcinoma compatible with a primary breast cancer. A bone scan revealed stepwise approach involving end users. malignancy in the lower spine. Methods Conclusions We conducted focus groups with 35 cancer survivors and 31 health Conclusions: Early stage breast cancer often recurs within 5 years of professionals to verify the features that were identified in the literature adjuvant therapy. As such, the sequential use of tamoxifen and letrozole review.Subsequently,16 survivors participated in an interview to evaluate has been considered a more effective mode of therapy. However, more content and visual design of a first prototype in PowerPoint. Finally, 7 data regarding the long-term effects of this therapy would be required to survivors participated in a usability test with a functional prototype. optimize current guidelines to monitor for recurrence. Participants performed several tasks (e.g., logging in, filling out a ques- tionnaire, 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 MASCC-0418 their information needs (overview of appointments, educational Survivorship 3 materials, access to personal medical record), whereas health pro- fessionals preferred features that provide them with relevant infor- SELF-REPORTED DISTRESS IN ADULTACUTE LEUKEMIA mation about the survivors. The interviews confirmed survivor SURVIVORS: DURING & AFTER INDUCTION THERAPY preferences and showed that they preferred an accessible layout. J. Lester1,R.Stout2, K. Crosthwaite2,R.Jones3,J.Flynn4, C. Holloman5, Suggestions for improvement included explanation of medical jar- 6 gon, using concise texts and adding a wallpaper. Usability tests B.L. Andersen 1Department of Psychology, The Ohio State University Comprehensive showed that it was relatively easy to navigate through the website, 2 although some buttons could be placed more logically. Participants Cancer Center, Columbus, USA; Division of Nursing, The Ohio State also pointed out several textual mistakes. University James Cancer Hospital & Solove Research Institute, Colum- bus, USA; 3College of Nursing, The Ohio State University, Columbus, Conclusions 4 Based on the results of the usability tests, a final version of the interactive USA; Division of Hematology Oncology, The Ohio State University Comprehensive Cancer Center,Columbus, USA; 5Department of Mathe- portal has been developed. During the symposium, we also aim to present 6 preliminary results of a more extensive feasibility study. matics, The Ohio State University, Columbus, USA; Department of Psychology, The Ohio State University, Columbus, USA

Background and Aims MASCC-0184 Acute leukemia in adults is a life-threatening cancer that is associated Survivorship 3 with significant morbidity and mortality, with critical distressing situations. The purpose of this study was to identify and compare distress among BONE AND LUNG METASTASES 13 YEARS AFTER INITIAL adult acute leukemia patient groups in acute survivorship & to compare EARLYSTAGE BREAST CANCER DIAGNOSIS: A CASE gender differences. REPORT Methods D. Lee1,E.Wong2,G.Bedard2, R. McDonald2,M.Popovic2,M.Poon2, A cross-sectional design compared distress in male (n=60) and female E. Chow2 (n=40) acute leukemia patients & represented four time periods in acute 1Faculty of Medicine, University of Toronto, Toronto, Canada; survivorship. The distress thermometer & related 38-item problem list 2Department of Radiation Oncology,Sunnybrook Health Sciences Centre, were used to measure the participants’ self-reported distress. Toronto, Canada Descriptive statistics summarized data. Relationships between time pe- riods were tested with Chi-square or analysis of variance (ANOVA). For Background and Aims significant findings, post hoc tests were performed to identify relation- Introduction: Although patients with early stage breast cancer can be ships between variables & pairs of time periods. treated with adjuvant tamoxifen therapy at an early stage with good Results prognosis, they can still have a risk of recurrence after 5 years of therapy. Participants (N=100) had a mean age of 52.3 years (SD=17.2) with age Evidence suggests that combining tamoxifen with letrozole improves range from 19-84. Participants reported their perceived health status as disease-free survival. excellent (3 %), good (39 %), fair (44 %), or poor (12 %) with a mean Objective: Case documentation of early stage breast cancer with meta- response of 2.3 (SD=0.7). Acute leukemia survivors reported a mean static recurrence following sequence therapy of adjuvant tamoxifen and distress score of 4.3 (SD=2.8; possible range 0–10), which was not letrozole would add to consequent follow-up recommendations. significant across time periods (ps=0.18). Methods The subscales with the highest number of endorsements included emo- Methods: The current report documents the case of a 73 year-old woman, tional (M=2.6;SD=2) & physical (M=6.5, SD=4.5) scales. The practical, who presented with bone and lung metastases 13 years after initial early family, & spiritual subscales had lower total endorsements (Ms 0.07 to stage breast cancer diagnosis and treatment. 0.92; possible range of 1–6). Distress was higher in women across time Results periods (M=5.3, SD=2.7) as compared to men (M=3.7, SD=2.8) Results: The patient underwent a right modified radical mastectomy in Conclusions 2000 due to early stage breast cancer, followed by 5 years of adjuvant Psychosocial distress is understudied in adult acute leukemia patients. tamoxifen and 2 years of extended-adjuvant letrozole. In January 2013, This study validates that significant distress exists in acute survivorship she started to experience significant pain in her back with no evidence of and should be measured and addressed. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S213

MASCC-0300 Methods Survivorship 3 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 THE TRANSITION FROM LIVING DESPITE CANCER TO severity of physical and psychosocial issues experienced by BCS, and the LIVING WITH CANCER - A QUALITATIVE STUDY ON THE barriers to follow-up care. SELF-PERCEPTION OF BREAST CANCER SURVIVORS Results H. Mayer1,J.Breuer1 A total of 127 OP from various professions, with mostly nurses (57.5 %) 1Department of Nursing Science, University of Vienna, Vienna, Austria and oncologists (19.7 %) participated in the survey. The most commonly reported survivorship issues that required management were fatigue Background and Aims (78.5 %) and anxiety (69.3 %). Financial burden (26.7 %) and fatigue Due to early detection and improved treatment methods, the rate of long- (18.3 %) were the most severe issues encountered. Reported practitioner- term Breast Cancer Survivors (BCS) has increased over the last years. specific barriers to follow-up care include a lack of time (61.6 %) and lack Considering this fact, there is a broad discussion in the health related of communication with other healthcare professionals (53.6 %). For literature on whether cancer can be considered a chronic disease. The aim patient-specific barriers to follow-up care, patient’s lack of awareness of this study was to clarify whether, from the perspective of the affected (76.0 %), financial constraints (72.0 %) and unwillingness to discuss individuals, cancer can be considered a chronic disease. sensitive issues (72.0 %) were commonly cited. Methods Conclusions Nine in-depth qualitative interviews with BCS were conducted and In Asia, psychosocial issues are the highest priority issues that must be analyzed. addressed in a survivorship program. Furthermore, additional resources Results are needed to overcome barriers to implementing survivorship programs An initial model of understanding the situation and the status of for BCS. BCS emerged from the data. It shows that the breast cancer diag- nosis means entering a new reality, without ever returning to their pre-diagnosis lives. Their perception is influenced by both illness- and health-related factors. The status of BCS is unstable; it is a shift MASCC-0310 between perspectives and a continuous challenge for the affected Survivorship 3 women. The results also showed two main transitions: living despite cancer turns into living with cancer, and suffering from cancer turns WELLNESS BEYOND CANCER: A PROGRAM REVIEW into having suffered from cancer. Conclusions M. Rushton1,C.Liska2, G. Larocque2,R.Morash2,R.Segal2 Although the results show similarities to current theories of chronic 1Internal Medicine, The Ottawa Hospital, Ottawa, Canada; 2Regional disease, BCS did not define themselves as chronically ill; nevertheless, Cancer Program, The Ottawa Hospital, Ottawa, Canada their reality had changed and they were never able return to a stable, ‘healthy’ status. Professional care must acknowledge these aspects of Background and Aims breast cancer survivorship, needs to be supportive and offer adequate As our population ages and cancer care improves there is a growing guidance to BCS. population of survivors. These individuals require surveillance for recur- rence 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) MASCC-0140 patients. Follow-up by Primary Care Physician (PCP), Nurse Practitioner Survivorship 3 (NP), or Oncologist stream is determined by the treating Oncologist(s) based on the patients’ complexity of needs and/or risk of relapse. Our FOLLOW-UP CARE AND SURVIVORSHIP ISSUES FACED BY study objective was to evaluate success of the program by reviewing BREAST CANCER SURVIVORS: PERSPECTIVES FROM referral volumes and satisfaction of discharged patients. ASIAN ONCOLOGY PRACTITIONERS Methods All patients discharged were registered into one of three care provider T. N g 1,M.R.Toh1,Y.T.Cheung1, R. Dent2,R.Ng3,A.Chan4 1 streams. For CRC patients discharged to their PCP,126 received a detailed Department of Pharmacy, National University of Singapore, Singapore, survey, 56 (44 %) responded. The survey asked questions around knowl- Singapore; 2Office of Clinical Sciences, Duke-Nus Graduate Medical 3 edge of care received, program content and satisfaction. Questions were School Singapore, Singapore, Singapore; Department of Medical On- scored from 1 to 5 on level of agreement with each statement: 1=strongly cology, National Cancer Centre Singapore, Singapore, Singapore; 4 disagree to 5=strongly agree. Department of Pharmacy, National Cancer Centre Singapore, Singa- Results pore, Singapore In the first 22 months of the program 1,466 patients were discharged. Summary of outcomes and comparison graphs per disease site are provided. Background and Aims Ta b l e 1 : Patient Survey Introduction In Asia, there is a lack of comprehensive survivorship programs for breast cancer survivors (BCS). In order to design relevant programs Care Plan Satisfaction WBCP for BCS, it is important to obtain insights from Asian oncology Clear Useful to Pt Useful to PCP Support Quality practitioners (OP). Objective: Number 50 52 50 49 50 To assess the OP’ self-reported roles and barriers in providing cancer- Score (1–5) 3.9 4.0 3.9 3.9 4.9 related follow-up care for BCS. S214 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

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 1clinical pathology, Zagazig university, Zagazig, Egypt; 2pediatric hema- tology and oncology, Zagazig university, Zagazig, Egypt; 3Clinical pa- thology, Zagazig university, Zagazig, Egypt; 4pediatric, Zagazig univer- sity, 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-pro- BNP,along with conventional echocardiography and TDI. Results Thirty percent of the survivors had abnormal NT-pro-BNP levels. Abnor- mal 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 abnor- malities. 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 dysfunc- tion 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 1The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland, USA

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 Figures 1–2: Number of patients in Breast & CRC WBCP streams 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 Conclusions checklist. Symptom occurrence (the presence or absence of a symptom) Our program has found success offering different provider options for and severity (mild, moderate, severe) were recorded. Correlations among discharge allowing care to be tailored to meet individual patient needs in pairs of symptoms (both prevalence and severity) were assessed with cancer survivorship. Spearman test (r). Cox proportional hazards analysis assessed the effect of Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S215 each symptom on survival; results are summarized as the hazard ratio MASCC-0362 (HR), 95 % confidence interval (CI) for HR, and P-value. Symptoms Results Twenty perent of patients have all 3 symptoms. Forty percent have 2 BRIEF HYPNOSIS INTERVENTION FOR TREATMENT OF symptoms, 33 % have 1 symptoms, and 7 % have none. Correlations HOT FLASHES AMONG BREAST CANCER SURVIVORS 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 J. Danis1, E. Barbier1, M.C. Falcou1, A. Burnod1, F. Campana2, (p<0.001) for severity; insomnia and pain r=0.084 (p=0.009) for prev- C. Bouleuc1 alence, r=0.132(p<0.001) for severity; depression and pain r=0.064(p= 1Supportive Care, Curie, Paris, France; 2Oncology, Curie, Paris, France 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, Background and Aims p=0.001). Survival was not associated with insomnia (HR 0.96, CI 0.84– Hot flashes are a major problem for breast cancer survivors. They are frequent 1.10, p=0.58), depression (HR 1.03, CI 0.90–1.18, p=0.67), or the and can cause discomfort, anxiety, decreased quality of life and may lead to number of three symptoms present (HR 0.95, CI 0.88–1.03, p=0.18). discontinuation of endocrine therapies (tamoxifen, aromatase inhibitors). Conclusions This study was developed to evaluate the effect of a hypnosis intervention Co-occurrence was not associated with survival. DIP co-occurred in on hot flashes. 20 %. DIP are not a symptom cluster in advanced cancer. Methods Fifty-eight female breast cancer survivors with hot flashes have received hypnosis interventions (five sessions weekly, with instruction in self- hypnosis). The major outcome measure was frequency of hot flashes MASCC-0027 and night sweats. Secondary outcomes measures were maximal discom- Symptoms fort of hot flashes and their impact on quality of life, by self-reports with Numerical Rating Scales. Results WEIGHT LOSS: PREDICTORS AND PROGNOSTIC Median age 49 years, 55 % received endocrine therapies, 2 % anxiolytic IMPORTANCE IN ADULTSOLID TUMORS and none antidepressant. S. Shrotriya1,D.Walsh1,L.Rybicki2, A. Aktas1,B.Estfan3 1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic 2 Before After After- P Taussig Cancer Institute, Cleveland, USA; Cleveland Clinic Taussig sessions sessions Before (Wilcoxon Cancer Institute, Cleveland Clinic, Cleveland, USA; 3Solid Tumor On- Average Average sessions signed rank (standard (standard difference test with cology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA deviation) deviation) continuity correction) Background and Aims Hot flashes 13.1 (9.49) 8.30 (7.66) 4.77 <0.0001 frequency Body weight change in adults with solid tumors was examined in outpa- during tients. Objective was to determine if demographics, clinical and biochem- 24 h ical indices predicted weight loss (WL). Examine if WL and related Hot flashes 9.3 (9.17) 5.2 (5.38) 4.1 <0.0001 frequency parameters were prognostic for survival. during the Methods day Night hot 3.93 (2.64) 2.75 (1.76) 1.18 0.0003 Electronic medical records (EMR) from a tertiary cancer center retrospec- flashes or tively reviewed from 2009 to 2011. Body weight and other clinical night ≥ sweats parameters on visit 1 - within a year post diagnosis; visit 2 3 weeks after frequency visit 1. Weight change categorized as: weight gain, 0–5%,5.01–10 %, Hot flashes 8.08 (1.48) 5.47 (1.78) 2.60 <0.0001 maximal >10 %. Logistic regression and Cox proportional hazards utilized for WL discomfort predictors and prognostic factors. Hot 7.39 (1.75) 4.64 (1.81) 2.75 <0.0001 Results flashness’s discomfort N=5901; Mean age (±SD): 61±12 years; 82 % were Caucasians; 16 % on quality African Americans. Common cancers were Prostate 19 %; Breast 15 %; Lung of life 15 %; Colorectal 6 %; Others 12 %. Metastatic disease was present in 18 %. Bone, brain, lymph nodes – common. 45 % had radiotherapy; 41 % chemo- Conclusions therapy. Median WL from visit 1 to visit 2=−1(−48, 66) kgs. Proportionate Hypnosis appears to reduce frequency of hot flashes and may have reduction in systolic BP, diastolic BP, pulse rate, albumin, hematocrit and benefits on comfort and on quality of life in breast cancer survivors. 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. ≤ MASCC-0377 Majority lost 5 % of body weight by visit 2 Symptoms 2. Head & Neck and GI cancers (primary) - the greatest risk of WL; – breast lowest. DEVELOPMENT OFA MULTIDISCIPLINARY,THREE 3. High BMI predicted greater WL compared to normal or PHASED SYMPTOM MANAGEMENT PATIENT CARE FACT underweight. SHEET FOR PATIENTS UNDERGOING HEAD AND NECK 4. ≤5 % WL had a survival advantage compared to 5.01–10 % and >10 % RADIATION THERAPY 5. WL remained prognostic for survival after adjusting for other prog- D. Saunders1, S. Carter2, E. Koutsoukis2,V. Charette3, K. Hubert4, nostic factors. A. Pearce5,F. Ishak6,C.Szeto6,T.Rouleau1, T. Fetterly1 S216 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

1Dental Oncology, Health Sciences North Northeast Cancer Center, therapy planning 1 week later showed profound dilatation of the stomach Sudbury, Canada; 2Supportive Care, Health Sciences North Northeast and descending duodenum (Figures 1&2), with compression and inva- Cancer Center,Sudbury, Canada; 3Health Sciences, Laurentian Univer- sion of the transverse duodenum by the uncinate mass. She was diag- sity, Sudbury, Canada; 4Systemic Care, Health Sciences North Northeast nosed with malignant gastric outlet obstruction that had progressed from Cancer Center,Sudbury, Canada; 5Radiation Oncology, Health Sciences transient to complete since the time of endoscopy. Several litres of fluid North Northeast Cancer Center, Sudbury, Canada; 6Surgical Oncology, were immediately suctioned via nasogastric tube and she underwent Health Sciences North Northeast Cancer Center,Sudbury, Canada urgent laparotomy and diverting gastrojejunostomy. She was discharged to home 1 week later and was able to receive subsequent chemotherapy. Background and Aims Other symptoms from advanced stage cancers of the pancreas include The Head and Neck team at Health Sciences North, Northeast Cancer jaundice, dark urine, pale stools, abdominal and back pain, weight loss Centre developed a Symptom Management Patient Care Fact Sheet and fatigue. (PCFS) to assist the patient on appropriate management of cancer- related 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 recom- mendations 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 manage- ment 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.

