nursing, supportive care

Poster Sessions Wednesday, 19 March 2014 S85

27,993 new cancer cases and 14,564 deaths from cancer in 2008, the mostrecent year for which international estimates are available (GLOBOCAN2008). The aim of this study is to determine the frequency and theepidemiological characteristics of breast cancer in Morocco.

Material and Methods: This is a retrospective analysis of breast cancercases, diagnosed and treated at Al Azhar Oncology Center in Rabatbetween 1994 and 2004.

Results: There were 1710 cases diagnosed with breast cancer at AlAzhar Oncology Center, 97.5% in women and 2.5% in men, giving a female-male ratio of around 39 and accounting for 24% of all new cancer casesreported during 1994–2004. The average age at diagnosis was 47±10years. The risk of developing breast cancer is strongly related to age with8.2% of new breast cancer cases diagnosed in people younger than 35years, 85.2% in those aged 35−64 years and 6.7% in those aged 65years and over. Nearly a quarter of these cases were treated with breast-conserving surgery. Of these, 37.2% were detected at stage I, 45.5% atstage II, 15.1% at stage III and 2.1% at stage IV. Among all detectedcases, 2% were diagnosed with metastatic disease and 12.2% died duringthe study period.

Conclusions: Breast cancer continues to be a major public healthproblem. Early detection in order to improve breast cancer outcome andsurvival remains the cornerstone of breast cancer control.

No conflicts of interest

Wednesday, 19 March 2014

POSTER SESSION

Nursing, Supportive Care

155 PosterThe perceptions of Israeli women with breast cancer of the

Breast Cancer Nurse

I. Kadmon1. 1Hadassah Medical Organization, Nursing Division,Jerusalem, Israel

Introduction: The role of the Breast Care Nurse Specialist (BCN) hasbeen developing in the last decades in some Western countries, mainly theUK, Australia, US and Israel. This newly recognized position encompasseswithin it the involvement of nurses as patient advocates, looking at issuessuch as breaking bad news and receiving the diagnosis, the participationof women in the decision-making regarding their care and navigating thewomen within the complex and ever demanding health care system. Inthis new paradigm of care, it is the woman and her significant others whoare in the center, and the role of the Breast Care Nurse Specialist is of acounselor, information provider and supporter, who makes sure the womanunderstands the complex and sophisticated options of care. The purpose ofthis research is, therefore, to examine the impact that Breast Care Nurseshave on Israeli women who are diagnosed with breast cancer.

Patients and Methods: About 300 women with non-metastaticbreast cancer (At seven institutions) were given two questionnaires −a demographic questionnaire developed for this study, and the IpswitchPatient Questionnaire, comprised of 21 questions, each divided to sub-questions. The questionnaire is focused on the following aspects ofnurse’s care: information about the role, coordination of care, provisionof information, psychological and mental support, practical support andreferral to other health care professionals.

Results: The stay results emphasised the general positive attittue andperceptions that women had towards all aspects of the role of the BCN aswere assessed. Detailed results and descriptions of the women’s views asanalysed will be further presented.

Conclusions: This study was an attempt to provide a national multi-centric study evaluating the role of the BCNs in Israel. This complex,demanding and multidimensional role has been examined and evaluatedin various relevant domains. These results emphasized the importance ofthe role and its contribution to women with breast cancer and their dearones. Further studies need to look at the impact of the role on the healthcare system and and other colleagues and also at different cultures.


156 PosterDoes a six week end of treatment programme make a positive

difference for patients diagnosed with breast cancer?

P. Dooher1, A. Patel1. 1Princess Alexandra Hospital, Breast Unit, Essex,United Kingdom

A private enterprise, Mind, Body and Vitality 365 (MBV365) and a DistrictGeneral Hospital Breast Unit have produced a 6 week programme toexplore the needs of breast cancer patients following treatment to allowprovision of information and support to help patients address the lifestylechanges required as a result of the effects of treatment regimes or theirchoice to make life changes, an area of care also identified as a need byThe Cancer Reform Strategy and Macmillan Cancer Support (2008).The programme was advertised and 12 patients self referred to the

pilot programme, 10 completed. The four aspects of the programme areMind, Nutrition, Exercise and Muscoskeletal. The programme was led by anexpert for each subject area and a Breast Care Specialist Nurse attendedeach week to ensure the MBV365 team were supported and specific breastcancer issues could be addressed. The programme is supported by localfundraising.Each patient was required to complete a needs questionnaire to

personalise the weekly programme content, a pre evaluation and postevaluation questionnaire to aid evaluation. The patients were alsoencouraged to have a body analysis at week 1 and repeated at week 6. Thepatients were provided with diary sheets to allow them to keep a food diaryand were asked to identify mood changes/energy levels to assess if thereare certain food groups having an impact on these factors. The group wereencouraged to participate in an exercise session during the exercise weekand perform arm and shoulder movements during the muscoskeletal week.Regular physical exercise and arm/back/shoulder exercises were promotedthroughout the programme with encouragement to continue after week 6.The needs evaluation showed that the majority of the group had areas of

concern; energy, exercise, lack of control, endurance, and muscoskeletalissues. The pre course and post course data showed an improvementin many of these areas at the end of the course. The body analysisdemonstrated an improvement over the course. The total for the groupshowed body fat decreased by 15.2%, Visceral fat 4% and Muscleincreased by 11.4%. During the muscoskeletal week the patients wereunable to perform some of the specific arm/shoulder movements but thisimproved by the end of the programme.The programme had positive verbal feedback which has also been

endorsed via the pre and post body analysis test results and the patientquestionaires. This programme has confirmed that patients do benefitfrom a 6 week programme which incorporates the four key areas ofMind, Nutrition, Exercise and Muscoskeletal. In addition the course hasdemonstrated that the NHS and private enterprise can work together toprovide patients with a programme to meet their needs. An on line supportforum has been developed to encourage continuation of the programmecontent at the end of the 6 week course.


157 PosterBreast cancer-related lymphedema after neoadjuvant chemotherapy,

surgery and radiotherapy

K.H. Shin1, M. Kim2, S.W. Park3, I.H. Park1, K.S. Lee1, J. Ro1,S.Y. Jung1, S. Lee1, H.S. Kang1, E.S. Lee1. 1National Cancer Center,Center for Breast Cancer, Goyang, Korea; 2Catholic University,Department of Radiation Oncology, Seoul, Korea; 3Chung-Ang UniversityHospital, Department of Radiation Oncology, Seoul, Korea

Background: The risk for lymphedema (LE) after neoadjuvant chemo-therapy (NCT) is little known in breast cancer patients. This study wasconducted to investigate LE after NCT, surgery and radiotherapy.

Materials and Methods: A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillarylymph node (ALN) dissection from 2004 to 2009 were retrospectivelyanalyzed. All patients received breast and supraclavicular radiation therapy(SCRT). The determination of LE was based on both objective andsubjective methods as part of a prospective database.

Results: At a median follow-up of 5.6 years (range, 3.0−9.1 years), 132patients had developed LE: 88 (28%) were grade 1; 42 (13%), grade 2;and two (1%), grade 3. The overall 5-year cumulative incidence of LE was42%. LE first occurred within 6 months after surgery in 62%; 1 year, in77%; 2 years, in 91%; and 3 years, in 96%. In multivariate analysis, age[hazard ratio (HR), 1.66; p < 0.01] and the number of dissected ALNs (HR,1.68; p < 0.01) were independent risk factors for LE. Patients with both ofthese risk factors showed a significantly higher 5-year cumulative incidenceof LE compared with patients with no or one risk factor (61% and 37%,

S86 Wednesday, 19 March 2014 Poster Sessions

respectively; p < 0.001). The addition of adjuvant chemotherapy did notsignificantly correlate with LE.

Conclusions: LE after NCT, surgery and SCRT developed early aftertreatment and with high incidence. More frequent surveillance of armswelling may be necessary in patients after NCT, especially during thefirst few years of follow-up.


158 PosterA feasible nurse-led project to improve the continuity in

breast cancer care

B. Raeymaekers1, L. Vandezande1, A.M. De Leyn1, E. Dancet2,M.R. Christiaens3. 1University Hospital Leuven, KU Leuven Departmentof Public Health and Primary Care University Hospitals Nursing Centerof Excellence, Leuven, Belgium; 2University Hospital Leuven Belgiumand Academic Medical Center Amsterdam University the Netherlands,Obstetrics and Gynaecology, Leuven and Amsterdam, Belgium;3University Hospital Leuven Belgium, Oncology, Leuven, Belgium

Background: Women confronted with breast cancer need high qualitycare while they are faced with different health care settings manned bydifferent professionals in an academic teaching hospital. This study aimedto improve the breast cancer clinical pathway in a nurse-led project withinan academic setting.

