Poster Abstracts - - 2014 - Asia-Pacific Journal of Clinical Oncology [PDF]

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Volume 10, Issue S8 December 2014 Pages 126–209 View issue TOC Special Issue: COSA's 41st Annual Scientific Meeting. Joining Forces - Accelerating Progress, 2-4 December 2014, Melbourne Convention and Exhibition Centre

Poster Abstracts

Poster Abstracts First published: 19 November 2014

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DOI: 10.1111/ajco.12305

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201 MELANOMA SHARED CARE. A TRIPARTITE APPROACH FOR SURVIVAL, THE PATIENT, THEIR GP AND THEIR SPECIALIST Martin Haskett 1 , Colleen P Berryman 2 , Tracey Tobias 2 1. Victorian Melanoma Service, The Alfred, Melbourne, Victoria, Australia 2. Southern Melbourne Integrated Cancer Service, East Bentleigh, Vic, Australia The combination of the high incidence of melanoma in Australia and the increasing survival rates (currently over 90%) means that there are increasing numbers of melanoma survivors in the Australian population whose healthcare needs can be safely and effectively provided using a shared care model. The project aim was to develop a model for long term care of survivors of malignant melanoma, incorporating patient self-management, general practice/specialist shared care, continuous supportive care screening, patient and family centred long term care planning and electronic reminders. Project participants were melanoma survivors (n=104), completing evaluation of the interventions at 3 months (3m n=44) and 9 months (9m n=34). All evaluations were completed using SurveyMonkey® software. Resources developed for and evaluated by the project participants included a personal melanoma diary, individualised risk stratified shared care treatment and surveillance pathways, automated electronic self-examination and supportive care reminders. An active learning module was designed to further develop general practitioner (n=8) confidence to diagnose and manage melanoma and survivorship issues in general practice. Personal utilisation of the diary was high with over 70% utilisation recorded in both rounds of evaluation (3m n=34, 9m n=28). Participants who valued the information and resources provided (3m n=34, 9m n=28), participants who felt actively involved in decisions regarding their care (3m n=35, 9m n=28). Using a likert scale, general practitioners (n=7) evaluated the overall quality of education provided to them through their participation in the melanoma active learning module as excellent. This pilot demonstrated that patients can be fully educated regarding their individual prognosis and empowered to confidently self-manage their survivorship needs, when provided with individualised risk stratified surveillance plans and the engagement of general practice in shared care arrangements.

202 THE DEVELOPMENT OF AN E-LEARNING PACKAGE FOR MULTIDISCIPLINARY CLINICIANS ON CANCER MALNUTRITION Amber Kelaart 1 , Lauren Muir 1 , Karen Donald 2 , Shruti Mundra 2 , Amanda Hill 1 1. Nutrition Department, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia 2. Peter MacCallum Cancer Centre, Melbourne, Vic, Australia The negative impact of malnutrition on patient outcomes and health care costs is well established. In 2012 a point prevalence study completed within the adult oncology population across 15 Victorian Health Services in 2012 determined 57% of inpatients, 32% of patients receiving chemotherapy, and 39% of patients receiving chemo-radiation were malnourished. One of the key recommendations from this study was that ‘Health services should have resources available to multidisciplinary clinicians and cancer patients to improve awareness, recognition and understanding of malnutrition’. In order to provide education to a large number of clinicians, across different disciplines and geographical locations, an e-learning package was determined to be the optimal strategy. The project aims to increase knowledge/learning for all cancer care clinicians, provide accurate and evidence-based information on cancer malnutrition, efficient use of resources/reduction of duplication in a resource that can be used by all health services, consistency of information/education provided in cancer-malnutrition care, promote recognition of the importance of early intervention and patient management. Four unique and discipline specific packages (with six learning modules in each) have been developed for doctors, nurses, allied health, community general practitioners and practice nurses. The interactive learning modules provide an opportunity for active learning regarding malnutrition in oncology, nutritional implications of cancer and cancer therapies, malnutrition risk screening, nutrition intervention and multidisciplinary team involvement. A range of case studies are also presented to consolidate understanding. Multiple experts in the field have been consulted and contributed to development, content and review of the resource. The e-learning packages will promote awareness amongst cancer care clinicians of the significant issue of cancer malnutrition, resulting in improved prevention, early identification, as well as appropriate and timely management of this high risk group. This in turn will improve patient care and reduce the burden of malnutrition for individuals and health services.

203 CAN MEDIA COVERAGE INFLUENCE RESEARCH ARTICLE CITATIONS? Yaping Liu 1 , Ying Zhao 1 , Monica Robotin 2 1. Cancer Council NSW, Woolloomooloo, NSW, Australia 2. School of Medicine, University of Sydney, Sydney, NSW, Australia Background:This paper aims to ascertain whether media coverage of cancer research articles may increase their citations in the scientific literature by observing whether journal articles covered by media would be cited more frequently than similar articles not covered by the media. Methods:We selected 4 journals with a wide range of journal impact factors(JIF), JAMA (30.4), Lancet Oncology (24.7), BMJ (16.4) and Medical Journal of Australia (3.8), searched the LexisNexis database to identify cancer related articles reported by the major world media in 2010. We used PubMed to find the journal articles corresponding to the news, grouped them by study type (randomized controlled trial or observational study), and compared the mean citations of articles covered by the media and with those of articles not covered by the media for a 4-year citing period using ISI Web Science. Results:We identified a total of 393 cancer related article in our 4 journals in 2010, and followed them for a 4-year citing period from 2010–2014. By comparison of the mean of 55.8 citations in 161 articles covered by the media with a mean of 35.7 citations in 232 articles not covered by the media, the citation ratio 1.55 suggested that article citations may be influenced by media coverage, and the JIF did not correlate with the mean citation index. Also, media were more likely to cover observational studies and less likely to cover randomized controlled trials (35% vs. 17%). Conclusions:this study suggests a possible association between media coverage of research and scientists' subsequent citations of the work. However, media coverage alone is unlikely to explain entirely our findings, as selection bias on the part of the health reporters is likely to play a significant part as well. Furthermore, this study represents only one snapshot of citation patterns. It is possible that the association between news coverage and citation rates could change with time and geogrphy, which will need further discussion.

204 DO PATIENTS WITH ADVANCED CANCER WANT TO DISCUSS AND PAY FOR UNFUNDED EXPENSIVE ANTICANCER DRUGS? Linda Mileshkin 1,2 , Edward Livshin 1 , Jeremy Lewin 1 , Sandra Harvey 3 , Mark Voskoboynik 1 , Emilia Agalianos 1 , Penelope Schofield 1 , Alan Herschtal 1 , Aparna Rao 1 , Ian Collins 1 , Damien Urban 1 , George Au-Yeung 1 , John Zalcberg 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. Peter MacCallum Cancer Centre, East Melbourne, Australia 3. Bankstown-Lidcome Hospital, Bankstown, NSW, Australia Background:Australian medical oncologists commonly may not discuss unfunded expensive anticancer drugs (EACDs), because of concern about causing distress. We aimed to evaluate the views of patients with advanced cancer about this issue . Methods:Eligible patients completed a questionnaire regarding their views on 4 hypothetical scenarios involving an EACD. The scenarios described EACDs associated with either improved overall survival of 4–6 months (OS), encouraging response rate (RR) in a treatment-refractory situation, improved treatment tolerability/quality of life (QOL), or an improvement in progression-free survival of 4 months (PFS). Results:176 patients participated (response rate: 94%). 156 patients (89%) wanted their oncologist to discuss a relevant EACD with 23 (13%) having previously discussed an EACD. Most wanted their oncologist to tell them about the 4 EACDs: improved OS=72%, encouraging RR=91%, better QOL=86%, improved PFS=90%; and receive the treatments (55– 71%). Those not wanting discussion were mostly concerned about either themselves (47%) or their family (40%) becoming distressed. Desire to be told about the EACD or receive treatment did not vary significantly by disease-type or demographic factors and most thought the government should pay for the EACD (81–86%). Compared to results from our general public survey, eligible patients were less likely to want to pay for an EACD (29–40% vs 51–76%) and less likely to consider paying if they were female or single. Most participants would change their mind about paying if they could easily afford it, treatment was curative, or PFS could be extended by >24 months. Conclusion:Most patients with advanced cancer want to be told about EACD treatment options by their oncologists, even if they are unwilling or unable to pay for them. Oncologists need to be realistic when discussing potential benefits of EACD's and remain sensitive to the distress it may cause. 1. L. Mileshkin, P. Schofield, M. Jefford, E. Agalianos, M. Levine, A. Herschtal, J. Savulescu, J. Thomson, J. R. Zalcberg. To tell or not to tell?: The community wants to know about expensive anti-cancer drugs as a potential treatment option. J Clin Oncol 2009 Dec 1;27(34):5830–5837. 2. Thomson J, Schofield P, Mileshkin L, Agalianos E, Savulescu J, Zalcberg J, Jefford M. Do oncologists discuss expensive anti-cancer drugs with their patients? Ann Oncol. 2006 Apr;17(4):702–708.

205 EVALUATION OF THE FIRST YEAR OF THE SYDNEY SURVIVORSHIP CLINIC AT CONCORD CANCER CENTRE: FEASIBILITY, FUNCTION AND CLINICAL PATHWAYS Cindy SY Tan 1,2 , Jane Turner 1,3 , Sue-Ellen Butler 1,4 , Cole Deguchi 1,5 , Sonia Khatri 1,5 , Ilona Cunningham 1,6 , Ashanya Malalasekera 1 , Haryana M Dhillon 3 , Janette Vardy 1,3 1. Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia 2. Nutrition and Dietetics Department, Concord Hospital, Concord, NSW, Australia 3. Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia 4. Psychology Department, Concord Hospital, Concord, NSW, Australia 5. Nursing Services, Concord Hospital, Concord, NSW, Australia 6. Haematology Department, Concord Hospital, Concord, NSW, Australia Background:Cancer survivors experience significant ongoing health problems compared to the general population. The Sydney Survivorship Clinic, based on a multi-disciplinary team model, commenced September 2013 at Concord Cancer Centre with the aim of helping survivors and their families better manage their disease and any lasting treatment effects. Here we evaluate the first 11 months of the Survivorship clinic. Method:Adult patients with localised cancer (breast, colorectal and haematological [commenced May 2014]) after completion of primary treatments (surgery, chemotherapy and/or radiotherapy) are eligible for referral. At the initial visit patients see a multi-disciplinary team consisting of oncologist/haematologist, cancer nurse, dietitian, psychologist and exercise physiologist. Patients complete questionnaires assessing distress, symptoms, quality of life, diet and exercise prior to attending the clinic. Current data are from 12th September 2013 to 7th August 2014. Results:Of 92 patients booked, 90 attended the clinic (2 no-shows); 80% were female. Cancer diagnoses represented: breast 51%, colorectal 39%, haematological 10%. Median age 54 (range 23–80) years. Of patients attending, 73 completed questionnaires (response rate 82%). 52 patients completed the Distress Thermometer (mean score 2.9/10; range 0–8); 23% scored >4, indicating concerning distress levels. Mean body mass index (BMI) post treatment was 27kg/m2 (range 18–59kg/m2); >50% were overweight or obese. More than 50% of patients were referred to the ENRICH program (exercise and dietary lifestyle intervention), and >50% were recommended for psychological follow up. 94% of patients agreed or completely agreed attendance at survivorship clinic was worthwhile. Conclusion:The Survivorship Clinic is well attended and rated highly by patients. The high rate of patient reported outcome completion in routine follow-up indicates this is acceptable to patients. A quarter of cancer survivors report distress and more than half are overweight. The Survivorship Clinic has the potential to identify and address important concerns for cancer survivors.

206 TARGETING THE RON/MST1R RECEPTOR USING LCRF004, MAY PROVIDE AN EFFECTIVE NOVEL INTERVENTIONAL STRATEGY IN MALIGNANT PLEURAL MESOTHELIOMA Anne-Marie Baird 2,1 , Kenneth O'Byrne 2,3,1 , David Easty 2 , Liam Shiels 4 , Annette Byrne 4 , Stéphane Raeppel 5 , Alex Soltermann 6 , Daisuke Nonaka 7 , Dean Fennell 8 , Luciano Mutti 9 , Harvey Pass 10 , Isabelle Opitz 6 , Steven Gray 2 1. Cancer and Ageing Research Program, Queensland University of Technology, Brisbane, Australia 2. Thoracic Oncology Research Group, St. James's Hospital, Trinity College Dublin, Dublin, Ireland 3. Divison of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia 4. Royal College of Surgeons in Ireland, Dublin, Ireland 5. ChemRF, Montreal, Canada 6. Zurich University, Zurich, Switzerland 7. The Christie NHS Foundation Trust, Manchester, UK 8. University of Leicester & Leicester University Hospitals, Leicester, UK 9. Vercelli Hospital, Vercelli, Italy 1 0. NYU School of Medicine, New York, USA Aims:Malignant pleural mesothelioma (MPM) is an aggressive inflammatory cancer. Using a phospho-receptor tyrosine kinase array, we identified RON as frequently activated in MPM patient samples and cell lines. RON is a member of the MET proto-oncogene family and is bound by macrophage stimulating protein (MSP). The aim of this study was to examine the MSP-RON signalling axis in MPM. Methods:Immunohistochemistry was performed for RON, MSP and CD68 on a MPM tissue-microarray (n=132). MSP levels were determined in MPM and control serum samples (n =40). Expression levels were correlated with clinico-pathological data. MPM cell lines and a normal mesothelial cell line were screened for the expression of RON and MSP at the protein (Western) and mRNA (RT-PCR) level. Downstream mediators affected by MSP stimulation were identified using a proteome profiler array. The effect of MSP, IMC-RON8 (humanised IgG1 monoclonal antibody), LCRF004 (small molecule inhibitor) and NRWHE (small peptide) was examined using proliferation (BrdU ELISA), viability and migration (xCELLigence) assays. An xenograft study was completed with LCRF004. Results:High positivity for total RON by IHC was an independent predictor of favourable prognosis. Additionally, elevated expression levels of MSP correlated with better survival. The protein and mRNA levels of RON and MSP were differentially expressed in MPM cell lines. MSP treatment resulted in the phosphorylation of a number of kinases including Src. Treatment with LCRF004 resulted in a significant decrease in proliferation, viability, migration and reduced tumour growth in vivo (p<0.05, compared with vehicle control). Conclusion:The seemingly counter intuitive results obtained from TMA studies and cell line data, may be dependant on RON isoform expression. Nevertheless, the in vivo and in vitro data generated in this study, indicates that the MSP-RON signalling axis is a potential target in MPM. LCRF004 is an encouraging novel targeted therapeutic agent in this disease.

207 TARGETING THE HEDGEHOG SIGNALLING PATHWAY IN TRIPLE NEGATIVE BREAST CANCER Mun Hui 1 , Jessica Yang 1 , Nicola Foreman 1 , Andrea McFarlane 1 , Aurélie Cazet 1 , Sandra O'Toole 1 , Alexander Swarbrick 1 1. The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia Background:The major improvement in breast cancer survival in the last two decades is due to the use of targeted therapeutics (tamoxifen in hormone-receptor-positive cancers, trastuzumab in HER2-amplified disease). To further improve breast cancer outcomes, new targeted agents are needed for triple negative breast cancers (TNBC) for which there is no effective therapy. Hedgehog (Hh) signalling is active in TNBC, predicts poor prognosis and drives an aggressive, metastatic phenotype in animal models. The aim of this preclinical study is to evaluate the efficacy of LDE225 (Hh inhibitor) in combination with docetaxel in mice bearing TNBC patient derived xenographs. Successful completion of this study will trigger the development of phase I and II clinical trials in TNBC patients. Methods:Immunodeficient NOG mice implanted with two different TNBC xenographs were randomised to 4 treatment arms: vehicle, LDE225, docetaxel, and LDE225 plus docetaxel. Treatment continued for 4 weeks and mice were aged to ethical endpoint. Primary endpoint was tumour growth. Overall survival and metastatic burden were also reviewed but the study was not designed to evaluate these. Results:LDE225 plus docetaxel led to significant retardation in tumour growth (p<0.0001) and improved overall survival in both TNBC xenograph models compared with monotherapy. Metastatic burden was also lowest in the combination therapy group. Immunohistochemistry evaluating histological changes, in vitro studies to examine cellular response and microarray profiling to identify molecular changes to treatment are in progress. Conclusions:The Hh inhibitor, LDE225 in combination with docetaxel is effective in the treatment of TNBC.

