Cancer Support Centre Research Articles

A cost analysis of a community-based support centre for cancer patients and their families in Ireland: the EVeCANs study.

Cancer patients and their families experience a range of physical, psychological and financial adverse effects. Community-based cancer centres offer a range of services and interventions, free of charge, to support those affected by cancer. While shown to be effective, there is a lack of information on the costs of these services. Our aim was to estimate the resource impact of a community-based cancer support centre. Over a 7-month period, there were 2032 contacts with 238 clients whose average age was 60years. The most frequently used services were transport to treatment (20%), complementary therapies (48%), exercise classes (10%) and counselling (9%). This cost analysis estimated total annual cost to provide all services was €313,744. Average annual cost per person was €1138. Current uptake at the centre represents 8% of all cancer incidences in seven counties surrounding the centre. If uptake increases by 10%, scenario analyses predict an increase in total costs increase to €429,043 and a decrease in costs per patient to €915. As cancer incidences increase, the need for supportive care is growing. Community-based services have been established to meet these needs and fill this gap in national health services. Long-term sustainability of these centres is uncertain as they are entirely reliant on donations and volunteers. This analysis estimates the costs of one such community-based cancer support centre, for the first time in Ireland. Findings can be used to inform future planning of cancer supportive care services, including establishing links between tertiary and community-based centres, and cost effectiveness analyses, nationally and internationally.

Development of a New Tool for Better Social Recognition of Cancer Information and Support Activities Under the National Cancer Control Policy in Japan.

Under the recent trend of an increasing number of cancer survivors, there is a need to devise measures for visualization of medical care and public health programs related to cancer control, which will enable better overview of the activities at hospitals and local communities and allow various stakeholders to share the information about such activities. The aim of this study was to propose a new tool for proper implementation of cancer information and support programs provided under the national cancer control policy in Japan. Considering 5 elements reported by Handler et al (macro context, mission, structural capacity, processes, and outcomes), we conducted the focus group discussions to confirm the goals of activities of Cancer Information and Support Centers. Eventually, 2 final goals (“reduction in the number of patients/families having difficulties related to cancer” and “being able to live at ease even after diagnosis of cancer”) were identified, accompanied by 5 semifinal goals and 16 prerequisite conditions needed to achieve the final goals, as well as the necessary states and the activity indicators corresponding to them. This tool was utilized by 180 (42.7%) of 422 cancer care hospitals designated by the government of Japan (designated cancer care hospitals [DCCHs]) in 2016 and by 336 (77.1%) of 436 DCCHs in 2018, which were the data at 6 months and 3 years after introduction of the tool, respectively. Thus, the tool for evaluating the Cancer Information and Support Centers' activity presented here is expected to stimulate the stakeholders involved in providing supports in various fields of each local community, to share the final goals, to evaluate the status of their achievement, and to further advance their own activities.

Physical Activity Across the Cancer Journey: Experiences and Recommendations From People Living With and Beyond Cancer.

The majority of individuals living with and beyond cancer are not sufficiently active to achieve health benefits. The aim of this study was to explore individuals' experiences of physical activity (PA) behavior across the cancer journey and to ask individuals living with and beyond cancer to identify strategies to support habitual PA. An exploratory, descriptive, qualitative design was used. Purposive sampling methods were used to recruit individuals living with and beyond cancer who had been referred to, and/or participated in, a community-based exercise program or were attending a cancer support center. The focus group discussions were audio recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Seven focus groups were conducted with 41 participants. Many individuals reported that regular PA provided a vehicle for recovery that created a sense of "self-power," defined as taking ownership and control of one's health to increase well-being. Barriers to PA participation included environmental-, patient-, and treatment-related challenges. Recommendations to support long-term adherence to PA included completion of fitness assessments at regular intervals and provision of a home exercise program. The benefits and barriers to PA participation for individuals diagnosed with cancers that were not represented may not have been identified. The strategies recommended to support habitual PA may be salient only to individuals whose cancer diagnoses were represented. Exercise is seen as a vehicle for recovery from cancer but long-term adherence for individuals is complex. The findings from this study can inform the development of exercise oncology rehabilitation programs and could support a greater likelihood of program success, thereby optimizing the health, well-being, and quality of life of survivors of cancer.