Materials and Methods: An Advanced Practice Nurse (APN) conducteda participatory observation of 12 weeks in all health care settings of theclinical pathway to identify the most prominent improvement target with aSWOT analysis and to gain insight in the feasibility of an enhancementproject. Next, the project was implemented and evaluated and optimizedafter 3 and 12 months.

Results: The most prominent improvement target was identified as‘increasing continuity of care’, in view of important detected weaknesseslike ever changing care settings, low nurse staffing levels and high numbersof rotating physicians, and the observed opportunity and value of a one-on-one patient-nurse relation.For each patient, a ‘track companion’ (tc) (oncology nurse or oncology

social worker) was appointed to conduct six consults at fixed ‘hingemoments’ that represented a high risk for personal or existential crisis,based on literature review and clinical experience. These ‘hinge moments’included: preoperative consultation, surgery, postoperative consultation,chemotherapy, radiation therapy, rounding. The tc was trained andempowered by the APN, who also developed patient education guidelinesand a recurring 4-element framework to guide all consults.The first project evaluation resulted in measures to increase patient

accessibility and to develop informatics support for preventing patient lossto follow-up and for facilitating administrative tasks. The proportion ofpatients followed by tc increased from 59% to 94% between the first andsecond evaluation and patients received an average of 5.5 consults withtheir tc.Based on the second evaluation, a short track was developed for a group

of postmenopausal women with limited surgery.Conclusion: Track companionship developed, structured, and super-

vised by an APN resulted in increasing continuity of care within ouracademic breast cancer center. This result was based on an observationalstudy with SWOT-analysis associated with the development of realisticAPN-led improvement projects. Further research is warranted before thissystem can be adopted by other hospitals.


159 PosterIntroducing a tailor-made care pathway specific to young women

diagnosed and receiving treatment for breast cancer

E. Vella1, M. Cassar2. 1Mater Dei Hospital, Breast Care Unit, Tal Qroqq,Malta; 2University of Malta, Faculty of Health Sciences, Tal Qroqq, Malta

When nurses are knowledgeable about their patients’ experience of illnessthey are able to care for them more efficiently and effectively. In view of thisa hermeneutic phenomenological research study was carried out, to betterunderstand the lived experience of young women diagnosed and treated forbreast cancer. This approach provided the opportunity to ‘borrow’ youngwomen’s experiences and reflections to gain a deeper meaning of theirexperience throughout their breast cancer trajectory.Women who are diagnosed with breast cancer at a younger age, have

age-related needs and concerns which are different from those of olderwomen with the same disease. However, due to the higher incidence ofbreast cancer amongst older women, to-date breast cancer services seemto be more focused on older patients, with less specific focus given to the

younger ones, that is to those under the age of fifty. An extensive literaturereview revealed a dearth in research related to the overall experiences ofyoung women with breast cancer.After obtaining University and Faculty Ethical approval as well as

permissions form the hospital Data Protection Office, data collection wascarried out through one-to-one, in-depth interviews across six Malteseyoung women aged less than forty-five, who had been diagnosed andtreated for primary breast cancer. All the participants had undergonesurgery and received chemotherapy as part of their treatment regime; theyhad all completed treatment in the last eighteen months.The findings of this study indicate that a cancer diagnosis is perceived

as a very challenging, life-threatening, untimely disease which effectswomen, physically and psychologically. The disease also effects their family,particularly their husbands/ partners and their children, who are, in turn,their source of strength and support. The results of this study suggestthat the development of a specific clinical care pathway, tailored for thisspecific younger patient group, would significantly address the challengesexperienced by these patients along their respective breast cancer journey.


160 PosterLong term follow up of breast cancer patients treated with

acupuncture for hot flashes

J. Hervik1, O. Mjaland2. 1Sykehuset i Vestfold, Seksjon for Smertelindring,Tønsberg, Norway; 2Sorlandet sykehus, Abdominal surgery, Kristiansand,Norway

Background: As treatment of breast cancer becomes increasinglyeffective, more women are living with side effects due to postoperativeinterventions affecting their quality of life. Women with breast cancer mayundergo years of post-operative treatments including endocrine therapy,affecting their daily lives. Several recent randomized controlled trials havedemonstrated that acupuncture may be effective for managing HF in breastcancer patients for up to 3 months post-treatment. However there is adistinct absence of randomized studies investigating long term effect. Theaim of this study was to investigate longer term effects of acupuncture, andpatient’s quality of life two years after treatment.

Materials and Methods: Eighty patients, who had 2 years previouslybeen randomized to either a course of 15 acupuncture treatments or shamacupuncture (control) over a period of 10 weeks, were asked to fill out aKupperman index (KI) indicating health related quality of life.

Results: Sixty-one women returned KI questionnaires. A mixed modelsprocedure with diagonal covariance matrix was used for statistical analyses.Baseline values between the sham-group and acupuncture group were notsignificantly different. However scores at the end of treatment and after 3months showed a statistically significant difference between the groups, thisdifference lost its significance when scores were analyzed after 2 years.

Conclusion: Acupuncture seems to have a positive effect on healthrelated quality of life for up three months post-treatment, this study suggeststhat these effects may be longer-term, however there was no significanteffect 2 years later.


161 PosterCase management: A task for nurses

M. van Rosmalen1, M.D. den Boer1, P. Veenstra2, A.C.M. Olsthoorn3,J. Rehorst3, A. Sparreboom4, L. van Wingerde4, H. van der Waal4.1Daniel den Hoed Cancer Center, Medical Oncology − room DHG-483,Rotterdam, Netherlands; 2Daniel den Hoed Cancer Center, MedicalOncology, Rotterdam, Netherlands; 3Daniel den Hoed Cancer Center,Surgery-room DHA1−07, Rotterdam, Netherlands; 4Havenziekenhuis,Surgery, Rotterdam, Netherlands

Background: To guarantee quality of care, the Dutch Inspection ofHealthcare demands that the patient’s treatment is overseen by a casemanager. Case management is a task for nurses, but the definition ofcase management and the tasks that come with it are not yet set. Everyhospital and sometimes even every discipline has its own interpretation ofcase management.On March eleventh 2013 nurses of Erasmus MC Cancer Institute and

Havenziekenhuis assembled for the start of the Academic Breast cancerCentre (ABC) project. In this project the nurses work in a subgroup and allnurses who work within breast cancer care of Erasmus MC Cancer Instituteand Havenziekenhuis are involved in this project. One of the main goals isto develop and implement case management.

Method: After a literature study the subgroup of nurses created their ownproposal of case management, which we will be implemented in the daily


care of breast cancer patients. This proposal oversees the whole treatmentstrategy, individualized for each patient. But before we can start with this,we have to find out what the quality of care at this moment is. So we starteda study to measure the patients’ rate of satisfaction.

Results: The nurse subgroup presented the proposal of case manage-ment to the board of the ABC. We included preconditions so that we areoff to a good start in March 2014. The study is ongoing at this moment andwill be closed and analyzed in February 2014.

Conclusion: The function and tasks of a case manager are unclear.The nurses of the nursing subgroup of the ABC have presented a proposalto create and implement a case manager for patients with breast cancer.Because of this proactive commitment we can use our knowledge andmanagement skills to influence the process and logistics so we can providegood quality of care, individualized for each patient.


162 PosterAlexithymia and time perspective in women with breast cancer

K. Papajova1, L. Kocianova1, Z. Vtıpil1. 1Palacky University, Psychology,Olomouc, Czech Republic

Background: Cancer, as a disease with a lethal prognosis, impacts greatlyon the patient’s life. When adjusting to this new reality, patients often showchanges in personality and behavior. In this research we aimed to make acomparison between women with cancer and relatively healthy women intwo areas: incidence of alexithymic features and predominant orientationon period of life (past, present, future).

Methods: Two questionnaires − TAS-20 and ZTPI − were administeredto two groups, each of 60 women aged over 50 years − women withbreast cancer (CW) and relatively healthy women (HW). Respondentswere recruited from hospitals (with ethics committee’s approval), cancerpatients’ associations and Universities of the Third Age. Data werestatistically analyzed using descriptive statistics, Fisher F-test, Student’st-test (at 5% significance level), and the Pearson correlation coefficient (at5% significance level, rcrit = 0.25).

Results: Women with cancer scored above average in almost alldimensions of the ZTPI. Relatively healthy women only scored higher in thedimension future, but they showed reduced scores in fatalistic presence.In TAS-20, women with cancer reached significantly higher levels than

relatively healthy women (tstat = 3.38 > tcrit = 1.98).Similar results were found for the total scores on TAS-20 and ZTPI’s

dimensions. The level of alexithymic speech correlated positively withinclination to fatalistic presence (rCW = 0.43, rHW = 0.25) and with pastnegative (rCW = 0.49).