208 EFFECTS OF TAXOL IN COMBINATION WITH CYCLOOXYGENASE INHIBITORS ON EXPRESSION OF CYCLIN D1 AND ANGIOGENESIS IN HUMAN OVARIAN CANCER XENOGRAFTS Wei Li 1 , Liang Wan 1 , Ling Yun Zhai 1. Department of Gynecology, Nanjing Medical University of Hangzhou Hospital, Hangzhou, Zhejiang, China Background:Chemotherapy in combination with taxol is the standard first-line therapy for patients with advanced ovarian cancer. It is often assumed that the antitumor effects of nonsteroidal anti-inflammatory drugs are due to inhibition of cyclooxgenase (COX) activity. Aim:To investigate the effects of taxol in combination with cyclooxygenase inhibitors on the expression of cyclin D1 and angiogenesis in human ovarian SKOV-3 carcinoma cells xenograft-bearing mice. Methods:The animals were treated with 100mg/kg celecoxib (a COX-2 selective inhibitor) alone or in combination with 3mg/kg SC-560 (a COX-1 selective inhibitor) by gavage twice a day, 20mg/kg taxol alone by intraperitoneal (i.p.) once a week or in combination with celecoxib, or SC-560/celecoxib/taxol for three weeks. To test the mechanism of the combination treatment, expression of cyclin D1 in tumor tissues were determined by immunohistochemistry. Microvessel density (MVD) and vascular endothelial growth factor (VEGF) mRNA levels of ovarian cancer were detected in the tumor tissues using immunohistochemistry and reverse-transcription polymerase chain reaction (RT-PCR) respectively. Results:The mean tumor volume in the treated groups was significantly lower than control ( p <0.05), and in the three-drug combination group, tumor volume was reduced by 58.27% ( p <0.01); cyclin D1 expression were statistically significant compared with those of the control group (both p <0.01). In the combination group, the expression of VEGF and MVD were inhibited significantly (all p <0.01, compared with control). Conclusions:This study suggests that COX selective inhibitors in combination with taxol may be superior than taxol alone as drug therapy against ovarian cancer xenografts. It may in part be mediated through suppression of cyclin D1, which may contribute to its ability to arrest the cell cycle, and that antiangiogenic therapy can be used to inhibit ovarian cancer growth.

209 SYMPTOM CLUSTERS IN CANCER PATIENTS: MYTH OR REALITY? THE IMPACT OF MULTIPLE SYMPTOMS ON OVERALL QUALITY OF LIFE, PHYSICAL HEALTH AND PSYCHOLOGICAL DISTRESS DURING CANCER TREATMENT Carlo Pirri 1,2 , James Trotter 3 , Evan Bayliss 3 , Paul Katris 2 , Peter Drummond 1 , Robert Bennett 1 1. Murdoch University, Murdoch, WA, Australia 2. WA Clinical Oncology Group, West Perth, WA, Australia 3. Medical Oncology, Royal Perth Hospital, Perth, WA, Australia Aims:Despite significant advances in the management of discrete symptoms, 40–61% of cancer patients report multiple symptoms during treatment. Unrelieved multiple symptoms are associated with reduced treatment compliance/completion, performance status and quality of life (QoL). Consequently, we examined the impact of multiple symptoms on overall QoL and physical/psychological health across treatment. Methods:A longitudinal secondary analysis involving 200 cancer patients who underwent combined modality treatment. Results:All patients reported multiple concurrent symptoms across treatment, with most experiencing at least 5. Severe symptoms included fatigue, sleep disturbance and role/social functioning impairment. Patients reporting high multiple concurrent symptoms experienced significantly worse overall QoL/physical health, cancer distress and depression across treatment, as did those who experienced high-symptom severity (.01≥ p ≤.06). Factor analyses of QoL scores at pre-/on-/post-treatment identified three recurrent symptom clusters of core or defining symptoms: physical-function related (physical/role/social functioning, fatigue); psychoneurological (emotional/cognitive functioning); and gastrointestinal (nausea/vomiting/appetite loss). Patients reporting high-symptom severity for each of these symptom clusters experienced significantly worse overall QoL/physical health (.001> p ≤.024), but not cancer distress except for the psychoneurological symptom cluster ( p <.001). Patients experiencing more severe psychoneurological or physical-function related cluster symptoms also reported significantly greater depression ( p <.001). Conclusions:This study confirmed that patients experience multiple symptoms concurrently across treatment, and that unrelieved multiple symptoms negatively impact QoL, physical and psychological outcomes. While traditional cancer treatments can induce new or exacerbate existing symptoms by damaging normal cells, targeted therapies±traditional chemotherapy/radiotherapy are still quite capable of producing dose-limiting toxicities. Patients rarely present with a single symptom, which likely explains why single-symptom management approaches do not necessarily improve QoL. Symptom management/QoL research must investigate beyond individual symptoms by examining symptom clusters. Gaining greater insight into the relationships between core symptoms within a cluster will allow clinicians to implement more effective interventions to alleviate multiple symptoms, and improve patient outcomes including QoL. To this end, further longitudinal studies involving homogeneous/heterogeneous cancer populations are needed to clarify the clustering of symptoms.

210 OUTCOMES FROM A PILOT RANDOMISED CONTROLLED TRIAL OF EARLY AND INTENSIVE DIETARY COUNSELLING IN LUNG CANCER PATIENTS RECEIVING (CHEMO)RADIOTHERAPY Nicole Kiss 2,1,3 , Elisabeth Isenring 5,4 , Karla Gough 1 , Greg Wheeler 6 , Andrew Wirth 6 , Belinda Campbell 6 , Mei Krishnasamy 2,1 1. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia 2. School of Health Sciences, Univesity of Melbourne, Parkville, Victoria, Australia 3. Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia 4. Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia 5. Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia 6. Lung Service, Peter MacCallum Cancer Centre, Malbourne, Victoria, Australia Aims:Intensive dietary counselling has not been evaluated in lung cancer patients receiving (chemo)radiation despite a high prevalence of malnutrition. This study aimed to evaluate the feasibility and impact of intensive dietary counselling on nutritional, functional and fatigue outcomes. Methods:This phase II nutrition intervention study included 24 lung cancer patients randomised to the intervention or usual care. The intervention employed a care pathway to guide intensive, individualised nutritional management up to 6 weeks following radiotherapy. Feasibility was assessed through recruitment, attrition and questionnaire completion rates. Nutritional (patient-generated subjective global assessment, weight, fat-free mass) and QOL (FACT-L functional and physical wellbeing) outcomes were assessed before randomisation, start and end of radiotherapy, at one and 3 months post-radiotherapy. Outcomes were analysed with linear mixed models. Results:Twenty-four participants were recruited (50% male, mean age 63.4+12.2 years). Recruitment, attrition and questionnaire completion rates were 57%, 37% and 100%, respectively. Relative to baseline, intervention patients (n=12) showed clinically important benefits at the end of radiotherapy compared to usual care patients (n=12): weight (3.0kg; 95%CI −0.8, 6.8, effect size=.7, p=.11) and fat-free mass (0.6kg; 95%CI −2.1, 3.3, effect size=.19, p=.66) improved, and physical (2.1; 95%CI −2.3, 6.5, effect size=.42, p=.33) and functional wellbeing (5.1; 95%CI 1.6, 8.6, effect size=1.29, p=0.01) deteriorated less. Three months post-radiotherapy, intervention benefits for weight (5.5kg; 95%CI −1.4, 12.3, effect size=.71, p=.71) and fat-free mass (1.48kg; 95%CI −0.5, 3.5, effect size=.67, p=.14) were sustained. At this time, physical and functional wellbeing had improved relative to baseline in both groups and between-groups differences were small. Conclusions:In this pilot, study dietary counselling improved weight, fat-free mass, fatigue and functional outcomes in lung cancer patients receiving (chemo)radiotherapy. Results suggest the intervention is feasible and should be further evaluated in a phase III randomised trial.

211 THE USE OF LABEL-FREE LC-MS/MS APPROACH TO IDENTIFY SIGNALING PATHWAYS ASSOCIATED WITH PROSTATE CANCER RADIORESISTANCE LEI Chang 1,2 , Valerie Wasinger 3 , Peter Graham 1,2 , Jingli Hao 1,2 , Jie Ni 1,2 , Julia Beretov 1,2 , Joseph Bucci 1,2 , Paul Cozzi 2,4 , John Kearsley 1,2 , Yong Li 1,2 1. Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia 2. St George Clinical School, Faculty of Medicine,UNSW, Kensington, NSW, Australia 3. Bioanalytical Mass Spectrometry facility, Mark Wainwright Analytical centre, UNSW, Kingsford, NSW, Australia 4. Department of Surgery, St George Hospital, Kogarah, NSW, Australia Aim:Radioresistance is still the major problem in current prostate cancer (CaP) radiation therapy (RT). Our objective in this study was to identify related signaling pathways and determine differential proteins in CaP radioresistant (RR) cell lines for biomarker candidates using a LC-MS/MS proteomic approach. Methods:Three CaP-RR cell lines (PC-3RR, DU145 and LNCaPRR) were developed in our lab. After extracting and digesting the proteins from CaP-RR (PC-3RR and LNCaPRR) and CaP-control (PC-3 and LNCaP) cells. Samples were cleaned prior to MS using 3 passes through a C18 Stage-tip (proxeon) with elution in between passes. LC-MS/MS using the LTQ Orbitrap Velos ETD (Thermo Scientific, US) was used for a relative and quantitative analysis. The findings were statistically analyzed using Progenesis LC-MS software (Non-Linear Dynamics, UK) and all MS/MS ions filed were searched using the Mascot search engine for peptide and protein identification. The results were searched against the human nonredundant NCBInr database. Results:Total 513 proteins were found to be statistically significant differences between CaP-RR and CaP-control cells ( p ≤ 0.05, fold differences>3, sort using >80% power). Of these 513 proteins, 186 proteins were up-regulated while 120 were down-regulated in PC-3RR cells. Whereas, 207 differential proteins, 110 were found higher while 97 proteins were lower in LNCaPRR cells compared to LNCaP cells. The several identified proteins are associated with CaP metastasis, progression, signaling pathways and radoresistance. Conclusions:Significant proteins were identification in the CaP-RR. These proteins are associated with CaP radioresistance and will be validated in human CaP-RR tissues. The characterization of these proteins is worthwhile in the future studies.

212 ANTICANCER DRUG TRANSPORT TO BREAST CANCER CELLS USING MINERAL NANOPARTICLES Chia Yuen Chong 1 , Iekhsan Othman 1 , Ezharul Hoque Chowdhury 1 1. Jefferey Cheah School of Medicine and Health Sciences, MONASH UNIVERSITY, Sunway Background:The current conventional way of chemotherapy using anti-cancer drugs has caused many side effects to patients. There are a high number of patients reporting intolerable symptoms, including nausea and vomiting, tiredness, depression, and more that results in poor quality of life. This is mainly due to non-selective cytotoxic effect of anticancer drugs that not only kill the cancer cells, but also affect the normal healthy cells. Eventually, these unbearable adverse effects increase the number of patients abandoning treatment, and in some others delaying their treatment progress. The pH sensitive carbonate apatite (CA), a major component of hard tissues in the body, has evolved as an efficient non-viral inorganic DNA nanocarrier. Due to heterogenous charge distribution and being armed with ability to prevent crystal growth for generation of nanoscale particles, CA nanoparticles offer an ideal way to deliver anticancer drugs to targeted cancer cells via endocytosis. Aim:The objective of this research project is to deliver anti-cancer drugs, in particular Exemestane, Letrozole and Tamoxifen specifically to breast cancer cells by using bio-responsitve salt nano-crystals. Methods:Bio-functionalized nanoparticles with loaded drugs were fabricated and characterized by measurement of particle size, zeta potential and drug binding affinity. Breast cancer cell lines, MCF-7 and 4T1 were cultured, maintained and seeded in a 24-well plate. Drug-loaded CA particles were incubated with the seeded cells for 48 hours before analysis of cell viability by MTT assay. Results:We found that cell treatment with drug-loaded CA particles have lower cell viability in comparison to cell treatment with only free drugs. And this result is consistent in all different drug concentrations being tested. Conclusions:It is likely that the CA has a promising future for clinical cancer treatment in increasing the effectiveness of chemotherapy and concurrently reducing its side effect. 1. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D. Changing patient perceptions of the side effects of cancer chemotherapy. Cancer. 2002;95(1):155–163. 2. Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, etal. On the receiving end. V: Patient perceptions of the side effects of cancer chemotherapy in 1993. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO. 1996;7(2):189–195. 3. Wilkes L, White K, Beale B, Cole R, Tracy S. Supportive care for women with breast cancer: Australian nurses' perspective. Nursing & health sciences. 1999;1(2):71–76. 4. Calagiuri B RJ, Morrow GR. How do patients expectancies, quality of life, and postchemotherapy nausea interrelated? Cancer. 2008;(113):654–661. 5. Osoba D, Zee B, Warr D, Latreille J, Kaizer L, Pater J. Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 1997;5(4):307–313. 6. Nordqvist C. Breast Cancer Drug abandoned by 36% of patients due to sife effects. Medical News Today. 2011. 7. Davis ME, Chen ZG, Shin DM. Nanoparticle therapeutics: an emerging treatment modality for cancer. Nature reviews Drug discovery. 2008;7(9):771–782. 8. Chowdhury EH, Maruyama A, Kano A, Nagaoka M, Kotaka M, Hirose S, etal. pH-sensing nano-crystals of carbonate apatite: effects on intracellular delivery and release of DNA for efficient expression into mammalian cells. Gene. 2006;376(1):87–94. 9. Chowdhury EH, Akaike T. High performance DNA nano-carriers of carbonate apatite: multiple factors in regulation of particle synthesis and transfection efficiency. International journal of nanomedicine. 2007;2(1):101–106. 10. Hossain S, Chowdhury EH, Akaike T. Nanoparticles and toxicity in therapeutic delivery: the ongoing debate. Therapeutic delivery. 2011;2(2):125–132. 11. Chowdhury EH. pH-sensitive nano-crystals of carbonate apatite for smart and cell-specific transgene delivery. Expert opinion on drug delivery. 2007;4(3):193–196. 12. Hossain S, Stanislaus A, Chua MJ, Tada S, Tagawa Y, Chowdhury EH, etal. Carbonate apatite-facilitated intracellularly delivered siRNA for efficient knockdown of functional genes. Journal of controlled release: official journal of the Controlled Release Society. 2010;147(1):101–108.

214 SELECTIVE CYTOTOXICITY OF GEMCITABINE ON SUPERFICIAL MALIGNANT VS. NORMAL HUMAN UROTHELIAL CELLS AND THE EFFECTS OF HYPERTHERMIA Stefanie Farr 1 , Russ Chess-Williams 1 , Catherine McDermott 1 1. Health Science and Medicine Faculty, Bond University, Gold Coast, QLD, Australia Background:Intravesical chemotherapy for bladder cancer limits systemic absorption but significant local urological side effects including dysuria and urgency of urination still occur. A newer agent, gemcitabine, has a favourable efficacy and toxicity profile in patients compared to other commonly used chemotherapies. Combined hyperthermia and chemotherapy has shown synergism in decreasing cell proliferation in bladder cancer cell lines and cancer recurrence in patients, however there are no reports on the effect of this therapy on the normal urothelial cells of the bladder. Aim:To investigate the toxicity of gemcitabine alone and in combination with hyperthermia in cultured human superficial bladder cancer cells with comparison to urothelial cells. Methods:The human urothelial bladder cancer cell lines RT4 and T24 and non-cancer UROtsa bladder cells in proliferative and differentiated forms were used in this study. Cells were treated with increasing doses of gemcitabine up to the maximal clinical concentration of 40mg/mL for 1 hour at either 37°C or 42°C. A resazurin viability assay was used to assess the effect of treatments on cell proliferation 72 hours post treatment. Results:All cell lines displayed a reduction of cell survival with increasing concentrations of gemcitabine, assessed 72hrs post treatment. The potency of gemcitabine on cancer cells (LC50 of 0.32µM for RT4 and 0.4µM for T24 cells) was substantially greater than its potency on non-cancer cells (LC50 of 32.4mM for differentiated UROtsas and 6.6mM for proliferative UROtsas). Hyperthermia did not enhance the cytotoxicity of gemcitabine on the cancer cell lines RT4 and T24. The only synergy between hyperthermia and gemcitabine occurred in the differentiated UROtsa cells. Conclusions:Gemcitabine toxicity is selective to cancerous cells, showing an approximate 100,000-fold higher potency on the cancer cell lines RT4 and T24 relative to the differentiated urothelial cell line. This selectivity may explain the low incidence of urological adverse effects following intravesical administration with this agent.

