Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

PURPOSE

Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase.

METHODS

Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%).

RESULTS

Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization.

CONCLUSION

Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.

Facing points of view: Representations on adjuvant endocrine therapy of premenopausal patients after breast cancer and their healthcare providers in France. The FOR-AD study

PURPOSE

Adjuvant endocrine therapy (ET) for 5-10 years is the backbone of the therapeutic strategy in patients with hormone receptor positive (HR+) early breast cancer (BC). However, long-term adherence to adjuvant ET represents a major challenge for most patients. According to prior studies, side effects of adjuvant ET are an important reason for poor adherence. In contrast, better communication and relational bond between patients and healthcare providers (HCPs) may improve adherence. The FOR-AD (Focus on non-adherence) study aimed at better understanding the representation of adjuvant ET by patients and their HCPs, in order to improve the care process.

METHODS

Three focus groups of premenopausal women (receiving adjuvant ET for variable amount of time) and two focus groups of HCPs (including oncologists, pharmacists, and nurses) were conducted, each including around ten participants. Thematic analyses using a general inductive approach were constructed to report participants' representations.

RESULTS

Two main themes emerged across groups, and appeared of major importance. Representations on adjuvant ET were often homogenous within each group, but differed between patients and their HCPs. The relationship between both groups was considerably discussed, particularly its importance in facilitating adherence to adjuvant ET. Suggestions on improving the care process were also given, such as systematically including psychologists in follow-up care paths and having a nurse navigator follow patients under treatment with adjuvant ET.

CONCLUSION

The present qualitative exploration may help buildi future tailored interventions to improve adherence to adjuvant ET, in particular regarding the role of nurse navigators.

PROACT: Implementing a PROACTive care pathway to empower and support breast cancer (BC) survivors

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Background: Optimal comprehensive survivorship care, beyond screening of recurrences and new cancers, and including health promotion, management of physical as well as psychosocial needs and chronic conditions is insufficiently delivered. To increase patient (pt) empowerment and maximize the uptake of multidisciplinary strategies serving all survivorship needs, we implemented a proactive survivorship care pathway offered for pts with early BC at the end of their primary treatment phase (surgery, chemotherapy, radiotherapy). Methods: The pathway consisted of the following components: 1) receipt of a personalized survivorship care plan (SCP), 2) invitation to attend face-to-face group seminars focused on specific themes and a comprehensive survivorship consultation for multidisciplinary referrals (”the transition day”) 3) access to a mobile application (app) delivering personalized education according to symptoms reported and 4) decision aids for helping physicians to manage prevalent symptoms and side effects related to BC treatment. Administrative data were collected. A pre-specified post-experience survey was sent to all pts four weeks post pathway delivery to inform program implementation with a minimum requirement of 50 responses. BC physicians and members of the multidisciplinary implementation team (MIT) answered a dedicated survey. For the overall pathway and each of its components we descriptively evaluated the following domains: satisfaction (primary outcome), uptake, perceived usefulness, barriers for delivery, and suggestions for improvement. A 70% satisfaction rate would define a positive experience. Results: From October 2021 to April 2022, 241 SCP were delivered, and 98 pts attended the “transition day”. 62 pts replied to the survey, 42 (67%) had received the SCP, 34 (55%) attended the “transition day”, 36 (57%) accessed the app. Only 21 pts (34%) who answered the survey received the full pathway, 81% of whom were very or completely satisfied with it. Perceived usefulness of individual components and for pts that received the full pathway were, respectively: 64% and 90% for the SCP, 91% and 95% for the “transition day”, 72% and 90% for the app. Among 14 BC physicians, agreement regarding the usefulness of the components was: 93% for the SCP, 86% for the decision aids, 93% for the “transition day”, and 86% for the app. The MIT (n = 13) reported high engagement and satisfaction (100%). Main actionable points for improvement included: automated screening and SCP preparation, virtual “transition day”, increase physicians’ awareness. Conclusions: In this pilot phase, pts were satisfied with receiving a proactive survivorship care pathway and the majority reported that the components were useful for supporting their needs. This study informed improvements on program penetration. Evolution towards sustainability phase is ongoing including dissemination to other cancers and centers.