Conclusions: The results show that women with cancer are morefocused on the negative past and fatalistic presence, and it is suggestedthat these women have more feelings of resignation and helplessness,and experiences of loss and disorientation. In contrast to relatively healthywomen, women with cancer recoil from the future, as the future is uncertainfor them.The study also confirmed an increased incidence of alexithymic

manifestations in the group of women with cancer − a particularly distinctivefeature of this group was that they had difficulties in describing theirfeelings.Investigation of the relationship between ZTPI dimensions and the

incidence of alexithymic features showed that, in both groups, symptoms ofalexithymia are associated with passivity, susceptibility to depression andanxiety, and increased dependence on others.


163 PosterGeographical comparisons of information and support needs of

Australian women following primary treatment of breast cancer:

A cross-sectional needs analysis survey

T. Ahern1, A. Gardner1, M. Courtney2. 1Australian Catholic University,School of Nursing Midwifery and Paramedicine, Canberra, Australia;2Australian Catholic University, School of Nursing Midwifery andParamedicine, Brisbane, Australia

Background: A decade ago, Raupach and Hiller examined the use of andsatisfaction with information and support following the primary treatmentof breast cancer from a sample of participants in South Australia. In 2013this study was replicated to include participants Australia wide and analysecomparisons based on geographical location.

Materials and Methods: A previously validated cross-sectional surveywith both structured and semi-structured questions was used. Six questionswere added to the original survey to collect geographical information.Participants were women aged 18+ years who had been diagnosed with

breast cancer between six and 30 months ago. Participants were sourcedfrom two national databases of women diagnosed with breast cancer. Thesurvey was delivered in an online format using Qualtrics survey software.Data were analysed using IBM SPSS, version 20.0.

Results: A total of 325 participants completed the survey. The internetwas the most commonly used source of information with 70% (n = 229) ofwomen using the internet to access information. The use of the internetas an information source was comparable in all three geographic areaswith 71% (n = 158) of women in major cities, 71% (n = 44) of women ininner regional areas and 69% (n = 27) of women in outer regional, remoteand very remote areas using the internet for information. Compared withthe original study, the percentages of women using the internet as aninformation source was statistically significantly higher in the present day(p < 0.0001). A comparison of sources of support showed that women inouter regional, remote and very remote areas were statistically more likelyto use the breast care nurse (BCN) for support (p 0.044). The study alsofound that the top four information issues rated as moderately/extremelyimportant by women in 2013 were identical in 2002.

Conclusions: Some of the needs of women have changed over time,but others have remained the same. Results indicate that specific, upto date information about issues important to women must be provided.Since much of this information is sourced via the internet, women mustbe educated about the use of only credible internet sites. BCNs have anopportunity to provide the information and education necessary to enablewomen to meet their information and support needs using technology suchas the internet. It is not yet known if BCNs currently do this, however anational study investigating the role of the Australian BCN has resultedfrom the findings of this study.


164 PosterOut-hospital primary surgical care in patients with breast surgery

and wound drains by trained district nurses is effective, safe

and friendly

I. Snijders1, M. Schurgers1, S. Rutten2, I. Debats3, E. van Haaren4.1Atrium medical center, Breast cancer center, Heerlen, Netherlands;2GKD homecare organization, Wound care, Maastricht, Netherlands;3Atrium medical center, Reconstructive surgery, Heerlen, Netherlands;4Atrium medical center, Surgery, Heerlen, Netherlands

Background: The breast cancer center of the department of surgery ofAtrium mc (BCC) concentrates and coordinates the surgical care aroundpatients with breast cancer. Several developments in recent years haveshortened postoperative stay significantly towards day surgery or shortstay (Cohen, 1996). Patients are often confronted at home with problems orquestions of their wounds and/or drains in spite of preoperative information.The result of this uncertainty was a large number of unscheduled visits tothe BCC or First Aid department.Purpose of this project was to reduce these visits and to improve

postoperative breast care and patient satisfaction by training district nurses,update and synchronize postoperative wound- and drain care protocolsbetween surgery, reconstructive surgery and homecare organizations.

Material and Methods: The pilot study in 2011 showed that 47 (95%)of 50 consecutive patients with a postoperative drain visited extra the BCCwith wound and/or drain problems or questions.Since 2012 primary postoperative wound and drain care was performed

by all patients with breast surgery and a wound drain by trained districtnurses. One week postoperative the indication of the unscheduled visits tothe hospital and patients satisfactory were evaluated.

Results:

2011: operated patients 216, expected extra visits: 205. We have seen26 patients. Reduction 87%.

2012: 185 patients, expected visits 176, seen 22. Reduction 88%.2013 (Jan–Oct): 178 patients, expected visits 169, seen 27. Reduc-tion 84%.In all years no missed diagnosis by the district nurses was seen.

Complications (N = 72) were infection (36%), seroma (45%), edema (5%)and others (14%).Patient satisfactory by questionnaire and a scale from 1−10 (bad-good)

was 8.3, 7.3 and 8.7 respectively in 2011, 2012 and 2013.Conclusions: Primary postoperative surgical care in patients after breast

surgery with a wound drain by trained district nurses reduces the extra andunnecessary hospital visits with more than 80% and is safe. Patients arevery wellbeing and satisfactory: the motivating and emotional guidance inthe home-situation reduces feelings of uncertainty and fear.



165 PosterThe psychological influence on pain and discomfort in breast cancer

P. Jansen1, I. Willers2, A.F.W. van der Steeg2, J.A. Roukema3,J. de Vries4. 1St. Elisabeth Ziekenhuis, Surgery, Tilburg, Netherlands;2Tilburg University, CoRPS Dept Medical and Clinical Psychology, Tilburg,Netherlands; 3St. Elisabeth Hospital, Surgery, Tilburg, Netherlands;4St. Elisabeth Hospital, Medical Psychology, Tilburg, Netherlands

Objective: To examine the role of personality, more specific trait anxietyand neuroticism, and age on pain and discomfort in breast cancer patientsover a period of five years in a prospective follow-up study.

Materials and Methods: Women (N = 608) with either a diagnosis ofbreast cancer (BC) or benign breast disease (BBD) participated in thisstudy. Scores on questionnaires concerning trait anxiety (STAI-trait) andneuroticism (NEO-FFI) (baseline) were dichotomized into high vs. not high.Assessments of pain and discomfort (WHOQOL-100) were completedprior to diagnosis (baseline), and 1, 3, 6, 12, 24, and 60 months afterdiagnosis (BBD) or surgery (BC). ANOVA for repeated measures andmultivariate linear regression analyses were performed to examine theresearch questions.

Results: There was no significant difference in pain and discomfortscores between BC and BBD patients (p = 0.592), but both groupsexperienced a similar decrease in pain and discomfort over time (p < 0.001).Concerning trait anxiety, we found significant differences between thepatient groups × time (for both p = 0.043). Patients high on trait anxietysignificantly differed on pain and discomfort scores from patients not highon trait anxiety (p < 0.001). For neuroticism it was found that patientshigh on neuroticism experienced more pain and discomfort than patientsnot high on this personality factor (p < 0.001). All four patient subgroupsshowed a decline of pain and discomfort across time. Regression analysisshowed that personality was the strongest predictor for scores on pain anddiscomfort (TA b range 0.202 through 0.311, p < 0.05; neuroticism b range0.174 through 0.272, p < 0.05), whereas age played no role (b range−0.017 through 0.241, p > 0.05).

Conclusion: Patients scoring high on trait anxiety or neuroticismexperience higher levels of pain and discomfort, irrespective of diagnosis,treatment, and age.


166 PosterWhat is considered good spouse’s support of breast cancer patients

in China? The diagnosed women and their husbands’ perspectives

L. Gao1, J.E. Liu1, Y.L. Su2, P.L. Wang2. 1Capital Medical University,School of Nursing, Beijing, China; 2Beijing Tiantan Hospital Affiliatedto Capital Medical University, Breast Cancer Center, Beijing, China

Background: The incidence of breast cancer in China has been on acontinuous rise and shown a younger trend during the last two decades.Normally, it is the spouses of the diagnosed women who would be in closecontact with them and become the caretakers and crucial source of socialsupport. Despite the undisputed position of the support from spouses ofbreast cancer patients in China, the experience of the couples during theinteraction of the support has not previously been studied.

Materials and Methods: A Phenomenological approach of qualitativeresearch was used. Eighteen participants, comprising nine dyads, wererecruited from a university-affiliated hospital breast center in Beijing.Inclusion criteria were that the women were married and with a diagnosis ofprimary breast cancer, especially the survivors who had returned to work.Using a semi-structured interview schedule, interviews were conducted ina private room. Audio-recorded data were transformed into the text versionand coded using an inductive content analysis method.