215 GEMCITABINE ENHANCES RELEASE OF ATP BUT NOT ACETYLCHOLINE OR PGE 2 FROM BLADDER UROTHELIAL CELLS Stefanie Farr 1 , Russ Chess-Williams 1 , Catherine McDermott 1 1. Health Science and Medicine Faculty, Bond University, Gold Coast, QLD, Australia Background:Intravesical chemotherapy promotes direct exposure of the cytotoxic agent to bladder cancers while limiting systemic absorption. However, significant local side effects (dysuria, frequency and urgency) are common. The urothelium releases mediators (ATP, acetylcholine, PGE 2 ) when stretched during bladder filling which activate sensory nerves to give sensation of fullness/pain. This normal function of the urothelium may be disrupted after intravesical treatment with chemotherapeutic agents such as gemcitabine. Aim:To investigate the effect of gemcitabine treatment on basal and stretch-induced release of these mediators from human urothelial cells. Methods:Human urothelial cells UROtsas were treated with increasing doses of gemcitabine for 1 hour. Following treatment, the basal and stretch-induced release (using hypotonic solution) of mediators was measured. Results:Following treatment with gemcitabine, stimulated release of ATP was unchanged but basal release of ATP from urothelial cells increased in a concentration-dependent manner. In the cells treated with 4mg/mL of gemcitabine, basal ATP release was significantly increased compared to control (16.4±2.5 to 6.0±0.7, p<0.05). Levels of basal and stimulated acetylcholine and prostanglandin E 2 release from urothelial cells were unchanged after incubation with gemcitabine. Conclusions:ATP has been shown to act on sensory nerves to initiate the micturition reflex and give rise to perceptions of pain (Burnstock 2009). The enhanced ATP release with gemcitabine treatment found in this study may explain the urological side effects of dysuria and increased frequency of urination observed in the clinical setting.

216 RELATIVE CYTOTOXIC POTENCY AND CELL DEATH MECHANISMS OF 1-ADRENOCEPTOR ANTAGONISTS ON PROSTATE CANCER CELL LINES Amanda Forbes 1 , Russ Chess-Williams 1 , Shailendra Anoopkumar-Dukie 2 , Catherine McDermott 1 1. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 2. School of Pharmacy, Griffith University, Gold Coast, QLD Alpha1-adrenoceptor antagonists increase apoptosis in the prostates of men with benign prostatic hyperplasia, while retrospective studies have shown that these agents also protect men against developing prostate cancer. The aim of this study was to assess the relative cytotoxic potencies and the cell death mechanisms (apoptosis and autophagy) of various 1adrenoceptor antagonists against prostate cancer. Human castration-sensitive LNCaP and castration-resistant PC-3 prostate cancer cells were exposed to prazosin, doxazosin, alfuzosin, terazosin, tamsulosin (0.01–100 µM) and also the autophagy inhibitor 3-methyladenine (3-MA, 5mM) for 24–72h. Resazurin reduction assay was used as an indicator of cell viability, caspase-3 activity as an index of apoptosis and a CytoID autophagy detection kit to quantify change in autophagic activity. All 1-adrenoceptor antagonists tested, except tamsulosin, resulted in a time- and concentration-dependent reduction of LNCaP and PC-3 survival. Following 72h treatment, the most potent cytotoxic drug was prazosin in LNCaP (mean IC50 with 95% CI=13 µM [8.6–19.6]) and PC-3 cells (IC50=21.3 µM [19.5–23.3]). Doxazosin was slightly less potent than prazosin (LNCaP IC50=17.2 µM [10.9–27.1] and PC-3 IC50=23.3 µM [21.0–25.7]). The relative cytotoxic potencies were found to be: prazosin>doxazosin>terazosin>alfuzosin>tamsulosin. Prazosin (30 µM) treatment resulted in a significant increase in autophagy and apoptosis (P<0.05). Prazosin-induced cytotoxicity and caspase-3 activity was enhanced following inhibition of autophagy in LNCaP cells (P< 0.001). In contrast, autophagy inhibition partially protected PC-3 cells from prazosin-induced apoptotic cell death (P<0.05). In conclusion, these findings demonstrate that 1adrenoceptor antagonists have cytotoxic actions, with prazosin exhibiting the greatest apoptotic potential. Prazosin-induced autophagy was found to play opposing roles, contributing to LNCaP survival and to PC-3 cell death. These findings suggest the anti-cancer activity of prazosin may be useful in mitigating early and advance stage prostate cancer.

217 PRE-TREATMENT INFORMATION NEEDS AND PREFERENCES OF RADIOTHERAPY PATIENTS Claire Goodwin 1 , Peter Ripoli 2 , Sarah Everitt 1 , Laura Sparks 1 , Andrea Myers 1 , Christina Kirpichnikov 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. Sunshine Hospital Radiation Therapy Centre, St Albans, VIC Aim:When patients commence radiotherapy (RT) it is vital they have a good understanding of their treatment and access to relevant information. This project aimed to determine whether the information received by patients commencing at Peter MacCallum Cancer Centre in East Melbourne and Sunshine Hopsital Radiation Therapy Centre is appropriate and sufficient. We aimed to conclude how patients would prefer to be provided with this information and plan to utilise the results to further develop our information processes. Method:Following ethics approval, patients commencing RT were asked to complete a short survey. The responses to questions were in a multiple choice format with some allowing the patient to elaborate with a written response. The survey attained the patient's opinion on the information they receive from the RT's prior to beginning their treatment. Results:Analysis of the data has shown that 78% of patients across both sites had a sound understanding of radiotherapy prior to commencing treatment. 97.6% of patients felt their information needs were met by the radiation therapist in their pre-treatment information sessions, and 96% felt prepared for their first treatment. 20% of patients felt they would benefit from further written information, the use of multimedia in their pre-treatment information session, or a group information session and department tour. Conclusion:The results have shown that a vast majority of the patients surveyed felt prepared for their radiotherapy treatment and satisfied with the information they were given. While this reflects positively on the information processes at both Sunshine Hospital Radiation Therapy Centre and Peter MacCallum Cancer Centre East Melbourne, there is potential for further development. The results will be utilized to determine how to improve the pre-treatment information process, be it through the introduction of multimedia before the commencement of treatment, or by updating the information sheets and pamphlets available to patients.

218 ALTERATIONS IN BLADDER UROTHELIAL ACETYLCHOLINE, ATP, PROSTAGLANDIN E2 AND INFLAMMATORY CYTOKINES BY THE CHEMOTHERAPEUTIC AGENT EPIRUBICIN Sung Hyun Kang 1 , Catherine McDermott 1 , Russ Chess-Williams 1 1. Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia Epirubicin is a cytotoxic agent administered intravesically for the treatment of superficial bladder cancer. During treatment the drug comes into close contact with the urothelium and post-treatment, patients may suffer urinary adverse effects. The aim of this study was to assess the effects of epirubicin on the release of urothelial mediators and inflammatory cytokines to determine if they may play a role in the adverse effects associated with intravesical epirubicin treatment. Immediately and 24hr following a 1 hour treatment of cultured UROtsa human urothelial cells with epirubicin, samples of incubation medium were prepared for analysis of basal and stretch-induced (using hypotonic solution) mediator release. Incubation medium was collected 24hr after epirubicin pretreatment for analysis of inflammatory cytokines. Immediately following epirubicin treatment, basal Ach release was significantly increased (2-fold, P<0.01) at 1mg/ml compared to the untreated controls and the Ach response to hypotonic stimulation was abolished (P<0.01). Both basal release and stretch-induced ATP release were significantly increased (2-fold, P<0.01) after 0.1mg/ml epirubicin. In addition, basal PGE2 release was significantly increased (2-fold, P<0.01), but stretch-induced release was abolished (P<0.05) after 1mg/ml epirubicin. Twenty four hours after pretreatment, basal Ach release was significantly increased (P<0.05) and stretch-induced Ach release was reduced by 70% (P<0.01) by 0.01mg/ml epirubicin. Both basal and stretch-induced ATP release were significantly increased (5-fold, P<0.01 and 4-fold, P<0.01 respectively) by 0.01mg/ml epirubicin. In contrast, PGE2 release was unaffected by epirubicin at any concentration. In addition, interleukin-6 and -8 were significantly enhanced (66-fold, P<0.01 and 5-fold, P<0.01 respectively) 24 hours after epirubicin pretreatment (0.01mg/ml). These findings indicate that inflammatory cytokines interleukin-6 and interleukin-8 are induced and urothelial mediator release is affected by treatment with epirubicin at clinically relevant concentrations and durations of treatment. These changes may play a role in the adverse effects observed in patients following intravesical epirubicin treatment.

219 INTRAVESICAL MITOMYCIN C TREATMENT ALTERS UROTHELIAL FUNCTION AND DETRUSOR CONTRACTION Sung Hyun Kang 1 , Russ Chess-Williams 1 , Catherine McDermott 1 1. Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia Intravesical treatment with mitomycin C (MMC) can result in a number of locally mediated urological adverse effects. The aim of this study was to use a porcine in vitro model to mimic the effects of intravesical MMC treatment and investigate how normal detrusor and urothelial function may be affected by treatment. Porcine anterior bladder wall was incubated with MMC (2mg/mL) applied for 2hr to the luminal surface only. Following treatment, the release of urothelial mediators and contractile responses of isolated tissue strips were examined. Isolated strips of urothelium/lamina propria from control bladders demonstrated a basal release of acetylcholine, ATP and PGE2, with increased release of ATP when tissues were stretched. In tissues from MMC-pretreated bladders, the basal release of PGE2 was 33.6±8.6pM and it was significantly enhanced (2-fold, P<0.05) compared to the untreated control. In contrast, the stretch-induced release of ATP (13.1±4.6nM) was reduced by 80% (P<0.05) and the release of acetylcholine was not affected. In control tissues, detrusor muscle strips contracted to carbachol and these responses were inhibited by 26.8±12.3% (P<0.001) in tissues with an intact urothelium. Following MMC-pretreatment, detrusor contraction was depressed by 6.6±14.6% (P<0.05). Also in tissues from MMC-pretreated bladders, the presence of an intact urothelium failed to inhibit detrusor contraction. The neurogenic detrusor muscle responses to electrical field stimulation increased with increasing stimulation frequency and the responses were depressed in MMC pretreated tissues compared to the control tissues with significant depression (P<0.05) at low stimulation frequencies of 1Hz and 5Hz. MMC applied to the luminal surface of the bladder had significant effects on urothelial function, enhancing PGE2 release and abolishing the normal inhibitory effect of the urothelium on detrusor contraction. MMC also depressed the contractile ability of the detrusor muscle (possibly reduced bladder compliance). These actions would tend to lead to bladder overactivity and reduced bladder volume, respectively, and may explain the increased frequency and urgency observed in patients following intravesical MMC treatment.

220 ENERGY AND PROTEIN INTAKE IN ONCOLOGY PATIENTS AT RISK OF SKELETAL MUSCLE ATROPHY Sarah King 1 , Gary Slater 1 , Tanya King 2 1. University of the Sunshine Coast, Sippy Downs, QLD, Australia 2. Nambour General Hospital, Nambour, QLD, Australia Background:Malnutrition and cachexia, characterised in part by skeletal muscle atrophy, are common in patients with cancer. Preliminary evidence in other populations suggests that manipulation of protein, in particular the quality, type, distribution, and dose can influence skeletal muscle mass and thus functional capacity. While energy distribution and total protein intake has been explored in patients with cancer, little is known about the specific aspects of protein consumption. The purpose of this study was twofold: to assess the current dietary intake of cancer patients with a specific focus on energy, protein quality, type, distribution and dose; and to identify if there is an association between energy and protein indices and presenting body composition. Methods:Patients with pancreatic, gastric, lung, colorectal, oesophageal or head and neck cancer were observed preceding treatment, with an accrual target of 82 participants. Dietary intake was determined using four day weighed food records, body composition was measured by dual energy X-ray absorptiometry and resting energy expenditure via indirect calorimetry using the ventilated hood. Nutrition status was assessed via the Patient-Generated Subjective Global Assessment tool, physical activity using the International Physical Activity Questionnaire and performance status using Eastern Cooperative Oncology Group criteria. Results:With data collection approaching completion, comprehensive results of this study will be presented with the aim of providing novel information on the pattern of ingested energy and protein intake and the association with body composition and metabolism. Conclusion:The findings will form the basis for further research focused on determining the ideal pattern of protein intake required to preserve lean body mass. This is critical to advancing nutrition interventions in clinical practice with the aim of improving functional status and quality of life.

221 EFFECTS OF COMBINING TAXOL AND SC-560 ON ANGIOGENESIS OF OVARIAN CANCER IN VIVO Wei Li 1 , Liang Wan 1 , Ling Yun Zhai 1. Department of Gynecology, Nanjing Medical University of Hangzhou Hospital, Hangzhou, Zhejiang, China Background:Taxol is known as a front-line agent for ovarian cancer chemotherapy; however, long-term treatment often results in chemoresistance. Over-expression of cyclooxygenase (COX)-1 is associated with elevated levels of angiogenic factors in ovarian carcinoma, which was inhibited by COX-1 selective inhibitors. Aim:To evaluate the effects of SC-560, a COX-1 inhibitor, administered in combination with taxol on angio-genesis of the antitumor efficacy in a human ovarian SKOV-3 carcinoma cell xenograft-bearing mice model. Methods:The experiments were continued for 28 days. Animals were treated with 3mg/kg SC-560 alone, 100mg/kg celecoxib (a COX-2-selective inhibitor) alone by gavage twice a day, 20mg/kg Taxol alone intraperitoneally once a week or in combination with SC-560 or celecoxib for three weeks. To test the antiangiogenic mechanism of the combination treatment, the mRNA levels of vascular endothelial growth factor (VEGF) in tumor tissues was determined by reverse transcription-polymerase chain reaction (RT-PCR). The Microvessel density (MVD) of ovarian carcinomaxenografts was determined by immunohisto-chemistry with anti-CD 34 as the label. Results:Mean tumor volume in SC-560/ taxol group was first significantly lower than control at day 14 ( p < 0.05 ). On day 7 after the end of administration, tumor volume in the combination group was reduced by 55.35% compared with control mice, which is significant statistically compared with that of control group ( p < 0.05 ). The MVD value in the SC560/Taxol group were notably inhibited compared with the Taxol group ( p < 0.001 ). Moreover, the VEGF mRNA levels and MVD value in the SC-560/Taxol group were significantly different from the celecoxib/Taxol group ( p < 0.05, p < 0.05 and p < 0.001 , respectively). Conclusions:The present study demonstrated that synergism between Taxol and SC-560 combination treatment has particular potential for chemoprevention of ovarian cancer growth, and that SC-560 enhances the anti-angiogenic effects of Taxol and these effects are better than with celecoxib.