Quelle est la place des professionnels de santé dans l’adhésion aux programmes thérapeutiques en ligne de l’insomnie ? Éléments de réflexion issus de l’étude Sleep-4-All-1 et protocole de l’étude Sleep-4-All-2.0

La thérapie cognitivocomportementale de l’insomnie (TCC-I) demeure difficile d’accès pour les patients atteints de cancer. Sa digitalisation semble une solution prometteuse pour bénéficier au plus grand nombre. La faisabilité d’un programme TCC-I québécois a été démontrée en France, tout en révélant les limites d’un dispositif suivi en autonomie et à distance. L’enjeu reste de mieux comprendre le rôle des professionnels de santé dans l’accompagnement des patients dans ce type de programme. C’est l’objectif de l’étude Sleep-4-All-2.0 dont nous présenterons ici le protocole.

Abstract P4-09-05: Focus on non-adherence: A qualitative exploration of perceptions associated to adjuvant endocrine therapy (ET) in premenopausal patients with breast cancer and their health care providers (HCP)

Background and Objectives: Despite the proven benefits on reducing time to recurrence and improving survival, recent studies indicate that only half or less of patients with early stage breast cancer (BC) complete their recommended full-course of adjuvant ET. Findings suggested that adherence therefore remains a challenge for both patients and professionals, with differences in representations that remain poorly understood. The main objective of this study is to investigate BC patient’s perceptions about ET. Secondary objectives are: (1): to capture potential gaps between their perceptions and the representations of their HCP (2): to explore preferences in patients regarding programs aimed to improve adherence to ET. Methods We conducted separately focus groups with patients and HCP to capture a multilevel framework regarding non-adherence. Inclusion criteria for patients’ focus groups were: non metastatic hormone-receptor positive (HR+) BC; ≥18 years old; premenopausal at time of diagnosis; receiving ET for at least 2 months; for HCP criteria were: to be a medical oncologist, radiation oncologist, pharmacist or nurse; with at least 5 years of experience on BC. The discussion schedule was non-directive and included: introduction remarks and three key- questions linked to our objectives as well as follow-up questions to facilitate the discourse. Discussions were audio recorded, anonymized and transcribed verbatim. We used a thematic analysis approach to identify patterns and themes. Results: Twenty-eight patients (median age=45 yrs) and 17 professionals (11 women, median professional experience with BC =9.5 yrs) participated. Major themes emerging among participants are showed in Table 1. Important differences between HCP and patients with BC were analyzed regarding their representations towards adherence and communication.Conclusions: Dissatisfaction concerning ET medical monitoring and communication is shared by patients and professionals. The HCP reported a lack of communication skills to support patients struggling with ET adherence. Strikingly, the major barrier to ET reported by patients is related to the employment and the lack of adaptation to sequelae of ET. This barrier is not reported by professionals and appears a critical challenge to face. The suggestions made by patients during the focus groups offer promising perspectives regarding support programs to improve adherence.

PatientsN=28Major themesSub-themes•Representations on ET : a multidimensional burden1.Side effects and management2.Benefit/risk balance 3.Seeking information on ET•Professional life1.Work reintegration2.Lack of empathy of coworkers3.Career change•Psychological adjustment to ET1.Daily struggling2.Self-image modifications3.Feelings of loneliness•Relations to health care providers1.Communication: negative and positive aspects2.Shared decision-making 3.Advice on follow-up careHCP (N=17)•Representations on ET : a therapeutic weapon1.Side effects 2.Impact on body image 3.Finding solutions regarding ET side effects•Discourse to patients1.Negotiating the adherence to treatment 2.Beliefs on patients’ suggestibility 3.Communication techniques•Emotional experience: negative impact of prescribing ET1.Emotional fatigue2.Guilt 3.Desire on having psychologists to handle the patients’ emotions•Difficulties related to the healthcare system1.Lack of time 2.Lack of training

Citation Format: Léonor Maria Fasse, Nicolas Roche, Diane Boinon, Gwenn Menvielle, Agnes Dumas, Sofia Rivera, Margarida Matias, Antonio Di-Meglio, Suzette Delaloge, Ines Vaz-Luis, Barbara Pistilli. Focus on non-adherence: A qualitative exploration of perceptions associated to adjuvant endocrine therapy (ET) in premenopausal patients with breast cancer and their health care providers (HCP) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-05.