Conclusions: Well spouses’ support of breast cancer patients atdifferent stages of the disease presents different features. It is closelyrelated to the cultural values and open communication between thecouples. Health care practitioners should identify the characteristics ofspouses’ support from different individuals and different stages, andimplement interventions to the dyads.


167 PosterEfficacy and safety of scalp cooling system to prevent hair loss in

breast cancer patients receiving adjuvant chemotherapy

T. Kinoshita1, K. Tamura2, A. Hashimoto2, S. Arai3, M. Asanabe4.1National Cancer Center Hospital, Surgical Oncology Division, Tokyo,Japan; 2National Cancer Center Hospital, Breast and Medical OncologyDivision, Tokyo, Japan; 3National Cancer Center Hospital, Department ofPharmacy, Tokyo, Japan; 4National Cancer Center Hospital, Departmentof Nursing, Tokyo, Japan

Background: Breast cancer is the most common cancer in womenworldwide. Chemotherapy is often used to treat breast cancer patientsboth pre- and post-surgically. Cyclophosphamide, Anthracycline and taxaneagents are most commonly used, with hair loss, nausea, vomiting,numbness, and fever as side effects. Nausea, vomiting, and fever can betreated pharmacologically, but since there are no preventive measures forhair loss, only symptomatic therapies such as the use of wigs or hats, hairloss significantly reduces patients’ quality of life (QOL). A questionnairesurvey of patients undergoing chemotherapy at this hospital showed thatthe most disturbing side effect suffered by female breast cancer patientswas hair loss. Hospital departments must improve their cooperation witheach other in order to confirm the efficacy of hair loss prevention andthe safety of scalp cooling equipment, and thus enhance patient recoveryand QOL.

Materials and Methods: This study used scalp-cooling equipment (Pax-man Cooler, U.K.) from the United Kingdom, and targeted female breastcancer patients scheduled to receive 4 cycles of postoperative adjuvantchemotherapy using either AC (60/600mg/m2) or TC (75/600mg/m2). Theprimary outcome was the proportion of patients able to complete 4 cyclesof postoperative adjuvant AC or TC therapy. Secondary outcomes were thedegrees of comfort, satisfaction, and hair loss prevention, as well as therates of adverse events and metastases to the scalp in patients who usedthe scalp cooling equipment.

Results: At the time of this writing we had evaluated 21 cases: 11 whoreceived AC therapy and 10 who received TC therapy. Protocol completionrates were 81.8% (9 cases) for AC therapy and 100% (10 cases) for TCtherapy. Hair loss was graded using the WHO classification scheme; thenumbers of cases for each Grade from 0−4, respectively, were 0, 3, 2,5, and 1 during AC therapy, and 0, 3, 3, 4, and 0 for TC therapy. A wigis not considered necessary for hair loss up to Grade 2. The proportionof patients with Grade 1−2 hair loss was 5/11 cases (45.5%) in the ACgroup, and 6/10 cases (60%) in the TC group, or 11/21 cases (52.4%)overall. Furthermore, scalp cooling resulted in greater hair loss preventionduring TC therapy than AC therapy. Two patients could not complete theprotocol treatment, 1 due to headaches and 1 due to chills. These patientsdiscontinued the scalp cooling procedure and had Grades 3 and 4 hairloss, respectively. In the questionnaire survey following completion of theprotocol, 15 of 21 (71.4%) patients responded that they would ‘stronglyrecommend the same treatment to others.’

Conclusion: We will continue studying the effects of scalp cooling inbreast cancer patients undergoing chemotherapy, and work to improve onthe design of the original scalp cooling equipment. Our goals are to developa hair loss prevention system that is effective enough to be implementedat clinical sites and in turn, can also increase patient satisfaction and QOL.


169 PosterThe current management of vasomotor symptoms in breast cancer

patients in the UK: Clinician versus patient perspective. NCRI Breast

CSG Working Party on Symptom Management (Vasomotor)

M. Ah-See1, C. Coles2, D. Fenlon3, E. Pennery4, J. Dunn5, A. Morgan6.1Mount Vernon Hospital, Marie Curie Research Wing, Middlesex,United Kingdom; 2Cambridge University Hospitals NHS Foundation Trust,Oncology, Cambridge, United Kingdom; 3University of Southampton,Faculty of Health Sciences, Southampton, United Kingdom; 4BreastCancer Care, Clinical Director, London, United Kingdom; 5Universityof Warwick, Clinical Trials Unit, Warwick, United Kingdom; 6IndependentCancer Patients’ Voice, Patient Advocate, London, United Kingdom

Background: The vasomotor symptom of hot flushes (or flashes) is a wellrecognised, commonly reported side-effect in breast cancer (BC) patientstreated with chemotherapy and endocrine therapy. It can significantlyimpact on quality of life and, for some patients, leads to the discontinuationof treatment resulting in worse BC outcomes. Managing this symptomis challenging and there is currently no consensus on best practice.In response to this challenge, and on the initiative of patient advocatemembers, the UK National Cancer Research Institute Breast Clinical


Studies Group (NCRI Breast CSG) has established a multi-disciplinaryworking party to evaluate and improve vasomotor symptom management.A starting point for the group was to establish the current opinions andpractice of UK clinicians and their patients.

Materials and Methods: A short questionnaire was circulated to themembers of the NCRI UK Breast Intergroup (BC healthcare professionals).A separate patient survey was opened on the BCC website and advertisedvia the BCC Facebook and Twitter Social media accounts.

Results: There were 185 respondents to the Healthcare Professionalsurvey and as yet, 625 respondents to the patient survey (still ‘live’).95% of healthcare professional respondents ‘agreed’ or ‘strongly agreed’that the treatment and management of hot flushes is currently an unmetneed. Treatments vary across the UK and include pharmacological andnon-pharmacological interventions. The most commonly prescribed drugsare the selective serotonin reuptake inhibitors (58%), such as venlafaxine,followed by clonidine (18%) and gabapentin (11%); Hormone ReplacementTherapy and progesterone preparations are used by a small number(6.7% and 4.7% respectively). Complementary therapies are commonlyrecommended, in particular, evening primrose oil and acupuncture. Accessto dedicated Cancer-related Menopause clinics is poor. The results of thepatient survey will be presented at the meeting along with the final resultsfrom the Healthcare Professional survey.

Conclusion: There is currently no consensus regarding best practicefor the management of hot flushes in BC patients within the UK. Ledby patient advocates, the NCRI Breast CSG has established a multi-disciplinary working party with the aim of addressing this unmet need byincreasing awareness, promoting clinical studies and contributing to theestablishment of evidenced-based clinical guidelines for BC patients withinthe planned NICE guidance on diagnosis and management of menopause.


170 PosterEncouraging patients to take an active role in their own pain

management after surgery for breast cancer

H. Williams1, E. Vaaben1. 1Rigshospitalet, Department of Breast Surgery,Copenhagen, Denmark

Background: The purpose of this study was to improve the overallpain management for patients undergoing surgery for breast cancer atCopenhagen University Hospital.

Materials and Methods: At the Breast Surgery Clinic at CopenhagenUniversity Hospital approximately 600 women undergo surgery for breastcancer each year. Each patient is allocated a named contact nurse.Information about wound management, postoperative pain managementand psychological aspects is given orally as well as in the format ofpamphlets before discharge.The department has introduced short stay for breast cancer patients.

Shortly after introducing short stay for breast cancer patients a surveywas carried out focusing on how the patients had coped at home afterdischarge. The survey focused on areas such as feeling safe and secure,wound management, pain management, psychological aspects etc.The survey showed that patient satisfaction had increased in all areas

apart from pain management. Not unexpectedly the patients also seemedto be worried before surgery about the level of pain after discharge.At the same time audits of the patients files showed that the nurses

systematically failed to pain-assess the patients according to the NumericalRating Scale (NRS). NRS is a reguirement according to accreditationstandards set out by the Danish Health authorities main body.The department set up a project with the aim of improving pain

management of the patients. As the ward is used to working within theframework of the Productive Ward series, the guidelines set out by theProductive Ward were used when the ward set out to improve painmanagement. The nursing staff started out by analyzing the proceduresregarding the administration of pain killers and analyzing the procedures,or lack of, regarding NRS scoring of the patients.The aim of the project was to:

• Educate the nurses in NRS scoring the patient• Focus on pain management by making the patients active participantsin their own pain management

• If possible save nursing time• Increase patient safety by adhering to national standards for patientsafetyResults: The patients (90%) are now NRS scored at set times during

the day and after pain killers have been administered (80%). The nursingstaff have introduced a folder regarding pain management: This folder ishanded out and gone through with the patient by the contact nurse inthe outpatient department before surgery. The nursing staff have saved150 working hours/annum by letting the patients administer their own painkillers.