222 THE EFFECT OF CAFFEINE ON ABCB1 EFFLUX TRANSPORTER FUNCTION Chin-Min Lin 1 , Chin-Chuan Hung 1,2 1. Department of pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan 2. Department of pharmacy, China Medical University Hospital, Taichung, Taiwan Background:Multidrug resistant (MDR) is one of the important obstacles in cancer chemotherapy. The over-expression of ATP-binding cassette (ABC) transporters is purposed to be one of the major cause of MDR cancers. Among the efflux transporters, ABC transporter-subfamily B member 1 (ABCB1/P-gp) has been demonstrated to play a key role. Therefore, identifying ABCB1 inhibitors may contribute to the successful chemotherapy. Aim:The aim of the present study is to evaluate the influence of caffeine on ABCB1 efflux function, and the potential of caffeine used as an ABCB1 inhibitor to overcome MDR cancers. Methods:HEK-293 cells were stable transfected human ABCB1 gene by lipofectamine 2000 and selected by hygromycin B. Calcein-AM uptake assay and rhodamine123 accumulation assay were performed to examine the influence of caffeine on ABCB1 function. Intracellular fluorescence accumulation was also recorded by fluorescence microscopy. Results:The intracellular fluorescent calcein intensity was increased in the presence of 10, 20, 50mM caffeine with a dose-dependent manner. These observations were also supported by images of fluorescence microscopy. As for the rhodamine123 efflux assay, caffeine could significantly inhibit the efflux of rhodamine123 by P-gp. Conclusions:These results demonstrated that caffeine may be a potential P-gp inhibitor. The molecular mechanisms and kinetic assays of how caffeine interacts with P-gp still need further studies.

223 MODULATION OF P-GLYCOPROTEIN FUNCTION BY CURCUMIN-LOADED NANOPARTICLES Nai-Yu Liu 1 , Chin-Chuan Hung 1,2 1. Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan 2. Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan Background:Multidrug resistance(MDR) is a phenomenon which cells become resistance to structurally and mechanistically unrelated drugs. This is one of the major problems in cancer treatment. The over-expression of ABC transporter is one of the main causes of MDR. Among ABC transporters, P-glycoprotein(P-gp) is the most studied and wellcharacterized one. Therefore, developing P-gp inhibitors to overcome MDR may provide better outcomes of chemotherapy. Aim:The aim of the present study is to investigate whether entrapped curcumin in nanoparticle carriers could modulate P-gp function. Method:Recombinant P-glycoprotein-expressing HEK293 cell line was established. Real-time qRT-PCR was conducted to confirm whether curcumin-loaded nanoparticles would affect P-gp mRNA expression. Influence of curcumin-loaded nanoparticles on P-gp function was evaluated by calcein-AM uptake assay and rhodamine123 efflux assay. Inhibitory effect of curcumin-loaded nanoparticles was identified by the dose-response study of rhodamine 123 efflux. Results:There was no significant influence of curcumin-loaded nanoparticles on P-gp mRNA expression after 72hr treatment. Inhibition effect of curcumin-loaded nanoparticles on Pgp function was demonstrated both in calcein-AM uptake assay and rhodamine123 efflux assay. Pretreating 1, 2.5, 5µM curcumin-loaded nanoparticles for 30, 60 minutes could significantly inhibit P-gp function. Results from rhodamine 123 efflux assay demonstrated that curcumin-loaded nanoparticles significantly inhibit P-gp efflux function with IC50 6.126 µM. Conclusion:These results demonstrated that curcumin-loaded nanoparticles inhibited P-gp efflux function under low concentrations. This study provide new nanotherapeutic treatment strategies for MDR cancers and it will be helpful in the future in vivo studies and clinical practice.

224 THE NEW SELECTIVE GLP-2 RECEPTOR AGONIST, ELSIGLUTIDE, IMPROVES IRINOTECANINDUCED DIARRHOEA AND MUCOSITIS IN THE RAT Bronwen Mayo 1,2 , Emma Bateman 1 , Andrea Stringer 2 , Erin Plews 1 , Anthony Wignall 1 , Belinda Wozniak 1 , Imogen White 3 , Claudio Pietra 4 , Sergio Cantoreggi 4 , Dorothy Keefe 1,2,5,6 1. School of Medicine, University of Adelaide, Adelaide, SA, Australia 2. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia 3. School of Medical Science, University of Adelaide, Adelaide, SA, Australia 4. Research and Development, Helsinn Healthcare, Lugano, Switzerland 5. Cancer Centre, Royal Adelaide Hospital, Adelaide, SA, Australia 6. Centre for Clinical Research Excellence (CCRE) in Oral Health, University of Adelaide, Adelaide, SA, Australia Introduction:Irinotecan is a common chemotherapeutic agent that's use is associated with severe gastrointestinal mucositis presenting as diarrhoea, nausea, vomiting, and pain and ulceration of the digestive tract. Elsiglutide, a glucagon-like peptide-2 receptor agonist, has recently been shown to decrease diarrhoea and gastrointestinal (GI) damage caused by irinotecan administration in a rat model. Interestingly, the trialled doses showed that 0.9mg/kg/day (subcutaneous, 5 days) was more effective than 1.8mg/kg (subcutaneous, 5 days) of elsiglutide, suggesting a bell-shape dose response. Objectives:To test whether a decreased dose of 0.45mg/kg of elsiglutide further improves the GI toxicity associated with irinotecan in the rat model of irinotecan-induced mucositis. Method:Dark Agouti rat model of irinotecan-induced mucositis was used to characterise effects of lower dose elsiglutide on irinotecan-induced diarrhoea and GI damage. Animals received 200mg/kg at 0 hours intraperitoneal irinotecan, and daily subcutaneous dosing of 0.45mg/kg elsiglutide for 5 days, then were killed at 6, 72 or 120 hours post-chemotherapy (n=6). Jejunum and ileum were taken for histology and microdissection. Results:Elsiglutide reduced duration of severe diarrhoea. Small intestinal wet weight increased significantly (grams, p<0.05) following elsiglutide with irinotecan (3.75±0.12g at 72 hrs, 7.64±0.33g at 120hrs) compared with irinotecan alone (3.21±0.07g at 72hrs, 6.39±0.39g at 120hrs). Villous blunting, crypt ablation and enterocyte disruption improved and inflammatory infiltrate decreased following elsiglutide and irinotecan compared with irinotecan alone. Villous area significantly increased (mm 2 , p<0.05) at 72hrs following elsiglutide with irinotecan (Jejunum 0.061±0.004; Ileum 0.042±0.003) when compared with irinotecan alone (Jejunum 0.042±0.005; Ileum 0.03±0.004). Conclusions:Elsiglutide 0.45mg/kg/day following irinotecan administration may protect against and reduce damage to the small intestine. However, this data suggests the overall effect of 0.45mg/kg/day may be lower than that in previous experiments using 0.9mg/kg/day, but is still significant. Additional studies are required to explain the variations and to explore a range of effective doses.

225 APOPTOSIS, PROLIFERATION AND INFLAMMATION ARE IMPROVED AFTER TREATMENT WITH THE NEW SELECTIVE GLP-2 RECEPTOR AGONIST, ELSIGLUTIDE, IN A RAT MODEL OF IRINOTECAN-INDUCED MUCOSITIS Bronwen Mayo 1,2 , Andrea Stringer 2 , Emma Bateman 1 , Joanne Bowen 3 , Anthony Wignall 1 , Belinda Wozniak 1 , Imogen White 3 , Claudio Pietra 4 , Sergio Cantoreggi 4 , Dorothy Keefe 1,2,5,6 1. School of Medicine, University of Adelaide, Adelaide, SA, Australia 2. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia 3. School of Medical Science, University of Adelaide, Adelaide, SA, Australia 4. Research and Development, Helsinn Healthcare, Lugano, Switzerland 5. Cancer Centre, Royal Adelaide Hospital, Adelaide, SA, Australia 6. Centre for Clinical Research Excellence (CCRE) in Oral Health, University of Adelaide, Adelaide, SA, Australia Introduction:Gastrointestinal mucositis (GIM) is a severe and debilitating side-effect of cancer therapy. There are currently few treatments which effectively prevent or ameliorate GIM. In a previous study it was shown that elsiglutide, a selective glucagon-like peptide-2 (GLP-2) receptor agonist, improved diarrhoea and histological damage associated with irinotecan-induced GIM in a rat model. Increased apoptosis, inflammation and decreased proliferation are associated with irinotecan-induced GIM. It is thought that elsiglutide may improve diarrhoea and damage through altering these gastrointestinal cellular effects. Objectives:To determine if elsiglutide reduces apoptosis and inflammation, and increases proliferation in the small intestinal crypts of the rat, following irinotecan administration. Method:Dark Agouti rats were given irinotecan once (200mg/kg, 0hrs) and elsiglutide (0.9mg/kg or 1.8mg/kg per day, subcutaneous) for 5 days, and killed at 6, 72 or 120hrs (n= 6). Markers for apoptosis (Caspase-3), proliferation (Ki67) and inflammation (myeloperoxidase, MPO) were analysed using immunohistochemistry in the jejunum and ileum. Positive stained cells were counted per crypt or field of view (FOV). Results:Apoptosis was significantly (p<0.05, cells/crypt) reduced following 0.9mg/kg/day elsiglutide and irinotecan at 6hrs (Jejunum 10.15±1.00; Ileum 13.85±1.44) compared with irinotecan control (Jejunum 14.84±1.15; Ileum 22.49±1.08). Proliferation was significantly (p<0.05, cells/demi-crypt) increased at 72hrs (peak damage) in this group (Jejunum 31.45±2.78; Ileum 28.47±2.64) compared with irinotecan alone (Jejunum 18.98±2.13; Ileum 18.64±1.62). Staining also showed that 0.9mg/kg/day elsiglutide given after irinotecan significantly (p<0.01, cells/FOV) reduces the number of MPO positive inflammatory cells in the jejunum (72hrs 67.02±6.72; 120hrs 42.08±5.52) compared with irinotecan alone (72hrs 106.69±6.04; 120hrs 64.30±7.65). Conclusions:Elsiglutide (0.9mg/kg/day) decreases apoptosis and inflammation, which may be contributors to irinotecan-induced GIM. In addition, elsiglutide improves proliferation of crypt cells, which may shorten the duration of GIM. These results provide a basis for future studies with elsiglutide to determine the exact mechanisms for this phenomenon.

226 CYCLOPHOSPHAMIDE AND IFOSFAMIDE ENHANCEMENT OF BLADDER SENSORY NERVE ACTIVITY Kylie Mills 1 , Luke Grundy 2 , Roselyn Rose'Meyer 3 , Catherine McDermott 1 , Russ Chess-Williams 1 1. Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 2. Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 3. Griffith Health Institute, Griffith University, Gold Coast, QLD Background:A major limiting factor in the use of the cytotoxic agents cyclophosphamide and ifosfamide is the resulting uro-toxicity which can result in ongoing bladder pain, urgency, feelings of residual volume and dysuria. Both drugs have been shown to cause increased micturition frequency and bladder hyperactivity in experimental models suggesting changes in sensory activity may be involved in the bladder dysfunction after treatment. Aim:To determine the effect of cyclophosphamide and ifosfamide on bladder sensory nerve activity. Methods:Twelve week old male mice were administered either 100mg/kg CPO or 200mg/kg IFO by intra peritoneal injection and sacrificed 24 hours after treatment. Intravesicle pressure and bladder afferent nerve activity were measured during bladder filling and emptying in vitro. Results:As volume in the bladder increased both intravesicle pressure and bladder sensory nerve activity increased. Nerve activity after treatment with cyclophosphamide or ifosfamide was enhanced throughout bladder filling. At maximum distension the total nerve activity was increased significantly from 182±13 pulses per second (pps) in control animals, to 230±14 pps in cyclophosphamide treated mice (p<0.05) and 226±17 pps in ifosfamide treated mice (p<0.05) (n≥6). Bladder compliance was not affected by systemic cyclophosphamide or ifosfamide pre-treatment. Conclusions:Both cyclophosphamide and ifosfamide enhance bladder sensory nerve activity without affecting bladder compliance. An increase in afferent sensitivity and firing may explain the pain, urgency and dysuria experienced by patients after treatment with cyclophosphamide and ifosfamide and provides a target for treating these adverse effects.

227 DIAGNOSIS AND MOLECULAR TARGETING FOR INDIVIDUALIZED TREATMENT OF PATIENTS WITH PRE-NEOPLASTIC LESIONS AND LOCALLY ADVANCED CERVICAL CANCER Pablo Moreno Acosta 1 , Alfredo Romero-Rojas 1 , Antonio Huertas 1 , Diana Mayorga 1 , Jinneth Acosta 2 , Oscar Gamboa 1 , Nicolas Magne 3 , Monica Molano 4 1. National Institute of Cancerology, Bogotá, Colombia 2. Patology, National University of Colombia, Bogotá, Colombia 3. Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez cedex, France 4. The Royal Women's Hospital, Melbourne, VIC, Australia Background:From the prospective study published in 2008, in which was reported the frequency of variants of HPV16 in invasive squamous cell carcinoma of cervix of Colombian population, we studied retrospectively one case in which was identified presence of the Asian-American variant of subclass c (AAc). A 43-year old woman was diagnosed with a highgrade squamous intraepithelial lesion of uterine cervix (HGSIL) in 1986. There were several colposcopy and directed biopsies with changes consistent with HGSIL and HPV infection. The gynecologist meeting decided that patient should be subjected to extended abdominal hysterectomy, being referred to another hospital. She returned to the National Cancer Institute on 2002 with a tumor of size of 5 cms, and is diagnosed with cervical cancer IIIB. She begins exclusive radiotherapy but abandoned and died in 2005. Aim:Make a diagnosis and molecular monitoring in biopsies of patient with pre-neoplastic lesions and cervical cancer. Methods:Analysis of molecular markers was performed on biopsies taken in 1986 and 2002. Results:HPV16 E6 E-r and AAc mixed variants were detected in samples took in 1986. A HPV16 E-r and AAc variant was detected in 2002, which indicate persistence of the infection. Polymorphism analysis of Arg72Pro p53 in 1986 and 2002 showed an Arg/Pro genotype. An increment of expression of IGF1R, Survivin, GLUT1, and CAIX was observed in biopsies(2002) compared with the analysis done 1986; hTERT expression in pre-neoplastic lesions was detected at 100%. Conclusions:In the prevention of cervical cancer, the presence of the AAc-HPV16 could be used as a prognostic marker of persistent infection, progression and treatment, as well hTERT expression as tumor progression marker. The analysis of molecular profiles that include biomarkers prognostic, predictive and molecular targets, and employed in this work could ensure early diagnosis and better therapeutic management of cervical lesions and cervical cancer. 1. IGF1R gene expression as a predictive marker of response to ionizing radiation for patients with locally advanced HPV16-positive cervical cancer. Moreno-Acosta P, Gamboa O, Sanchez de Gomez M, Cendales R, Diaz GD, Romero A, Balart Serra J, Conrado Z, Levy A, Chargari C, Magné N. Anticancer Res. 2012 Oct;32(10):4319–4325.