MASCC-0586 Symptoms

MALIGNANT GASTRIC OUTLET OBSTRUCTION FROM PANCREATIC CANCER: A REPORT OFAN EXCEPTIONAL CASE AND A NARRATIVE REVIEW OF SYMPTOMS CHAR ACTERISTIC OFADVANCED STAGE DISEASE E. Nguyen1,A.Tsang1,P. Ciesielski2, K. Dennis3 1 2 Conclusions Faculty of Medicine, University of Ottawa, Ottawa, Canada; Faculty of Patients with advanced stage pancreatic cancer typically carry a heavy Medicine, Jagiellonian University Medical College, Krakow, Poland; 3 symptom burden, and malignant gastric outlet obstruction must be in- Radiation Oncology, Ottawa Hospital Research Institute & University cluded on the differential diagnosis when they present with obstructive of Ottawa, Ottawa, Canada upper gastrointestinal symptoms.

Background and Aims Patients with advanced stage pancreatic cancer are typically burdened by many symptoms which impair functioning and worsen quality of life. We MASCC-0445 report an exceptional case of malignant gastric outlet obstruction; a lesser Symptoms known yet potentially life threatening complication of disease progres- sion. Wealso review the other symptoms characteristic of advanced stage EXPLORATORYANALYSIS OF CHEMOTHERAPY INDUCED pancreatic cancer. PERIPHERAL NEUROPATHY (CIPN), CONCURRENT Methods SYMPTOMS AND INTERFERENCE WITH WALKING AND Case report and narrative review. GENERAL ACTIVITY:A URCC CCOP RESEARCH BASE Results STUDY A 73-year-old woman with known T4N1M0 adenocarcinoma of the uncinate process of the pancreas presented with worsening anorexia, M. Flannery1, J. Roscoe1, C. Heckler1, M. Janelsins1, L. Peppone2, nausea, emesis and distension. Endoscopy did not reveal convincing C. Kamen2, J.L. Wade3, J.L. Berenberg4,J.T.D’Olimpio5,J.Keech6, findings of external compression, but CT images obtained for radiation G.R. Morrow1,K.Mustian1, S. Mohile1 Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S217

1Cancer Control, University of Rochester, Rochester NY, USA; 2Cancer patients received intraperitoneal injection (DDP 60 mg and Control, University of Rochester, Rochester, USA; 3Oncology, Decatur Thymopentin5 10 mg). 64 patients (90.14 %) got temporary symp- Memorial Hospital, Decatur, USA; 4Oncology, Cancer Research Center toms relief. 60 patients (84.5 %) were considered effective (CR+ of Hawaii, Honolulu, USA; 5Oncology, North Shore-LIJ Monter Cancer PR+SD), while 11 patients (15.49 %) were PD. The median relief Center,Lake Success, USA; 6Oncology, NORTHWEST, Tacoma, USA time for ascites was 18 days. The biological characteristics of the ascites, primary tumor site have no relationship with the effect of Background and Aims the ascite control. CIPN is a dose limiting chemotherapy toxicity with widely variable Conclusions severity, impact on functioning and minimal treatment options. In this Abdominal paracentesis was still an effective method for relieving secondary analysis we explored the relationships between CIPN severity, symptoms in terminally ill cancer patients with malignant ascites, concurrent symptoms and interference with walking and general activity. although the median relief time is short. How to prolong the relief Methods time with few adverse effects for these patients deserved to be Four hundred sixty-two individuals (71 % female, n=328) with mixed studied. 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 interfer- ence with walking and general activity were evaluated with the Clinical MASCC-0494 Symptom Inventory using a 10-point scale. Summary number of symp- Symptoms toms was computed by adding additional symptoms reported (possible range 0–9). A PILOT RANDOMIZED CONTROLLED TRIAL OFA Results BEHAVIORAL SELF-MANAGEMENT INTERVENTION FOR Patients reported a range in CIPN severity of 4–10 (M=6.51, SD= BREATHLESSNESS IN LUNG CANCER 1.51). 98.1 % (n=433) of individuals reported additional symptoms, 1 1 2 3 4 5 with 84.7 % (n=383) reporting 4 to 9 (M=5.42, SD=2.05). Most D. Howell ,A.Bezjak ,S.Sidani ,D.Dudgeon , S. Mayo , J. Bourbeau , 6 7 commonly reported symptoms were: fatigue 93.3 % (n=421), dis- R. Goldstein ,C.Kitely 1 2 turbed sleep 83.8 % (n=379), drowsiness 82.3 % (n=372), trouble Nursing, Princess Margaret Cancer Centre, Toronto, Canada; Nursing, 3 remembering 80.8 % (n=365), distress 74.3 % (n=74.3), and dys- Ryerson University, Toronto, Canada; Palliative Care, Kingston General 4 pnea 51.8 % (n=234). 89.6 % (n=394) of patients reported interfer- Hospital, Kingston, Canada; Nursing, Princess Margaret Cancer Cen- 5 ence with walking (M=4.47, SD=2.90) and 87.8 % interference with ter, Toronto, Canada; Medicine, Montreal Chest Institute, Montreal, 6 general activity (M3.90, SD=2.60). Interference with walking was Canada; Rehabilitation, West Park Hospital, Toronto, Canada; 7 correlated with CIPN (r=.34) and number of symptoms (r=.35); Palliative Care, Trillium Health Care Center,Toronto, Canada interference with activity was correlated with CIPN (r=.42) and number of symptoms (r=.43), all p<.01. Background and Aims Conclusions Breathlessness is a prevalent and terrifying symptom of lung Patients with moderate to severe CIPN experience multiple co-occurring cancer. Little attention has been paid to the extensive responsibility symptoms; both CIPN severity and additional symptoms are significantly of patients in daily management and high quality intervention trials associated with the outcome measures of interference with walking and that support the patient’s independent performance of self- general activity. management behaviors to reduce breathlessness are needed. Study Aims: 1) To test the feasibility of randomization, recruitment, accept- ability of the intervention; 2) Assess the variability of breathlessness severity, distress and with ADLs to calculate power for a full trial; 3) MASCC-0359 Explore the effects of the intervention on perceived self-efficacy and Symptoms mastery of breathlessness. Methods A Phase II RCT, single blinded, two-group parallel assignment, with MANAGEMENT OF MALIGNANTASICTES IN TERMINALLY repeated measures was conducted. The home-based SMI targeted behav- ILL CANCER PATIENTS iors such as breathing control, stress/anxiety management and physical D.R. Gu1,D.R.Cheng1 activity. Stage II-IV lung cancer patients were recruited from ambulatory 1Department of Palliative Care, Department of Palliative Care Fudan lung cancer clinics at Princess Margaret Cancer Center. Using an inten- University Shanghai Cancer Center Departme, Shanghai, China tion to treat analysis, control and intervention group differences were examined using Wilcoxon rank sum test or Fisher’s Exact Test and GEE Background and Aims mixed models. The aim of this research is to analyze the effectiveness of abdominal Results paracentesis and peritoneal drainage in management of malignant ascites Groups (n=22) were similar at baseline on demographic and disease of terminally ill cancer patients. variables. Improvements in breathlessness at “best” at 4 weeks (mean: Methods 4.40 SD 1.96 (0–10 NRS) compared to the control group (mean of 2.89/ The data of 71 patients who received abdominal paracentesis in 1.62), breathlessness “distress” at 4 weeks (mean of 4.40/SD: 2.12 (0–10 Palliative Care Department were collected during 2011.10–2012.10. NRS) versus 3.56/SD 2.65 for the intervention group). A more significant CR(complete remission),PR(partial response),SD(stable disease) and decline in breathlessness ADL was noted for the control group at 8 weeks PD (progressive Disease)were used to assess the effective of the (mean 3.20/SD: 1.32 control versus 3.13/SD: 1.13 for the intervention paracentesis and drainage. group). Results Conclusions Forty-three (60.56 %) patients got the paracentesis more than This study provides preliminary data on the effectiveness of a SMI for twice. The average volume of drainage fluid was 5400 ml. 58 lung cancer breathlessness. S218 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0500 Background and Aims Symptoms 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 SELF-MANAGEMENT INTERVENTIONS FOR with advanced lung cancer, using the Patient Care Monitor (PCM) version BREATHLESSNESS IN ADULTCANCER PATIENTS: A 2.0 electronic symptom assessment tool. SYSTEMATIC REVIEWAND META-ANALYSIS Methods D. Howell1, A. Bezjak1, S. Sidani2, D. Dudgeon3, A. Husain4, Ninety-nine patients with advanced non-small cell lung cancer were G. Fernandez5, E. Atenafu6, A. Molassiotis7 asked to complete the PCM electronic symptom assessment tool at up 1Nursing, Princess Margaret Cancer Centre, Toronto, Canada; 2Nursing, to 4 clinic visits between 2007 and 2009. Ryerson University, Toronto, Canada; 3Palliative Care, Kingston General Results Hospital, Kingston, Canada; 4Palliative Care, Temmy Latner Palliative Functional concerns were most prominent across study visits. Patients Care Centre, Toronto, Canada; 5Psychosocial Oncology, Princess Mar- consistently reported significant difficulty (score of 7–10 out of 10) with garet Cancer Center,Toronto, Canada; 6Biostatistics, Princess Margaret running (33–43 %), doing hard work/activity (29–49 %), attending a paid Cancer Center, Toronto, Canada; 7Biostatistics, The Hong Kong Poly- job (20–31 %), and doing household work (17–22 %). Severe dyspnea technic University, Hong Kong, China 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 Background and Aims 29 % of patients, and fatigue by over 50 %. Sexual dysfunction was also Breathlessness is one of the most distressing cancer symptoms due to one of the ten most prevalent severe symptoms (20.8–29 %). Depression impacts on function and quality of life. Patients assume responsibility for was reported infrequently,with over half of patients at each visit reporting daily self-management of this symptom. The primary objective of this “none;” moderate or severe difficulty was seen in just 2.5–9.3 % and 3.4– systematic review was to assess the effectiveness of self-management 6.2 % of patients, respectively, across all study visits. interventions in reducing severity of breathlessness in adult cancer pa- Conclusions tients and on secondary outcomes i.e. emotional distress and quality-of- Patients with advanced lung cancer report functional limitations as their life at any disease stage or phase of treatment. most severe concerns. Dyspnea, fatigue, and sexual dysfunction also Methods figured prominently and consistently. The persistence of these severe This systemic review followed Cochrane methods to identify randomized symptoms throughout the study suggests a need for more targeted atten- controlled trials (RCTs) and controlled clinical trials searching multiple tion to the most prevalent symptoms in this population. empirical and gray literature databases up to June 2013. Quality assess- ment 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 MASCC-0323 Intervals (CI) based on a fixed-effect model. Symptoms Results The literature search yielded a total of 3080 references from empir- AVASCULAR NECROSIS OF THE FEMORAL HEAD IN A ical data bases, forward referencing, and hand searching. Following PATIENT WITH METASTATIC BREAST CANCER removal of duplicated references (n=345), title scan of non-relevant 1 1 2 1 1 references i.e. chemotherapy trials or not in cancer (n=2640), a total B. Lechner , N. Thavarajah ,L.Probyn,N.Pulenzas, L. Holden , 1 1 of 93 abstracts followed by a review of 33 full studies, four trials N. Lauzon ,E.Chow 1 (n=246) of psychosocial counseling with breathing-relaxation train- Rapid Response Radiotherapy Program Department of Radiation On- ing met the inclusion criteria. A large effect size of 0.62 (CI 0.36, cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, To- 2 0.88) in favor of the intervention was demonstrated based on a SMD ronto, Canada; Department of Diagnostic Radiology, Sunnybrook but the studies at moderate to high risk of bias and the point Health Sciences Centre, Toronto, Canada difference less than 1. Conclusions Background and Aims High quality RCTs for breathlessness are still needed and self- Avascular necrosis (AVN) of the femoral head commonly presents as management interventions may demonstrate meaningful change breath- unilateral hip pain. AVN can be a complication of many treatments for lessness reduction. cancer, including corticosteroids and radiation. This report discusses a breast cancer patient with AVN and explores possible causes and differ- ential diagnoses. Methods MASCC-0416 A 70 year old female was referred to the Rapid Response Radiotherapy Symptoms Program (RRRP) at the Sunnybrook Health Sciences Centre with meta- static breast cancer and AVN of the femoral head. Results WHAT BOTHERS LUNG CANCER PATIENTS THE MOST? A The patient was diagnosed with breast cancer in 1987, with local recur- PROSPECTIVE, ELECTRONIC, PATIENT-REPORTED rence in 1996. In 2008, metastatic disease was found at L5 vertebra and OUTCOMES STUDY IN ADVANCED NON-SMALL CELL LUNG has since developed throughout the spine and liver. In June 2012, the CANCER patient was referred to the RRRP with left groin pain. Metastases were T.W.LeBlanc1, M.S. Nickolich2, C.N. Rushing3,G.P.Samsa3,S.C.Locke3, present in the left femoral head and acetabulum. The patient received A.P. Abernethy3 radiotherapy of 30 Gy in 10 fractions. In December 2012, a CT scan 1Department of Medicine, Division of Hematologic Malignancies and demonstrated collapse of the anterior and superior articular surface within Cellular Therapy, Durham, USA; 2Department of Medicine, Program in the left femoral head, with a large area of sclerosis. Previously identified Internal Medicine, Durham, USA; 3Duke Clinical Research Institute, as metastatic disease, it is now considered advanced AVN of the femoral Center for Learning Health Care, Durham, USA head. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S219