Abstract P4-11-27: A multimodal and personalized digital companion to help survivors of breast cancer (BC) manage side effects of adjuvant endocrine therapy (ET): A qualitative exploration

Background: Mobile health (mHealth) applications (app) and remote monitoring demonstrated tangible value in terms of improving dose delivery, quality of life and mitigating the severity of acute treatment-related side effects, both in the metastatic setting and during the active phase of treatment in patients (pts) with early-stage solid tumors. However, the value of mHealth in ‘after primary treatment’ survivorship phase is less studied. Most BC pts have hormone receptor-positive disease and are eligible for adjuvant ET for 5-10 years. ET is associated with multiple side effects that negatively impact quality of life and treatment adherence. A prior survey among French survivors suggested that pts are willing to use digital companion app to help them in the after-cancer experience. In this setting, we developed a digital companion for survivors of BC receiving ET. Objectives: In this study, we explored acceptability, representations, levers, and barriers to a multimodal mHealth intervention among BC pts treated with ET. Methods: This was a qualitative study based on 3 focus groups (FG) with survivors of BC receiving adjuvant ET. The multimodal mHealth intervention had the following features: measure (symptom reporting), understand, and appease (information on interventions to relieve the symptom). FG were conducted via videoconference, lasted approximately 60-90 min, were recorded and transcribed for analysis. A content, thematic analysis was performed. All participants provided oral informed consent and socio-demographic information. Results: 17 BC survivors from diverse professional and socio-economic background participated. Mean age was 48.5 years (range: 32-61). There was a consensus regarding the acceptability and perception of usefulness of an app during treatment with adjuvant ET. A feeling of loneliness during this period was also expressed. Emergent themes cited included: a) positive representations i) satisfaction with the educational support with language and the level of information of the app judged as appropriate and reliable; ii) hope in the role of the app as a companion to alleviate the loneliness; iii) vehicle to enhance family interaction; iv) tool to boost engagement towards their treatment. b) concerns associated with i) fear of human contact replacement ii) fear of loss of interest over time, particularly in the setting of a 5-10 year journey. Pts were pro-active in providing feedback regarding innovative features that could be integrated: i) including interest on the use of biosensors (step counting, nutritional tracking); ii) to receive personalized encouragement messages and iii) updated information regarding scientific advances related to the treatment of early breast cancer. Most participants found the app to be aesthetically pleasing and easy to use. Conclusions: Findings from this qualitative study are promising regarding the acceptability and perception of usefulness of a personalized app for the mitigation of ET side effects in the adjuvant setting. It highlights the need of personalized educational material, but also maintenance of ‘bi-directional’ communication with health professionals. Optimization of the tool is ongoing and updated FG results will be presented. This tool will be tested in a randomized controlled trial starting in Q1/2022, which will evaluate its effectiveness.

Quotes from participantsThemes emergedParticipants’ quotes from focus groupsSatisfaction with educational support‘’Today we find everything on the internet, bad and good things, we cannot know what is true and what is fake. (⋯) If an app can give us reliable information, good, summarized information, this would be great!’’Satisfaction with educational support; Hope in the role of the app to alleviate loneliness“I didn’t even know we had so many side-effects linked to endocrine therapy. Now I understand that it’s true, it’s not something from my head. It’s related to the treatment and it’s really nice to have this support.”Alleviation of loneliness‘’I often feel lonely, sometimes is difficult to have contact with the doctor.’’, ‘’We feel lonely, even our family cannot understand.’’Alleviation of loneliness‘’We need to exchange with people that lived the same situation.’’, “We go to forums, chats, Instagram⋯”, ‘’We realize that we are not alone, that we are not the only ones with the symptoms.’’Fear of human contact replacement‘’It is a good addition, but it will never replace the relationship that we have with our doctor.’’Fear of loss of interest over time‘’It is a good app to start endocrine therapy⋯ How to make the app interesting and useful during several years of treatment?’’