228 NO MORE VAGUE DESCRIPTORS: BUILDING COMPETENCY IN ASSESSMENT, IN COLLABORATION WITH ALL STAKEHOLDERS. THE DEVELOPMENT OF A COMPREHENSIVE ASSESSMENT TOOL FOR PATIENTS IN THE DAY ONCOLOGY SETTING AT CABRINI MALVERN Briege O'Donnell 1 , Amanda Proposch 1 , Mel Pritchard 1 1. Cabrini Hospital Malvern, Malvern, VIC, Australia Introduction:The previous assessment tool used by the Cabrini Malvern Day Oncology Unit was nurse dependent and not person centred. This meant that patient symptom assessment was not regulated and did not meet national standards. After identifying this as a concern a new comprehensive Assessment Tool was drafted to meet the National Standards and the units person centred care Aims: 1. To develop a comprehensive Assessment Tool which meets the needs of all Oncology patients 2. To adhere to the National Standards of patient assessment 3. To ensure conformity across the multi disciplinary team when assessing symptoms and ensuring that all are using the same accredited language Method: 1. Draft and implement a new assessment tool 2. Obtain feedback from staff, 3. Monitor implementation 4. Ongoing assessment of tool in relation to patient needs. Results:Results will be measured through a number of different measures: 1. Press Ganey results 2. By monitoring the number of accurate and timely referrals to allied health services 3. Feedback from patients and staff

229 SOMATIC MUTATIONS OF THE EGFR, KRAS AND BRAF GENES: HOMOGENEITY IN SINGLE CELLS FROM CELL LINES AND HETEROGENEITY IN CIRCULATING EPITHALIAL TUMOR CELLS (CETC) AS DETERMINED USING THE COBAS® Z 480 ANALYZER Katharina Pachmann 1 , Monika Pizon 1 , Dorothea Zimon 1 , Ernst Ludwig Stein 1 , Ulrich Pachmann 1 1. SIMFO GmbH, Bayreuth, Germany Background:Targeted therapies directed against somatic mutations in genes involved in signalling pathways have been shown to improve outcome compared with chemotherapies in patients with tumors carrying the respective mutations. Purpose/Objectives:Identification of such mutations is performed from the primary tumor. However, such material is not always available but cells with metastatic potential must be released to reach their distant loci. Using maintrac® CETC can be detected and individually isolated in almost all patients with lung and colon cancer and melanoma and can provide a liquid biopsy to monitor the course of disease. We, here, report on the successful analysis of such isolated cells for gene mutations in tumor driver genes EGFR, KRAS and BRAF. Materials and Methods:Blood from patients with NSCLC, colon cancer and malignant melanoma was analyzed for cells positive for epithelial antigen (EpCAM) using the maintrac® approach. Between 8–20 EpCAM positive cells from each patient were isolated individually. The DNA was subsequently amplified by whole genome amplification and assayed using either the cobas® EGFR, the cobas® KRAS or the cobas® BRAF V600 Test. Results:DNA could be amplified from all indiviually isolated cells. EGFR mutation was detected in 12% of isolated tumor cells from a patient with NSCLC, KRAS mutation was detectable in 28% of cells from a patient with colon cancer and the BRAF mutation in 100% of cells from a BRAF cell line and in 50% of cells from a melanoma patient. Conclusions:Individually isolating epithelial tumor cells from the peripheral blood allows not only detection of driver mutations in circulating tumor cells but also to determine the frequency of mutated cells. The results were confirmed by single cell analysis of a BRAF mutated cell line. This proves that at least part of the CETC from the tumor. They can, in the future, be used as markers of response to the action of drugs and contribute insight into how resistance may be acquired.

230 A COMPLEX QSTREAM© PAIN ASSESSMENT INTERVENTION ON CANCER NURSES' PAIN SCREENING AND ASSESSMENT PRACTICES: RESULTS FROM A QUASI-EXPERIMENTAL STUDY Jane L Phillips 1,2 , Nicole Heneka 1,2 , Lawrence Lam 3 , Tim Shaw 4 1. University of Technology Sydney, Ultimo, NSW, Australia 2. University of Notre Dame Australia, Darlinghurst Campus, NSW, Australia 3. Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong SAR,, CHINA 4. Director, Workforce Education and Development Group (WEDG), Sydney Medical School, The University of Sydney, Sydney, NSW, AUSTRALIA Background:Routine cancer pain screening and assessment is the foundation upon which effective pain management is built. Whilst these simple practices are recommended in all evidence based cancer pain guidelines, they are often not routinely implemented, resulting in undetected and undertreated cancer pain in people living with cancer. This translational research study utilised a novel online performance feedback intervention to improve cancer nurses' pain assessment practices. Aim:To measure the impact of a tailored Qstream© cancer pain assessment performance feedback intervention on inpatient cancer nurses': i) pain assessment capabilities; and ii) adherence to cancer pain screening and assessment guideline recommendations. Methods:A quasi-experimental, prospective follow-up study involving specialist cancer nurses in five acute care settings within one translational cancer research network in Australia. Participant survey and patient chart audit data were collected: pre (T1) and post (T2-T3) intervention, with final chart audit 4 weeks (T4) post audit and feedback. Participants' completed 11 case based pain assessment scenarios delivered to their nominated email using a spaced learning format, with the T1-T2 pain assessment chart audit data fed back to participants at T3. Results:Participants who completed the intervention (n=44) increased their pain assessment knowledge, assessment tool knowledge and confidence to undertake a pain assessment (p<0.001), with this change maintained at 10 weeks post intervention. The positive changes in nurses' pain assessment capabilities' translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at three time points (2 trend=18.28, df=1, p<0.001). The median pain assessment documentation quality scores also increased during the study period (Kruskal-Wallis test 21=7.17, p=0.007)]. Conclusions:Integrating specialised pain assessment clinical content and audit and feedback into a spaced on-line learning platform improved cancer nurses' pain assessment practices. These results need to be confirmed in a controlled study.

231 UPREGULATION OF ROR INHIBIT PROLIFERATION, INVASION AND MIGRATION OF HUMAN GASTRIC CANCER CELLS INDUCED BY DIALLYL DISULFIDE Su Qi 1 , Su Jian Xia, Hong Zeng Xi 1 , You-Hua Wu, Wen-xiang Dai, Xiao-Hong Ai 1 1. Chinese Anti Cancer Association, Hengyang, Hunan, China Objective:ROR is a member of the nuclear receptor superfamily that plays a critical role in cancer. We previously show that upregulation of ROR in gastric cancer cells induced by diallyl disulfide (DADS) were identified using proteomic technique. This study to investigate the effect of ROR in proliferation, migration, and invasion of gastric cancer cells induced by DADS. Methods:The expressions of ROR were detected by Indirect immunofluorescence, RT-PCR and Western blot in gastric cancer cells by DADS. The effect of overexpression and knockdown of ROR on proliferation, migration and invasion in gastric cancer cells by DADS were detected by MTT, soft agar colony formation, flow cytometry, wound healing and Transwell invasion assays. Results:Indirect immunofluorescence showed that the expression rate and fluorescence intensity of ROR in gastric cancer MGC803, BGC823, SGC7901 and MKN28 cells treated by DADS were elevated. RT-PCR and Western Blot showed that the ROR expression was increased. Overexpression of ROR or DADS inhibited the proliferation, migration and invasion in MGC803 cells. However, knockdown of ROR strengthened the capacity of proliferation, migration and invasion. DADS inhibited the migration and invasion in knockdown of ROR cells. However, knockdown of ROR weakened the inhibition of proliferation, migration and invasion induced by DADS in MGC803 cells. Conclusion:DADS can upregulate the expression of ROR in gastric cancer cells. DADS or overexpression of ROR may inhibit the proliferation, migration and invasion in gastric cancer cells. This information suggests that DADS can become a active drug of treatment of gastric cancer, and ROR is a potent tumor suppressor and a potential therapeutic target for gastric cancer.

232 WHY EARLY TREATMENT OF OBESITY MATTERS: PAKT/MTOR AND GLYCOLYSIS IS ACTIVATED IN OBESE WOMEN DURING THE INITIATION OF TRIPLE-NEGATIVE BREAST CANCERS AND CAN BE TARGETED BY METFORMIN CHEMOPREVENTION Victoria Seewaldt 1 , Catherine Ibarra 1 , Patricia Keely 2 , Chistopher Sistrunk 1 , Adrian Ambrose 1 , Amira Carter 1 1. Duke University, Durham, NC, USA 2. University of Wisconsin, Madison, WI, USA Background:Obesity is one of the most important preventable causes of cancer, accounting for >20% of cancer deaths. Obesity increases insulin and activates Akt/mTor, glycolysis, and glucose-uptake. AMPK counters these signals and is activated by metformin. Hypothesis:pAkt/mTor and glycolysis are elevated in obese women prior to development of TNBC and are targeted by metformin-chemoprevention. Methods/Results:Using proteomic-profiling and metabolic-imaging, we tested pAkt/mTor and metabolism in TNBC and matched normal breast tissue from lean (BMI<25) and obese (BMI>30) women. In obese women, pAkt/mTor and metabolism was activated in TNBC and normal tissue. In lean women only TNBC exhibited pAkt/mTor/metabolic-activation. We tested sequential biopsies from women who had normal biopsy and did or did not progress to TNBC within 12 months. In women that progressed, we observed activation of Akt/mTor/glycolysis/glucose-uptake in the “normal” biopsy. Conclusions:pAkt/mTor/metabolic-signaling is activated in normal tissue prior to development of TNBC. Enrollment in our ALLIANCE-prevention trial is ongoing and will test the ability of metformin to target pAkt/mTor and metabolism.

233 THE EFFECT OF ORAL MICROBES ON THE PROLIFERATION, HEALING, AND IMMUNE RESPONSE OF INTESTINAL EPITHELIAL CELLS (IEC6) TREATED WITH SN-38 (METABOLITE OF IRINOTECAN) Andrea Stringer 2,1 , Helen McInnes 3 , Bronwen Mayo 1 , Richard Logan 4 , Barbara Vanhoecke 5,6 1. Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia 2. School of Medical Sciences, University of Adelaide, Adelaide, SA, Australia 3. School of Dentistry, University of Adelaide, Adelaide, SA, Australia 4. School of Dentistry, University of Adelaide, Adelaide, SA, Australia 5. Laboratory of Microbial Ecology and Technology, University of Ghent, Ghent, Belgium 6. School of Medicine, University of Adelaide, Adelaide, SA, Australia Introduction:Gastrointestinal mucositis is a toxicity of chemotherapy. Gut microbial composition has been shown to be altered following chemotherapy, and therefore may affect proliferation and healing properties of intestinal cells. Toll-like receptors (TLRs) are immune regulators triggered by microbes that may contribute to the initiation of mucositis. The aim was to investigate effects of microbes on intestinal epithelial cells (IEC-6) following SN-38, and whether microbes affects TLR signaling. Methods:IEC-6 cells were seeded and cultured in 24-well Transwell TM plates until confluent. Next, monolayers were wounded by means of a sterile pipette tip and treated with 500 µM SN-38 or DMSO (control). In parallel, microbes from an oral swab were transferred onto an agar/mucin layer in the TranswellTM inserts and inserts were placed on top of the wounded monolayers. Wound areas were calculated at baseline and after 24h of exposure to the microbes. Proliferation of the cells at 24h was evaluated using an SRB assay. TLRs were measured with real time PCR. Results:In the presence of microbes, SN-38 significantly inhibited wound healing at 24h (p<0.05), while SN-38 as such had no effect. In contrast, cell proliferation was significantly inhibited by SN-38 and more pronounced when microbes were present (p<0.05). At 48h, TLR4 expression significantly increased in the presence of microbes, irrespective of the presence of SN-38 (p<0.05). Results are pending for TLR2, 5 and 9. Conclusions:Cellular activities such as proliferation and migration (wound healing) are clearly impacted by the presence of microbes. The increased expression levels of TLR4 following exposure to microbes suggests a mechanistic role for this receptor in these events.

234 -CAROTENE, A CAROTENOID, IS A POTENTIAL INHIBITOR OF MULTIDRUG RESISTANT PROTEIN Yu-Ning Teng 1 , Chin-Chuan Hung 1,2 1. Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan 2. Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan Background:Chemotherapy is the most common treatment for cancer. However, the ability of cancer cells simultaneously becoming resistant to different drugs, a phenomenon called multidrug resistance (MDR), remains a major difficulty to successful chemotherapy. The efflux transporter, P-glycoprotein (P-gp, encoded by ABCB1 gene), is reported to play an important role in MDR cancers. Although three generations of P-gp inhibitors have been developed, the outcomes of clinical trials did not provide promising results. The development of “fourth generation inhibitors” aims at identifying potent and relative non-toxic substances from natural products. Aim:The aim of the present study is to investigate the effect of -carotene on human P-gp, and evaluate whether -carotene has the potential to reverse MDR cancers. Methods:HEK293 cell line harbored human ABCB1 gene was established. MTT assay was performed to examine the cytotoxicity of -carotene. Real-time RT-PCR was conducted to confirm the P-gp expression. The doxorubicin accumulation assay, rhodamine123 efflux assay and calcein-AM uptake assay were carried out to examine the function of P-gp in the established HEK293 cells, and were also used to evaluate the effect of -carotene on P-gp function as well. Results:The IC 50 of -carotene were 195µM and 175µM for HEK293 and HEK293/ ABCB1 cell line, respectively. The ABCB1 mRNA expression in HEK293/ ABCB1 cell line was not influenced by treatment of 100µM -carotene for 24 and 48 hours. Results from doxorubicin accumulation assay, rhodamine123 efflux assay and calcein-AM uptake assay demonstrated that pretreated 10, 25, 50, 100µM -carotene for 0.5 and 24 hours significantly inhibited P-gp function (p<0.01). Conclusions:The results revealed that -carotene is a potential human P-gp inhibitor. Whether it can reverse MDR cancer warrants further investigations.

236 INTEGRATED TARGET DISCOVERY IN THE EMP ATHY BREAST CANCER NETWORK – MULTIDIMENSIONAL ANALYSIS OF EPITHELIAL MESENCHYMAL PLASTICITY (EMP) IN EXPERIMENTAL SYSTEMS Melissa Davis 1 , Elizabeth D Williams 3,2 , Tony Blick 3 , Gayle Philip 4 , Eva Tomascovic-Crook 5 , Nick Wong 6 , Izhak Haviv 8,7 , Kaylene Simpson 9 , EMPathy BCN 10 , Gregory Goodall 11 , Erik (Rik) W Thompson 3,5,12 1. Systems and Computational Biology Laboratory, The University of Melbourne, Melbourne, VIC, Australia 2. Australian Prostate Cancer Research Centre – QLD, Translational Research Institute, Melbourne 3. IHBI and School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia 4. Victorian Life Sciences Computing Initiative, University of Melbourne, Melbourne, VIC, Australia 5. Invasion & Metastasis Unit, St. Vincent's Institute, Melbourne, VIC, Australia 6. Translational Genomics & Epigenomics Laboratory, Olivia Newton-John Cancer & Wellness Centre, Melbourne 7. Faculty of Medicine in Galilee, Bar Ilan University, Zfat, Israel 8. Patho-Genomics, University of Melbourne Department of Pathology, Melbourne, VIC, Australia 9. Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia 10. http://www.mtci.com.au/TEMTIA/EMPathy.html , IHBI, QUT, Brisbane 11. Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia 12. University of Melbourne, Department of Surgery,St. Vincent's Hospital, Melbourne, VIC, Australia Epithelial mesenchymal plasticity (EMP) is instrumental in embryological development and has been implicated in stemness, therapy resistance and metastasis of breast cancer (BC). EMP markers are elevated in basal-like, triple negative BC, which are over-represented in women with BRCA1 mutations and are associated with early recurrence and poor prognosis. The EM Pathy Breast Cancer Network (BCN) is a national collaborative effort including scientists clinicians and a consumer advocate investigating the role of EMP in BC recurrence. The 7 thematic research projects and 9 program Satellite projects of EM Pathy BCN are aligned with the Cooperative Research Centre for Cancer Therapeutics (CTx) (www.cancercrc.com/index), so that potential drug targets identified may progress into the CTx drug development program. Multiple parallel approaches in the Target Discovery theme were used to identify candidate regulators and effectors of EMP. A total of 10 functional or gene expression experiments provided 7,950 significant events were cross referenced against 10 public BC datasets relevant to EMP and/or BC stem cells. A series of criteria were used to select a panel of 127 candidates that were combined with 123 ad hoc candidates (mainly hits close to the cut-off and breast cancer context genes) to give a total of 250 candidates to be analysed in breast cancer tissues using Nanostring technology. The 2,301 ‘significant events’ in any functional screen were further cross-referenced to 10 public functional datasets relevant to EMP in any system and a series of criteria were used to select a panel of 320 candidates that were analysed in an siRNA ‘functional screen’ of multiple BC cell lines, to support the choice of candidate targets for drug development. Several candidates have emerged and are being pursued. In particular, a strong underpinning of the TGF signaling pathway has been revealed, which may be held in check by IRS1. The EMP athy BCN is supported by an NBCF National Collaborative Research Program Grant.