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 M. Mori1,Y.Ji2,S.Kumar2, T. Ashikaga3, S. Ades2 1Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; 2Hematology/Oncology, University of Vermont College of Figure 1: Axial CT image showing curvy linear sclerosis in the Medicine/Fletcher Allen Health Care, Burlington, USA; 3Medical Bio- subchondral aspect of the anterior superior left femoral head. statistics, University of Vermont, Burlington, USA Conclusions The diagnosis of AVN can be difficult as it often appears as areas of Background and Aims sclerosis and can be mistaken for metastases. Possible factors contributing Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist to AVN in this patient could include bisphosphonates, radiotherapy, or shown to relieve severe OIC in patients with advanced disease receiving chemotherapy. 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. MASCC-0326 Methods Symptoms 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 REVIEW OF SYMPTOM CLUSTER RESEARCH IN THE during the preceding week were eligible. Exact 95 % confidence intervals ’ RAPID RESPONSE RADIOTHERAPY PROGRAM (RRRP) for incidence rates, Friedman s test for laxation over time, and univariate/ bivariate Cox proportional hazard models for laxation times were B. Lechner1, N. Pulenzas1, N. Thavarajah1,E.Chow1 employed. 1Rapid Response Radiotherapy Program Department of Radiation On- Results cology, Odette Cancer Centre Sunnybrook Health Sciences Centre, Twelve patients received methylnaltrexone. Seven and 4 patients had Toronto, Canada 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 Background and Aims had rescue-free laxation within 4 and 24 h, respectively, and 10 Patients with advanced cancer often experience various concurrent symp- (83.3 %[95 %CI:51.6–97.9 %]) had laxation within 48 h (p=0.006). toms which can predict changes in patient functioning, treatment out- Mean time to laxation of those who had laxation within 4, 24, and 48 h comes, and affect their quality of life. Clinical evidence of patients was 3.3, 15.8, and 20.1 h, respectively. Bivariate Cox models revealed frequently experiencing multiple symptoms has prompted research in that shorter time to laxation was associated with higher baseline morphine the identification and analysis of symptom clusters. The Rapid Response equivalent daily dose (HR=1.02; p=0.018) and smaller number of laxa- Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Cen- tions in the preceding week (HR=0.13; p=0.035). Patients tolerated tre provides timely radiotherapy for palliative cancer patients, focusing on methylnaltrexone well without evidence of opioid withdrawal. quality of life (QOL) as an important endpoint. This paper reviewed the Conclusions past research in the RRRP on symptom clusters in patients with advanced Methylnaltrexone may relieve severe OIC in cancer patients who are not cancer. receiving palliative care. A larger prospective study is justified in this Methods population. A literature search was completed to identify studies investigating symp- tom clusters in cancer patients conducted in the RRRP from 2007 to 2013. All publications pertaining to symptom cluster research were included. Results MASCC-0321 Research in the RRRP has addressed symptom clusters in patients with Symptoms brain metastases, bone metastases and has reviewed external publications concerning symptom clusters in cancer patients. Research in the RRRP THE EFFECTS OF INSPIRATORY MUSCLE TRAINING IN THE has shown that methodological inconsistencies between studies have MANAGEMENT OF BREATHLESSNESS IN PATIENTS WITH resulted in a lack of consensus among symptom clusters for certain LUNG CANCER: A PILOT FEASIBILITY RANDOMIZED patient populations. TRIAL Conclusions The efforts of the RRRP have aimed to broaden the available information A. Molasiotis1,A.Charalambous2,P. Taylor3,Y.Summers3, Z. Stamataki4 on symptom clusters in patients with advanced cancer and how these 1School of Nursing, The Hong Kong Polytechnic University, Hong Kong, clusters are impacted by RT. There are still inconsistencies in research Hong Kong China; 2Department of Nursing, Cyprus University of Tech- methodologies and results for patients with various cancer types. Further nology, Limassol, Cyprus; 3Medical Oncology, Wythenshawe Hospital, S220 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Manchester,United Kingdom; 4Research & Development, Christie NHS Results Foundation Trust, Manchester,United Kingdom 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 Background and Aims scores at time of consent showed that both CBT-I+Armodafinil (p= Breathlessness in patients with lung cancer is common, managing breath- 0.001) and CBT-I+Placebo (p=0.01) groups had significantly less insom- lessness is complex, treatment options are limited and treatments are nia than placebo group, with effect sizes of 1.31 and 1.02, respectively. sometimes unsuccessful. The aim of this study was to assess the feasibility Armodafinil and placebo groups were not significantly different (p= of a trial with inspiratory muscle training (IMT) in lung cancer patients. 0.584); nor were CBT-I+Armodafinil and CBT-I+Placebo groups signif- Methods icantly different (p=0.421). Follow-up ISI scores were essentially the After randomisation, the experimental group received IMT using a pres- same as post scores. sure threshold device for 12 weeks. Patients in the control group received Conclusions standard care. Outcome measures were completed at baseline and month- These findings show that CBT-I results in clinically significant improve- ly for 3 months (T1, T2, T3), including: physiological ment in insomnia, with effects persisting long term. Armodafinil had no parameters(FEV1,FVC); breathlessness severity,distress,ability to significant effect on insomnia nor on the efficacy of CBT-I. cope,and satisfaction with breathlessness management;modified Borg NCI Grant:R01CA126968. Study medication: Teva Pharmaceutical, scale;quality of life;anxiety,depression. USA. 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. MASCC-0454 In paired comparisons, average and worst breathlessness over past 24-h Symptoms 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 A CASE REPORT OF CHRONIC LYMPHOCYTIC LEUKEMIA IMT group, only at T3 (p=0.018). Statistically and clinically important AND MULTIPLE MYELOMA differences over time (R-ANOVA) were seen with regards to ability to N. Pulenzas1,A.Porwit2,K.J.Craddock2, N. Thavarajah1,B.Lechner1, cope with breathlessness (p=0.02), satisfaction with breathlessness man- L. Holden1, N. Lauzon1,E.Chow1 agement (p=0.024), fatigue (p=0.007), emotional function (p=0.006), 1Radiation Oncology, Odette Cancer Centre, Toronto, Canada; breathlessness mastery (p=0.031), anxiety (p=0.027) and depression (p= 2Department of Pathology, University Health Network, Toronto, Canada 0.048). The m-Borg difference between groups (T3) was 0.80, which is borderline clinically significant but not statistically significant. However, Introduction: Association of chronic lymphocytic leukemia (CLL) and m-Borg at T2 was significantly lower in the IMT group (p=0.029). multiple myeloma (MM) in the same individual is rare. These malignan- Conclusions cies may be related through a common clonal origin, or can exist as IMT trial is feasible in lung cancer . The details of this trial allow us to separate malignancies from different clones. refine the treatment protocol and findings guarantee a fully-powered Objective: The purpose of this report was to outline and discuss a rare larger trial. 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 MASCC-0540 in November of 2012. Symptoms Results: As described in the literature, MM may exist simultaneously with CLL, or is diagnosed several months after CLL diagnosis. Common EFFECT OF COGNITIVE BEHAVIORALTHERAPY FOR symptoms experienced in these rare cases are generally a combination of INSOMNIA (CBT-I) AND/OR ARMODAFINIL ON INSOMNIA IN clinical features typically seen in CLL and MM separately. In our case, CANCER SURVIVORS 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 A.R. Peoples1, J.A. Roscoe1, C.E. Heckler1,M.Shayne2, L.J. Peppone1, cells. G.R. Morrow1 Conclusion: Combined CLL and MM in one individual remain rare, and 1Surgery, University of Rochester Medical Center, Rochester, USA; continuation of documented cases may facilitate for more knowledge 2Medicine, University of Rochester Medical Center,Rochester,USA obtained about this rarity. Further research should aim to detect if there are differences in disease progression between patients with CLL and Background and Aims MM from the same or different clones. Additional knowledge may guide Insomnia is an underreported distressing side effect of cancer and its physicians to make more informed treatment strategies and potential treatment, which can persist for months post-treatment, reducing quality clinical markers to observe these malignancies. 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 over- MASCC-0620 all reduction in insomnia among cancer patients following completion of Symptoms chemotherapy and or/radiotherapy. Methods DISEASE-FREE OVARIAN CANCER PATIENTS REPORT Wereport on 88 cancer survivors (mean age 56, 88 % female, 68 % breast SEVERE PAIN AND FATIGUE OVER TIME: PROSPECTIVE cancer) randomized to one of four 7-week long intervention conditions: 1) QUALITY OF LIFE ASSESSMENT IN A CONSECUTIVE CBT-I+Armodafinil, 2) CBT-I+Placebo, 3) Armodafinil only, and 4) SERIES Placebo only.Insomnia severity was assessed by Insomnia Severity Index (ISI) at consent, following intervention (post), and 3 months later (follow- S. Shinde1, J. Aminah1 up), with higher scores indicating greater insomnia. 1Hematology Oncology, Mayo Clinic, Rochester,USA Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S221

Background and Aims chemotoxicity risk and prophylaxis type. Prophylaxis was correctly ini- Among ovarian cancer patients, treatment is aggressive and yet survival is tiated as either primary or secondary per EORTC guideline recommen- often so limited. This study sought to measure quality of life with the dations (considering chemo-related FN risk and patient-related factors) in ultimate goal of identifying ways of improving it over the duration of 51 % of patients (Fig 1). EP-2006 was started on average 3.0±3.7 days these patients’ lives. after chemo and given for 5.1±2.3 days, mainly (54 %) as 30MIU/day. Methods CIN occurred in 14.3 % of all cycles and 34.6 % of patients had ≥1 All ovarian cancer patients who received some/all of their initial chemo- episodes. 22.8 % of patients had ≥1 episode of Grade 3 or 4 CIN and therapy at the Mayo Clinic in Rochester, Minnesota from late 2010 5.9 % FN. CIN/FN-related hospitalizations were experienced by 6.0 % of through 2012 were included. Patient-reported quality of life was derived pts. CIN/FN-related chemo disturbances (dose reduction, delay or can- from the following 10-point linear analogue scale questions administered cellation) occurred in 9.2 %. 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. Patients Hematology Oncology Results 23 % 77 % – Among 59 eligible patients, 1.15 year (range: 3 months 3.2 years) FN risk >20 % 71 % 36 % was the median cumulative interval during which quality of life was – assessed. Area under the curve for pain, fatigue, and global quality 10 20 % 25 % 51 % of life showed no significant differences between patients treated <10 % 4 % 13 % with dose-dense chemotherapy with carboplatin/paclitaxel (n=10) Primary prophylaxis 74 % 72 % 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 ≥4painor 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.

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. Turner 6, M. Muenzberg6, I. Abraham7, K. Denhaerynck7, K. MacDonald7 1Institut 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 Conclusions Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Variation in treatment with biosimilar GCSF is evident in terms of Battista di Torino, Torino, Italy; 5Onkologisches Zentrum, decision to treat with primary prophylaxis, day of initiation, duration Universitaetsklinikum Hamburg Eppendorf, Hamburg, Germany; and dose, yet incidence of CIN/FN and related events is low.Forthcoming 6, Sandoz Biopharmaceuticals, Holzkirchen, Germany;7,Matrix45, analyses will determine whether treatment variability is associated with Tuscon, USA differential outcomes. 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. MASCC-0600 Methods Symptoms Prospective, observational study at 191 centers in 12 European countries of patients (n=1452) for up to 6 cycles within a single chemotherapy line PAT I E N T S ’ REPORTED OUTCOMES ABOUTA SUPPORTIVE (total of 8,324 cycles). CARE SERVICE Results Mean ± SD age in this predominantly female (61 %) sample was 61.3± I.M. Brunetti1,E.Vasile1,L.Ginocchi1,M.Lucchesi1, S. Ricci1, 11.8y.Most common cancers were breast (32 %), lung (24 %), lymphoma A. Falcone1, A. Antonuzzo1 (17 %). Table 1 compares hematology vs. oncology patients in terms of 1Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy S222 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Background and Aims studies. Further study investigating gender differences in the symptoms The management of uncontrolled symptoms or relevant toxicites is very experienced by advanced cancer patients as the primary endpoint is important for many patients during active anticancer treatment. recommended. 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. MASCC-0464 Methods Symptoms We proposed to patients visited at the supportive care service a simple questionnaire investigating the reasons for the access to the service, SYMPTOM CLUSTERS IN PATIENTS WITH BRAIN METAST the feeling about treatment of the symptoms and the alternative routes that ASES TREATED WITH RADIATION – 3 DIFFERENT patients would follow if the service would not be available. STATISTICAL ANALYSES Questionnaires were answered anonymously and on a volountary basis. 1 1 1 1 1 1 Results E. Wong ,L.Zhang ,G.Bedard,R.McDonald , M. Tsao , C. Danjoux , 1 1 1 1 During a 1-month period, a total of 32 questionnaires have been E. Barnes , L. Holden ,M.Popovic, E. Chow 1 completed. Radiation Oncology, Odette Cancer Centre, Toronto, Canada There was a good correlation between the symptoms indicated by patients and those registrered by physicians in the same period in an electronic Background and Aims database. All patients with exception of one reported good feeling about Advanced cancer patients often experience symptoms that may occur the understanding and treatment of symptoms. together in symptom clusters (SCs). The purpose of this study was to At the question of what patients would do if the service would not be explore the presence of SCs using three different statistical analyses at available, half of patients answered that they would access emergency both baseline and follow-up after radiotherapy treatment for brain department, 3 would plan a medical oncology visit or would take home metastases. self-medication, ten would contact general practitioner. Methods Conclusions One hundred and fifty five patients at baseline and 100 patients at 1 month The patients’ perceptions about a supportive care service are good. follow-up completed the European Organisation for Research and Treat- The integration of this service in oncology unit may reduce the access of ment of Cancer Quality of Life Questionnaire Brain Module (EORTC cancer patients to emergency departments. QLQ-BN20 or BN20+2). Three different statistical methods were ap- plied: 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. MASCC-0449 Results Symptoms 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 ‘ ’ GENDER DIFFERENCES IN SYMPTOMS EXPERIENCED BY three methods, three clusters were identified: 1) difficulty concentrating , ‘ ’ ‘ ’ ‘ ’ ‘ ADVANCED CANCER PATIENTS: A LITERATURE REVIEW motor dysfunction , seizures , drowsiness and difficulty remember- ing,’ 2) ‘future uncertainty’, ‘headaches’, ‘hair loss’ and ‘bladder control’, 1 1 1 1 1 E. Wong ,G.Bedard,N.Pulenzas,B.Lechner,H.Lam, 3) ‘itchy skin’ and ‘weakness of legs’. Post-radiation, five clusters were 1 1 1 1 N. Thavarajah ,L.Holden,E.Chow, N. Lauzon identified using the 3 methods: 1) ‘future uncertainty’, ‘drowsiness’ and 1 Radiation Oncology, Odette Cancer Centre, Toronto, Canada ‘hair loss,’ 2) ‘difficulty communicating’ and ‘remembering difficulty,’ 3) ‘difficulty concentrating’ and ‘visual disorder’,4)‘motor dysfunction’ Background and Aims ‘weakness of legs’ and ‘bladder control,’ and 5) ‘headaches’ and ‘sei- Advanced cancer patients are multi-symptomatic and require attentive zures.’ Consistency of grouping indicated higher correlation between palliative care. As gender differences are apparent in multiple aspects of symptoms. everyday life, this literature review aims to determine the gender differ- Conclusions ences seen in the population of advanced cancer patients and the symp- Determining SCs is therapeutically important as treating one symptom in toms that they experience. a cluster may serve to alleviate other symptoms. Our results suggest that Methods SCs change after radiation treatment for brain metastases. 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, MASCC-0119 and antalgic treatment were included. The patient population, tools/ Symptoms 2 questionnaire used and gender differences in symptoms found statistically or qualitatively significant in the respective studies were extracted. SYMPTOM CLUSTERS IN ADVANCED CANCER PATIENTS IN Results GREATER LISBON: AN INTERIM ANALYSIS Of the 163 studies resulting from the literature search, 19 publications were identified. Gender differences in multiple symptoms were discov- P.C. Barata1, A. Trindade1, A. Cardoso2, M. Alves3, A.L. Papoila3, ered. Gender differences were commonly found in symptoms of emo- D. Virella3, A. Barbosa4,P.G. Lawlor5 tional changes, fatigue, gastrointestinal symptoms (nausea, vomiting, and 1Medical Oncology,Centro Hospitalar Lisboa Central, Lisbon, Portugal; diarrhea) anxiety, tension, sleep problems and pain. 2Palliative Care, Centro Hospitalar Lisboa Central, Lisbon, Portugal; Conclusions 3Epidemiology and Statistics, Centro Hospitalar Lisboa Central, Lisbon, At present, gender differences are observed in symptoms experienced by Portugal; 4Center for Bioethics, University of Lisbon, Lisbon, Portugal; advanced cancer patients however it continues to be inconclusive across 5Palliative Care, University of Ottawa, Ottawa, Canada Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S223