The ward has planned to measure patient satisfaction in January 2014with special focus on adequate pain management.

Conclusions: By focusing on improving different aspects of painmanagement for the breast cancer patients it is possible to:• Increase patient safety by adhering to accreditation standards• Improve the level of pain management and save nursing time at the sametime

• Improve patient satisfaction by involving the patients in their own painmanagement.


171 PosterHome treatment with intravenous zoledron in patients with advanced

breast cancer

L. Poulsen1. 1Aarhus University Hospital, Aarhus C, Denmark

Background: In Denmark, intravenous (IV) treatment with zoledron inwomen with advanced breast cancer and bone metastases is administeredat hospital outpatient clinics. The women find the treatment very timeconsuming involving waiting for blood sampling, results and the actualtreatment. The waiting time can be very straining for these women.Furthermore, it adds to their frustration that they often meet and receivetreatment from different staff.The aim of the study was to compare the experiences of 20 women

receiving IV zoledron treatment in their own home with standard treatmentin the outpatient clinic.

Material and Methods: Twenty women (median age 62.5 years) withadvanced breast cancer and need for zoledron treatment were offeredhome treatment with IV zoledron by two hospital oncology nurses toinvestigate how the patients experienced home treatment.The nurses kept a log for a period of three months containing their

observations, the women’s comments, experiences and impressions. Thismaterial was used to form an interview guide for a questionnaire. A total of17 individual interviews took place at the women’s homes and three tookplace at the hospital.

Results: Patients had received treatment for a mean time of 36 months.The participants felt secure and the frustration linked to treatment athospital was reduced. The women felt more like persons end less likepatients. It improved their every day life and felt they wasted less time.Surprisingly hospital treatment was experienced burdensome due to

co-patients. They expressed that other patients’ stories, at this stage oftheir illness, troubled them and their need for networking and support wasfulfilled by their personal network.The women reported they developed a closer and more confident contact

to the nurses involved in the home treatment.Conclusions: A vast majority of the women reported physical, practical

and psychological benefits of receiving treatment in the home.If home treatment for this patient group is to be standardised it requires

an optimisation of procedures.It would be appropriate to develop collaboration with the primary care

sector on how to bridge the gap between primary and secondary sector inthe treatment of this patient group.This study was supported by an unrestricted grant from Novartis

Healthcare A/S.


172 PosterIn post-operative adjuvant chemotherapy, does using the arm on

the operated side after axillary lymph node dissection following

breast cancer surgery induce lymphoedema?

Y. Yanagita1, T. Miyamoto1, T. Fujisawa1, H. Matsumoto2, T. Saitoh3,F. Arisawa3, R. Matsushima4, K. Katayama5, T. Hirakata5, K. Ichikawa6.1Gunma Prefectural Cancer Center, Breast Oncology, Ota, Japan;2Gunma Prefectural Cancer Center, Nursing, Ota, Japan; 3SaitamaRed Cross Hospital, Surgery, Saitama, Japan; 4Saitama Red CrossHospital, Nursing, Saitama, Japan; 5 Isesaki Municipal Hospital, Surgery,Isesaki, Japan; 6 Isesaki Municipal Hospital, Nursig, Isesaki, Japan

Background: It is generally believed that lymphoedema is more likelyto occur if vascular access is performed with the arm on the operatedside in breast cancer patients who have undergone axillary lymph nodedissection. However, there is no scientific evidence. This study was plannedto investigate whether lymphoedema would result from the use of vesselsin the operated side arm of patients after axillary lymph node dissection inpostoperative chemotherapy.

Material and Methods: Multicentre randomized controlled study. Themain inclusion criteria were as follows: (1) patients who had undergoneaxillary lymph node dissection of level 1 or higher for breast cancer;


(2) patients who were scheduled for sequential dosing of 4 cycles ofboth an anthracycline and a taxane regimen as postoperative adjuvantchemotherapy; and (3) patients in whom lymphoedema was not seen inboth arms objectively at the time of enrolment. The enrolled patients wererandomly assigned to either a control group (vascular access performedwith the arm on the healthy side only) or an experimental group (vascularaccess performed alternately with arms on the healthy and operated sides),and stratified by centre. The primary end point was the incidence oflymphoedema. The secondary end points were the incidence of phlebitisand the number of punctures until vascular access. The occurrence oflymphoedema was defined as a disparity between the operated and healthysides in the circumference of the arms in at least 1 of 4 places (10 cmabove the elbow, 10 cm below the elbow, the wrist, and the hand), with theoperated side enlarged �2 cm more than the healthy side. Measurementswere made before the administration of each cycle.

Results: Forty-nine patients were enrolled (control group, 25; experi-mental group, 24). The subjects comprised 44 patients who fulfilled theeligibility criteria (control group, 22; experimental group, 22). Four patientsin each group (18%: 95%CI: 5.2–40.3) developed lymphoedema betweenthe start of and 3 weeks after the end of chemotherapy. Phlebitis occurredat least once in 27% (95%CI: 10.7–50.2) of patients in the control groupand 14% (95%CI: 2.9–34.1) in the experimental group. Cycles required2 or more punctures for adjuvant chemotherapy in 8.3% (95%CI: 4.5–13.8) of patients in the control group and 7.8% (95%CI: 4.2–12.9) in theexperimental group.

Conclusions: Our results suggest that the occurrence of lymphoedemais not increased, even with the use of the arm on the operated side forpostoperative adjuvant chemotherapy in patients who have undergoneaxillary lymph node dissection. A large-scale study will be needed toconfirm these findings.


173 PosterA unique challenge: Sexuality in young women after breast cancer

treatment from a developmental perspective

M. Jankowska1. 1Great Poland Cancer Centre, Clinical PsychologyDepartment, Poznan, Poland

Background: Earlier diagnosis and advances in breast cancer treatmenthave significantly improved survival rates. Consequently, quality of life hasbecome a matter of great importance and more attention has been focusedon sexuality. Although sexuality is important at every stage of life, it playsa crucial role for young women in achievement of developmental tasks:establishing intimate relationship and starting a family. Altered sexualityafter cancer treatment may create a unique challenge in their development.

Materials: Review of literature was made to present up-to date researchfindings on sexual life in young women with breast cancer. The PubMed,Elsevier, Medline browsers and the web were searched for scientific articlespublished in English language in the period of 1999–2013. Followingphrases were used: breast cancer, young women, premenopausal, sexual,sexual functioning, sexuality, development, developmental tasks. Literaturereview was supplemented by the author’s own clinical experience.

Results: Numerous studies report that many young women experiencedisturbances in body image after breast cancer treatment. Invasive therapyraises concerns about fertility. A wide variety of sexual dysfunctions arereported including low sexual desire, decreased arousal and lubrication,impaired orgasm, painful intercourse, diminished sexual satisfaction andfrequency of sexual activity. What is more, treatment may induce prematuremenopause. Altered sexuality challenge future and present relationships.Single women face concerns about cancer disclosure and engaging in newintimate relationships whereas couples have to resume sexual activity aftercancer and adjust to a new sexual situation.

Conclusions: Breast cancer treatment may affect sexuality of youngwomen in all its domains: biological, psychological and relational andsexual act in all its functions: procreation, pleasure and intimacy atthe time when sexuality is essential in successful attainment of specificdevelopmental tasks: being in an intimate romantic relationship and startinga family. Altered sexuality may threaten natural developmental trajectory.Consequently, young women after breast cancer treatment are at highrisk of sexual dysfunctions and are more vulnerable to disruptions inbiopsychosocial development. Due to this unique developmental contextyoung women require special attention of researchers and clinicians.


174 PosterDoes a cooling ‘pillow topper’ reduce hot flushes and sleep

disturbance in women receiving adjuvant endocrine therapy for

breast cancer?

R. Marshall-McKenna1, A. Morrison2, A. Armstrong3, C. Hutchison3,E. McCartney4, C. Hewitt5, M. Robertson4, P. McIlroy3, A.M. Rice1,I. MacPherson3. 1University of Glasgow, Nursing, Glasgow Scotland,United Kingdom; 2Beatson West of Scotland Cancer Centre, Education,Glasgow Scotland, United Kingdom; 3Beatson West of Scotland CancerCentre, Oncology, Glasgow Scotland, United Kingdom; 4Cancer ResearchUK, Clinical Trials Unit, Glasgow Scotland, United Kingdom; 5BeatsonWest of Scotland Cancer Centre, Psychology, Glasgow Scotland, UnitedKingdom

Background: Due to rising incidence and survival rates, the number ofwomen living with the long term side effects of breast cancer treatment,including endocrine therapy has increased. Recent clinical trials report that10 years of tamoxifen significantly reduced the risk of recurrence. However,almost 40% of women stop treatment after two years due to side effects,one of which is hot flushes. The pillow topper is a commercial product,promoted to help improve quality of sleep disrupted by hot flushes. Thispilot study aimed to identify if the pillow topper can reduce the severity ofsleep disturbance by minimising the effects of hot flushes and to assessthe extent of sleep disturbance caused by hot flushes.