CN59 - Measuring the impact of the Irish Cancer Society’s cancer information services

BackgroundThe Irish Cancer Society is committed to monitoring the impact of our Cancer Information Services (CIS) at 4key stages (prevention, support, survivorship and palliative) to demonstrate the positive changes our services bring to the people affected by cancer. CIS incorporates Cancer Nurseline (freephone cancer helpline) and Daffodil Centres (walkin cancer information and support centres) based in cancer centres. Both are staffed by specialist cancer nurses. CIS provides support, advice and information to anyone affected by cancer. The information provided is tailored to the needs of each individual enquirer giving them greater access to cancer support and information which complements the service provided by the clinical teams in hospitals or in the community. In 2018 there were 47371 contacts to the service. MethodsImpact Monitoring uses surveys (paper and online) to collect information from service users. The nurses recruited cancer support enquirers over a two month period during September and October 2018. An enquirers’ distress level was assessed (using distress screening) by the nurse to determine if they were suitable to take part in the survey. Consent was obtained from participants across all services. Returned surveys were entered into a database and analysed according to themes and patterns. All respondents were anonymous. ResultsCIS had many positive impacts. Enquirers to the service appreciated the opportunity to access information from a healthcare professional either by phone or within a Daffodil Centre. During analysis some of the main benefits of the service identified include • Increased knowledge of cancer and its symptoms • More supported and aware of emotional supports • More in control • Reduced anxiety. Accurate and reliable information from a CIS healthcare professional offered reassurance to patients. ConclusionsHaving access to a cancer nurse through the CIS gave cancer patients the opportunity to avail of support, information and advice as and when they needed it. Enquirers felt they could talk through their questions and concerns, with the nurse providing information and guidance which reassured them. Talking to a nurse helped people feel more supported, more knowledgeable about their cancer and hopeful about the future. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Support for both medical treatment and work∼Perspective of an occupational health physician ∼

Abstract There are approximately 100 thousand registered occupational health physicians certified by the Japanese Medical Association, and 31% of physicians have an occupational health qualification. Moreover, among the physicians registered, about 60% are practicing occupational medicine, and 55% of physicians who work in occupational health spend under 10% of their working hours practicing it. Furthermore, there are only 1,128 physicians whose primary work is in occupational health. In order to provide sufficient support to patients for both medical treatment and work, the number of people working in occupational health must increase, and not only some doctors, but all physician and part-time occupational health physicians have to focus on support for it. Medicine and nursing are not the only elements that need to be in place to provide support for both medical treatment and work; knowledge about psychological assessment, labor and career management, and the social security system is also invaluable. In other words, there is also a need for participation from and cooperation between people from a variety of fields in addition to medicine, such as welfare, labor and social security attorneys, as well as the government. While cancer patients are receiving treatment, they also need to solve problems related to work and finances. Patients are likely to be experiencing many things for the first time, including taking time off from work. Having to visit many different offices while they are unwell is a major burden. Hence, it is important to divide things up so that consultation offices such as cancer consultation and support centers can synthesize content for consultation from the outset and address issues. The role of these centers will become even more important moving forward. We would like to cover the above information along with actual examples and discuss expectations from relevant personnel and departments from the perspective of occupational health physicians.

CN45 - The cost of survival study: A mixed methods exploration of quality of life outcomes in colorectal cancer survivorship