Background and Aims MASCC-0049 Cancer patients have been reported to experience concurrent or clustered Symptoms 2 symptoms that together may reflect an overlap or sharing of underlying pathological mechanisms, and cumulatively impact quality of life. How- PHYSIOLOGIC EFFECTS OF VAGINAL ever, there is a paucity of such studies in advanced cancer patients (ACPs) DEHYDROEPIANDOSTERONE (DHEA): ALLIANCE TRIAL who are not receiving chemo- or radiotherapy. N10C1 The primary aim was to estimate the prevalence of concurrent symptoms in ACPs and identify symptom clusters at referral. D.L. Barton1,J.A.Sloan2, L.T. Shuster3,T.Dockter2,J.Thielen4,P. Gill5, Methods J.D. Bearden6,P.J. Atherton2,D.B.Johnson7,P.J. Stella8,S.Terstreip9, Consecutive ACPs referred to a Tertiary Palliative Care Outpatient F.N. Rana10,D.M.Anderson11 ,C.L.Loprinzi12 Clinic over 16 months rated the Edmonton Symptom Assessment 1Cancer Center, Mayo Clinic, Rochester, USA; 2Biostatistics, Mayo System and 10 other symptom intensity (0–10) scores at initial Clinic, Rochester, USA; 3Wo m e n ’s Health, Mayo Clinic, Rochester, consultation (T0). Data at T0 were subject to interim analysis, as USA; 4Internal Medicine, Mayo Clinic, Rochester, USA; 5Cancer part of a longitudinal cohort study. Exploratory factor analysis (EFA) Center, Mayo Clinic Health System- Franciscan Healthcare, La- was conducted using principal factor analysis. Four factors were Crosse, USA; 6Oncology, Upstate Carolina CCOP, Spartanburg, chosen a priori to facilitate comparison with similar published stud- USA; 7Oncology, Wichita CCOP, Wichita, USA; 8Oncology, Michi- ies, and 2 or more symptoms with factor loadings>0.4 and clinically gan Cancer Research Consortium, Ann Arbor, USA; 9Oncology, meaningful interpretation were considered. Sanford Community Cancer Consortium CCOP, Fargo, USA; Results 10Oncology, University of Florida, Jacksonville, USA; 11 Oncology, Of 200 included ACPs with solid tumors and a median (range) age Metro MN CCOP, St. Louis Park, USA; 12Medical Oncology, Mayo of 70 (37–94), 57.5 % were male. Tiredness (88.0 %, 95 % CI: Clinic, Rochester, USA 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 mem- ory (37.9 %, 31.8–44.9) and hiccups (19.1 %, 13.6–24.6) were less Background and Aims common. The Kaiser-Meyer-Olkin statistic was 0.68, reflecting Effective treatments for female sexual dysfunction are needed. This adequate sampling. The 4 clusters identified in EFA are shown in analysis of secondary endpoints evaluated the impact of vaginal DHEA Ta b l e 1 . on vaginal health, hormone concentrations, bone turnover and sexual function. Methods Item Factor 1 Factor 2 Factor 3 Factor 4 Postmenopausal women, diagnosed with breast or gynecologic cancer, Pain 0.41 0.42 -0.02 −0.11 were eligible if they reported ≥ moderate vaginal symptoms. Women were Tiredness 0.68 −0.02 0.02 0.12 randomized to 3.25 versus 6.5 mg of DHEA versus plain moisturizer (PM). DHEA was compounded into a bioadhesive vaginal moisturizer. Somnolence 0.33 0.11 0.42 0.41 Women inserted the study moisturizer using a pre-filled syringe daily for Nausea 0.28 0.65 0.14 0.09 12 weeks, just before sleep, after sexual activity. Laboratory tests, vaginal Lack of appetite 0.46 0.27 −0.04 0.27 pH and maturation index were done at baseline and 12 weeks. Analysis included independent t-tests and Wilcoxon rank tests, comparing each Dispnea** 0.31 −0.33 0.40 0.41 DHEA arm with PM. Depression 0.67 0.16 0.16 0.03 Results Anxiety 0.46 0.20 0.20 0.18 One hundred forty-seven women on each arm provided blood samples; Well-being 0.80 0.02 0.10 −0.02 47 total provided pre/post vaginal samples. Vaginal cell maturation was 100 % (3.25 mg), 86 % (6.5 mg) and 64 % (moisturizer); pH decreased Vomiting 0.02 0.83 0.03 0.11 more in DHEA arms. Total score improvement on the female sexual Constipation* 0.28 0.35 −0.06 0.15 function index was better in those using 6.5 mg (p=.001). Mean changes Weight loss* 0.37 0.11 0.06 0.29 from baseline in lab values are shown below: Disphagia 0.05 −0.04 0.06 0.74 Dry mouth 0.25 0.13 0.06 0.64 Hiccups −0.28 0.45 0.11 0.53 Aromatase No Aromatase Sweating* 0.34 0.15 −0.05 0.22 Inhibitor Use Inhibitor Use Insomnia 0.17 0.08 0.88 0.07 3.25 mg 6.5 mg PM 3.25 mg 6.5 mg PM − − Sleep disturbance 0.09 0.12 0.85 0.10 Osteocalcin 0.5 0.3 0.5 0.2 0.1 0.2 − Lack of memory* 0.22 0.22 0.11 −0.14 Estradiol 0 0.2 0.3 2.1* 1.4* 0.1 DHEA-Sulfate 11.4* 24.1* −1.6 21.6* 34* 1.6

*symptom loading<0.4 on any factor *Significantly different from plain moisturizer (p<0.05) **lack of meaningful interpretation Conclusions Conclusions This study provides evidence of some systemic absorption of DHEA, but Clinically meaningful symptom clusters occur in in ACPs. Further re- given no improvement in bone biomarkers, not estrogenic activity.DHEA search is needed to establish their consistency and their association with improves physiologic vaginal health and sexual function more than a severity or survival. moisturizer alone. S224 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0067 MASCC-0034 Symptoms 2 Symptoms 2

NARRATIVES OF PATIENTS LIVING WITH DOES HOPE CORRELATE WITH SYMPTOM BURDEN RADIATION-INDUCED XEROSTOMIA: DEMYTHOLOGIZING A. Platt1,J.Gross1, M. Davis1, R. Lagman1,F.Fielding1,T.Sanford1, THE SYMPTOM H. Goforth1,C.Patel1 A. Charalambous1,M.Charalambous2, T. Tsitsi2 1Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA 1Nursing, Cyprus University of TEchnology, Limassol, Cyprus; 2Nursing, Cyprus University of Tchnology, Limassol, Cyprus Background and Aims The Herth Hope Index (HHI) is a validated and reliable tool that measures Background and Aims hope and emotional wellbeing. Comparing the HHI with Edmonton Introduction: Head and neck cancer patients often experience a number Symptom Assessment Scale (ESAS) provides a means of comparison of persistent treatment related symptoms, such as xerostomia. The impact between symptom burden and hope. Weassessed hope and its relationship of xerostomia can be profound and wearing on the patients, hence to symptom burden in an inpatient palliative medicine unit as a pilot trial. negatively influencing their quality of life. Methods Objectives: To explore the in-depth experiences of head and neck cancer Eligible patients verbally consented, participated in the study. Patients patients living with radiation-induced xerostomia. Emphasis is placed on completed or were assisted in completing the HHI and ESAS. Correlation the psychological and social impact of this symptom. between the HHI and symptom burden will be estimated using a 95 % Methods: This is a hermeneutic phenomenological study inspired by the confidence interval once the study is completed. A correlation of >0.20 or Philosophy of Paul Ricoeur. Research data were retrieved with individual <−0.20 would be considered clinically relevant. One hundred ninety- narratives from 15 patients diagnosed with head and neck cancer. Inter- three patients will be needed to have 80 % power at a 5 % significance pretation was influenced by the hermeneutic paradigm and Ricoeur’s level based on pilot data. theory of interpretation. The interpretation proceeded through three Results phases: naïve reading, structural analysis and comprehensive From pilot data of 25 patients, no correlation between hope and symptom understanding. burden was observed. Mean ESAS score is 35/90, mean Herth score is 35/ Results: Five themes emerged from the narratives reflecting on the 48. The mean ESAS NRS scores for pain is 4/10, nausea 2/10, and patients’ lived experiences. These were “suffering of the body”, “suffer- tiredness 5/10. A large study powered to 196 patients for a correlation ing of the person’sworld”, “being helpless against xeostomia”, “suffering of <0.2 will be completed January 2014 with final analysis available for of the mind” and “being alone”. The comprehensive understanding presentation. disclosed new possibilities for being-in-the world in relation to living Conclusions with xerostomia. Comparison between symptom burden and hope is relevant to patient Table 1: Examples of hermeneutic phenomenological structural analysis 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 Meaning Unit Condensation Sub-Theme Theme delivery in an inpatient palliative medicine units. It is an awkward Inability to Being strangled Suffering of situation, wanting swallow by xerostomia the (physical) to swallowing and body not been able to I had to settle with an Inability to Being withdrawn Suffering of the MASCC-0033 important asset of my communicate from the person’sworld Symptoms 2 everyday living…my others communication with CORTICOL CORRELATES OF SUNITINIB-INDUCED FATIGUE the outer world IN METASTATIC RENAL CELL CARCINOMA Drugs for xerostomia are Lack of effective Feeling despair Beeing helpless a joke, they have no effect treatment from the against D. Janini1,D.Cunningham1, N. Varnerin1, D. Allexandre1,E.Plow1, at all and when they do it ineffective xerostomia M. Davis1, B. Rini1 only lasts for a while and treatments 1Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA then the wheel is again set in motion with the same effects Background and Aims I have lost my eagerness Feeling despair Being Suffering of Fatigue is one of the most common adverse effects of sunitinib treatment to live…living is about emotionally the mind for renal cell carcinoma (RCC) and may be associated with changes in the doing the things you like drained motor cortex. Transcranial Magnetic Stimulation (TMS) is a noninvasive and be with the people method to study cortical maps. The aim of this study was to assess you love, I think that sunitinib-induced fatigue changes in cortical maps of fatiguing muscle. Ihavelostboth 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 Conclusions a hand muscle. Fatigue was assessed by the Brief Fatigue Inventory (BFI) Conclusions: The precedent consideration of xerostomia mainly as a and duration of a sustain 30 % of MVC. TMS was applied in a 7×5 grid physical side-effect of radiotherapy was outweighed by the social and (1 cm resolution) while electromyography was recorded from muscle. psychological effects revealed by this study. These xerostomia’seffects Variables included: 1) map area, 2) excitability of map, measured as the are inflicted on the patients and their families with an obvious reflection sum of electromyographic responses, and 3) location of map. on their perceived quality of life. The findings call upon a shift towards Results acknowledging the severity of xerostomia and the need to care for these Six patients have been analyzed. Average BFI score increased (p=0.043). patients holistically. MVC significantly decreased for 5 who reported greater fatigue on BFI Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S225

(p=0.043). There was no significant change in duration of sustaining MASCC-0288 30 % MVC contraction. The area map area decreased (p=0.07) shifted Symptoms 2 antero-medially (p=0.028), but the excitability did not change. Conclusions VALIDATION OF THE NUMERICAL RATING SCALE Four weeks of sunitinib increases fatigue and reduces muscle strength VERSIONS (NRS) OF THE EDMONTON SYMPTOM which parallels reorganization of the muscle’s map in the brain. The map ASSESSMENT SYSTEM (ESAS) AND ESAS-R AMONG shift suggests spread to higher motor regions in order to maintain muscle OUTPATIENTS WITH ADVANCED CANCER drive. An additional 6 patients have been entered, results will be available for the meeting. Future studies should use fMRI image connectivity B. Hannon1,M.Dyck1,A.Pope1,N.Swami1,C.Lo1,L.Le1, between brain regions. C. Zimmermann1 1Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada

Background and Aims MASCC-0077 The ESAS is commonly presented as a NRS, but has been only been Symptoms 2 validated as a visual analogue scale for outpatients with cancer. Weaimed to validate the NRS versions of ESAS and ESAS-r, and assess patient ENHANCING SYMPTOM SELF-MANAGEMENT THROUGH A preference for either version. SMARTPHONE APPLICATION: DEVELOPMENTAND PILOT Methods TESTING Patients with advanced cancer (N=202) attending ambulatory palliative care clinics at the Princess Margaret Cancer Centre, Toronto, between 1 1 2 2 3 4 C. Dubey , C. Hoeppli ,F. Carrino ,E.Mugellini ,M.Kueng ,S.Kropf , February 2012 and January 2013, completed the ESAS (with an added 4 2 S. Zuercher , M. Eicher time window of ‘past 24 h’), and the ESAS-r, (which includes a time 1 School of Health Science, University of Applied Arts and Sciences window of ‘now’ and symptom definitions). Participants completed the 2 Western Switzerland, Fribourg, Switzerland; Technology for Human Memorial Symptom Assessment Scale (MSAS) and a patient-rated ver- Wellbeing Institute, University of Applied Arts and Sciences Western sion of the Eastern Cooperative Oncology Group (ECOG) performance 3 Switzerland, Fribourg, Switzerland; Oncology and internal medicine, status measure. Physicians rated the ECOG independently. At 24 h, 26 4 Hopital Fribourgeois, Fribourg, Switzerland; Lindenhof Gruppe, patients completed a test-retest study. Lindenhof Spital, Berne, Switzerland Results ESAS and ESAS-r total scores both correlated well with total MSAS Background and Aims scores (Spearman’s rho: 0.62 and 0.64, respectively). Correlations of Cancer treatment usually comes with burdensome symptoms. As the individual ESAS symptoms with MSAS symptoms and with ECOG are majority of multimodal treatments are provided in the ambulatory sector, shown in the Table, as are correlations of the overall ESAS scores with patients often have to self-manage these symptoms. The World Health physician and patient-rated ECOG. Participants preferred the ESAS-r Organization recommends symptom management interventions from ini- (42.8 % versus 18.6 %), but preferred the ‘past 24 h’ window (52.8 %) tial diagnosis and continuing throughout illness trajectory while respecting over ‘now’ (21.3 %). The 24 h test-retest evaluation of the ESAS showed patient’s autonomy in developing his or her symptom self-management. good correlation (ICC=0.74). The aim is to present development and implementation of a smartphone Conclusions application to support symptom self-management of patients during The ESAS and ESAS-r NRS are valid and reliable for outpatients with cancer treatment. advanced cancer. The 24-h time window was preferred and may best Methods capture fluctuating symptoms in this population. In a multidisciplinary approach, we developed a three stage patient Ta bl e – Correlations of ESAS scores/subscores with validations measures support that differentiates between a) Definition of stable symptom experience and related preventive self- Measure ESAS score/subscore ESAS ESAS-r management strategies, Patient ECOG, N (r) EDS 193 (0.40) 192 (0.33) b) Definition of unpleasant symptom experience and optional self- managed interventions, Physician ECOG, N (r) EDS 173 (0.35) 172 (0.24) c) Definition of symptom experience that should be monitored/treated MSAS by health care professionals. Pain * 0.68 0.66 We defined symptom experience and related evidence based self- Lack of energy Tiredness 0.58 0.52 management strategies for the following 11 symptoms: anxiety, Nausea * 0.72 0.64 mucositis, neuropathy, hand-foot syndrome, lack of appetite, bleed- ing, diarrhea, fatigue, hair loss, nausea and vomiting, obstipation. A Sad Depression 0.66 0.64 smartphone application (iOS and Android) was developed to facil- Nervous Anxiety 0.57 0.59 itate an easy use of these management strategies. The interface was Worry Anxiety 0.64 0.65 conceived following user-centered design paradigms (in particular, visibility, accessibility and legibility) aiming at improving usability Drowsiness * 0.66 0.61 for aged people. Appetite * 0.63 0.73 Results TMSAS Wellbeing 0.45 0.46 The application is currently tested for its applicability. In springtime 2014 Shortness of breath * 0.80 0.74 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 *same item name for ESAS; EDS; ESAS distress score; TMSAS, Total the meeting. MSAS score S226 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0112 Background and Aims Symptoms 2 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 INTERNAL LYMPHEDEMA CORRELATES WITH lack content specific to RMHNC. Consequently, we undertook development SUBJECTIVE AND OBJECTIVE MEASURES OF DYSPHAGIA of the Vanderbilt Head & Neck Symptom Survey - Recurrent/Metastatic IN HEAD AND NECK CANCER (VHNSS-RM) to assess tumor-related symptoms, residual toxicity from prior L.K. Jackson1, S.H. Ridner2,J.Deng2,C.Bartow3, K. Mannion4, therapy and side effects from current therapy. The tool contains 35 physical K. Niermann5,J.Gilbert1, M.S. Dietrich6, A.J. Cmelak5, B.A. Murphy1 symptoms and 12 psychosocial issues scored from 0 (none) to 10 (severe) 1Department of Medicine, Vanderbilt University Medical Center, Nash- (ASTRO abstract 46, 2014). We report preliminary testing of the tool. ville, USA; 2School of Nursing, Vanderbilt University Medical Center, Methods Nashville, USA; 3Department of Speech and Hearing Sciences, Vander- A pilot trial with 39 patients was completed 6/2013–1/2014. Inclusion bilt University Medical Center,Nashville, USA; 4Department of Surgery, criteria: non-curable recurrent/metastatic HNC. The tool was adminis- Vanderbilt University Medical Center, Nashville, USA; 5Department of tered to patients online during clinic. Radiation Oncology, Vanderbilt University Medical Center, Nashville, Results USA; 6Department of Biostatistics Schools of Medicine and Nursing, No barriers to online tool completion were noted. Patients found the tool Vanderbilt University Medical Center,Nashville, USA 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. Background and Aims VHNSS-RM includes 12 novel symptom questions and 7 novel psychosocial Tumor/treatment-related external (EL) and/or internal lymphedema (IL) issues. Overall, symptom burden was high with moderate-to-severe symp- are associated with functional deficits and increased symptom burden in toms (VHNSS-RM ≥5) identified in >30 % of patients for 33/47 questions head and neck cancer (HNC) patients. Wenoted associations between EL/ (70.2 %), of those 48.5 % had severe symptoms (VHNSS-RM ≥7). IL and patient-reported dysphagia using the Vanderbilt Head and Neck Conclusions Symptom Survey (VHNSS) version 1.0. Consequently, we studied the The VHNSS-RM is feasible and can be completed in a timely manner. relationship between EL/IL with subjective and objective measures of RMHNC symptoms are often different than at initial presentation and during swallow function. primary treatment. The 19 novel questions could aid in improved palliation to Methods these patients. There are plans to validate the VHNSS-RM and analyze its role Eighty-one HNC patients completed: 1) VHNSS version 2.0: including in assessment of treatment response and impact on overall symptom burden. 13 swallowing/nutrition-related questions grouped into 3 clusters: swal- low 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 MASCC-0190 Dysphagia Outcome and Severity Scale (DOSS) and in conjunction with Symptoms 2 a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied timepoints to assess SYMPTOM DISTRESS IN HONG KONG CHINESE the lymphedema spectrum, from baseline (n=15, 18.1 %) to 18 months GYNAECOLOGIC CANCER SURVIVORS post-therapy (n=20, 24.1 %). Results T. Kwan1,K.Chan2,M.Chu2,R.Ho3,C.Chan3,H.Ngan2 VHNSS swallow/nutrition items scores correlated with NOMS and 1Centre on Behavioral Health, The University of Hong Kong, Hong DOSS ratings. Highest correlation was with NOMS: ss (−0.73; Kong, Hong Kong China; 2Department of Obstetrics & Gynaecology, p<0.001); sl (−0.61; p<0.001); nt (−0.56; p<0.001). VHNSS swallow/ The University of Hong Kong, Hong Kong, Hong Kong China; nutrition scores correlated with maximum grade of swelling for any single 3Department of Social Work & Social Administration, The University of structure on Patterson scale: ss (0.43; p=0.001); sl (.38; p=0.004); nt Hong Kong, Hong Kong, Hong Kong China (0.41; p=0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis and pyriform sinus were most strongly correlated with VHNSS and Background and Aims NOMS ratings. There were no meaningful correlations with VHNSS Cancer survivors may experience distressing symptoms long after the swallow/nutrition items or NOMS/DOSS ratings and EL. completion of curative treatment. This study aimed to assess the preva- Conclusions lence and associated factors of physical symptoms in Chinese IL correlated with subjective and objective measures of swallow dysfunc- gynaecologic cancer survivors. tion. Longitudinal analysis of trajectory and impact of IL/EL on dyspha- Methods gia is ongoing. 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 MASCC-0070 comprising women with benign gynaecologic diseases (n=26, mean Symptoms 2 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. PRELIMINARY TESTING OFA PATIENT REPORTED Results OUTCOME MEASURE FOR RECURRENT OR METASTATIC The cancer and control groups were demographically similar except for HEAD AND NECK CANCER marital status. Nearly all of the cancer group (96 %) and 31 % of the control L.K. Jackson1, J. Deng2,S.H.Ridner2, M.S. Dietrich3,B.A.Murphy1 group had hysterectomy with removal of ovaries. The three most common 1Department of Medicine, Vanderbilt University Medical Center, Nash- symptoms were vaginal dryness (12/14, 86 %), tiredness (17/24, 71 %) and ville, USA; 2School of Nursing, Vanderbilt University Medical Center, dyspareunia (8/14, 57 %) for the cancer group; tiredness (20/26, 77 %), lack Nashville, USA; 3Dept of Biostatistics Schools of Medicine and Nursing, of energy (19/26, 73 %) and numbness of hands/feet (15/26, 58 %) for the Vanderbilt University Medical Center,Nashville, USA control group. The two groups did not differ in their mean physical distress Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S227 scores by Mann–Whitney test (p=0.251). Hysterectomy with ovarian con- extent of subjectivity in the illness experience, which appears to be servation was significantly correlated with higher symptom distress (p= inconsistent to standardization. The aim of this study was to gain insight 0.013). No associations were found between symptom distress and time in the situation and the experiences of patients with advanced colon since surgery, age, income, education, marital status or work status. cancer currently undergoing chemotherapeutic treatment, and to identify Conclusions relevant phenomena that influence their situation. This knowledge should The overall symptom distress of women treated for gynaecologic cancer help to develop an individualized and adequate symptom management by hysterectomy only was not different from those of women surgically program. treated for benign gynaecologic disease. Methods Thirteen in-depth interviews were conducted with patients suffering from advanced colon cancer and currently undergoing chemotherapeutic treat- ment. The interviews were analyzed using thematic content analysis and MASCC-0295 type-building procedures. Symptoms 2 Results The interviews showed a broad range in experiences of disease and SYMPTOM-DISTRESS AND PSYCHOSOCIAL RESOURCES therapy, as well as different coping strategies. However, within these OF PATIENTS WITH ADVANCED COLON CANCER – A individual experiences, essential phenomena, resources, and destabilizing CROSS-SECTIONAL DESCRIPTIVE STUDY factors could be identified, that applied across individuals. Based on these findings, three ‘types’ were identified: the ‘persister’,the‘cooperator’, S. Köck-Hódi1, M. Matzka1,M.Wallner1,M.Koller1,H.Mayer1 and the ‘fighter’. Due to the type-specific phenomena, resources and 1Department of Nursing Science, University of Vienna, Vienna, Austria destabilizing factors are experienced in different ways and therefore result in different behaviors and coping strategies. Furthermore, they are vul- Background and Aims nerable to different ‘critical incidents’ thatmayleadtodestabilizationof Individual and adequate symptom management programs for patients their situation. with advanced colon cancer in the course of chemotherapeutic treatment Conclusions require specific knowledge about symptom-distress and influencing fac- While in clinical practice caution should be exercised with catego- tors, as well as knowledge about the impact of psychosocial resources. rizing, ‘types’ may help to understand different kinds of experiences This study aimed to explore the type and the extent of symptom-distress and individual strategies in coping with illness situations. For devel- and its relation to resilience, general or treatment-specific optimism, oping adequate symptom management programs, it is important to be social support, and socio-demographic factors. responsive to these different types, their perceptions, and coping Methods strategies. The study employed a cross-sectional descriptive design. Five different stan- dardized 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 MASCC-0191 currently undergoing chemotherapeutic treatment in a day-unit at a general Symptoms 2 hospital in Vienna were assessed between January and September of 2013. Results METASTATIC LUNG CANCER TO SPINE, LIVER AND Fatigue, peripheral neuropathy, altered sense of taste, nausea, ADRENAL GLAND IN A 27 YEAR OLD FEMALE: A CASE depressiveness, and anxiety were identified as the symptoms causing REPORT the highest levels of distress. Symptom-distress had a significant impact M. Milakovic1, M. Popovic1, E. Wong1, G. Bedard1, R. McDonald1, on QOL, especially for women and elders. A high correlation exists E. Chow1 between resilience, general optimism, and social support. Furthermore, 1Rapid Response Radiotherapy Program, Odette Cancer Center,Toronto, significant differences were identified between patients receiving differ- Canada ent types of therapy (infusion, oral, or antibody). Conclusions Background and Aims For high-quality cancer care and individual symptom management pro- Lung cancer accounts for 14 % of new cancer cases in Canada and has a grams for patients with advanced colon cancer, assessing the impact of 17 % 5 year survival rate. The incidence of lung cancer in patients 20– psychosocial resources and other influencing factors, such as gender, age, 29 years of age in Canada is reported to be only 20 out of 25,500 cases per or type of therapy on symptom-distress is crucial, especially for the year. This report discusses the implications of a rare case of a young development of nursing management interventions. 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. MASCC-0298 Methods Symptoms 2 A 27 year old woman was referred to the Scarborough Hospital in December 2013 for assessment of recurrent hemoptysis. Results THE COMPLEX SITUATION OF PATIENTS WITH ADVANCED A chest x-ray upon admission demonstrated right hilar and right upper COLON CANCER – THE EXPERIENCE OF COPING WITH lobe opacity, suggesting pneumonia, but not ruling out lung cancer. An DISEASE AND THERAPY urgent CTscan showed soft tissue to the right of the trachea to the thoracic H. Mayer1,S.Köck-Hódi1,C.Wollank1 inlet, paratracheal adenopathy, a compression fracture of the T9 vertebra, 1Department of Nursing Science, University of Vienna, Vienna, Austria and soft tissue extending into the spinal cord. A CTscan of the abdomen and pelvis showed 3 liver lesions, a lytic lesion on the L3 vertebra, and a Background and Aims left adrenal gland lesion. Due to the patient’s age, lymphoma was possi- Developing specific symptom management programs for patients with ble. However, a lung biopsy demonstrated malignant cells consistent with advanced colon cancer is challenging for nursing, because of the great a lung adenocarcinoma. S228 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Conclusions of pain at metastatic sites following radiotherapy, typically occurs within This case demonstrates the importance of screening all patients who the first 5 days post-treatment. exhibit symptoms consistent with lung cancer, regardless of age. 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 MASCC-0197 A 70-year-old man, diagnosed with metastatic colorectal carcinoma, Symptoms 2 presented to the Rapid Response Radiotherapy Program (RRRP) at the Sunnybrook Health Sciences Centre with right-sided chest pain. Com- puted tomography revealed progression of a destructive right anterior SYMPTOM CLUSTER: RECONCEPTUALIZED FOR CANCER sixth rib metastasis with surrounding soft tissue mass, and pain was NURSING PRACTICE reported in the associated area. The patient was treated with radiotherapy H. Nguyen1, S. Thanasilp2 and given a single dose of 8 Gy. 1Department of Nursing, Thang Long University, Hanoi, Vietnam; Results 2Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand The patient experienced rapid onset of pain flare approximately half a day following treatment. He also experienced a rapid onset of complete pain Background and Aims relief the following morning at 1 day post-therapy, an uncharacteristically Despite numerous studies have been conducting to examine symptom short duration relative to previously reported cases. clusters in cancer, the concept of symptom cluster appears not to be different Conclusions from its first introduction. Many limitations in conceptualization and empir- This case supports that pain flare is indicative of a positive response to ical approaches to this concept are hindering its application in real practice. radiotherapy as has been previously proposed. Our findings also suggest This paper aims to re-conceptualize symptom cluster to promote the the potential subjectivity of the timing and severity of pain flare onset usefulness of this concept in nursing practice. across bone metastases patients, which warrants therapy and follow-up Methods tailored on a case-by-case basis. 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 MASCC-0058 (directly or indirectly) or share the same etiology. A cluster is claimed as Symptoms 2 stable if it remains its ‘quality’ or ‘nature’ rather than to remain certain number of members. Moreover, a symptom cluster should have sentinel ASSOCIATION OF BREAST CANCER SYMPTOMS AND symptom(s). For the purpose of either symptom assessment or symptom CANCER IN POPULATION-BASED SCREENING IN FINLAND management, sentinel symptom could be the predictive symptom of the cluster or could be the one, which interacts significantly with other D. Singh1, N.E.A. Malila2, A.H.T.I. Anttila2 members. It may be helpful to find symptom clusters, which are highly 1health Sciences, University of Tampere, Tampere, Finland; 2mass screen- common or highly generalizable. However, for the better understanding ing, finnish Cancer Registry, helsinki, Finland towards such clusters, they should be examined in specific population. Most importantly, there is an urgent call for a framework to examine Background and Aims clinical relevancy of symptom cluster. This could be the key point to In Finland, organized national screening program for breast cancer is enhance the state of science related to this concept. based on mammography and clinical examination of possible symptoms. Conclusions The purpose of the study was to assess the association of symptoms at The nature of associations among symptom members, stability, sentinel screening visits with the detection of breast cancer. symptom, commonality, and clinical relevancy would be critical charac- Methods teristics of symptom cluster. Further theoretical and empirical works on A cross-sectional study was performed among women aged 50 to 69 years these attributes are recommended. 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 MASCC-0231 calculated for each symptom using the odds ratios (OR) at 95 % confi- Symptoms 2 dence intervals (CI) using logistic regression models. Results Out of 1,198,410 screening visits symptoms was reported in 298,220 RAPID ONSETS OF PAIN FLARE AND PAIN RELIEF (25 %) visits, of which breast cancer was detected in 2,323 (0.78 %) FOLLOWING PALLIATIVE RADIOTHERAPY IN A PATIENT women. Women reporting lump had an increased odd of breast cancer WITH BONE METASTASES (OR 6.47, CI 5.89–7.09) than retraction (OR 2.19, CI 1.90–2.49) and M. Popovic1, A. Agarwal1, B. Lechner1, N. Pulenzas1,P. Sheehan1, other symptoms. The sensitivity of symptoms in detecting breast cancer L. Holden1,G.Bedard1,E.Wong1, R. McDonald1, E. Chow1 was 35.5 % however individual sensitivity of symptoms ranged from 0.66 1Rapid Response Radiotherapy Program, Odette Cancer Centre to 14.7 %. The 1857 (36 %) out of 5,165 invasive tumors were reported as Sunnybrook Health Sciences Centre University of Toronto, Toronto, symptom/s. Canada Conclusions Our findings reinforce the importance of fully evaluating the symp- Background and Aims toms as a predictor of breast cancer. This study was done in a setting Pain is a common accompanying symptom in patients with bone metas- where the size of breast tumors is usually rather small. Still, the tases. Palliative radiotherapy is well-established for symptomatic bone findings may have relevance also for such countries, which plan to metastases, with pain relief onset varying from several days to 4 weeks develop CBE as an alternative to mammography screening in breast and lasting between 3 and 6 months. Pain flare, or temporary worsening cancer control. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S229