237 PREVENTIVE SCREENING FOR CANCER AMONG PEOPLE ATTENDING AN ABORIGINAL COMMUNITY CONTROLLED HEALTH SERVICE Natasha Noble 1 , Christine Paul 1 , Nicole Turner 1 , Heidi Turon 1 , Stephen Blunden 1 1. University of Newcastle, Newcastle, NSW, Australia Aboriginal Australians have higher mortality and lower survival from cancer than non-Aboriginal Australians. Screening rates for cancers including breast, cervical and colorectal cancers are known to be lower than for non-Aboriginal Australians. Aims:To examine a) the prevalence of self-reported under-screening for breast, cervical and colorectal cancers among people attending an Aboriginal Community Controlled Health Service (ACCHS); and b) socio-demographic predictors of under-screening. Methods:Consecutive adult patients attending an ACCHS in regional/ rural New South Wales Australia completed a health risk survey on a touch screen computer. Health risks included self-reported time since last screening test for cervical, breast or colorectal cancer, tailored to participant age and gender. Results: 406 participants completed the survey (61% female, 79% Aboriginal). For women aged 18–69yrs (n=198), 32% (CI 25–38%) had not had a pap smear test within the last 2 years. Of the 77 women aged 50–69yrs, 42% (CI 30–53%) had not had a mammogram in the last 2 years. For participants aged 50yrs and over (n=154), 49% (CI: 41–57%) had not been appropriately screened for colorectal cancer (CRC). Age, Indigenous status, education level, income source and smoking status were not significant predictors of underscreening, but women who had experienced physical or emotional violence in the last 12 months were more likely to have been appropriately screened for cervical cancer (n=187, OR=2.69, p=0.025). Current smokers were less likely than non-smokers to have been appropriately screened for breast cancer (n=73, OR=0.16, p=0.001). There were no significant predictors of screening for CRC. Conclusion:Although a significant proportion of those attending an ACCHS had not been appropriately screened, screening rates among this sample were significantly higher than reported in other national Indigenous samples. Predictors of under-screening were inconsistent, but suggest that health care providers may need to encourage female smokers to undergo mammography.

238 BREAKING DOWN THE BARRIERS: EXAMINATION OF THE BARRIERS TO PSYCHOLOGICAL SCREENING AND REFERRAL OF MEN WITH CHRONIC ILLNESS DISPLAYING SIGNS OF DISTRESS Georgina Wiley 1 , Trish Livingston 2 , Leila Heckel 2 , Margaret Staples 1 1. Cabrini Hospital Malvern, Malvern, VIC, Australia 2. Faculty of Health, Deakin University, Melbourne, Victoria, Australia Introduction:Chronic illness and associated treatments impose immense psychological burden on the individual. Provision of information and counselling services have been demonstrated to be effective in increasing coping ability, reducing levels of anxiety and depression, and increasing satisfaction with personal participation in medical decision-making among people across all phases of their illness. Men with chronic illness are less likely to report anxiety or depression and it is unknown what barriers may prevent men with chronic illnesses from accepting referrals for psychological support Aims: 1. Identify the number of patients presenting to a day oncology unit who were experiencing distress. 2. Identify male perceptions towards, and usage of, support services and determine the barriers to follow up care with support services. Methodology:A two phase exploratory study, mixed method approach, incorporating both quantitative and qualitative research designs, were employed. The sample population were patients presenting to the Day Oncology Unit at Cabrini Malvern for treatment. Phase One:Utilised quantitative research data in the form of a questionnaire which included the collection of demographical information (e.g. age, time since diagnosis) and the Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith 1983) from 231 participants at the Day Oncology Unit at Cabrini Malvern. Eligible patients were identified from the day oncology unit's CHARM computer system. Phase Two:Encompassed qualitative data collection. Selection was purposive. A total of 11 males who were identified as having reportable or high levels of psychological distress from the HADS tool were asked to take part in a questionnaire and semi structured interview. Patients were identified from their consent forms. Results:The results of this study will identify gaps in service delivery for men with chronic disease and will inform the development of recommendations to improve support services for those affected by anxiety and depression. 1. Zigmond, AS & Snaith, RP 1983, ‘The hospital anxiety and depression scale’, Acta psychiatrica scandinavica, vol. 67, no. 6, pp. 361–370.

239 EFFECTS OF HIGH DOSE THORACIC RADIOTHERAPY WITH CONCOMITANT AND SEQUENTIAL TRASTUZUMAB ON ISOLATED RAT AORTA: A FUNCTIONAL STUDY Oguzhan Yildiz 1 , Melik Seyrek 1 , Guler Yavas 2 , Melis Gultekin 2 , Ferah Yildiz 2 1. Medical Pharmacology, Gulhane School of Medicine, Ankara, Turkey 2. Radiation Oncology, Hacettepe University, Ankara, Turkey Background:Radiation-induced changes in blood vessels such as endothelial injury is well-known. Trastuzumab (T) has been shown to produce cardiac dysfunction, however its effects on vascular functions is not clear. Aim:The aim of this study is to elucidate if there is an additive or supraadditive deleterious effect of T and radiotherapy (RT) – on vascular functions when they are used either sequentially (neoadjuvant and adjuvant) or concomitantly. Methods:Female adult Sprague–Dawley rats (250–300g, n=72) were divided into 6 groups (G) composed of 12 animals each: G-1 (control), G-2 (T), G-3 (RT), G-4 (RT+ neoadjuvant T), G-5 (RT+concomitant T) and G-6 (RT+adjuvant T). Isolated organ bath experiments were performed 21 days after radiotherapy. The rats were anesthetized and thoracic aortae were dissected out and cleaned of adhering fat and connective tissue. Aortic ring segments (3mm in length) were cut and mounted in isolated tissue baths containing oxygenated 10ml Krebs-Henseleit solution. Isometric tension measurements were recorded by a force–displacement transducer and analyzed using a data-acquisition and analysis software. Thoracic aorta segments were first contracted with KCl (68mM) and then with phenylephrine (PE, 1µM). After PE -induced contraction reached to plateau, acetylcholine (ACh) was applied at increasing concentrations. The relaxation to ACh were recorded and expressed as percentage of PE maximum contraction. Results:Contractions to KCl and PE did not differ among groups. However, relaxation responses to ACh as percentage of PE maximum contraction were significantly lower in G-3, G4, G-5 and G-6 groups when compared to control group (P<0.05). T caused a slight but not significant extra relaxation deficit when it was used either sequentially or concomitantly. Conclusions:Our study revealed that mediastinal high dose RT when combined with T may lead to severe endothelial damage. 1. Tanja Marinko, Jure Dolenc, Cvetka Bilban-Jakopin. Cardiotoxicity of concomitant radiotherapy and trastuzumab for early breast cancer. Radiol Oncol 2014; 48(2): 105–112.

240 C-MYC PLAYS PART IN DRUG RESISTANCE MEDIATED BY BONE MARROW STROMAL CELLS IN ACUTE MYELOID LEUKEMIA Yizhuo Zhang 1 , Bing Xia 1 , Shanqi Guo 1 , Le Zhang 1 1. tianjin cancer hospital, Tianjin, China Acute myeloid leukemia (AML) is a malignant disease not sensitive to chemotherapy. The dynamic interaction between AML cells and bone marrow (BM) microenvironment plays a critical role in response of this disease to chemotherapy. It's reported that marrow stromal cells (MSC) are essential component of bone marrow microenvironment which affects the survival of AML cells. The aim of our research is to elucidate the mechanism of drug resistance of AML cells associating with MSC. We found that adhesion of AML cell lines U937, KG1a and primary AML cells to MSC inhibited cytotoxic drug-induced apoptosis. Western blot showed that c-myc of AML cells cocultured with stroma was up-regulated. Treatment with 10058-F4, a small molecule inhibitor of MYC-MAX heterodimerization, or c-myc siRNA significantly induced apoptosis. Western blot analysis further showed that inhibition of c-Myc increased expression of caspases-3, cleavage of PARP and reduced expression of Bcl-2, Bcl-xL and vascular endothelial growth factor (VEGF). Thus, we conclude that MSCs protected leukemia cells from apoptosis, at least in part, through c-Myc dependent mechanisms, and that c-myc contributed to microenvironment induced drug resistance in AML. In summary, we declared that c-Myc is a potential therapeutic target which mediated drug resistance in AML.

241 COMBINED INHIBITION OF BTK AND PI3KΔ AS A POTENTIAL THERAPEUTIC STRATEGY IN MANTLE CELL LYMPHOMA Yizhuo Zhang 1 , Fulian Qu 1 , Bing Xia, Shanqi Guo 1. tianjin cancer hospital, Tianjin, China B-cell receptor (BCR) provides essential growth and survival signals to B-cell lymphomas. Inhibitors of BCR signaling have become an area of substantial clinical interest. We studied the role of BCR signaling in stroma-mediated cell survival and drug resistance in mantle cell lymphoma (MCL). We demonstrated that adhesion of MCL cells to lymph node stroma enhanced activation of BCR signaling: PI3K, BTK and ERK pathways. Inhibition of BTK by PCI 32765 or PI3K by CAL101 significantly blocked intrinsic and stroma-conferred BCR signaling, lymphoma-stroma interaction and triggered lymphoma cell apoptosis. Combined treatment of BTK and PI3K inhibitors synergistically disrupt BCR-signaling, overcome microenvironment-mediated drug resistance, and suppress cyclin D1 expression and lymphoma cell growth in MCL cell lines and primary samples. Collectively, these data support that BCR activation controls intrinsic survival as well regulates stroma-mediated extrinsic lymphoma cell survival. Combined targeting of BCR pathway intermediates is a promising therapeutic strategy to MCL therapy.

242 IMPROVING PATIENT EXPERIENCE IN A DAY ONCOLOGY SERVICE Emma F Alder 1 1. Icon Cancer Care, Brisbane, QLD, Australia Aims:Icon Cancer Care completed a study in December 2012 identifying issues around patient experience in a private day oncology hospital setting. A project was established in 2013 with the aim of improving the patient and family experience by re-designing workflow for all stakeholders. Improving the patient experience was key and the goal to improve and streamline patient flow with reduced wait times. Improving the team climate by implementing a cultural change would increase productivity with improved processes and documentation. Methods:Detailed mapping of the existing patient flow was carried out with input from patients, providers and employees. New potential processes and improvement initiatives were produced, mapped and then prioritised. The project was split into stages, each stage using the PDCA (Plan, Do, Check, Act) Cycle. Project roles and work streams were outlined, with assessment and reallocation of expertise in the team, keeping a strong focus on the new design. Results:The patient waiting time has reduced by 40%, with the percentage of patients waiting 30 minutes or less increasing. Activities around patient engagement were re-distributed with direct data entry and accessibility of all information remotely. The new medication supply process increased efficiency for the team and impacted the time a patient spends awaiting treatment. Documentation underwent significant change with reallocation of resource and has seen a reduction in outstanding orders on day of treatment from 60–70% to 10%. Efficiency gains include chemotherapy ordering, reduced patient waiting times and an improved patient experience. Conclusions:The project encompassed operational processes which led to re-defining work flow, capability development and re-allocating responsibilities and expertise. The project has led to a cultural change at one day hospital, with the initiatives now transferrable across other clinics. The new team culture is providing continuous and ongoing improvement. 1. PDCA Cycle -source Quality Improvement Tools & Techniques 2. Enzyme International (Australia) 2013- New Patient Flow Map

243 WHAT SORT OF FOLLOW-UP SERVICES WOULD AUSTRALIAN BREAST CANCER SURVIVORS PREFER IF WE COULD NO LONGER OFFER LONG-TERM SPECIALIST-BASED CARE? A DISCRETE CHOICE EXPERIMENT Taryn Bessen 1 , Gang Chen 2 , Jackie Street 3 , Jaklin Eliott 3 , Jonathan Karnon 3 , Dorothy Keefe 4 , Julie Ratcliffe 2 1. Royal Adelaide Hospital, Adelaide, SA, Australia 2. School of Medicine, Flinders University, Adelaide, SA, Australia 3. School of Population Health, University of Adelaide, Adelaide, SA, Australia 4. School of Medicine, University of Adelaide, Adelaide, SA, Australia Introduction:Early diagnosis and improved treatment have increased breast cancer survival rates which, in turn, has led to increased demand for follow-up. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important, yet currently we know little about patient preferences. The purpose of this study was to determine the preferences of breast cancer survivors for alternative modes of delivery of followup services, if we could no longer offer long term specialist-led hospital based follow-up. Materials and methods:A self-administered questionnaire (on-line or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency, and method of delivery of routine follow-up care; as well as perceived value of “drop-in” clinics providing additional support. Participants were recruited through breast surgeons (SA only), limited local and national print media, Cancer Voices SA, Cancer Council Australia, Breast Cancer Network of Australia, National Breast Cancer Foundation and Register 4, over a 6 month period from May to October 2012. Results:836 women participated in the study, of whom 722 (86.4%) completed the DCE. Women demonstrated strongest positive preferences for a breast physician (followed by breast cancer nurses), 6-monthly visits, local breast cancer clinics, face-to-face attendances (followed by alternate face-to-face and telephone), and treatment side-effects (followed by secondary prevention) drop-in clinics (all p<0.01). Conclusions:Women prefer to have their routine breast cancer follow-up by a breast physician (or a breast cancer nurse) in a dedicated local breast cancer clinic, rather than with their local general practitioner. Drop-in clinics for the management of treatment related side-effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors.

244 ONE SIZE DOES NOT FIT ALL? COST UTILITY ANALYSES OF ALTERNATIVE MAMMOGRAPHIC FOLLOW-UP SCHEDULES, BY RISK OF RECURRENCE Taryn Bessen 1,2 , Dorothy Keefe 3 , Jonathan Karnon 2 1. Royal Adelaide Hospital, Adelaide, SA, Australia 2. School of Population Health, University of Adelaide, Adelaide, SA, Australia 3. School of Medicine, University of Adelaide, Adelaide, SA, Australia Publish consent withheld

245 THE SIGNIFICANCE OF DATA IN CAPTURING A BIRD'S EYE VIEW OF A HOSPITAL AND HEALTH SERVICE'S (HHS) PROGRESS Eliza Bott 1 , Leisa Brown 1 , Maree Bransdon 1 1. Central Integrated Regional Cancer Service, Queensland Health, Brisbane, QLD, Australia Collecting data has enabled CIRCS to improve and validate service delivery in Queensland Health's hospital and health care facilities. CIRCS provides a vast array of education to health professionals in Queensland through Telehealth sessions and a Learning Management System (LMS). Collecting feedback and participation data allows CIRCS to capture an overview of how HHSs are progressing with standardising their education. Telehealth and the LMS have been the predominant delivery methods in 2014 and the collated feedback and online progress statistics have shown them to be extremely successful methods. CIRCS employs a Likert scale as a psychometric measure through the use of feedback questionnaires to quantify the impact of the education offered. These are completed at the end of an education session to gain both quantitative and qualitative response data. CIRCS target for all education sessions is a Likert score of 3.5 or above and endeavour to improve areas that fall below this. The scale is often presented as a graph for easy interpretation and efficient responses to improvement opportunities. Collecting data provides a strong base for creating visually stimulating presentations for HHS stakeholders. Each month, a report is prepared on the LMS education statistics to compare against the previous months. This has so far shown a steep uptake of standardised education as staff become more familiar with the online education concept. The data is on offer to Chief Executives, Nurse Educators, Clinical Facilitators and anyone else charged with supervising education uptake.