BackgroundCancer survivors may live with an array of physical, psychological and social disabilities which impact their day-to-day lives. The literature exploring quality of life in cancer survivorship is predominantly quantitative in nature; with inconsistencies in symptom prevalence owing to the multiplicity of generic and disease-specific quality of life instruments. This study explores the quality of life outcomes and symptom experiences of colorectal cancer survivors using a mixed methods sequential explanatory research design. MethodsA purposive sample of adult colorectal cancer survivors between six and 60 months post-diagnosis (n=304) were recruited from three public and private hospitals and 21 cancer support centres in Ireland. Participants completed a cross-sectional questionnaire; quality of life was evaluated using the EuroQol and FACT-C questionnaires. A sub-sample of 22 survey participants selected using a maximum variety sampling strategy took part in semi-structured interviews to explore their quality of life and symptom experiences in greater depth. ResultsQuality of life scores reported by the sample were postive on average; however, more than half were dissatisfied with their quality of life, and more than three-quarters reported at least one physical, psychological or social survivorship issue. Negative body image (74%), sexual dysfunction (66%) and fatigue (64%) were the most common issues reported by survey participants. However, qualitative data suggest that less prevalent symptoms such as bowel dysfunction (28-57%) and peripheral neuropathy (47%) were associated with higher levels of unmet need and greatest distress, as they had the greatest potential to negatively impact social and psychological well-being. ConclusionsThe findings of this study demonstrate that although cancer survivors report positive quality of life outcomes, many may experience distressing physical, psychological and social effects. Given the finding that survivors associated greater unmet need and symptom-related distress with less common symptoms, it is imperative cancer survivors receive information and support that is based upon holistic person-centred evidence. Legal entity responsible for the studyAmanda Drury. FundingHealth Research Board. DisclosureAll authors have declared no conflicts of interest.

Reaching Out to Public Libraries to Help Reduce Cancer Information Disparity

In light of growing interest in people taking more proactive roles in managing the course of long term illnesses, ensuring ready access to cancer information supporting programs has become one of the paramount mandates, for many national cancer control programs. In Japan, the Center for Cancer Control and Information Services, a division of the National Cancer Center Japan (NCC-CIS), is tasked with dissemination of reliable and comprehensive cancer information for all citizens including patients and their families. NCC-CIS compiled cancer information has long been delivered via both dedicated portal “Ganjoho (Cancer Information) Service” ( https://ganjoho.jp ) as well as brochures. As majority of cancer patients and their carers tend to be seniors who are not net-savvy, the portal has its limitations as dissemination channel. A more personalized support is provided by a nationwide network of Cancer Information and Support Centers (CISCs), collocated within 434 state-designated cancer hospitals. CISCs offer both information and counseling support to anyone who has cancer related issues, even if they have never been treated at the given facility. While CISC is a public service, subsidized with national and prefectural funding, many of those in need, remain unaware of the CISCs - at least in part, due to its very location, within a hectic acute care settings. To reach a wider audience, NCC-CIS and CISCs have started to collaborate with public libraries which have traditionally been a neighborhood source of reference information for both the young and old, and clearly more approachable than medical professionals in large hospitals. We have begun by disseminating a “starter-kit” of NCC-CIS publications to public libraries that have signed up with “Cancer Information Gift” project, a donor funded effort launched last summer. To date, almost 60 libraries have taken up this opportunity to either launch a new “Cancer Information Corner”. We have also brought the participating libraries and local CISCs together in regional workshops settings, to explore ways to mutually complement the information services offered by both parties. Collaborative initiatives that have come out of such explorations include “Book Talk on Disease in Library”, an interactive session in relaxed settings, where participants can feel more at ease, raising a wide range of personal concerns, around an issue highlighted in a given book, with both librarians and cancer counselors mediating the discussion. Referrals to CISCs from libraries are also beginning though in low volumes. While the “Cancer Information Gift” project, and its related initiatives are still very much at a nascent stage, we believe this collaboration could potentially go a lot further, to make reliable cancer information (and CISCs) more accessible to a wider segment of those in need, and in the process, help reduce the cancer disparity across the nation.