MASCC-0230 MASCC-0365 Symptoms 2 To x i c i t i e s

COMORBIDITIES AMONG PATIENTS WITH BREAST DOCETAXEL-INDUCED NAILTOXICITYAND ITS CANCER (BC) OR NON-HODGKINS LYMPHOMA (NHL) WHO PREVENTION WITH ICE-WATER FINGER DIPPING DO AND DO NOT DEVELOP FEBRILE NEUTROPENIA (FN) H.J. An1,C.Kim2,G.M.Kim3,S.Lee4,E.Park4,H.Kim1 DURING THEIR FIRST CHEMOTHERAPY CYCLE 1Medical Oncology, Catholic University, Suwon, Korea; 2Pulmonology, X. Li1,R.Luthra2,P.Morrow3, M. Fisher2,M.Reiner4,J.Page5, Catholic University, Suwon, Korea; 3Dermatology, Catholic University, R. Barron1,W.Langeberg5 Suwon, Korea; 4Hospice center,Catholic University, Suwon, Korea 1Global Health Economics, Amgen Inc., Thousand Oaks, USA; 2Health Economics and Outcomes Research, HealthCore Inc., Wilmington, USA; Background and Aims 3Global Development, Amgen Inc., Thousand Oaks, USA; 4Global Bio- Introduction: Docetaxel-induced nail toxicity is reported in 10–50 %. statistical Sciences, Amgen Inc., Thousand Oaks, USA; 5Center for Risk factors include cumulative dose and weakly administration. Severe Observational Research, Amgen Inc., Thousand Oaks, USA nail toxicity impairs patient’s quality of life which leads to treatment discontinuation. Ice-mitten is used to decrease peripheral circulation to Background and Aims nail, but but hard to get. Some comorbidities can increase FN risk among patients receiving Objectives: We observed serial changes of nails in patients receiving chemotherapy. Few studies have comprehensively examined possi- docetaxel for lung cancer and tried to prevent nail toxicity with ice-water ble FN-related comorbidities across cancers. This study compared finger dipping. comorbidity prevalence among BC and NHL patients with and Methods without FN. Methods: Patients received weekly docetaxel at a dose of 20 mg/m2,1h Methods intravenous infusion, on days 1, 8 and 15, every 4 weeks. In two patients, Using claims from managed care plans assembled by HealthCore, natural nail changes were observed, and later, another two patients did this case–control study selected the first chemotherapy cycle of adult ice-water finger dipping while intravenous infusion of docetaxel. BC or NHL patients from 2007 to 2011. Each patient who developed Results FN (case) was matched with up to 4 patients without FN (controls) by Results: In two patients without intervention, painful subungal hemor- cancer type, metastasis, chemotherapy regimen (eg, CHOP-based for rhage and nail ridge (cumulative dose: 140–160 mg/?,) followed by NHL, TC for BC), age (18–44, 45–54, 55–64, 65–74, 75+), and sex. hemopurulent subungal hematomas, longitudinal ridges, onycholysis Comorbidities were identified by diagnosis codes in the year before and paronychias developed. The whole finger nail became hyperpigment- chemotherapy. Adjusted odds ratios (aORs) and 95 % CIs for FN ed and onycholysis resulted in nail extraction. After then, regeneration were calculated comparing the risk of each comorbidity among cases from proximal nail areas (dose over 300 mg/m2) happened with relative to controls using conditional logistic regression, adjusting for onychodystrophy, subungal hyperkeratosis, trachyonychia at the distal potential confounding factors (granulocyte colony-stimulating factor areas. Nail change of toes was somewhat delayed and less severe than prophylaxis and previous hospitalization, surgery, and healthcare hands. In two patients who did ice-water finger dipping, any of nail expenditure). changes developed but in toes and patients were tolerable to ice-water. Results Four patients showed more than stable disease with chemotherapy. Numerous comorbidities were more prevalent in FN cases than controls Conclusions (Table). Conclusions: Finger nail changes in patients receiving weakly docetaxel were subungal hemorrhage, purulent change, onycholysis, and then re- generation. Ice-water finger dipping was effective to prevent nail toxicity. BC NHL FN cases 308 179 Controls 1,232 690 Comorbidity* aOR (95 % CI) MASCC-0400 To x i c i t i e s Chronic obstructive pulmonary disease 1.1 (0.6,1.8) 1.5 (0.9,2.4) Coronary artery disease NA 0.9 (0.5,1.6) MORBIDITY OF HYPERTHERMIC INTRAPERITONEAL Diabetes 1.2 (0.8,2.0) 1.1 (0.7,1.8) CHEMOTHERAPY:A REPORT OF 21 CASES IN A CANCER Dyslipidemia 1.0 (0.7,1.4) 1.4 (0.9,2.0) CENTER Hypertension 1.2 (0.9,1.7) 1.2 (0.8,1.8) J. Danklou1,G.Lefebvre1,E.Dalle1, G. Marliot2,I.Sakji2, N. Leroux3, 3 3 4 4 Liver disease NA 1.6 (0.9,2.8) D. Lefebvre ,R.Rohn,F. Narducci , E. Leblanc 1Oncology supportive care department, Centre Oscar Lambret, Lille, Renal disease NA 2.3 (1.2,4.1) France; 2Clinical pharmacy department, Centre Oscar Lambret, Lille, Osteoarthritis 1.8 (1.1,3.2) NA France; 3Anesthesy department, Centre Oscar Lambret, Lille, France; Osteoporosis NA 1.6 (0.9,2.9) 4Surgery department, Centre Oscar Lambret, Lille, France Thyroid disease 1.2 (0.8,1.7) 1.4 (0.8,2.4) ≥ Background and Aims *Comorbidities with 20 FN cases shown 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 sig- Conclusions nificant morbidity. The aim of this study was to investigate mor- Certain comorbidities (eg, osteoarthritis in BC, renal disease in NHL) bidity according to the Clavien-Dindo classification, in 21 patients should be further evaluated and considered in FN risk assessment. treated by HIPEC. S230 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Methods Results This is a review of all patients treated for peritoneal disease by HIPEC Five patients who received ponatinib for either treatment-refractory between 2006 and 2013. They had laparotomy with or without CML or metastatic gastrointestinal stromal tumors, developed cytoreductive surgery and heated fluid with chemotherapy irrigated with prominent hyperkeratotic folliculocentric eruptions involving the a temperature of 41–43°. scalp, face, trunk and extremities resembling pityriasis rubra pilaris Results or inflammatory keratosis pilaris; these eruptions began 2–4 weeks One man and 20 female were included. The median age was 60 years into therapy. Multiple patients also exhibited marked xerosis, [37–71]. 57 % were obese (BMI>30) and 5 % were morbidly obese asteatosis and striking areas of ichthyosiform scale, particularly (BMI>40). The PS was 0 (n=17), 1 (n=3) and unknown for one person. on the lower extremities. 52 % had preoperative albumin<30 g/l. 38 % had first recurrence of Conclusions ovarian carcinomatosis, 62 % had peritoneal mesothelioma or While the mechanism for these eruptions remains undefined, we suspect pseudomyxoma. 43 % had received a first line chemotherapy before that ponatinib, and other tyrosine kinase inhibitors, result in dysregulation HIPEC. 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 Drug Dose Route of Hystologic Number critical insight into mechanisms for the pathogenesis of pityriasis rubra admistration type or organ of patients pilaris and other follicular and ichthyosiform disorders. Cisplatin 80 mg/m2 Intraperitoneal Ovarian 8 for 30 mn carcinomatosis 5 Fluorouracil 400 mg/m2 Intravenous Pseudomyxoma 13 Oxaliplatin 300 mg/m2 Intraperitoneal Mesothelioma for 30 mn MASCC-0609 To x i c i t i e s Irinotecan 200 mg/m2 Intraperitoneal for 30 mn PAPULOPUSTULAR (ACNEIFORM) SKIN ERUPTIONS Severe outcomes were reported: digestive hemorrhage grade III 10 %, RESULTING FROM HER2 INHIBITION WITH TRAS anemia grade II 10 %, pneumonia grade II 30 %, febrile aplasia grade II TUZUMAB 10 %, thrombocytopenia grade II 10 %, septic shock grade IV 10 %, renal J. Sheu1, E. Hawryluk2,N.R.LeBoeuf1 failure grade II 30 %, renal failure grade IV 10 % . 1Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Insti- There is no statistically significant difference in overall complications tute, Harvard Medical School, Boston, USA; 2Dermatology Brigham & according to the type of chemotherapy used (p>0.05). Wo m e n ’s Hospital/Dana-Farber Cancer Institute, Boston Children’sHos- pital, Boston, USA Conclusions Although some complications may be related to the surgery,this study has Background and Aims identified high toxicity due to HIPEC including febrile aplasia, severe The epidermal growth factor cell surface receptors (HER1/EGFR, renal failure and thrombocytopenia. HER2, HER3, HER4) are common oncologic targets. It is well- described that HER1/EGFR inhibitors frequently cause a papulopustular eruption. However, reports of these eruptions in pa- tients treated with HER2 inhibitors are rare. A single case of acneiform dermatitis associated with trastuzumab has been reported, MASCC-0610 despite the increasing use of HER2 inhibitors for breast cancer. With To x i c i t i e s 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. PONATINIB-INDUCED FOLLICULOCENTRIC, ICHTH Methods YOSIFORM AND PITYRIASIFORM ERUPTIONS We describe the acneiform/papulopustular eruption from trastuzumab, A. Alloo1,J.Sheu1, A. Watson1,J.Butrynski2, G. Murphy3,N.R.LeBoeuf1 discuss its management and review the pathophysiology of the epidermal 1Dermatology Brigham & Women’s Hospital/Dana-Farber Cancer Insti- growth factor receptors in skin keratinocytes. tute, Harvard Medical School, Boston, USA; 2Medical Oncology/ Results Program in Sarcoma, Dana-Farber Cancer Institute, Boston, USA; Four patients undergoing treatment of breast cancer with trastuzumab 3Pathology, Brigham and Women’s Hospital, Boston, USA developed an acneiform eruption 7 to 22 days following initiation of therapy. In one case, the eruption prompted dose interruption. All pa- Background and Aims tients’ eruptions resolved with treatment. No patients experienced erup- Ponatinib, a potent third-generation tyrosine kinase inhibitor active tion recurrence and all patients continued or completed the trastuzumab against mutated and wild-type BCR-ABL, has demonstrated significant course. All are alive today, two still undergoing treatment, with no efficacy in CML and Philadelphia-chromosome positive ALL. It is also evidence of breast carcinoma. currently being explored in various other solid organ-tumor trials. Re- Conclusions cently published trial data suggests that dermatologic toxicity, in the form Compared with HER1/EGFR homodimers, the predominant dimerization of a non-specific ‘rash,’ or ‘dry skin,’ is the most common side effect form of these cell surface receptors in skin keratinocytes, HER2 associated with the use of ponatinib. homodimers and HER1/HER2 heterodimers are thought to be expressed Methods at very low levels. HER2 inhibition is significant enough to also cause a We describe five patients treated with ponatinib who experienced derma- papulopustular reaction, although less frequently. Prompt recognition and tologic side-effects, review the management of these eruptions and hy- appropriate treatment of this papulopustular reaction in patients treated pothesize on pathophysiologic mechanisms that may result in these with HER2 inhibitors prevent chemotherapy treatment interruptions and effects. may also improve patient quality of life. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S231

MASCC-0432 Conclusions To x i c i t i e s The most common AEs observed with afatinib were characteristic of EGFR- inhibiting agents. Grade ≥3 AEs were short-lived and responded to dose interruptions/reductions. Treatment discontinuation due to EGFR-related EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) AEs was low, indicating that afatinib has a manageable safety profile and -MEDIATED ADVERSE EVENTS (AES) IN PATIENTS WITH is suitable for the long-term treatment of EGFR M+ NSCLC patients. 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, MASCC-0453 S.L. Geater6, D. Massey7, D. O’Brien8,V.Zazulina9,Y.L.Wu10 To x i c i t i e s 1Oncology, National Taiwan University Hospital, Taipei, Taiwan; 2 Medicine, Massachusetts General Hospital Cancer Center,Boston MA, NEUTROPENIC ENTEROCOLITIS DUE TO TREATMENT USA; 3Medical Oncology, Princess Alexandra Hospital, Brisbane, 4 WITH DOCETAXEL-BASED ADJUVANT CHEMOTHERAPY IN Australia; Medical Oncology, West German Cancer Center University PATIENTS WITH BREAST CANCER Duisburg-Essen, Essen, Germany; 5Clinical Oncology, The Chinese Uni- versity of Hong Kong, Hong Kong, Hong Kong China; 6Internal Medi- A. Paisan1, A. Bujedo1,C.Churruca1, N. Ancizar1,J.Blanco1, cine, Prince of Songkla University, Songkhla, Thailand; 7Biometrics and J. Gomez1,G.Lizeaga2, I. Alvarez1 Data Management, Boehringer Ingelheim Limited, Bracknell, United 1Medical Oncology Unit, Hospital Universitario Donostia, San Kingdom; 8Global Pharmacovigilance, Boehringer Ingelheim Pharma- Sebastian, Spain; 2Pharmacology Unit, Hospital Universitario Donostia, ceuticals, Ridgefield CT,USA; 9Clinical Development & Medical Affairs, San Sebastian, Spain Boehringer Ingelheim Limited, Bracknell, United Kingdom; 10Vice Pres- ident, Guangdong General Hospital, Guangzhou, China Background and Aims Neutropenic enterocolitis (NE) or typhlitis is a life-threatening complica- Background and Aims tion of chemotherapy.Typhlitis is more often associated with hematologic Afatinib, an oral, irreversible ErbB family blocker, showed superior malignancies but it has also been reported in solid tumors, especially in efficacy to chemotherapy in EGFR M+ patients in the LUX-Lung 3 those treated with taxane-containing chemotherapy. (LL3) and LUX-Lung 6 (LL6) first-line trials. Here, we present data on Methods common EGFR-mediated AEs from both phase III trials. Retrospective analysis of breast cancer patients treated with adjuvant doce- Methods taxel containing polychemotherapy that presented NE as adverse event. 345 (LL3) and 364 (LL6) EGFR M+ patients were randomized (2:1) to Patients were treated between March 2007 and January 2013, at Hospital afatinib (40 mg) or chemotherapy. On-treatment AEs were summarized Universitario Donostia. The schemes used were TAC (docetaxel-adriamycin- by preferred and grouped terms. No AE diaries were supplied; patients cyclophosphamide) plus GCSF or TC (docetaxel-cyclophosphamide). recalled AE start/stop dates during clinic visit. AEs were graded using Results NCI-CTCAE version 3.0. Four hundred sixty-three cases were evaluated: 331 (TAC) and 132 (TC). Results NE occurred in 17 patients (3.67 %), 12 TAC and 5 TC, with a mean age of Two hundred twenty-nine and 239 EGFR M+ patients were treated with 52.7 (28.5–69.9). In 15 patients (88.24 %) typhlitis appeared in first cycle afatinib in LL3 and LL6, respectively, and reported ≥1 AE. The com- and mean interval debut after chemotherapy was 8.2 days (5–18). Thirteen monly observed EGFR-mediated AEs are included in the Table (n=468). 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 # # Most common Diarrhea Rash/acne Stomatitis/mucositis Paronychia unit. Mean hospital stay was 12.4 days (1–42). NE was resolved without EGFR-mediated AEs* All grades, n (%) 434 (92.7) 399 (85.3) 293 (62.6) 208 (44.4) sequelae in 13 cases (76.47 %). 3 patients (17.65 %) died (1 TC and 2 TAC). Grade ≥3, n (%) 48 (10.3) 72 (15.4) 33 (7.1)† 26 (5.6) Chemotherapy was halted in 6 patients (35.29 %). One (5.88 %) resumed Onset of Grade ≥3 event, n (%) the same treatment, 8 (47.06 %) reduced dose, and 2 (11.76 %) changed to Before Week 6 32 (6.8) 16 (3.4) 23 (4.9)† 1(0.2) other scheme without docetaxel. No new episodes of NE appeared. After Week 6 16 (3.4) 56 (12.0)† 10 (2.1) 25 (5.3) Conclusions Median duration of an episode 5.0 10.0 8.0 14.0 NE as adverse event of docetaxel-containing adjuvant chemotherapy for with ≥1daypf Grade ≥3 event (days)± breast cancer is uncommon, but is a life-threatening complication, and Event led to dose 64 (13.7) 78 (16.7) 32 (6.8) 32 (6.8) intensive supportive care should be started immediately. reduction, n (%) Grade 3 recurred after 6(1.3) 8(1.7) 2(0.4) 3(0.6) dose reduction, n (%) Event led to treatment 3(0.6) 5(1.1) 1(0.2) 2(0.4) MASCC-0573 discontinuation, n (%) Serious AE, n (%) 17 (3.6) 4 (0.9) 3 (0.6) 0 To x i c i t i e s

THE ROLE OF PEGFILGRASTIM IN THE TREATMENT OF *All events regardless of relationship to study treatment. NEUTROPENIA - DATA FROM LATVIAN ONCOLOGY #Grouped term. CENTER †Includes 1 patient with a Grade 4 event. ±Based on patient recollection. S. Plate1, Z. Zvirbule1,S.Kasperova1 No Grade 5 events were observed. 1chemotherapy, Riga East University Hospital Latvia Oncology center, The majority of patients experienced 1 or 2 episodes of diarrhea (69.2 %) Riga, Latvia and rash/acne (78.8 %). Other drug-related EGFR-mediated AEs includ- ed cheilitis (7.7 %), conjunctivitis (4.7 %), and dry eyes (3.2 %). Related Background and Aims interstitial lung disease-like events occurred in 4 (0.9 %) patients (Grade Hematologic toxicity, especially neutropenia, from chemotherapy is the 1, Grade 3, Grade 4, Grade 5). most prevalent serious side effect. S232 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Neutropenia can lead to complications such as fever, patient hospitaliza- and expression of tumor suppressor genes increased significantly. BP-C2 tion and schedule delays. Several hematopoietic growth factors have been stimulated the innate immune system. The effect is properly mediated via identified. Filgrastim and pegfilgrastim are in reimbursement in Latvia. several cytokines (TNF-α, INF-γ, GM-CSF, IL-1β, IL-6, Il-25) and The study has been conducted to clear up the impact of efficacy of apoptotic genes. pegfilgrastim. Conclusions Methods BP-C2 is potential for clinical use protecting and treating radiation The clinical data of patients who recieved pegfilgrastim in the Latvian induced skin injuries. Oncology center from September 2009 until December 2012 were Fig1: 5 weeks after irridatiation 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 Fig 2: Histologic of full-thickness skin biopsy 5 weeks after exposure to with other cancer types. All patients start therapy with pegfilgrastim after 30 GY. 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. MASCC-0420 To x i c i t i e s