Materials and Methods: This was a randomised Phase II trial. Womenwith early breast cancer were eligible if they received endocrine therapy,experienced hot flushes and met criteria for insomnia. Following consent,participants completed a 2 week diary including sleep-related components,Hot Flush Score, Hospital Anxiety and Depression Scale (HADS)and Fact-B questionnaires. Participants were randomised (stratifying bybaseline sleep efficiency and menopausal status) to pillow topper plusstandard care (intervention) or standard care alone (control). Standardcare was advice on lifestyle, diet and physical activity. The primaryendpoint was change in average sleep efficiency score from −2 to 0 wksto 2 to 4 wks. Comparisons were performed via Mann–Whitney U tests(1-sided, 10% significance level).

Results: 74 of the 80 patients recruited were evaluable. Medianage 49 years (range 35−70 years); pre-menopausal (68.9%), post-menopausal (31.1%). Endocrine therapies included tamoxifen (93.2%),non-steroidal aromatase inhibitors (6.8%). Median sleep efficiency scoresimproved in both arms but the increase on the intervention at wks 2 to 4was almost twice that on control (p = 0.024) which is statistically significantat the 10% level. There was a greater reduction in hot flush score on theintervention (p = 0.09) which is marginally significant at the 10% level. Therewas no significant difference in FACT-B total score or HADS anxiety score,but the decrease in HADS depression score from Week 0 to Week 4 wasstatistically significantly different between arms at the 10% level (p = 0.036).

Conclusion: The primary objective was achieved and supports use ofthe pillow topper as an aid to reduce sleep disturbance and the frequency/severity of hot flushes.

Conflict of interest: Ownership: None Advisory board: None Board ofdirectors: None Corporate-sponsored research: None Other substantiverelationships: Soothe Soft supplied pillow toppers at reduced cost.

175 PosterEfficacy of frozen gloves and socks and frozen cap in breast cancer

chemotherapy

K. Futsuhara1, T. Rikiyama1, T. Mori2, Y. Iwaoka2. 1Saitama MedicalCenter, Jichi Medical University, Surgical Department, Saitama, Japan;2Saitama Medical Center, Jichi Medical University, Nursing Department,Saitama, Japan

Background: Breast cancer chemotherapy improves convalescenceat early breast cancer and is an important therapeutic method toimprove quality of life at metastatic breast cancer. However, treatmentcontinuation becomes difficult by toxicity of the chemotherapy. In particular,anthracycline and taxane which are an important drug of the breastcancer treatment have toxicity such as hair loss, skin disorder, peripheralneuropathy. We thought that reduction of toxicity led to improvement ofthe treatment will. Therefore we started the cooling treatment with frozengloves and socks and a frozen cap by the head and both hands and footsfor the purpose of symptom palliation of hair loss and skin disorder andperipheral neuropathy from January, 2010.

Patients: 27 patients who had a diagnosis of breast cancer pathologi-cally, and that chemotherapy was treated. The toxicity were assessed byNational Cancer Institute Common Toxicity Criteria.

Method: Frozen gloves and socks and frozen cap were cooledto −30 degrees. The patient attaches these from 15 minutes before


chemotherapy and these are changed every 20−30 minutes. The coolingtreatment is finished 15−30 minutes later after chemotherapy.

Results: 3 patients received doxorubicin and paclitaxel followed byweekly paclitaxel, one patient doxorubicin and paclitaxel. 7 patientsreceived docetaxel and cyclophosphamide. 8 patients received doxorubicinand cyclophosphamide followed by weekly paclitaxel and one patientdoxorubicin and cyclophosphamide. 4 patients received weekly paclitaxeland 3 patients nab-paclitaxel. The average age was 48 years (28−63).A frozen cap was performed to 23 patients and frozen gloves and sockswere performed to 26 patients. 4 patients (15%) stopped frozen gloves andsocks. 10 patients (43%) stopped a frozen cap. Hair loss was grade 1 in15% patients and grade 2 in 85%. Skin disorder was grade 0 in 77% andgrade 1 in 23. Peripheral neuropathy was grade 0 in 55%, grade 1 in 36%and grade 2 in 9%.

Conclusions: The cooling treatment is very effective for few cases aboutthe hair and reduces peripheral neuropathy and skin disorder associatedwith chemotherapy in breast cancer.


176 PosterActive counselling about influence against reproductive function

by adjuvant systemic therapy and fertility preservation by breast

oncologist and gynecologist for reproductive age women with

cancer in Japan

T. Shien1, M. Ito1, M. Hatono1, T. Mizoo1, T. Iwamoto1, T. Nogami1,T. Motoki1, N. Taira1, M. Nakatuka2, H. Doihara1. 1Okayama UniversityHospital, Breast and Endocrine Surgery, Okayama, Japan; 2OkayamaUniversity Hospital, Gynecology, Okayama, Japan

Background: The number of young breast cancer patients who wantto bear children is increasing every year in Japan. The influence of thetreatment on fertility and the fetus are of great importance to young cancersurvivors who wish to start a family. In contrast, an increasing numberof women are marrying late in life, and advances in the field of perinataland reproductive medicine have improved the safety of infertility treatment.Therefore, advanced reproductive techniques can be used in patientsreceiving systemic therapy who want to have children after breast cancertreatment.

Patients and Methods: We started the pretreatment active fertilitycounseling about influence of adjuvant systemic therapy and fertilitypreservation (FP) for the young breast cancer patients who want tobear children from April 2009. Our counseling system was performed bybreast care nurse, breast oncologist and gynecologist. We retrospectivelyanalyzed the correlation between FP and clinicopathologic features andsocial background of patients. Moreover we indicated present situation offertility preservation in Japan.

Results: 52 (35%) of 149 patients who were under 45 at breastcancer diagnosis underwent active fertility counseling. Median age was36 (24−45). 35% patients with counseling were not married. Counselingwere performed within one month after primary surgery. 10 patients (7%)underwent FP (egg: 5 and embryo: 5) before starting systemic therapy.All patients who underwent it did not have children. 5 patients (3%)did not receive adjuvant endocrine therapy after surgery against DCIS.The reasons of decision which patients did not receive FP were anxietyabout recurrence and unreliability and cost of fertility procedure.

Conclusion: In Japan, only 7 % patients under 45 underwent FP. It isvery difficult to decide the eligibility of breast cancer patients for FP dueto differences in the individual’s situation and environment. Therefore, anactive counseling system tailored to each patient must be devised by therespective attending specialists.


177 PosterA prospective observational study on chemotherapy-induced

nausea and vomiting (CINV) for patients with breast cancer by

CINV Study Group of Japan

T. Saeki1, H. Mukai2, M. Fujimori3, T. Ishikawa4, Y. Kai5, N. Tamaki6,S. Noguchi7, H. Doihara8, K. Takeda9, Y. Ito10. 1Saitama InternationalMedical Center Saitama Medical University, Breast Oncology, Saitama,Japan; 2National Cancer Center Hospital East, Breast and MedicalOncology Division, Chiba, Japan; 3Tokyo Medical University IbarakiMedical Center, Department of Breast Surgery, Ibaraki, Japan;4Yokohama City University Medical Center, Breast and Thyroid Surgery,Kanagawa, Japan; 5Oita breast cancer hospital, Oita, Japan; 6NahanishiClinic, Department of Breast Surgery, Okinawa, Japan; 7 Osaka UniversityGraduate School of Medicine, Department of Breast and EndocrineSurgery, Osaka, Japan; 8Okayama University Hospital, Departmentof Breast and Endocrine Surgery, Okayama, Japan; 9Osaka City GeneralHospital, Department of Clinical Oncology, Osaka, Japan; 10CancerInstitute Hospital of JFCR, Breast Oncology Center, Tokyo, Japan

Background: Chemotherapy-induced nausea and vomiting (CINV) areamong the most feared and distressing side effects for patients receivedcancer treatment. However detailed profile of CINV in Japanese patientswith breast cancer is not known. We performed a prospective multi-centerobservational study to assess the current status of CINV as a nationalsurvey for the first time in Japan.

Materials and Methods: Between April 2011 and December 2012, 2068cancer patients received highly or moderately emetogenic chemotherapy(HEC or MEC) were registered, and the data in 431 female breast cancerpatients of those were evaluated. Under the written informed consents,the incidence and severity of daily CINV were assessed with patient diaryincluding scale of a 100-mm horizontal VAS on days 1−7. The perception ofCINV by medical stuffs was also investigated. We analyzed CINV in acutephase (within 24 hours postchemotherapy) and delayed phase (after 24hours postchemotherapy) and evaluated the relations with CINV and thepredictive factors.