Ebene Joining Hands Fundraising Campaign

Amount raised: 641,704 Mauritian rupees Background and context: Link to Life Cancer Support Centre, is the first cancer NGO that has been founded in 2012 in Mauritius. With the increasing rate of cancer, 2607 new cases in 2016, it a must for us to sensitize, prevent and provide screening for cancer. As a cancer support association, it is quite difficult to get funds for the running of the NGO as well as the various activities. Apart from the CSR (corporate social responsibility) that some companies willingly give to us we have to innovate in creating novel fundraising campaign each year. The Ebene Joining Hands also known as the Ebene Chain is an innovative fundraising campaign that was performed in June 2016. Ebene is a suburb on the island of Mauritius and this region has been promoted as being the new information technology hub. It is a cluster of modern skyscrapers from afar with more than 150 to 200 companies. Link to Life campaign was mainly to collaborate with the various companies in Ebene to raise funds for one of our main projects which is free transport facilities to cancer patients. Aim: Create awareness on cancer and related activities of the NGO. Make the companies contribute toward the fight against cancer. Sensitize the public in general about cancer. The Ebene Joining Hands - uniting our force together “hand in hand” we are able to give a helping hand to cancer patients. Break the taboo on cancer/common cancer myths. Empower cancer beneficiaries. Strategy/Tactics: Create a cancer support truck whereby cancer patients and survivors will be in it. The truck will then drive along a predestined track which will cover the entire Ebene hub region. With the help of two main companies Minerva Fiduciary Ltd. and Afrasia Bank, we have been able to create a successful fundraising campaign. The various companies in Ebene were contacted to introduce them the fundraising project. The said company will have to contribute to a minimum fee of 2500 Mauritian rupees and at the same time, we would sensitize their staff to participate in the Ebene Joining Hands event, whereby they will be on the track, hold the hands of the person next to them, waiting for the cancer support truck to pass by. They will then lift their hands up and applaud by welcoming the cancer survivors on the truck. Timing of the event was taken into consideration. Since most of the employees were during their working time, we had to fix the event during lunch time for a period of 30 to 45 minutes (i.e., from noon to 1:45 pm). Costs: Rs. 130,000 What was learned: Preparation for such event will have to be done well in advance. Attitude is everything. All participants were here to show their support. The patients were proud to have participated to the campaign and were deeply moved by the welcome that they have received on the streets.

An ethnographic inquiry into the psychosocial care for oncology patients in the community: Healing from the 4Es.

The aim of this study was to explore how the provision of community care in a cancer support center can help cancer patients and survivors cope with the demands of cancer and its treatment. A focused ethnographic approach was adopted. Data were collected through participant observations and focus groups with various stakeholders. The data from the focus groups were transcribed verbatim and analyzed using constant comparative analysis. Four main themes emerged: 1. Enabling users to achieve mental well-being on their coping journey, 2. Empowering users to deal with their uncertainties, 3. Enhancing meaningful nurturing interactions through the design of spaces and colors in the Centre, and 4. Evolving through seeing more value in themselves. These 4Es occurred through intimate human interaction in the Centre, which resulted in psychological renewal and the rebuilding of a sense of self among the users. This study provides insights on the provision of community support services for cancer patients/users, specifically on how to help them to regain control over their lives, not only through providing services for psychosocial renewal by engaging in intimate human interactions, but also by contributing to an understanding of the effect of the physical environment and space on healing. The results also reveal a virtuous circle of the 4Es as the synergies from the services, activities and the environment in the Centre, which provide a harmonious context for the users in coping with their cancer journey.

EL6 - Cancer care and treatment in community and the critical path for cancer

Medical care is essential for community life. Above all that for cancer is becoming more important than ever with aging of population. In Japan, regional cancer cooperate hospitals are designated by the government in each predefined medical administration areas to promote standard care for cancer. Our institution is one of the designated hospital in the northern part of Miyagi prefecture, the population in which is about 300,000. Other than cancer, the medical center in a local area like ours usually has a role as an emergency medical institution and is also responsible for the other group of disorders such as cardiopathy, neurovascular disease and so on. In such an institution, the department that comprehensively control cancer care is needed. Our cancer center plays the leading role in deciding on the multidisciplinary treatment policy within the organization, where medical oncologists play key roles other than anticancer drug therapy, sometimes cooperating with the palliative care team. In addition, through our cancer support center we collaborate with community healthcare institutions including in-home treatment support clinics where cancer patients and families can receive required medical care and live safely in spheres of daily life. To manage the standard care process of cancer, we developed several critical paths for cancer. Among these we most frequently operate the clinical paths of cancer chemotherapy, the purpose of which is the safe induction of the first course of regimen with successful self-management by the patients themselves. In addition, the recently developed information sharing system with regional pharmacies and the critical path for cooperate palliative care will be reviewed. In short, medical oncologists should fulfill central roles in cancer treatments and developing networks for cancer care in local communities as well.