MASCC-0374 A PRACTICAL APPROACH TO IMPROVE SAFETYAND To x i c i t i e s MANAGEMENT IN AMBULATORY CHEMOTHERAPY UNITS BASED ON A CHEMOTHERAPY NETWORK MONITORING BP-C2, A NEWANTI-RADIATION COMPLEX PREVENTAND PROGRAM CURE RADIOTHERAPY INDUCED SKIN INJURIES IN MICE F. Scotté1, H. Aboudagga2,R.Elaidi3,C.Thibault3,B.Bonan4, A. Rasmussen1,F.F.Fares2, B.A. Azzam2,B.F.Fares2,S.L.Laresn3, S.L.J. J. Stevens3,V. Tual3, S. Oudard3 Lindkær-Jensen2 1Medical Oncology AND Supportive Care in Cancer Unit, Georges 1Clinical Oncology, Meabco A/S, Copenhagen, Denmark; 2Dep. of Mo- Pompidou European Hospital, Paris, France; 2Pharmacy Department, lecular Biology, Carmel Medical Center University of Haifa, Haifa, Georges Pompidou European Hospital, Paris, France; 3Medical Oncol- Israel; 3Controlled Clinical Trials and Biostatistics, University Oslo, ogy, Georges Pompidou European Hospital, Paris, France; 4Pharmacy Oslo, Norway Department, Foch Hospital, Suresnes, France

Background and Aims Background and Aims BP-C2 is a topical radio-protective drug based on a benzene-poly- The PROCHE [Programme for optimisation of the chemotherapy carboxylic acid complex with molybdenum having detoxifying properties network] initiative is an innovative oncology-monitoring program and BP-Cx-1, a globular polydentant ligand known for its free radical designed to reduce patient waiting time and chemotherapy wastage, scavenging, anti-oxidant and detoxifying activity.BP-C2 results in highly ultimately improving patient care. This program is evaluated on a significant survival in animals receiving either lethal or sub-lethal doses 4 years period. of gamma irradiation; LD50/30 at 6.56 GY. In vitro studies demonstrated Methods no toxicity (LDH release) after administering BP-C2. This prospective study compared the program Data from patients entered Methods in the PROCHE program with 513 control patients. This study included a prophylactic treatment group (PTG), a post treat- Results ment group (PoTG), and a control group (CG) (n=8 each) of mice Between Oct 2008 and Feb 2014, 2,040 patients participated in the irradiated with 30 GY at the one hind leg. The PTG was sprayed with program, representing 21,920 scheduled chemotherapy. Main ad- BP-C2 dose 0.75 mg/ml on the day of irradiation and 3 times a week for verse events (AE) were collected on an ongoing basis (percentages 5 weeks. The PoTG was treated with BP-C2 similarly after occurrence of are rounded to nearest integer, m=mild, M=moderate, S=severe, skin injuries. The effects were investigated by H&E histopathology, LT=life threatening). cytokine and gene expression by immunohistochemistry. Fatigue was the most incident: 25 % (m), 35 % (M), 16 % (S) and 3 % Results (LT). Pain: 11 % (m), 14 % (M), 5 % (S) and 1 % (LT). No skin injury was observed in the PTG. All mice in the CG and PoTG At least one episode of infection was present in 5 % of patients. developed severe skin injuries with ulcerations (Fig1). In the PoTG all Nausea: 12 % (m), 6 % (M) and 1 % (S) and vomiting : 3 % (m), 1 % (M), mice were cured after 5 weeks of BP-C2. Histological evaluation of the <1 % (S) and <1 % (LT). skin demonstration protection (fig2). Oncogenes expression decreased Weight loss: 6 % (m), <1 % (M) and <1 % (S). Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S233

Mucositis: 6 % (m), 2 % (M) and <1 % (S). Methods Diarrhea: 6 %(m), <1 %(M) and <1 %(S). Methods: Between January 2010 and February 2014, data from patients Constipation: 12 %(m), 1 %(M), <1 %(S) and <1 %(LT). with metastatic RCC good/intermediate risk and treated with Sunitinib Neuropathy: 22 % (m), 6 % (M), 2 % (S) and <1 % (LT). were collected. Response to treatment was assessed by RECIST criteria Results demonstrated significant reductions in mean hospital stay i.e. (v1.1) and toxicities were graded according to NCI-CTC (v4.0). decreased it by 53 min allowing 95 % of patients satisfied with the care. Results Conclusions Results: A total of 19 patients, median age of 63 (46–88) years, 95 % The PROCHE initiative resulted in improved patient quality of care and men, were included. The most frequent symptom leading to diagnosis improved hospital as well as pharmacy efficacy. 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 hyperten- MASCC-0519 sion (26 %). Those were responsible for a treatment delay/dose reduction/ To x i c i t i e s suspension in 53 %, 32 % and 26 % of the cases, respectively. Median progression-free survival (PFS) was 14.17 months (10.9–17.4) and over- NEUROCOGNITIVE OUTCOME IN CHILDREN WITH ACUTE all survival (OS) was 27.5 months (11.7–43.3). LYMPHOBLASSTIC LEUKEMIA FOLLOWING HIGH-DOSE Conclusions METHOTREXATE Conclusions: Despite similar toxicity profile compared with other stud- ies, there is still room to optimize supportive care, as a significant number L. Sherief1, E. Abdel khalek1,A.Shebl2, R. Sanad2,A.ElHada3, of changes to treatment plan was obtained. N. Kamal4, E. El-Safy5,E.Ibrahim6 1Pediatric 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, MASCC-0530 Egypt To x i c i t i e s

Background and Aims EFFICACY OF LIPEGFILGRASTIM VERSUS PEGFILGRAS To investigate neurocognitive function in children treated for acute TIM IN PATIENTS WITH BREAST CANCER: SUBGROUP lymphoblastic leukaemia (ALL) with high dose methotrexate ANALYSIS BASED ON AGE, WEIGHT, AND TYPE OF (HDMXT) and to identify treatment-related risk factors that can lead TREATMENT to impairment. C. Volovat1,A.Buchner2,P. Bias2, U. Mueller3 Methods 1medical oncology, Centrul de Oncologie Medicala, Iasi, Romania; In this multi-centres study, 102 survivors with ALL and 5o healthy 2Clinical, Teva Rathiopharm, Ulm, Germany; 3Clinical, Teva Pharma- control were included. All patients and controls were subjected to test ceuticals Inc., Ulm, Germany the Cognitive function through the Wechsler Intelligence Scale. Results Background and Aims There is impairment in full scale in ALL survivors than the control except Background and Aims: Lipegfilgrastim is a long-acting, fixed-dose, for coding. The impact of HDMXT was dependent on young age at glycopegylated recombinant granulocyte colony-stimulating factor diagnosis for intelligence, academic, and memory functions but not in developed to reduce the duration of severe neutropenia and the picture completion and object assembly. incidence of febrile neutropenia (FN) in adults receiving myelosup- Conclusions pressive chemotherapy with a ≥20 % risk of FN. This analysis HDMXT appears to have effects on neurocognitive functions. We hope evaluated the effects of age, weight, and treatment type (adjuvant that this new study will help us for early identification for preventive vs metastatic disease) on the efficacy of lipegfilgrastim vs behavioral or educational intervention. pegfilgrastim using data from 2 studies (1 phase II, 1 phase III) in breast cancer patients receiving chemotherapy. Methods MASCC-0583 Both studies randomized patients to subcutaneous lipegfilgrastim (3, To x i c i t i e s 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 doce- taxel) for 4 21-day cycles. Blood samples for absolute neutrophil EFFICIENCYAND TOXICITY STUDY OF SUNITINIB IN counts (ANC) were obtained 24 h before chemotherapy (cycle 1), RENAL CELL CARCINOMA – EXPERIENCE OFA LARGE daily until day 15, and during cycles 2, 3, and 4. This post hoc LISBON’S HOSPITAL CENTER analysis, pooled data from the lipegfilgrastim and pegfilgrastim 6- A. Trindade1,P.Barata1, S. Oliveira1,F.Gomes1, C. Ribeiro1,F.Filipe1, mg groups from both studies. Study endpoints included duration of M. Custódio1,R.daLuz1, L. Batarda1 severe neutropenia; time to ANC recovery; depth of ANC nadir; and 1Oncology, Centro hospitalar Lisboa Central, Lisboa, Portugal incidence of grade 4 neutropenia stratified by age, weight, and type of treatment. Background and Aims Results Introduction: Sunitinib is the current standard of care in the first-line Data for stratified efficacy endpoints are summarized in the Table. treatment of advanced RCC. As incidence of side effects with Sunitinib Conclusions varies between clinical studies, clinical information from different popu- Treatment with lipegfilgrastim limits the extent of neutropenia re- lations is very useful to help physicians to maximize efficacy and to gardless of patient age, weight, or type of treatment. This post hoc optimize supportive care for patients treated with this drug. analysis demonstrates a trend for a lower rate of grade 4 neutropenia Objectives: To evaluate the response to treatment with Sunitinib in with lipegfilgrastim treatment that is consistent across all subgroups metastatic RCC and related toxicity. evaluated. S234 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

MASCC-0361 Results Toxicities 2 Patients characteristics are summarized in table 1.

Table 1. Patients’ characteristics IS THERE A ROLE OFA PRONE POSITION WITH A BELLY BOARD AND IMRT FOR MAXIMAL SMALL BOWEL SPARING IN ADJUVANT RADIOTHERAPY OF ENDOMETRIAL Parameters N CANCER Number of patient 30/459 (7 %) 1 1 2 1 S. Akyurek ,T.Kutuk,K.Kose, S. Cakir Gokce Sex 1Radiation Oncology, Ankara Üniversity Faculty of Medicine, Ankara, Turkey; 2Biostatistic, Ankara Üniversity Faculty of Medicine, Ankara, Male 16 (53 %) Turkey Female 14 (47 %) Age Background and Aims Median 58 Small bowel dose is major dose limiting factor for adjuvant radiotherapy – of endometrial cancer. In this study we aimed to determine whether the Range 30 80 combination of a prone position with belly board device (BBD) and Primary tumor intensity-modulated radiotherapy (IMRT) would further reduce the radi- Colorectal cancer 15 (50 %) ation dose to the small bowel compared with IMRT in supine position. Breast cancer 5 (17 %) Methods Ten endometrial cancer patients scheduled for pelvic postoperative adju- Gastrointestinal (not colorectal) cancer 5 (17 %) vant external beam radiotherapy were selected. Patients were Lung cancer 2 (6 %) immobilized with BBD in prone position or in supine position for CT Other 3 (10 %) simulation. Oral gastrograffin was used as small-bowel contrast. Clinical and Planning target volumes (CTV and PTV) as well as organ at risk Performance Status (OAR) (small bowel, bladder, rectum) were delineated in both studies. A 022 comparison of DVH parameters for PTV, small bowel, bladder, and 16 rectum were performed. 22 Results The percentage of volume receiving 10, 20, 30, 40, 45 and 50 Gy (V10– Histology V50) for small bowel was 42.6 %, 28.5 %, 12.6 %, 4.7 %, 2 %, and 0.5 % Adenocarcinoma 21 (70 %) in the prone group and 44 %, 34 %, 18 %, 7 %, 4 %, and 0.7 % in the Invasive ductal carcinoma 5 (17 %) supine group. These difference were significant for V30 and V40, p=0.005 Other 4 (13 %) and p=0.009, respectively. Similarly, the dose-volume histograms for bladder and rectum were obtained, there were not any significant differ- Anti-tumoral treatment ence. The comparison showed a similar PTV coverage of 95 % of the Antiangiogenic drug (Bevacizumab of others) 12 (40 %) prescribed dose and for target conformity in IMRT plans (prone vs supine). Cetuximab/Panitumum ab-based therapy 5 (17 %) Conclusions We found that, the combination of a prone position with BBD and IMRT Herceptin 1 (3 %) can spare small bowel volumes of 30Gy and 40Gy dose levels. Standard chemotherapy (Platinum-based) 12 (40 %) Stage of disease M0 8 (27 %) M1 22 (73 %) MASCC-0195 Toxicities 2 Catheter-related complications occurred in 30 out of the 459 analysed cancer patients (7 %): 5 of them were receiving chemotherapy (17 % of LOCAL COMPLICATIONS OF CENTRALVENOUS the patients developing complications and 1 % of all the treated patients) CATHETERS IN THE TARGET THERAPY ERA while the remaining 25 were receiving biological drugs (83 % of the R. Berardi1, S. Rinaldi1,D.Santini2, B. Vincenzi2,R.Giampieri1, patients with complications and 5 % of all the treated patients). Forty per E. Maccaroni1,F.Marcucci1, M. Francoletti1,A.Onofri1, A. Lucarelli1, cent of the patients were receiving an antiangiogenic drug, 43 % were C. Pierantoni1, G. Tonini2, S. Cascinu1 receiving an anti-EGFR. Treatment with a biological drug has been 1Clinica di Oncologia Medica, Università Politecnica delle Marche, shown to be the only one related to the central venous catheter compli- Ancona, Italy; 2Oncologia Medica, Campus Biomedico, Roma, Italy cations (p=0.02).(Table2)

Background and Aims Table 2. Complications’ Treatment Totally implantable central venous accesses (port-à-cath) are often used for chemotherapy administration or prolonged intravenous infusions in Ty pe Outcome Dehiscence Infection Dislodgement of Chemotherapy Biological Chemotherapy Biological Chemotherapy Biological cancer patients. Despite the technique has been well described, some therapy complications may occur. Among the others, thrombosis and infections drugs drugs drugs Antibiotic Resolution 2 (6 %) 3 (10 %) 5 (17 %) therapy are well known. The aim of the study is to investigate complications with Removal 2 (6 %) 1 (2 %) 1 (3 %) 3 (10 %) the new target therapies. New Resolution 6 (20 %) 1 (3 %) suture Methods Removal 1 (3 %) 5 (17 %) Over a 2 year period 459 devices were placed in two Academic Italian Institutions. Patients characteristics, catheter-related complications and No differences between anti-angiogenic drugs and anti-EGFR have been correlation with target therapy administration were analyzed. shown. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S235

Conclusions MASCC-0202 Our results showed that targeted therapy may influence the occurrence of Toxicities 2 biological complications (i.e. infection and dehiscence) and that the onset of these complications occurs earlier in patients receiving biological drugs SAFETY OF RENAL FUNCTION IN EASTASIAN (and in particular during bevacizumab vs. anti-EGFR therapy) than in OUTPATIENTS TREATED WITH A SHORT HYDRATION FOR those undergoing traditional chemotherapy.Further studies are required in CISPLATIN COMBINATION CHEMOTHERAPY order to establish how to manage complications due to new target thera- pies. Y. Choi1, K. Kim1, D. Shin2, H. Kang2,Y.Kim1, J. Park1, H. Lee1, K. Kwon1,B.Seo1,I.Na2, S. Yang2 1Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea; 2Internal Medicine, Korea Cancer Center Hos- pital Korea Institute of Radiological and Medical Sciences, Seoul, Korea