Citation Format: Elise Martin, Antonio Di Meglio, Pietro Lapidari, Daniele Presti, Davide Soldato, Léna Degousee, Marion Aupomerol, Barbara Pistilli, Léonor Fasse, Diane Boinon, Florian Scotte, Gwenn Menvielle, Agnès Dumas, Céline Lazorthes, Jonathan Benhamou, Matthieu Pozza, Raphaëlle Martin-Neuville, Nicolas Helleringer, Jeanne Eelkema, Fabrice Andre, Ines Vaz-Luis, Maria Alice Franzoi. A multimodal and personalized digital companion to help survivors of breast cancer (BC) manage side effects of adjuvant endocrine therapy (ET): A qualitative exploration [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-27.

[Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]

INTRODUCTION

Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process.

METHODS

Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care.

RESULTS

One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%).

CONCLUSION

Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

BEAUTY and the breast: is adjuvant chemotherapy the right time for a beauty boost? Lessons learned from a large randomized controlled trial

PURPOSE

Beauty care (BTC) is offered at many cancer hospitals having a great uptake among patients. Nevertheless, its benefits in the Quality of life (QoL) of cancer survivors have not been assessed so far.

METHODS

Our study aims to determine whether BTC improves patients' QoL related to their body image measured by the BRBI scale of the QLQ-BR23 questionnaire at the end of adjuvant chemotherapy, after breast cancer (BC) surgery. The BEAUTY study is a prospective, randomized, controlled intervention trial. The following patient-reported outcomes were filled before initiation of chemotherapy (T1) and after their last cycle (T2): EORTC QLQ-C30, QLQ-BR23, and Body Image Scale (BIS). Primary objective was improvement in the BIS of BR23 (BRBI). A qualitative assessment of patients' experience was performed at each cycle through a relevant questionnaire.

RESULTS

In total, 269 (67%) patients filled BRBI at T1 and T2. Mean BRBI scores substantially decreased between T1 and T2 and were not different with or without BTC (p = 0.88). Qualitative assessment suggests impact of BTC in physical well-being and avoids thoughts related to the disease.

CONCLUSION

A substantial proportion of patients have a poor body image and chemotherapy induced a substantial degradation of BRBI scores. Although BTC does not seem to impact BRBI scores, the qualitative assessment suggests some benefit of BTC in other domains. Our study highlights the need to assess patients-perceived body image and build tailored interventions at this critical phase of their disease and generates hypothesis for the impact of BTC among BC patients. Clinical trial registration The study is registered at ClinicalTrials.gov under the NCT01459003 number since October 25, 2011.

Feasibility of a video-based cognitive behavioral therapy for insomnia in French adult cancer outpatients: results from the Sleep-4-All-1 study

BACKGROUND

Insomnia affects up to 63% of patients with cancer. Cognitive behavioral therapy for insomnia (CBT-I) is considered to be the non-pharmacological gold standard treatment, but it remains underutilized in France. Self-administered interventions offer new ways to overcome some of the barriers that restrict access to efficacious supportive care.

OBJECTIVE

To assess the feasibility, among French adult cancer outpatients, of a validated Quebec video-based, self-administered, cognitive behavioral therapy for insomnia (VCBT-I).

METHODS

A pre-post design with quantitative measures (Insomnia Severity Index, Edmonton Symptom Assessment System, Treatment Perception Questionnaire) and qualitative measures (semi-structured interviews) was used.

RESULTS

One hundred and seventy-three cancer outpatients were self-screened for insomnia, and 57% (n=99) reported significant symptoms. Among them, 80% (n=79) agreed to participate in the VCBT-I. The download rate of the VCBT-I was 78% (n=62/79). Several technical and contextual barriers to the delivery and the applicability of the VCBT-I emerged. However, participants reported a high level of satisfaction, and some valuable benefits at post-immediate intervention (increased knowledge about sleep, better quality of sleep, and higher acceptance of the burden of insomnia), regardless of whether or not they still had insomnia.

DISCUSSION

This study confirms that there is a demand for a VCBT-I, which was perceived as appropriate by a sample of French cancer outpatients with insomnia, but it also highlights some limitations in terms of implementation and practicality. Remote professional support appears to be a core need in order to address these issues and personalize the guidance process.