Close HER2 Home: Breast Cancer Patients Preferences For Treatment Delivery

This study is currently being undertaken to identify the preferences of people diagnosed with HER2 positive breast for delivery of subcutaneous trastuzumab (Herceptin) therapy. The introduction of a product with a less invasive administration method holds out the prospect of delivering care in non hospital based environments. The design of care pathways that incorporate patient preferences is a key stage in achieving the best clinical outcomes from available resources. Important attributes for the delivery of trastuzumab therapy have been identified through two focus groups undertaken with breast cancer survivors attending a cancer support centre. The group will act as a steering group for the implementation of a discrete choice experiment: confirming the delivery of attribute levels; piloting of the questionnaire and commenting on choice sets; providing feedback on the interpretation of data achieved from respondent participation. Given the number of attributes and levels, the number of combinations is 128. A series of 16 choices will be employed using a D-efficient main effects design. The model will be assessed using conditional logistic regression and mixed logit regression in Stata. If possible, latent class modelling will be performed. A community pharmacy pathway will be implemented using data generated from the study and the feasibility of treatment delivery assessed using a realist evaluation approach. Predicted uptake will be estimated and compared to the current situation. Attributes identifed by the patient group for delivery of treatment are: travel time; travel cost; identity of provider; treatment site; "They know your name". The potential to deliver cancer care in primary care settings is large, given the rise in cancer prevalence due to an ageing population and increasing survivorship amongst cancer sufferers. Design of care pathways that explicitly meet patients' preferences for care delivery is therefore a key step to successful service redesign.

The use of psychosocial support services among Japanese breast cancer survivors.

This study aimed to investigate the use of psychosocial support services, the intention to use these services, and to elucidate the characteristics of survivors most likely to use support services among Japanese breast cancer survivors. We invited breast cancer survivors to complete an online questionnaire via an email sent to subscribers of a non-profit organization mailing list. We asked participants questions related to demographics, opinions on the state of psychosocial support services, and their interest in using these services. Participants were also asked to complete the Hospital Anxiety and Depression Scale and the Brief Cancer Worry Inventory (BCWI). We analyzed the data of 171 participants. Those who used some form of psychosocial support service constituted 50.9% of the participant population. Participants used cancer consulting and support center services (13.5%), hospital and non-hospital support groups (12.9%, respectively), psychiatry (11.1%), hospital and non-hospital cancer salons (8.8%, respectively), psychosomatic medicine (8.2%), therapist counseling (6.4%) and psycho-oncology department services (4.1%). Non-users who suffered from adjustment disorders or major depression (52.1%) reported higher total BCWI and the subscale scores had no concrete plans to use psychosocial support services. The usage levels of psychiatry, psychosomatic medicine and psycho-oncology services in our study were higher than those reported in any previous Japanese study within the psycho-oncology field. Participants joining a breast cancer survivors' mailing list, or their being female, may have led to a higher use of such services. A high degree of distress does not necessarily lead cancer survivors to seek psychosocial support services.

Effect of a Mindful Eating Intervention on Lifestyle Factors in Overweight and Obese Postmenopausal Breast Cancer Survivors – a Pilot Study