246 USING AN ACTION RESEARCH APPROACH TO QUALITY IMPROVEMENT OF CHEMOTHERAPY DAY UNIT DOCUMENTATION: ENGAGING HEALTH PROFESSIONALS AND IMPLEMENTING SUSTAINABLE CHANGE Jill Beattie 1 , Linda Marshall 2 , Peter Briggs 3 , Joan Thomas 4 , Gael Wilder 5,3 , Tracey Tobias 3 , Lisa Brady 3 1. Monash University, Frankston, VIC, Australia 2. Monash Health, Moorabbin 3. Southern Melbourne Integrated Cancer Service, Moorabbin 4. Peninsula Health, Frankston 5. Alfred Health, Prahran Engaging clinicians in change can be difficult because of the tension they experience between care delivery and ensuring efficient and effective processes are in place to assess, communicate, deliver and evaluate care. This pilot used a systematic, participatory process to engage clinicians in implementing standardised plan of care documentation for patients in three Haematology/Oncology Day Care Units in Victoria, Australia. An action research approach using plan-do-study-act (PDSA) cycles tested small changes and their impact on clinicians. Data collection included: field notes, a project journal, informal conversational interviews and documentation audits. Analysis included descriptive statistics for the audits and thematic analysis for qualitative data. The nurse unit managers led the process, with chemotherapy day unit medical and nursing clinicians participating. Two of the three units piloted the documentation, with the other opting out until electronic records have been developed. The medical leadership in the two participating units varied from full support to little support, and engaging off-site consultants was a challenge. PDSA cycles identified issues such as availability of the ‘old’ documentation, document format and content issues, documents not being completed, lack of written evidence of patient consent, treatment plans not being scanned, and lack of computer access for nurses to check previous patient records and results. All these issues were resolved except for written evidence of patient consent, which is ongoing. The primary recommendation was to convene a working party to review the documentation and adopt it with agreed modifications. The nurse unit managers found themselves in a position to influence practice by leading their colleagues in piloting and evaluating new documentation. Conducting PDSA cycles provided an effective means of implementing change, by making data-driven decisions, at low risk and cost. The aim of standardised care plan documentation across the three sites was not achieved at this time and collaboration is ongoing.

247 FILLING THE GAPS: IMPLEMENTATION AND EVALUATION OF THE HAEMATOLOGY/ONCOLOGY PLAN OF CARE DOCUMENTATION IN A CHEMOTHERAPY DAY UNIT Lisa Brady 1 , Linda Marshall 2 , Tracey Tobias 1 , Jill Beattie 3 1. Southern Melbourne Integrated Cancer Service, Melbourne, Vic, Australia 2. Monash Health, Bentleigh, Vic, Australia 3. Monash University School of Nursing and Midwifery, Melbourne, Vic, Australia Previously, there was no systematic, streamlined multidisciplinary Haematology/Oncology plan of care documentation for Chemotherapy Day Unit (CDU) patients treated in a Victorian metropolitan health service. A consultative process was used to develop and implement the new Haematology/Oncology plan of care to improve clinician access to accurate and timely, assessment and documentation of treatment requirements and care delivered. The project used an action research approach, to monitor the changes and impact on clinicians as they occurred over 4 months. Following the pilot, focus groups were conducted to identify barriers and enablers related to implementation and its impact on clinicians and patients. A pre/post documentation audit was conducted to assess improvement and gaps. Analysis included descriptive statistics of audit data and thematic analysis of focus group data. While results indicated a notable improvement, areas related to patient safety such as documentation of treatment intent, priority of when to start treatment, frequency of medical review, written evidence of patient consent, falls risk assessment, chemotherapy administration procedures and post treatment final checks were still not being completed in all cases. Duplication included documentation of nosocomial infection and nursing discharge notes. Key barriers to implementation included: initial overwhelm; lack of support from consultants; the need to scan medical records with increased workload and duplication, and documentation format and flow issues. Enablers included: good leadership, informed staff, familiarity with the documentation process following initial overwhelm and addressing issues as they arose through PDSA cycles. The introduction of the plan of care supported a more timely assessment process, a more comprehensive multidisciplinary approach and consistency across assessments, and improved patient safety with the addition of side effect cues. These findings suggest that the implementation of the Haematology/Oncology plan of care indicated advancements in health service quality improvement, increased patient safety, improved timeliness and reduction in costs.

248 CHEMOTHERAPY SERVICES, SAFETY HIERARCHY – WHAT YOU NEED TO KNOW Leisa Brown 1 , Maree Bransdon 1 1. QLD Health, Bowen Hills, QLD, Australia Background:A multiplicity of documents identifies the potential risk for occupational exposure to chemotherapy as a hazardous substance which has led to a plethora of regulatory standards and guidance documents. Regulations outline a hierarchy of control measures to be implemented in order of rank from most effective to least effective to manage risk in relation to the handling of hazardous substances and related waste. If the risk is unable to be eliminated, it must be minimised so far as is reasonably practicable (State of Queensland 2011). Aims:To provide an impartial consistent documented review including recommendations, to assist with identifying how a facility is meeting legislative requirements and best practice standards with regard to the supply, administration and safe handling of hazardous substances (namely chemotherapy) and related waste. Methods:The review requires access to local policies and procedures related to chemotherapy management. The process involves a site visit which includes meeting with Workplace Health and Safety, Pharmacy, Waste Management and nursing representatives and a walk around the facility. Subsequent recommendations provide practical assistance to enable a current service to measure its compliance or support facilities planning to establish chemotherapy services. The review is structured around the hierarchy of control measures from state and territory regulations: 1. Elimination 2. Substitution 3. Isolation 4. Engineering controls 5. Administrative Controls 6. Personal Protective Equipment Results:Recommendations become the responsibility of the facility's Workplace Health and Safety team. Completed reviews have highlighted ongoing work is necessary related to who requires training, training content and the most appropriate training delivery method. Conclusions:The review provides facilities the means to deliver a chemotherapy service that has optimal control measures. Regardless of location, size or level of complexity, meeting the education requirements is the greatest challenge. Central Integrated Regional Cancer Service is undertaking to formulate an education requirement hierarchy.

249 OUTREACH CARE IN A CHANGING HEALTH LANDSCAPE – MAKING THE LINK Maree Bransdon 1 , Leonnie Hurst 1 1. Queensland Health, Bowen Hills, QLD, Australia Background:Outreach services have been provided by a tertiary service over the past 20 years. These services have expanded in response to patient demand and changes to service delivery. Changes to the national funding model in conjunction with redesign of health services required a change in the way outreach services were administered. Aims:To establish governance frameworks to support the continued delivery of outreach clinical care and maintain inter-service relationships through improved transparency. The establishment of a service level agreement (SLA) guaranteed an agreed level of service while clarifying the financial and service expectations of both parties. Method:Central Integrated Regional Cancer Service (CIRCS) acted as an intermediary between parties as well as legal and funding bodies to ensure the delivery of a comprehensive SLA. A regional site visit between the business support providers was conducted to establish a mutually agreed baseline for activity and cost recovery (where possible). It was essential that the advice of health funding and allocations was incorporated into these decisions to ensure that any ABF and legal obligations were met. The SLA was structured in such a way that allowed for flexibility at a facility level using a series of schedules in addition to the standard “head agreement”. Results:The SLAs for four statutory bodies were first approved for the 2012–14 period with the intention of periodic iterations to address changes in both patient care and service models. Conclusion:The SLAs have transitioned from a care provision model to offering the additional benefit of supporting activities such as referral triage, participation in MDT meetings and collaborative professional development. The parties to the SLAs acknowledge that cancer services in QLD are undergoing a transition to greater self-sufficiency and local leadership and as such, SLAs must underpin the delivery of a wider range of specialist cancer services.

250 THE ‘SPECTER’ OF CANCER: SECONDARY TRAUMA FOR HEALTH PROFESSIONALS PROVIDING CANCER SUPPORT AND COUNSELING Lauren J Breen 1 , Moira O'Connor 1 , Lauren Y Hewitt 1 , Elizabeth A Lobb 2 1. Curtin University, Perth, WA, Australia 2. Calvary Health Care Sydney, Cunningham Centre for Palliative Care and University of Notre Dame Australia, Sydney, NSW, Australia Publish consent withheld

251 REDUCING HEALTH COSTS BY TREATING LOW-RISK NEUTROPENIC FEVER PATIENTS AT HOME Christine Brown 1,2 , Trish Joyce 1 , Karin Thursky 1 , Ben Teh 1 1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia 2. Western & Central Melbourne Integrated Cancer Service, Melbourne, Vic, Australia Introduction:Neutropenic fever (NF) is the most common complication of anticancer therapy that results in unplanned admission. The MASCC (Multinational Association for Supportive Care in Cancer) index is a validated tool to assess a patient's risk of developing complications associated with their NF presentation. Patients identified as low-risk using the MASCC tool have a <5% incidence of medical complications and can be safely treated with oral antibiotics and/or managed in an ambulatory setting 1 . Methods:A WCMICS project funded in 2013 has established an ambulatory program to manage low-risk NF patients at Peter MacCallum facilitated by a nurse coordinator. Low-risk NF patients are assessed for eligibility for oral antibiotics and suitability for the ambulatory program. Hospital discharge is aimed at 24–48 hours from admission with Hospitalin-the-Home daily visits until neutrophil count recovery (>1.0×10 9 cells/L) then nurse led clinic review. Results:Twelve patients have been enrolled into the Peter Mac program from February-July 2014; the median age is 57, with eight (67%) men and 10 (83%) solid tumors. Two (17%) patients required readmission for ongoing fevers. Median hospital length of stay is 1.3 days (0.2–2.9) versus to 3.6 days (1.1–11.0), and median duration of intravenous antibiotics is <1 day versus 3 days when compared with a historical cohort of low-risk NF patients. These reduced timeframes represent over $2000 per patient episode in health care cost savings 2 . Patients and clinicians have reported high levels of satisfaction with the program. Conclusion:The ambulatory program represents a change in culture in the routine management of NF and the uptake while initially slow has shown very promising results. Ambulatory models of care are expected to become increasingly utilised and are likely to lead to significant health care cost savings whilst allowing the patients to remain at home during their neutropenic period.

252 ACHIEVING CONSENSUS IN THE MANAGEMENT OF NEUTROPENIC FEVER AND SEPSIS IN CANCER Christine Brown 1,2 , Karin Thursky 1 , Ben Teh 1 , Neutropenic fever project steering committee 2 1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia 2. Western & Central Melbourne Integrated Cancer Service, Melbourne, Vic, Australia Introduction:Neutropenic fever (NF) is the most common complication of anticancer therapy and is a subset of patients with sepsis. While neutropenic fever guidelines require the presence of fever, up to 30% of patients with severe sepsis will be afebrile. With severe sepsis mortality rates of up to 25%, this may lead to the under recognition of neutropenic patients at risk 1 . WCMICS is undertaking a project to standardise the management of NF across their six hospitals. The goals of the project are to optimise patient health outcomes and their experiences of NF and to improve institutional efficiencies in the management of NF. Methods:A detailed gap analysis was performed across the hospitals with the aims of; identifying concordance with the national published consensus guidelines for the management of NF 2 ; to compare practices between sites; to establish whether sepsis management principles were included in the NF guidelines. Results:While there was good concordance with antibiotic management, there were differences in definitions of NF (temperature and/or neutropenia) and importantly while institutional guidelines made reference to the ‘unwell’ patient or the ‘clinically unstable’ patient, no guideline included evidence based recognition and management of patients meeting the criteria for sepsis. Conclusion:At the first project steering committee meeting consensus was readily achieved on definitions of fever and neutropenia, initial investigations and antimicrobial management. There was unanimous support for the inclusion of sepsis management guidelines based on the principles of the Sepsis Kills initiative from the Clinical Excellence Commission of NSW 3 . Each WCMICS hospital is now in the process of implementing a clinical pathway for the management of sepsis and/or neutropenic fever in cancer patients. In two WCMICS hospitals, senior nurse led model of care is being introduced for the management of low risk neutropenic fever.

253 INVOLVING FAMILY IN TREATMENT DECISION-MAKING: A NEW CONCEPTUAL FRAMEWORK AND CONSULTATION STRATEGIES Rebekah Laidsaar-Powell 1 , Phyllis Butow 1 , Stella Bu 1 , Cathy Charles 2 , Amiram Gafni 2 , Wendy Lam 3 , Kirsten McCaffery 4 , Jesse Jansen 4 , Heather Shepherd 5 , Martin Tattersall 5 , Ilona Juraskova 1 1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia 2. Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada 3. School of Public Health, The University of Hong Kong, Hong Kong 4. Screening and Diagnostic Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia 5. University of Sydney, Sydney, NSW, Australia Aims:Family members are often considered to be vital members of the multidisciplinary care team. However, their involvement may raise challenges such as role confusion or reduced patient privacy. In three studies we explored patient, family and physician views on family involvement, their actual behaviours, and reviewed the evidence on this topic. We have utilised this research to propose a new conceptual framework and practical consultation strategies. Methods:A systematic review identified 52 triadic consultation communication/decision-making papers. Interviews were conducted with 30 patients, 34 family members, 10 nurses and 11 oncologists examining attitudes and experiences. 20 audiotaped triadic oncology consultations were qualitatively analysed. On the basis of all of the above a new triadic interaction analysis (TRIO) coding system was developed and applied to 72 audiotaped cancer consultations. Results:The systematic review revealed 5 themes, interviews with health professionals resulted in 10 themes, and interviews with patients/family were arranged into 11 themes. Although health professionals held positive attitudes to family involvement, they also reported many challenges such as conflicting patient-family treatment wishes. Physicians also highlighted strategies to manage family involvement. However, consultation analyses using the TRIO coding system revealed that physicians rarely initiated interaction with family members (e.g. 10% invited family questions) and never clarified preferences for family members' role. In 56% of consultations physicians interrupted the family member, and analyses revealed more experienced physicians were more likely to interrupt (p<.001). The varying roles of family in decision-making inside and outside of consultations were highlighted in patient/family interviews, and the issue of balancing patient decision-making authority with the ethical rights of the family was discussed. Conclusion:Family can be helpful or challenging in cancer consultations. A triadic decision-making conceptual framework may help guide future research about ethical family involvement. Additionally, dissemination of practical strategies to improve consultation communication may be beneficial.

254 CANCER COUNCIL HELPLINE 13 11 20: WHO USES THIS INFORMATION AND SUPPORT SERVICE – AND WHY NOT? Monica Byrnes 1 , Sandy McKiernan 2 , Nicola Quin 3 , Kathy Chapman 4 , Paul Csoban 5 , Joan Bartlett 6 1. Cancer Council SA, Eastwood, SA, Australia 2. Cancer Council WA, West Perth, WA, Australia 3. Cancer Council VIC, Melbourne, Victoria, Australia 4. Cancer Council NSW, Woolloomooloo, New South Wales, Australia 5. Cancer Council QLD, Spring Hill, Queensland, Australia 6. Cancer Council ACT, Fairbairn, ACT, Australia Introduction:The 13 11 20 Helpline lies at the heart of Cancer Council information and support services and is a gateway to a myriad of programs providing informational, emotional and practical support in the community. A national dataset inclusive of demographics, cancer type and primary reason for contact has been collected for a number of years. Calls to 13 11 20 have been steadily declining from nearly 70,000 in 2010 to the current level of approx 55,000/annum despite increasing incidence and survival rates. Aim:Research was undertaken to understand the reasons for calling the Helpline, satisfaction with the service, and barriers to using the Helpline. Methodology:A market research company was commissioned to undertake a community attitudes survey of people touched by cancer (n=428) including patients (n=128) and carers (n=300) by phone (84% response rate of identified sample). Key questions included awareness of Helpline; who referred, awareness of assistance that could be provided by Helpline, and reasons for calling (or not) Helpline. Results:People affected by cancer reported seeking information mainly through internet (32% of respondents) and doctors (31%). Only 3% of respondents had contacted the Helpline and 11% had sought information on the Cancer Council website in the last 2 years. Most common reasons for not contacting the Helpline was not feeling the need to call, seeking information from doctor or other information sources usually online, and low awareness of the service. Conclusions:The perception of not wanting or needing help is a barrier preventing calls and there is a need to widen understanding of the information and support that can be provided by contacting Cancer Council 13 11 20. Knowing more about what is available would provide people greater clarity about why to call the service. Strategies that engage medical professionals to recommend people call is critical and should be an ongoing focus.