Decision of adjuvant chemotherapy in intermediate risk luminal breast cancer patients: A prospective multicenter trial assessing the clinical and psychological impact of EndoPredict® (EpClin) use (UCBG 2-14)

Purpose

Genomic tests can identify ER-positive HER2-negative localized breast cancer patients who may not benefit from adjuvant chemotherapy. Such tests seem especially interesting in “intermediate” clinico-pathological risk categories. The psychological impact of the decision uncertainty in these women remains largely unexplored. We assessed the clinical and psychological impact of EndoPredict® (EpClin), a clinico-genomic test, in these patients.

Methods

This multicenter, single arm prospective study (NCT02773004) enrolled patients for which adjuvant chemotherapy was uncertain, based on predefined criteria. The primary endpoint was the proportion of change between initial adjuvant decision and final administration of chemotherapy. Secondary endpoints included post-test (Day 17) and 1-year patient reported outcomes.

Results

One third of 200 evaluable patients had a high EpClin score (≥3.32867; 10 years cumulative risk of distance failure ≥10%). The overall change rate of chemotherapy decision was 72/200 (35.8%, 95% CI 29.2–42.4). Chemotherapy was withdrawn in 57 cases (28.4% [22.2–34.8]) and added in 15 (7.5% [3.8–11.2]. 6 changes (8%) were based on patients’ decisions. Anxiety and distress levels increased at Day 17 when adding chemotherapy after the test result (p < 10⁻⁷ and 0.00022 respectively), while stable in other situations. At 1-year, all patients had returned to the baseline anxiety and distress levels (mean anxiety 51.5, +/− SD = 2.5 [max. 80], mean distress 3±1 [max. 10]).

Conclusions

EndoPredict ® (EpClin) is clinically useful in deciding whether or not to administer adjuvant chemotherapy in patients with intermediate risk. A single-step decision is preferable since adding chemotherapy at a later stage increases anxiety and distress.

•

EndoPredict ® (EpClin) allowed a chemotherapy decision modification in 35% of the patients included in the Adendom trial.

•

Patient-physician concertation is important: 8% of treatment changes are based on patients’ will.

•

A single-step decision including the test appears preferable to limit anxiety and distress.

[Feedback on a complementary care program combining physical activity, mindfulness-based meditation and socio-aesthetic care]

INTRODUCTION

Increasing physical activity among cancer patients is one of the priority recommendations in tertiary prevention; the level of physical activity is one of the determining factors in reducing the risk of relapse and mortality. However, many barriers to initiation and maintenance of regular physical activity have been identified. A program combining bi-weekly adapted physical activity sessions, mindfulness-based meditation and socio-aesthetic care was put together in 2015, in a Cancer Center, in order to facilitate adherence and sustainable attendance.

METHODS

Data on patient participation of program components, patient satisfaction, and psycho-corporal changes, collected in ecological conditions between 2015 and 2017 from 144 participants, were retrospectively analyzed to provide a first assessment.

RESULTS

Nearly 60% of the patients were in treatment, 17% were metastatic. The average participation time was 9 months, with an average of one physical activity session per week. Changes were observed, both quantitatively and qualitatively, in terms of emotional state, sleep and body image. The overall satisfaction rate was 96%.

DISCUSSION

The conclusions of the study support the continuation of the program. The methodological limitations of this pilot format may be overtaken in future research, which will allow further in-depth investigations into the effects of combined approaches on sustainable physical activity.

SFSPM 2018 — Congrès de la Société Française de Sénologie et de Pathologie Mammaire (Avignon, 7-9/11-2018)

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018.

Hereditary breast and ovarian cancer: successful systematic implementation of a group approach to genetic counselling

The increase in referrals to cancer genetics clinics, partially associated with the "Angelina Jolie effect", presents a challenge to existing services, many are already running at full capacity. More efficient ways to deliver genetic counselling are therefore urgently needed. We now systematically offer group instead of standard individual counselling to patients with suspected Hereditary Breast and Ovarian Cancer. Group sessions last 30 min. The first twenty consist of a presentation by the genetic counsellor, the next ten of a discussion involving a cancer geneticist and a psychologist. A short individual consultation ensues, where personal and family issues are addressed and consent obtained. Blood is drawn afterwards. Satisfaction and knowledge are evaluated. We report data for the Oct-2014-Aug-2015 period. 210 patients attended group counselling, up to eight simultaneously. We always fitted them within a 4-h time frame. Mean satisfaction score was 41/43. Knowledge scores increased from 3.1/6 to 4.9/6 post-counselling (p value < 2.2 × 10^-16). Thanks to group counselling, we have withstood increases in referrals without compromising care. The "Angelina Jolie effect" and rapid developments in personalized medicine threaten to overwhelm cancer genetics clinics. In this context, our innovative approach should ensure that all patients have access to approved services.