Studies have shown that postmenopausal breast cancer survivors are more likely to be sedentary and have poorer diet quality than their non‐cancer counterparts, contributing to weight gain. In addition, they are more likely to have increased levels of psychological stress. Heightened mindfulness is associated with healthier eating behaviors, lower BMI, and reduced stress. However, little is known about the effect of mindful eating on these lifestyle factors in overweight and obese postmenopausal breast cancer survivors. The objective of the study was to examine the effect of a mindful eating intervention on lifestyle factors, including mindfulness, stress, and nutritional intake in overweight and obese postmenopausal breast cancer survivors. Participants were recruited through local physician's offices, cancer support centers, and newspaper advertisements in 2016. Participants completed 8 weekly 2‐hour Mindful Eating Workshop© group sessions, led by a certified mindfulness instructor. The workshop addressed mindless, stress‐related, or emotional related eating, and disordered eating patterns through mindfulness meditation and group discussion. Data were collected at the University of Georgia Clinical and Translational Research Unit at 2 time points: baseline and follow‐up (week 12). Nutritional intake was assessed using the 2014 Block Food Frequency Questionnaire. Mindfulness was assessed using the Mindful Attention and Awareness Scale, and stress was assessed using the Perceived Stress Scale. Paired t‐tests and Wilcoxon signed rank test were used to compare outcomes pre‐ and post‐intervention. The analytic sample included 10 postmenopausal breast cancer survivors in remission with a BMI of ≥ 25 kg/m2 who completed the intervention. Mean age was 64.4 ± 6.0 years, 90.0% were non‐Hispanic white, 50.0% were married, and 50.0% had an annual household income of more than $80,000. All participants significantly lost weight (mean weight change: −0.8 ± 0.8 kg; p= 0.015). There was a trend towards increased mindfulness (mean change= 8.4% ± 0.5; p=0.090); but perceived stress did not change over the course of the intervention. At baseline and follow‐up, participants underreported energy consumption (1,237.7 ± 304.2 and 1,094.0 ± 319.4 kcal/ day, respectively), marking no significant change in caloric intake post‐intervention. Mean fat and saturated fat intake at baseline were 40.7 ± 3.8% and 13.8 ± 1.9% of daily energy, respectively. Participants reduced overall fat intake by −10.6 + 7.1 grams/ per day (p=0.002), and saturated fat by −3.56 ± 3.0 grams/ day (p=0.008) without significantly changing protein or carbohydrate intake. In addition, participants reduced intake of sweets by 2.5 ± 1.9% of daily energy (p=0.003). Despite not meeting current dietary recommendations, intake of fruits, vegetables, and whole grains were not altered. Findings of this study suggest that a mindful eating intervention may lead to improvements in fat, saturated fat, and sweets intake, but not other lifestyle factors, in overweight and obese postmenopausal breast cancer survivors. Larger, more adequately powered studies are needed to confirm the findings and examine effects if the intervention is carried over long‐term.Support or Funding InformationThe study was funded through the University of Georgia Clinical and Translational Research Unit seed grant.

Breast Health Disparities: A Primer for Medical Students.

While breast cancer incidence rates have remained stable and mortality rates have declined for white women, breast cancer mortality has steadily increased for African American women since the 1950s. It has often been assumed that genetic risks linked to African ancestry are the cause for these disparities. However, a better understanding of the role of stress and social and environmental factors in health lends evidence to the social determinants behind the increasing gaps in breast health outcomes. This resource's goal is to raise awareness among undergraduate medical students about breast cancer disparities, particularly the late-stage diagnoses and the higher mortality rate for African American women. Our educational session included a lecture on basic epidemiological data and information on breast cancer etiology followed by a case study, which was created with the founder of a local cancer support and resource center serving mainly African American women diagnosed with breast cancer. As part of the case exercise, we utilized concept mapping as a tool to apply learning. Pre-/postquizzes showed significant improvements in knowledge and confidence in working with patients. Narrative reflections from students indicated an improvement in targeting at-risk populations, educating patients about their risk and options, and understanding the complex role that socioeconomic factors may play in patient outcomes. By raising awareness and exposing medical students to the socioeconomic and cultural aspects of breast health, we hope to improve medical students' knowledge of risk factors and preventive strategies, as well as their abilities to guide patients through appropriate screening and follow-up.

What is needed to implement Institute of Medicine (IOM) 2013 supportive oncology recommendations in community settings?