MASCC-0252 Background and Aims Toxicities 2 Cisplatin presents an important chemotherapeutic agent for many solid tumors. However, renal toxicity, which limits its use, requires a 24 h AN ITALIAN ASSOCIATION FOR SUPPORTIVE CARE IN hydration schedule in an inpatient regimen to ensure safe administration. CANCER: THE CASE OF NICSO (NETWORK ITALIANO DI In this study, we studied the safety of short hydration in outpatient for CURE DI SUPPORTO IN ONCOLOGIA) intermediate to high dose of cisplatin administration. Methods 1 2 3 4 F.Roila, C. Ripamonti ,A.Antonuzzo,P. Bossi Outpatient data was examined retrospectively for patients treated with 1 2 Medical Oncology, S Maria Hospital, Terni, Italy; Supportive Care in cisplatin (> or=60 mg/m2/cycle) from January 2010 to December 2012. Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, They were given a short hydration regimen, which included 2000 ml of 3 Italy; Supportive Care in Cancer Unit, Polo Oncologico, Pisa, Italy; fluids with control of diuresis. Serum creatinine and creatinine clearance 4 Head and Neck Medical Oncology, Fondazione IRCCS Istituto levels were monitored. Nazionale dei Tumori, Milano, Italy 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 Background and Aims cancer (17.3 %). One patient was withdrawn from chemotherapy because In the oncological setting, there is an increased need of a comprehensive of renal toxicity. For the other 184 patients, the maximum median per- assessment and treatment of cancer and/or treatment related symptoms, centage change in creatinine from baseline during the cycles of chemo- toxicities and/or complications from diagnosis to treatment and follow- therapy was 0 % ranging from −30 to 40 % (95 % CI=−20–30). There up. was no difference in serum creatinine and creatinine clearance between Methods the groups with co-morbid conditions (hypertension, diabetes, heart On 14th December 2013 a new Italian Association (NICSO) was born disease) during treatment (P=0.36). with these aims, requiring to be recognized by MASCC. Conclusions Results A short hydration regimen, which included 2,000 ml of fluids, for the The Association does not have political or confessional characteristics, it outpatient administration of cisplatin at≥60 mg/m2 was feasible. 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. MASCC-0222 Design, development and implementation of epidemiological Toxicities 2 studies; 2. Design, development and implementation of biomedical research; A COMPARISON OF TOXICITYAND SUPPORTIVE CARE USE 3. Acquisition and use of the technical means required to carry out the BETWEEN FOUR CYTOTOXIC AGENTS USED IN PATIENTS research and studies described above; WITH TRIPLE NEGATIVE METASTATIC BREAST CANCER 4. Design and development of educational programs to release to all (TN-MBC) professional medical and nursing personnel, patients and their asso- 1 2 3 C. Faria , G. Dranitsaris ,D.Cox ciations and volunteers; 1 2 Outcomes Research, Eisai Inc, Woodcliff Lake, USA; Outcomes Re- 5. Assistance and support for the growth and scientific culture of young search, Augmentium Pharma Consulting, Toronto, Canada; 3Outcomes people by support to meetings and awards, also through other Research, Eisai Inc., Woodcliff Lake, USA collaborating institutions; 6. Assistance and support for development of communication skills, Background and Aims particularly for medical-scientific congress organization, video re- Eribulin (E), Capecitabine (C), gemcitabine (G) and vinorelbine (V) are leases, informative books, brochures and further related literature commonly used as single agents in patients with TN-MBC. In this study, relating to patients or health professionals; toxicity and supportive care use was compared between the four agents in 7. Participation in medical-scientific congresses a sample of TN-MBC patients. Methods 8. Publication of articles or independent reviews; The study identified 225 TN-MBC patients treated with single 9. Creation of a dedicated website agent E (n=47), C (n=69), G (n=56) or V (n=53) in 19 commu- Conclusions nity oncology clinics across the U.S. Data collection included In May 12th, will be held in Rome the first NICSO meeting, with patient and disease characteristics, prior therapies, supportive care aim to define the social membership’s duties and to discuss scien- drugs, the occurrence of dose limiting toxicities and their impact tific protocols. on health care resource use. S236 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Results MASCC-0113 The median lines of therapy with C, G, Vand E were 2nd, 3rd, 3rd and 4th Toxicities 2 respectively. The most common toxicities for patients who received C, G and V were diarrhea (29.4 %), anemia (32.1 %) and neutropenia (45.3 %) HEPATOTOXICITY REPORTED IN ASSOCIATION WITH respectively. The most common toxicities for E were anemia (32 %) and VISMODEGIB: A RESEARCH ON ADVERSE DRUG EVENTS neutropenia (31 %). Blood transfusions were most prevalent with G AND REPORTS (RADAR) PROJECT (12 %) and E (19 %). In contrast, unplanned clinic visits were most common with C (7 %). Erythropoietin stimulating agents (ESAs) use B. Edwards1,D.Raisch2,S.Saraykar1,R.Arabyat3,J.Hammel4, was highest with V (26 %) relative to E (15 %), G (18 %) and C (16 %) I. Aslam4,F.Herlong5,D.West4 respectively. Toxicity was the cause of treatment discontinuations (D/Cs) 1General Internal Medicine, UT MD Anderson Cancer Center,Houston, in more patients receiving C (12 %) compared to 7 %, 6 % and 2 % of G, USA; 2Pharmacy Practice & Administrative Sciences, University of New Vand E patients respectively. Mexico, Albuquerque, USA; 3Pharmacy Practice & Administrative Sci- Conclusions ences, University of New Mexico, Albquerque, USA; 4Dermatology, More patients receiving vinorelbine required support with high cost Northwestern University, Chicago, USA; 5Gastroenterology and ESAs. Capecitabine had less neutropenia and anemia, but more D/Cs Hepatology, UT MD Anderson Cancer Center,Houston, USA due to toxicity. In contrast, fewer patients receiving eribulin required treatment D/Cs because of toxicity. 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 MASCC-0250 for surgery or radiation and for patients with metastatic disease. The aim Toxicities 2 of this study is to evaluate the FDA adverse event reporting system (FAERS) for adverse events with visdmodegib. DOCETAXEL-INDUCED NEUROPATHY IN EARLY-STAGE Methods BREAST CANCER FAERS was searched using terms such as hedgehog pathway, vismodegib, liver, jaundice, hepatitis, and hepatic dysfunction. 1 2 3 4 L. Eckhoff ,A.S.Knoop,M.B.Jensen,M.Ewertz Disproportionality analyses of proportional reporting ratio (PRR) and 1 Department of Oncology, Odense University Hospital Institute of Clin- Empirical Bayes Geometric Mean (EBGM) were conducted. ical Research University of Southern Denmark, Odense, Denmark; Results 2 Department of Oncology, Rigshospitalet Copenhagen University Hospi- Thirteen reports of AEs were identified in FAERS, of which 7 were severe 3 tal Denmark, Copenhagen, Denmark; Danish Breast Cancer Coopera- (SAE) resulting in 3 hospitalizations, 1 life threatening event, and 3 tive Group, RigshospitaletCopenhagen University Hospital, Copenha- deaths. Hepatotoxicity was more common in females (8:5). 4 gen, Denmark; Department of Oncology, Odense University Hospital Disproportionality analysis results were: PRR=6.9 (95 % C.I. 4.2– Denmark Institute of Clinical Research University of Southern Denmark, 11.2), EBGM=6.3 (95 % C.I. 3.3–10.4), chi-square 61.8, p=0.001. Odense, Denmark Although, a review of data for 18 vismodegib cases at two NCI Compre- hensive Cancer Centers revealed no reported liver toxicity, FAERS data Background and Aims represents a larger exposed population. To date, no safety notifications Adjuvant chemotherapy with taxanes plays a key role in reducing the risk have been issued by the FDA related to hepatotoxicity nor does the FDA of recurrence and death from early-stage breast cancer but has side-effects labeling require liver function monitoring. such as peripheral neuropathy (PN). Conclusions We evaluated occurrence, persistence, and consequences of PN in two Thirteen reports of liver toxicity associated with vismodegib produced a adjuvant docetaxel-containing regimens, and the impact of PN on health safety signal in FAERS. Further proactive pharmacovigilance related to related quality of life (HRQOL). vismodegib and hepatotoxicity is warranted. 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 cyclophospha- MASCC-0271 mide and docetaxel (D75). Among these, 1,031 patients completed NCI Toxicities 2 CTC-like scores, EORTC QLQ-C30 and EORTC CIPN20 1 to 3 years after randomization. All patients received at least one cycle of docetaxel BEVACIZUMAB-INDUCED HYPERTENSION, PROTEINURIA and provided patient-reported outcomes including PN. AND ACUTE KIDNEY INJURY IN CANCER PATIENTS Results Overall 597 patients (35 %) reported PN, grades 2–4. The risk of PN after C.P. Escalante1,A.Lahoti1,J.Song1,M.Lu1,A.Zalpour1,R.Abisaid the first cycle of docetaxel was significantly 3-fold increased for the D100 Baker1, M.N. Richardson1, M. Mudireddy1,M.Overman1,M.George1, regimen. Patients with PN received significantly lower cumulative doses J.B. Durand1 of docetaxel than patients with no PN. Occurrence of PN was significant- 1General Internal Medicine, University of Texas MD Anderson Cancer ly reduced if patients wore frozen gloves and socks during treatment. One Center,Houston, USA to 3 years after completion of docetaxel, 157 patients (15 %) reported PN, grades 2–4. Persistent PN had a significant negative correlation with Background and Aims HRQOL, functional scales and symptoms scales. Introduction: Vascular endothelial growth factor (VEGF) inhibitors such Conclusions as bevacizumab (BV) can result in hypertension (HTN), proteinuria (PU) Patients developing PN after the first cycle are less likely to receive and acute kidney injury (AKI). docetaxel at the planned dose intensity and usage of frozen gloves and Objectives: To assess frequency of PU and AKI; evaluate BV dose socks may modify the risk. Persistent PN has a significant negative changes from PU and AKI; and define time to first resolution post-BV impact of HRQOL. treatment (TX) for HTN, PU and AKI. Support Care Cancer (2014) 22 (Suppl 1):S1–S238 S237

Methods MASCC-0357 Methods: We reviewed charts of 98 cancer patients on BV TX Toxicities 2 with≤6 months follow-up from 1/1/2009 to 9/30/2011. This includ- ed demographic, clinical and outcome parameters, using descriptive REAL LIFE EXPERIENCE WITH A statistics. NIACINAMID-CONTAINING BODY BALM FOR THE Results PREVENTION OF CHEMOTHERAPY-INDUCED SKIN Results: 49 (50 %) were males and median age 58 years (19–84). 17 REACTIONS AND IMPROVEMENT OF QUALITY OF LIFE IN (17 %) had lung cancer and 15 (15 %) colorectal. 91 (93 %) had BREAST CANCER PATIENTS metastatic disease and were on BV with other agents. At entry, 47 (48 %) had HTN, 14 (14 %) diabetes and 7 (7 %) chronic kidney J. Schilling1,K.Heinig2,D.Guth3, E. Wierick4,P.Ortner5 disease. 59 (60 %) had PU and 27 (28 %) AKI at least once. None 1BNGO e.V., BNGO e.V., Neuenhagen b. Berlin, Germany; 2Practice of had BV dose reduction due to PU or AKI. 1 (1 %) and 1 (1 %) Gyneco-Oncology, Practice of Gyneco-Oncology, Spremberg, Germany; patient had BV TX delay due to PU and AKI, respectively. 4 (4 %) 3Practice of Gyneco-Oncology, Practice of Gyneco-Oncology, Plauen, and 1 (1 %) had BV withdrawal due to PU and AKI, respectively. Germany; 4Practice of Gyneco-Oncology, Practice of Gyneco-Oncology, Of the 28 (29 %) who had BV-induced HTN, 11 (11 %) had a first Lohsa, Germany; 5Pomme-med, Pomme-med, München, Germany 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 Background and Aims 14 (0–34), respectively. Chemotherapy-induced skin reactions such as dry or sore skin and Conclusions itching can impair the quality of life of cancer patients. A 4 % Conclusions: This first report of the time post-BV TX for HTN, PU and niacinamid body balm reduced symptoms and improved quality of AKI will impact monitoring practices and suggests limited end organ life of breast cancer patients receiving (neo)adjuvant anthracycline- dysfunction due to BV. or 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 MASCC-0363 balm under real life conditions in German practices of Gyneco-Oncology. Toxicities 2 Methods Between May 2013 and Feb 2014, data of 122 breast cancer patients CISPLATIN OR CARBOPLATIN AS PALLIATIVE TREATMENT receiving chemotherapy were recorded by the ODM Quasi® GYN sys- FOR ADVANCED LUNG CANCER tem, the online documentation system of the BNGO. Data were collected at start of chemotherapy, 6 weeks after 1st course of chemotherapy and 1 1 A. Mellemgaard , J. Johansen 18 weeks after study enrolment. The documentation is ongoing. 1 Oncology, Herlev Hospital, Copenhagen, Denmark Results Median patient age was 54 years. 77,9 % of pts received anthracyclines, Background and Aims 74,5 % taxanes. 66 % of taxane-containing regimens were sequential with Cisplatin has been shown to be more effective in terms of survival than T given after the A courses. As per 2 February 2014, 122 patients filled in carboplatin, but cisplatin use is limited due to more side effects. Further- questionnaire 1, 110 questionnaire 1+2, 56 questionnaire 1, 2+3: No skin more, infusion time is much longer for cisplatin. problems during the past 7 days: questionnaire 1: 69 %, questionnaire 2: In this study we addressed the two main limitations of cisplatin use: 64,5 %, questionnaire 3: 62,5 %. Skin improved by body balm: ques- infusion time and QOL in patients receiving chemotherapy for advanced tionnaire 1: 20 %, questionnaire 2: 34,5 %, questionnaire 3: 37,4 %. lung cancer. Influence of supportive care with body balm on quality of life: question- Methods naire 1: 25 %, questionnaire 2: 58 %, questionnaire 3: 75 %. Study A (n=20) was a prospective single arm study of short Conclusions infusion time for cisplatin (3½h). Glomerular filtration rate Patients benefit from prophylactic and concomitant supportive skin care (GFR) measurements done for every series of cisplatin based with niacinamid containing body balm. chemotherapy. Study B (N=43) was a prospective observational study where QOL was measured by self-administered question- naires (EORTC QLQ C30). Questionnaires were filled out for every cycle up to 6. MASCC-0038 Results Toxicities 2 Study A: 20 patients received 4 series of cisplatin combination treatment with a short infusion time. GFR before first and after last treatment was VERTEBRAL FRACTURES IN LOCALLYADVANCED NSCLC 50–120 ml and 64–111 ml respectively. No significant change in GFR PATIENTS TREATED WITH RADICAL IMRT was observed. In study B, 14 and 29 patient was treated with cisplatin or carboplatin combinations respectively. Generally QOL remained un- W.Uyterlinde1, C. Chen1 changed throughout the treatment period. However, a small number of 1Thoracic Oncology, NKI-AVL, Amsterdam, Netherlands patients in both groups experienced some degree of toxicity and decrease in QOL. Conclusions Background and Aims No sign of kidney toxicity was observed with a shortened infusion Little is known about late toxicity of radical radiotherapy (RT) for time of 3½h for cisplatin combinations. QOL of life remained locally advanced non-small cell lung cancer (NSCLC). Since sur- unchanged in both patients receiving cisplatin and carboplatin vival is slowly increasing however, we learn more about this combination treatment. With effective antiemetic supportive care, phenomena. One of the late toxicities identified in our patient cisplatin combinations can be used with little excess in toxicity for cohort is the vertebral fracture, leading to symptoms and impaired the patient. health related quality of life. S238 Support Care Cancer (2014) 22 (Suppl 1):S1–S238

Objectives vertebral fractures. All fractures were located from the 6th to 8th To report on the incidence of vertebral fractures and its association with thoracic vertebra. The median onset time for the fracture was the RT dose to the vertebrae. 7 months (range 2–26). The median Dmax was 40 Gy (range 0–83) Methods and72Gy(range42–83) for non-fractured and fractured vertebrae, Planning and follow-up CTor MRI scans of 524 patients were retrospec- respectively. The median Dmean was 12 Gy (range 0–65) and 51 Gy tively utilized to identify vertebral collapses. Clinical and dosimetric (range 18–71) for non-fractured and fractured vertebras, respectively. parameters were retrospectively collected. The RTdose effect relationship Both Dmax and Dmean were significantly (p<0.001) associated with was analyzed using the maximum (Dmax) and mean (Dmean) dose to vertebral fractures. each vertebra. Dose–response was modeled using Cox model with patient Conclusions as random effect. Vertebral fractures were identified in 8 % of the patients. Both Dmax and Results Dmean of the vertebra were associated with fractures. Before reduction of Three hundred sixty-six patients were eligible for analysis. The the RT dose can be considered, a case–control study is in progress to median follow-up was 24 months. Twenty-eight (8 %) patients had analyze the dose–response relationship in the entire population.