Patient satisfaction with a rapid diagnosis of suspicious breast lesions: Association with distress and anxiety

Few studies have explored with standard measures patient satisfaction with care at the time of the diagnosis through rapid diagnostic pathways. This study aimed to assess satisfaction levels at the time of the diagnosis in a One-Stop Breast Unit and to examine associations with psychological states. An anonymous cross-sectional survey was conducted at a single center's One-Stop Breast Unit, to assess patient satisfaction regarding several aspects of the Unit. Two days after the diagnosis, 113 participants completed self-reported questionnaires evaluating satisfaction (Out-Patsat35), anxiety (State Anxiety Inventory), and psychological distress (Distress Thermometer). Overall, patients were very satisfied (80.7±20.7) with the One-Stop Breast Unit. The highest mean satisfaction scores concerned nurses' technical skills, interpersonal skills and availability. The lowest mean scores concerned physicians' availability, waiting time, and the provision of information. The results revealed a significant association between high state anxiety levels, lower levels of satisfaction with doctors' interpersonal skills (r=-.41, P<.001) and lower levels for information provided by nurses (r=-.38, P<.001). Moreover, greater psychological distress was associated with less satisfaction with the different aspects of care (doctors' interpersonal skills, doctors' availability and waiting-time). The results of regression models showed that doctor-related satisfaction scales explained 20% of the variance in anxiety (P<.01). Facing cancer diagnosis remains a stressful situation. However, our study suggested that a substantial part of this anxiety is sensitive to the quality of the patient-doctor relationship. Consequently, further efforts should be expended on adapting patient-doctor communication to improve patient reassurance.

Abstract P5-11-06: BEAUTY and the breast: Is adjuvant chemotherapy the right time for a beauty boost? Results of a randomised controlled trial

This abstract was not presented at the symposium.

The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic

PURPOSE

Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic.

PATIENTS AND METHODS

A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively.

RESULTS

Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420.

CONCLUSIONS

One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.

Abstract P3-10-03: Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment

Background: Women's awareness about their personal breast cancer (BC) risk in the general population is generally low. Mass screening and mass prevention interventions have as yet been moderately efficient in breast oncology. "Personalized prevention" including risk communication, personalized screening and primary prevention recommendations is a promising. A personal history of BBL slightly increases subsequent BC risk.

Objectives: the main objective was to evaluate the acceptability of a mathematical tool- based breast cancer risk assessment and subsequent proposal of a personalized BC prevention program in a BBL population. Secondary objectives were to evaluate information receipt, awareness, satisfaction, and anxiety.

Methods: Women were eligible for the study if aged 40-74, were recently diagnosed with a benign breast lesion at the one stop breast Unit of the center, had no personal history of cancer or atypical lesions and were not BRCA carriers. Women were proposed a personalized risk assessment using a mathematical tool (BCSC score adapted to the French population-Ragusa et al) together with personalized information on risk, BC screening and prevention, release of a personalized program and evaluation of their receipt. The main end point was the proportion of women willing to have a risk assessment and personalized counseling. A cut-off point of 70% was considered critical to consider acceptability. Secondary end points were perceived BC risk, satisfaction, anxiety and distress levels at day 2 using standardized questionnaires, as well as adherence with the proposed programs.

Results: Of 150 women proposed BC risk assessment and personalized prevention information between 02/2014 and 03/2015, 129 (86%) accepted. Median age: 53.6 years. 33% had a low BC risk (&lt; 1.1% at 5 yrs [mean risk of 50 yrs-old women in France]), 53% a moderate risk (1.1-1.66% at 5 yrs), while 14% were high risk (&gt; 1.66% at 5 yrs). 87% had never had any previous information on BC risk. 3 pts required a genetic assessment.