49 Background: The IOM 2013 report recommends supportive oncology services from diagnosis through survivorship and end of life. We examined what community institutions need to implement IOM recommendations. Methods: Survey of 35 institutions in a urban area (13 cancer centers; 14 cancer support centers, 8 hospices). Institutions ranked the top 5 supportive oncology project ideas, that their organization was most interested in participating in, from a list of 27. Results: Survey response rate was 100%. Respondents agreed on 8 of top 10 priorities across the three organization types (Table). Local inter-institutional collaboration leveraging respective resources and facilitating care consistency across sites was the most frequently need. It was followed by the need for stratified care processes based on patient need and improved supportive oncology reimbursement. Priorities differed between Cancer Centers and other institution types on Consolidated screening tools* (p = .05, .09) and Care process for family / caregiver** (p = .006, .04). Conclusions: Supportive oncology care processes and tools are needed to implement IOM recommendations in the community. Our findings inform a roadmap for practical collaborative implementation of the IOM recommendations. Differing priorities across cancer institution types should be further explored and addressed within the roadmap. [Table: see text]

Evaluating programmes from The Haven's Breast Cancer Support Centres: Results and challenges

Evaluating programmes from The Haven's Breast Cancer Support Centres: Results and challenges

A Community-Based Exercise and Support Group Program Improves Quality of Life in African-American Breast Cancer Survivors: A Quantitative and Qualitative Analysis.

African-American (AA) breast cancer (BCa) survivors have higher mortality rates, more comorbidities and are less likely to meet national physical activity guidelines after diagnosis compared to Caucasian BCa survivors. We previously reported that a 20-week resistance exercise intervention coupled with a support group and home walking program, conducted using facilities and personnel at a community cancer support center, in Stage I-III AA BCa survivors improved strength, fitness and circulating C-peptide levels. Here, we report our findings on changes in quality of life (QoL) and other behavioral measures associated with this 20-week intervention and, discuss findings from a qualitative analysis of semi-structured patient interviews. We found a clinically relevant improvement in QoL using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B) (Baseline, B: 101.1 ± 21.5; End-of-Intervention, EOI: 108.5 ± 21.6; p = 0.05) and, a significant decrease in depression using the Beck Depression Inventory-II (B: 11.9 ± 8.1; EOI: 9.0 ± 5.5; p = 0.03). Our analysis of the patient interviews support improvements in these behavioral measures in that participants stated that they "feel better", were "more motivated" and "uplifted" after the program. The patient interviews also provided insights to the primary motivators (e.g., social support, improvements in strength and function, weight loss) and barriers (e.g., family and health issues) in adhering to the program and provided suggestions for improving the program (e.g., incorporating nutritional and treatment related side-effect discussions). Our results suggest that community-based lifestyle interventions may improve QoL and depression in AA BCa survivors and lend insights for improving future programs.

How to implement Institute of Medicine (IOM) 2013 recommendations on supportive oncology in community setting.

172 Background: The IOM 2013 report recommends supportive oncology services from diagnosis through survivorship and end of life. We examined what community institutions need in order to implement IOM recommendations. Funded by the Coleman Foundation. Methods: We conducted a survey of 35 institutions in a large urban area (13 cancer centers; 14 stand-alone cancer support centers, and 8 hospices) on institutional needs in implementing IOM recommendations. Results: Survey response rate was 100%. Respondents agreed on 8 of the top 10 priorities across the three organization types (Table). Local inter-institutional collaboration leveraging respective resources and facilitating care consistency across sites was the most frequently noted need. It was followed by the need for stratified care processes based on patient need and improved supportive oncology reimbursement. Priorities differed between Cancer Centers and other institution types on Consolidated screening tools* (p = .05, .09) and Care process for family / caregiver** (p = .006, .04). Conclusions: Supportive oncology care processes and tools are needed to implement IOM recommendations in the community. Our findings inform a roadmap for practical collaborative implementation of the IOM recommendations. Differing priorities across cancer institution types should be further explored and addressed within the roadmap. [Table: see text]

P180. Audit of referrals to a family history clinic

P180. Audit of referrals to a family history clinic

P181. Integration of physical activity into breast cancer care pathway “Can-Move” programme

P181. Integration of physical activity into breast cancer care pathway “Can-Move” programme