Results: Of 431 patients, 359 were HEC and 72 were MEC. Median agewas 54 (21−85) in HEC and 52 (31−72) in MEC. In acute phase, nauseaand vomiting were observed in 44.3% and 12.3% in HEC, and 5.6% and0.0% in MEC. In delayed phase, nausea and vomiting were observed in53.8% and 8.1% in HEC, and 41.7% and 8.3% in MEC. The incidences ofacute nausea and vomiting in HEC were significantly higher than those inMEC (P < 0.0001 and P = 0.0004), but there were no significant differencein delayed phase (P = 0.0705 and P = 1.0000). In the univariate analysis,the incidences of acute and delayed CINV were significantly higher in thegroup of patients who have the history of motion sickness and morningsickness respectively. The predictions of CINV by medical stuffs in bothacute and delayed phase were low coincidence in comparison to thoseactually happened to the patient.

Conclusions: Antiemetic drugs were used appropriately in accordancewith antiemetic guidelines for the prevention of CINV in Japan, and controlof vomiting was well managed. However it was suggested that control ofnausea is not yet sufficient in breast cancer patients. The presence ofmotion sickness and morning sickness should be affected by efficient CINVmanagement. Further intervention to prevent acute and delayed phaseCINV should be considered, especially in high-risk emetogenic patientsin breast cancer.

Conflict of interest: Other substantive relationships: Public HealthResearch Foundation

178 PosterHow German gyneco-oncologists adhere to antiemetic guidelines

in breast cancer patients receiving AC-containing (neo)adjuvant

chemotherapy

J. Schilling1, H.J. Hindenburg1. 1BNGO e.V., Berlin, Germany

Background: Supportive care guidelines are an important instrument tomaintain quality of treatment and quality of life in cancer patients (pts).However, there are limitations in the adherence to guidelines andapplication of guideline changes such as the recent change of theantiemetic risk group of AC-based chemotherapy. ASCO recommends tripledrug prophylaxis with 5-HT3-receptor-antagonist (RA), Neurokinin1-RA anddexamethasone (DEX).

Material and Methods: In order to evaluate the awareness ofmodern antiemetic guidelines (GL) among German practice-based gyneco-oncologists and the practical use of guideline recommendations in ptsreceiving AC-containing chemotherapy we conducted an online survey.49 practices of the BNGO used the ODM Quasi® GYN system for the


documentation of data on institutions, patients, therapies, and knowledgeand application of antiemetic GL. From October 2012 until August2013, antiemetic treatment was documented in 250 breast cancer ptswho received cycle 1 and 3 of AC chemotherapy (80% adjuvant,20% neoadjuvant).

Results: Awareness of antiemetic GL: AGO (AGO = German WorkingGroup of Gynecologic Oncology) 78%, ASCO 82%, NCCN 31%,MASCC 22%; application of GL: AGO 57%, ASCO 53%, MASCC 12%,NCCN 8%, other 2%, none (2%). 94% were aware of the change of theemetic group of AC in the ASCO GL. 84% of doctors stated they alreadyused triple drug antiemesis, 12% planned to do so, 4% refused to use tripledrug antiemesis.Antiemetic treatment documentation in 246 pts: Cycle 1: On day 1, 82 pts

(33%) received the triple drug schedule according to GL, 113 pts (46%)a combination of 5-HT3-RA and DEX. Cycle 3: triple drug combination onday 1: 35% of pts, 5-HT3-RA +Dex: 44% of pts. 4 pts were lost to follow up.

Conclusions: Although gyneco-oncologists are aware of national andinternational antiemesis guidelines as well as of the classification of AC-chemotherapy as highly emetogenic, only 33% of pts received the triplecombination according to GL in the first cycle of AC, 35% in the third cycle.


179 PosterInfluence of fenugreek on grafted and spontaneous mouse mammary

tumours development

V. Zhylenko1, S.P. Zaletok1. 1Inst. exp. Pathol. Oncol. Radiobiol.,Department of tumor growth biochemistry, Kiev, Ukraine

Background: fenugreek (Trigonella foenum graecum L.) is one of theoldest medical plants being used in treatment of multiple diseases. Lastyears, some works deal with anticancer properties of the fenugreek. Butthese studies were mainly performed in vitro. The aim of our researchwas to study fenugreek’s antitumor effect in vivo on the grafted Ca755mammary carcinoma growth in C57Bl/6 mice, spontaneous mammarytumors yield in C3H/Sn mice, average lifetime of the experimental miceand correlation of fenugreek’s antitumor effect with content of growthregulators − polyamines (PA) − in the tumor tissue.

Material and Methods: Experiments were carried out on the adultC57Bl/6 female mice with subcutaneously grafted Ca755 mammarycarcinoma and C3H/Sn female mice. C57Bl/6 mice in experimental groupswere administered with the mix of fenugreek powder (250mg/kg of bodymass) and standard mash from the day of tumor grafting up to sacrifices(17 days in total). The C3H/Sn mice were administered with the mix offenugreek powder (0.2; 2.0 mg/kg of body mass) and standard mash during19 months, and then they were administered standard mash up to theirdeath (total duration of the experiment was 28 months). PA content in thetumor tissue was evaluated by high pressure liquid chromatography.

Results: The fenugreek consumption led to significant (48%) inhibitionof Ca755 tumor growth in C57Bl/6 mice and increased their lifetime by18%; decreased the spontaneous mammary tumors yield in C3H/Sn miceto 30% (0.2mg/kg) and 15% (2.0mg/kg) versus 60% in control animals.The fenugreek increased C3H/Sn mice lifetime by 11% (0.2mg/kg) and24% (2.0mg/kg) versus the control mice. In Ca755 tumors, fenugreekconsumption decreased level of putrescine (35%), spermine (12%) andspermidine (11%) and increased acetylated spermidine content (12%).These biochemical data are in agreement with the tumor growth retardation.

Conclusions: Thus, these results show that fenugreek can be a potentialagent against breast cancer.


180 PosterSatisfaction with a therapeutic sleeve for arm lymphoedema

secondary to breast cancer treatment: Controlled cross-over trial

F. Osorio1, L. Ferro2, L. Garrido2, A. Henriques3, J. Cruz4, R. Fangueiro4,J.L. Fougo2, A. Azevedo3. 1Sao Joao Hospital − University of PortoMedical School, Breast Center, Oporto, Portugal; 2Sao Joao Hospital,Breast Center, Oporto, Portugal; 3University of Porto Medical School −ISPUP, Dept. Clinical Epidemiology Predictive Medicine and PublicHealth, Oporto, Portugal; 4University of Minho, Fibrous Material ResearchGroup, Guimaraes, Portugal

Background: Our purpose was to obtain the subjective assessment ofPRADEX®, a class 1 (15−21mmHg wrist compression) elastic therapeuticsleeve, compared to commercially available sleeves, in patients withlymphoedema secondary to breast cancer treatment.

Material and Methods: This analysis includes 46 women with grade 1arm lymphoedema due to axillary surgery and/or radiotherapy for breast

cancer treatment, with wrist circumference 17−23 cm, who already usedan elastic class 1 sleeve on a daily basis, prescribed by a physiatristand provided by the hospital free-of-charge. Women used their usualsleeve and PRADEX® daily for 2 weeks each, in a crossover design.The primary outcome was satisfaction with the sleeve, as assessedby 11 items, each measured in a 10-point Likert scale (higher scoremeaning lower satisfaction), covering esthetics, comfort, usability and staticelectricity dimensions. Secondary outcomes were subjective assessmentof severity of edema and measured upper limb perimeters. All outcomeswere assessed at days 15 and 30.

Results: The median (interquartile range (IQR)) age of women was54 (47−63) years, 50.0% were overweight and 26.1% obese. Themedian (IQR) time since the onset of lymphoedema was 2.2 (1.8−3.5)years and in 54.4% of patients it affected the right arm.The new therapeutic sleeve was classified as having a better design

[median (IQR) difference between sleeves: −3.0 (−6.0; −1.0), p < 0.001]but no differences were found regarding the color [0.0 (−2.0; 4.0),p = 0.22]. The new sleeve was more comfortable [thin: −6.5 (−8.0; −4.0);fresh: −5.5 (−7.0; −2.0); soft: −4.0 (−8.0; −3.0); flexible: −6.0 (−9.0; −3.0);comfortable: −4.5 (−7.0; −1.0), all p < 0.001] and usability [easy to dress:−4.0 (−8.0; −1.0); easy to wear: −4.0 (−8.0; −1.0); resistance to dirt: −3.0(−7.0; −0.0), both p < 0.001)]. There were no differences regarding staticelectricity [0.0 (−4.0; 0.0), p < 0.001].Women’s subjective opinion about the severity of lymphoedema favoured

their usual sleeve in detriment of PRADEX® (p < 0.001), but no differenceswere found regarding the perimeters of the wrist, forearm and arm afterusing PRADEX® and the previous usual sleeve [mean (SD) differencebetween sleeves: +0.2 (3.5), p = 0.807; +0.5 (9.0), p = 0.166; −1.6 (10.3),p = 0.256, respectively].Approximately 90% of women offered suggestions for the improvement

of both sleeves, particularly a color more similar to skin color, an interiorsilicon band for better grip to the upper arm and the possibility of havingdifferent levels of compression at different levels of the arm’s length.