Participants were globally very satisfied with physicians' and nurses' interpersonal skills, availability and provision of information (mean score &gt; 4; range 2-5). The mean scores of clarity of the BC risk information (4.14±1;range 2-5) and screening program information (4.21±0.93; range 2-5) were high.

The mean score of perceived risk level was estimated to 33.5% (SD=21.9).

Mean scores of state anxiety (36.7±12.2; range 20-71), trait anxiety (39.5±8.9; range 23-59), depressive symptoms (3.4±3.3; range 0-12) and psychological distress indicated low levels of all. Higher level of state-anxiety was associated with lower scores of satisfaction with doctors and nurses human qualities (r = 0.26, p&lt;.05) and with lower scores of clarity of information about screening program (r = 0.25, p&lt;.05).

Conclusion: The receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with BBL was high (86%). Information need is high given the low level of real risk awareness. Such population may benefit from personalized prevention. Anxiety and distress scores were low and satisfaction rates high.

Citation Format: Tlemsani C, Boinon D, Yung MF, Ragusa S, Mazouni C, Balleyguier C, Saghatchian M, Ghouadni A, Rivera S, Michiels S, Delaloge S. Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-10-03.

Relations between arthralgia and fear of recurrence: results of a cross-sectional study of breast cancer patients treated with adjuvant aromatase inhibitors therapy

PURPOSE

The aim of this study was to explore associations between arthralgia and fear of recurrence in breast cancer patients treated by aromatase inhibitors (AI).

METHOD

We sent a set of questionnaires to 100 patients examining their pain characteristics, anxiety (STAI), depression (BDI-SF), quality of life (SF-36), fear of recurrence (FCRI), and representations of AI treatment (ad hoc questionnaire). Nonparametric tests were used to investigate between-group comparisons (arthralgia vs. nonarthralgia) in these domains as well as the associations between arthralgia and fear of recurrence.

RESULTS

Of the 77 patients who returned the questionnaires (response rate = 77%), 60 (78%) reported arthralgia. The mean score of fear of recurrence exceeded the pathological threshold in the arthralgia group and was significantly higher than that in the nonarthralgia group (14.8 vs. 10.7, p < 0.01). Significant associations were observed between fear of recurrence and pain intensity (r = 0.274, p < 0.05) and pain relief (r = -0.409, p < 0.05). More than 80% of the total sample declared that they were well informed about the aim of AI, their side effects, and the risk of developing arthralgia. Fear of recurrence did not appear to be associated with representations of AI.

CONCLUSION

The study revealed a close relationship between pain intensity and fear of recurrence. In particular, it showed that effective pain management was accompanied by a reduced fear of recurrence. Information, although essential, appeared insufficient to overcome patients' concerns about pain. Therefore, the implement of a systematic screening for arthralgia and the improvement of analgesic treatment are essential issues. New strategies for pharmacological and nonpharmacological treatment must be developed.

Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support

BACKGROUND

Although research on social sharing suggests it could be an important factor in subsequent adjustment, it has rarely been examined in combination with the nature of the support received by patients. The goal of this study was to determine whether and to what extent social sharing concerning the disease and perceived social support after breast surgery explain psychological adjustment at the end of the treatment.

METHODS

One hundred two participants were recruited consecutively at a large cancer care center (Gustave Roussy, France). After surgery (T1) and at the end of the adjuvant treatment (T2), patients responded to self-report questionnaires assessing psychological adjustment (depressive symptoms and cancer-related distress), social sharing concerning the illness, and perceived social support (generic and cancer specific).

RESULTS

When the initial levels of adjustment were controlled for, hierarchical multiple regression models showed that greater instrumental support at T1 accounted for favorable changes in depressive symptoms at T2. In contrast, the perception of aversive attitudes in the environment and the avoidance of social sharing explained an increase in intrusive cancer-related thoughts.

CONCLUSION

The results suggest a negative impact of aversive attitudes from the environment on adjustment during treatment. It also confirms the importance of practical aspects of social support after surgery. In line with Lepore theory, sharing about the illness in a supportive environment may be of primary importance in the cognitive processing of cancer and thus may promote adjustment. These results have original implications for the counseling of patients and their relatives.