Conclusions:Our study confirms the better design, usability and comfortof the new therapeutic sleeve over the traditional ones. Despite similarobjective arm measurements, women perceived better lymphoedemacontrol with the old sleeve. Further research is needed to ascertain whichfactors are associated with these preferences.


181 PosterEvaluating the value of supportive medical apps during the treatment

for breastcancer

D.A. Young-Afat1, C.H. van Gils2, C.C. van der Pol3, A.J. Witkamp3,S. Sijtsema3, H.J. van den Bongard4, M.G. Ausems5, R.M. Bijlsma6,H.M. Verkooijen1. 1UMC Utrecht, Radiotherapy/Epidemiology, Utrecht,Netherlands; 2UMC Utrecht, Epidemiology, Utrecht, Netherlands; 3UMCUtrecht, Surgery, Utrecht, Netherlands; 4UMC Utrecht, Radiotherapy,Utrecht, Netherlands; 5UMC Utrecht, Medical Genetics, Utrecht,Netherlands; 6UMC Utrecht, Medical Oncology, Utrecht, Netherlands

Background: The use of medical apps in routine clinical care is increasing.Before practitioners (physicians and nurses) can advise their patients to useapps during their treatment, information about their safety and effectivenessshould be available.To gain experience with the use of apps and their specific functions

during treatment, we selected a supportive breast cancer app which:(1) provides information about disease and treatment, (2) serves asa patient repository for information (i.e. audio taped consultations),(3) registers physical and mental health status (i.e. pain), and (4) providesan overview of the course of treatment (e.g. timeline).We evaluated patient, doctor and nurse experience with this supportive

app during the entire process from diagnosis to treatment.Material and Methods: Between June and December 2013, twenty

breast cancer patients were invited shortly after diagnosis to use asupportive breast cancer app (OWise®, Px Healthcare, The Netherlands)during 6 months.After a consultation, both patient and practitioners were interviewed sep-

arately. All interviews were conducted by one researcher, either face-to-faceor by phone, based on a standard open-ended questionnaire. Patients wereasked which features of the app were used and for what purposes (e.g.preparation for consultations, monitoring feelings/symptoms). Practitionerswere interviewed about the recording function (i.e. influence on consultationtime, how it felt to be recorded) and about the level of patients’ diseaseknowledge.

Results: Patients felt that the app provided them with useful information(90%) and they all felt (100%) that replaying audio from recorded consultswith practitioners was helpful (e.g. sharing with family members that werenot present at the consultations). Not all patients used the symptom


registration function (50%). Overall, 90% would recommend this app toother patients.Doctors and nurses rated the recording function as useful (80%), and

reported that it did not increase consultation time or alter the informationgiven to the patient. Twenty percent of practitioners felt that patientsappeared better informed during consultations. Please note: Updatedresults will be presented at the EBCC conference (or whenever requested).

Conclusion: Based on this study, we conclude that supportive breastcancer apps could be useful for patients during treatment for breast cancer.However to fully utilize specific functions that an app has to offer andintegrate this into consultations, both patients and physicians should obtainpersonal experience with the app.

Conflict of interest: Other substantive relationships: Px Healthcareprovided 3 iPads (on loan) for 3 patients (who did not own one themselves)to use during this study. The other patients used their own devices.

182 PosterProspective comparison of prognostic factors in patients starting a

third line of chemotherapy for metastatic breast cancer: An ancillary

study to the CirCe01 trial

C. Helissey1, F. Berger2, C. Bouleuc1, M.N. Rodrigues1, P. Beuzeboc1,V. Dieras1, P. Cottu1, L. Mignot1, J.Y. Pierga1, F.C. Bidard1. 1InstitutCurie, Oncology, Paris, France; 2INSERM U900, Oncology, Paris, France

Background: Several prognostic factors and composite scores basedon either patients general condition and/or usual blood analyses havebeen described in the setting of advanced metastatic cancers to estimatepatients overall survival (OS). Over the past decade, circulating tumorcells (CTC) have been repeatedly reported as being a strong prognostictool in metastatic breast cancer patients. We took the opportunity of theobservational part of a prospective clinical trial (CirCe01, NCT01349842)that included 3rd line metastatic breast cancer patients to assess andcompare several prognostic factors/scores and circulating tumor cell count.

Patients and Methods: Metastatic breast cancer patients wereincluded before the start of a 3rd line chemotherapy at the Institut Curie,Paris, France. The following adverse prognostic factors were assessedprospectively and compared to overall survival: altered performance status(PS� 2), lymphopenia (<1,000 lymphocytes/mL), elevated CTC count(CellSearch, �5 CTC/7.5ml), low albumin (<35 g/l), elevated CA 15.3(>30 UI/ml), elevated CEA (>5 ng/ml), elevated LDH (>50 UI/l). Twocomposite scores were also evaluated: the Barbot score (combiningKarnofsky index, number of metastases, albumin and LDH; Barbot JCO2008) and the Prognostic Inflammatory and Nutritional Index (PINI;combining albumin, prealbumin, orosomucoid and C-reactive protein).Metastatic sites (liver, lung, bone) were also analyzed. Survival wasanalyzed by Kaplan–Meier curves; multivariate analysis was done usinga Cox model.

Results: 56 patients have included prospectively and 36 of them (64%)died. CA 15.3 and CEA levels, lymphopenia and metastatic sites had nosignificant impact on OS in univariate analysis.In multivariable analysis, the three independent prognostic markers on

OS were: elevated CTC count (p = 0.003, HR = 3.4 95%CI [1.5−7.7]),poor PS (p = 0.005, HR = 4.1 95% IC[1.5–11.3]) and low albumin(p < 0.0001, HR = 11.3 95% IC[3.9–32.5]).

Discussion: CTC are an independent prognostic marker, even inadvanced metastatic breast cancer. The disease aggressiveness beingcaptured by the CTC count, usual clinical and biochemical tests appearto be sufficient to evaluate the patient prognosis, whereas more complexscore (PINI, Barbot) appear to be of low interest.


183 PosterQuality of life in breast cancer patients undergoing breast conserving

surgery in Greece

M. Zafrakas1, P. Eskitzis2, I. Demetriades3, G. Sympilidis4,E. Panagopoulou2, A. Papanikolaou2, B.C. Tarlatzis2. 1AlexanderTechnological Institute of Thessaloniki, School of Health and MedicalCare, Thessaloniki, Greece; 2Aristotle University of Thessaloniki,Medical School, Thessaloniki, Greece; 3Theageneio Oncologic Hospital,Pathology, Thessaloniki, Greece; 4Theageneio Oncologic Hospital, BreastSurgery, Thessaloniki, Greece

Background: The aim of the present study was to evaluate quality oflife (QL) in women undergoing breast conserving surgery, due to primarybreast cancer, in Greece.

Materials and Methods: This was a prospective, questionnaire-basedstudy in women with primary operable breast cancer, aged 30−80 years.

A modified Greek translation of the Functional Assessment of CancerTherapy-Breast (FACT-B) questionnaire was used. Patients answered thestudy questionnaire prior to, one week after and one year after breastconserving surgery. Participants received adjuvant therapy accordingto current treatment guidelines. Patients with metastatic disease, anypsychiatric co-morbidity and those treated with neoadjuvant therapy wereexcluded from the study. Data were analyzed statistically using 1-wayANOVA repeated measures, t-test for independent or paired samples, aswell as non parametric tests.

Results: In total, 155 women, with a mean age of 59.2 years, filledout the study questionnaire. Patients’ social and family well-being had anegative impact on QL prior to surgery as compared with QL one weekand one year after the operation (p < 0.05). In contrast, functional well-being and patients’ relationship with their doctors adversely affected QLone year after surgery than prior to or a week after surgery (p < 0.017).Finally, emotional well-being and ‘additional concerns’ were associated withbetter QL one week after the operation than prior to or one year after theoperation (p < 0.017 and p = 0.007, respectively).

Conclusion: QL of breast cancer patients appears to be differentiallyaffected by different parameters prior to, one week after and one year afterbreast conserving surgery for primary breast cancer.


nursing, supportive care

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