255 MALNUTRITION PREVALENCE IN AN OUTPATIENT CANCER CARE SETTING Sara Kuzma 1,2 , Eimear Mahon 1 , Jessica Ramage 1 , Belinda Camilleri 1 , Alwyn Todd 1,2 1. Mater Hospital and Health services, South Brisbane, QLD, Australia 2. Griffith Health Institute, Griffith University, Southport, Gold Coast, QLD, Australia Aims:Malnutrition is highly prevalent in inpatient cancer care settings and is associated with numerous detrimental effects for the patient, including reduced tolerance to anti-cancer treatment and poorer quality of life. Currently there is a paucity of research on the prevalence of malnutrition in outpatient cancer care settings. The aim of this research was to (1) determine the requirement for nutrition screening in an outpatient oncology setting; and (2) determine if the requirement for nutrition screening increases as cancer outpatients' progress through treatment. Methods:The Malnutrition Screening Tool (MST) was utilised to conduct nutrition screening amongst all patients, followed by the validated Patient Generated Subjective Global Assessment (PG-SGA) for subjects with MST score ≥2. Cross tabulation between nutritional status and variables were conducted to identify statistical associations. Results:A total of 76 subjects were included in the study with the most common tumour types observed across the patient sample; breast (n=27, 35.5%), gynaecological (n=21, 27.6%), lung (n=10, 13.2%) and gastrointestinal (n=8, 10.5%). An MST score of ‘0’ was most frequently recorded with 52.6% (n=40) of respondents falling into this category. The prevalence of malnutrition as indicated by PG-SGA (score B or C), was 3.9% (n=3 PG-SGA B; n=0 PG-SGA C). Conclusion:The results of this study suggest the prevalence of malnutrition may be low in outpatient cancer care centres which provide chemotherapy to subjects with cancers associated with low nutritional risk. Further investigation into the prevalence of malnutrition amongst subjects in outpatient cancer care settings, especially those treating patients with cancers associated with higher nutritional risk, is required.

256 THE EVALUATION OF CLINICAL PHARMACY SERVICES IN AN AMBULATORY CANCER DAY CARE UNIT Christine V Carrington 1 , Andy Lo 1 , Brittany Marler-Baxter 2 1. Princess Alexandra Hospital, Brisbane, Queensland, Australia 2. School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia Clinical pharmacy services to the ambulatory day care patient focus on improving the quality use of medicines for patients returning home after receiving chemotherapy. The pharmacist's role in day care includes medication history taking, patient education and discharge facilitation. The aim of this study was to quantify clinical pharmacy services in day care and to assess the patient-pharmacist relationship in the cancer day care unit in a tertiary metropolitan hospital. Method:A prospective study was conducted over 2 weeks as a ‘snap-shot’ of the pharmacist's activity and key tasks performed. An anonymous self-completion survey was used to assess patient satisfaction and perceived benefits of the interaction with the pharmacist. Results:Ninety-four patients were seen by the pharmacist in day care over the 2-week time period. Thirty-six patients were new to treatment and receiving their 1st cycle of chemotherapy while 58 patients were follow up patients receiving subsequent cycles of chemotherapy. The pharmacist performed 51 medication histories, documented 30 adverse drug events and provided verbal medication counselling to 68 patients. The pharmacist provided 107 Consumer Medicine Information leaflets and 44 medication diaries documenting medication instructions for the patient. Surveys were returned by 32 patients. Over 90% (n=29) of respondents believed they learnt something new by speaking with a pharmacist and were very satisfied with the pharmacist's ability to answer their questions. Eighty-four percent (n=26) strongly agreed that the pharmacist helped them correctly take their medications. All respondents believed it to be important for patients to see a pharmacist when starting cancer treatment. Conclusions:This evaluation quantifies the tasks that the clinical pharmacist performs in day care. These tasks are recognized as supporting the safe and effective use of medicines and achieving continuity in medication management for the patient when they leave day care (1) . The relationship between the pharmacist and the patient was identified as positive and the service well-accepted by patients indicating the value patients place on the service. 1. Australian Pharmaceutical Advisory Council; Guiding principles to achieve continuity in medication management 2005. Australian Government Department of Health & Ageing. Citied August 2014.

257 TIME FROM DIAGNOSIS OF RECTAL ADENOCARCINOMA TO COMMENCEMENT OF LONG COURSE CHEMORADIOTHERAPY (LCCRT) FOR METROPOLITAN VERSUS RURAL PATIENTS REFERRED TO A QUEENSLAND TERTIARY REFERRAL HOSPITAL Hayden Christie 1 , Matthew Burge 1 , Melissa Eastgate 1 , David Wyld 1 1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia Background:Evidence shows that cancer patients living in rural Australia suffer inferior outcomes. Putative reasons include delayed diagnosis, referral processes, and difficulty with access to treatment services. We wanted to compare access to care between patients living in rural and urban areas. We chose a cohort of rectal cancer patients treated with LCCRT at the Royal Brisbane and Women's Hospital as this cohort require multi-disciplinary team (MDT) discussion and multi-modality treatment. Methods:Eligible patients treated with concurrent 5-fluorouracil and radiation from January 2011 to December 2013 were identified using electronic chemotherapy prescribing software. Dates were retrospectively determined for diagnostic biopsy, commencement of CRT, MDT discussion. Metropolitan was defined as including Brisbane, Ipswich, Sunshine Coast and Gold Coast. All other areas were considered rural. Results:131 patients were identified. 62 (47%) were rural. The median time from diagnostic biopsy to commencement of treatment for the rural and the metropolitan populations were 65 (95% CI 56–74) and 58 (95% CI 50–65) days respectively (p=0.2). Median time from MDT discussion to treatment commencement was 33 days for both patient groups. Conclusion:We found no difference in time from diagnosis to treatment among rural versus metropolitan patients. However, our analysis does not exclude the possibility that a lower percentage of rural patients access a treatment centre or that these patients present later in the course of their disease. Access to diagnostic services such as colonoscopy has been postulated as a factor and is being looked into by others. Nevertheless, once diagnosed, our data suggests many rural patients do not wait longer than urban patients to commence therapy. Assessment of an earlier cohort would be useful to determine to what extent, if any, this has improved over time. Looking at long term outcomes for these patients will also be helpful to determine any differences.

258 A 15 YEAR LONGITUDINAL STUDY OF BREAST CANCER TREATMENT OUTCOMES IN A REGION Paul Craft 1 , Yvonne Epping 2 , Yanping Zhang 2 1. Medical Oncology, The Canberra Hospital and ANU Medical School, Woden, ACT, Australia 2. Breast Screen ACT, Canberra, ACT, Australia Objectives:To assess within a region, the management of operable breast cancer, treatment outcomes and agreement with published national treatment guidelines. Methods:A prospective longitudinal study of consecutive patients presenting with breast cancer to participating clinicians was conducted for the purpose of quality assurance and to facilitate uptake of treatment guidelines. Annual feedback of individual patterns of care was provided to contributing clinicians. Written consent was obtained from all participants. Results:Over 15 years, 5700 subjects were enrolled, representing an estimated 95% of incident breast cancers in the region. There were 3819 (81%) subjects with unilateral invasive disease, 481 (10.2%) with DCIS, 246 (5%) with bilateral invasive disease; 83 subjects had de novo metastatic disease. There were 28 male subjects. Of the female subjetcs with unilateral invasive disease 1885 (49.4%) had breast conserving surgery (BCS) and 1934 (50.6%) underwent mastectomy (Mx). Subjects living in rural areas were less likely to have post-BCS adjuvant radiotherapy. 1805 (95.7%) of subjects who underwent BCS were offered RT. Of the 472 female patients with positive axillary lymph nodes, aged under 50 years, 467 (98.9%) were offered adjuvant chemotherapy. There were clear changes in the pattern of practice over the course of the study. BCS increased over time. CMF was intially the most commonly used chemotherapy regimen, but was replaced by anthracycline-based regimens and subsequently taxane-based regimens. The number of subjects who received an aromatase inhibitor increased rapidly after 2002. With a median follow up of 8.5 years, of 3819 subjects with unilateral invasive disease, 310 were current status unknown, 605 patients had died with 349 breast cancer related deaths, there were 140 patients remain alive but with disease; 2764 (78.8%) remain alive and free from relapse. Conclusions:Long term follow-up of a breast cancer cohort is feasible. Overall, there was high concordance of treatment received with published guidelines with but some variation between rural and metropolitan residents.

259 RADIOTHERAPY FOR PEOPLE WITH CANCER: WHAT DO WRITTEN INFORMATION MATERIALS TELL THEM? Sian K Smith 1 , Ben Yan 2 , Chris Milross 2,3 , Haryana M Dhillon 2,4 1. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia 2. University of Sydney, Sydney, NSW, Australia 3. Chris O'Brien Lifehouse, Sydney, NSW, Australia 4. Centre for Medical Psychology & Evidence-based Decision-making, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background:People undergoing radiation therapy for cancer need information to participate in treatment decision-making, prepare for treatment and manage side effects and followup care. Few studies have assessed how comprehensive written radiotherapy information is, in addressing patients' information needs. Aim:To review the content of written information materials available to patients through Australian radiotherapy hospital departments and cancer control organisations. Method:A coding framework, informed by previous studies examining the information needs of patients undergoing radiotherapy, wasdeveloped and applied to the patient information materials. The final coding framework included a total of 71 categories, which fell into 11 broad themes: cancer diagnosis, preparing for treatment, treatment planning, daily treatment information, external radiotherapy, internal radiotherapy, impact on daily activities, post-treatment, prognosis, psychosocial health and well-being, and finally, ‘extra content,’ which includes sections such as glossaries and question prompt sheets. Our analysis compared and contrasted how different information sources, namely (i) hospital radiotherapy departments vs cancer control organisations and, (ii) generic vs tumour specific materials addressed patients' information needs. Results:A total of 54 information resources were included in the final analysis. Overall, general radiotherapy information available from cancer control organisations was more comprehensive than materials available at radiotherapy departments (p<0.001). Hospital department sources provided more information about the logistics of undergoing treatment compared to resources produced by cancer control organisations. Internal radiotherapy and long-term consequences of radiotherapy were poorly covered by most sources. Compared to general radiotherapy information resources, tumour-specific resources were found to be superior at providing information about cancer diagnosis, prognosis, daily treatment and side effects to general radiotherapy information resources. Conclusion:Radiotherapy information from sources provides different information to patients. It is important that together, they comprehensively address patient information needs. Future research is needed to determine whether radiotherapy information is suitable for lower literacy populations.

260 IMPLEMENTATION OF A COMPREHENSIVE GERIATRIC ASSESSMENT PROGRAM AT THE ROYAL PERTH HOSPITAL (RPH) FOR NEWLY DIAGNOSED OLDER CANCER PATIENTS Chandra Diwakarla 1 , Andrew Kiberu 1 , Muhammad A Khattak 1 , Lydia Warburton 1 1. Royal Perth Hospital, Perth, WA, Australia Background:The RPH Cancer Registry data shows a steady increase in the number of older patients diagnosed with cancer representing about 40% of new outpatients and 26% of inpatients. This patient group has complex medical and social needs and on average require longer in patient admissions when compared with their younger counterparts. This study aimed to evaluate the implementation of a comprehensive geriatric assessment program at the RPH utilising the existing allied health resources. Methods:Data was prospectively collected for patients seen in the Seniors Adult Oncology clinic between August 2013 – August 2014 through a screening questionnaire (Modified Adelaide Tool) posted out to the patient prior to their first consultation. Baseline demographics and clinical data were recorded from the case notes and electronic patient records. Results:Data was available for 56 patients. Their median age was 84 years. GI cancers (38%) and thoracic malignancies (18%) were the commonest tumour types with 54% of the patients having an advanced malignancy. Self-reported health status was good (40%), fair (35%) and poor (20%). 56% of patients had ≥4 co-morbidities. The number of patients on ≥5 medications was 62%. A limited proportion of patients had severe pain score or distress scores ≥7 (15% and 25% respectively). 42% of patients were living alone. Common interventions as a result of screening included dietetics and physiotherapist review, falls clinic referral, medication rationalisation and social worker review. The original management decision was reversed in three patients after review in the geriatric oncology clinic. Conclusion:Our preliminary data indicates the feasibility of initiating a geriatric oncology service utilising the existing allied health resources.

261 FAST TRACK COLONOSCOPY FOR POSITIVE FAECAL OCCULT BLOOD TESTING (+FOBT) IN A PUBLIC HOSPITAL SETTING Donna Gillies 1 , Jon Gani 1 , Rob Foster 1 , Peter Pockney 1 , Anne Duggan 1 1. Hunter New England Health, Newcastle, NSW, Australia Aim:To reduce the median / mean time from GP referral to colonoscopy for public patients referred to the Greater Newcastle Sector (GNS) following a+FOBT. Method:1. To review current processes across 3 hospitals (GNS) and 2 specialties and make changes accordingly to improve time from GP referral to colonoscopy for+FOBT referrals who meet the National Health and Medical Research Council (NHMRC) guidelines. 2. Change Process:Employ a colorectal coordinator / project officer. Develop:a process for fast track (FT) colonoscopy, a screening tool for assessing patients for direct access (DA) colonoscopy (no endoscopist consultation), a standard phone conversation when screening patients, a standard bowel preparation and instruction sheet, a process to fairly allocate patients to endoscopist and hospital. Create a database to record information. Results:Pre N=71 post N=111 patients, 75 progressed to DA colonoscopy, a further 4 were FT to colonoscopy. 26 patients were not suitable for DA: 11 (<50 or >75yrs), 4 recent colonoscopy (<18 months), 11 complex medical conditions. A further 6 had their colonoscopy in the private system. Median / mean days to colonoscopy pre: 82 (102), post change process: DA 42 (46), FT 27 (31). Pathology:12% had a carcinoma, 33% had tubular adenomas or high risk sessile adenomas. Conclusion:Multifaceted and systemised coordinated approach to processing+FOBT patients reduces the time to diagnosis and definitive treatment of colorectal cancer. The process changes introduced in our study would be adaptable to other institutions.

262 YOU CAN LEAD A HORSE TO WATER, BUT YOU CAN'T MAKE IT DRINK: DOES A NEEDS ASSESSMENT TOOL INCREASE DISCUSSION OF PSYCHOSOCIAL CONCERNS OF PEOPLE WITH ADVANCED CANCER? Tom Bellamy 1 , Sylvie Lambert 2,3 , Afaf Girgis 2 1. Lake Macquarie Mental Health Service, Charlestown, NSW, Australia 2. Psycho-oncology Research Group, Ingham Institute for Applied Medical Research, UNSW Medicine, Liverpool, NSW, Australia 3. Ingram School of Nursing, McGill University, Montreal, Quebec Aims:This study examined 1) approaches used by health professionals to administer an unmet needs assessment tool in the consultation setting, 2) potential of this tool to facilitate discussion of psychosocial issues, and 3) whether use of the tool by clinicians alters the length of consultations with patients with advanced cancer. Methods:Anaudiotaping sub-study was undertaken as part of an interrupted time series study of the impact of systematic utilisation of the Palliative Care Needs Assessment Tool (PCNAT) on the health outcomes and service utilisation of individuals with advanced cancer and their caregivers. The main trial included 219 outpatients across four hospitals in NSW who were diagnosed with advanced cancer and aged 18 years or older. Of 45 patients at one site who were asked for consent to audio-tape their consultations, 20 agreed (oncologist also agreed). Audio-recording were transcribed and thematic analysis was undertaken; and the mean length of consultations in minutes was determined. Results:Despite an academic detailing approach to introduce the PC-NAT to clinicians, it was not implemented as anticipated, with minimal integration of the tool into the consultation and little explanation of its function given by oncologists. The use of the tool did not increase discussion of psychosocial issues; the majority of consultation time pertained to medical issues. Coding of consultation content revealed comparable empathy levels across medical and psychosocial concerns. However, codes which reflected “dismissing” or “denying” the concern were more frequently recorded for psychosocial concerns compared to medical concerns. The PC-NAT did not significantly lengthen consultations in which it was used. Conclusions:People with advanced cancer report high unmet psychosocial needs. Staff training to enhance understanding and timely assessment and response to unmet needs as part of routine care is warranted to facilitate use of a needs assessment tool and discussion of psychosocial issues. Funding:Project – Australian Government Department of Health & Ageing; Professor Girgis – a Cancer Institute NSW grant.

263 DOCUMENTATION OF ANTIMICROBIAL THERAPY IN HAEMATOLOGY AND ONCOLOGY – A NURSING LED ANTIMICROBIAL STEWARDSHIP INTERVENTION PILOT PROJECT Christine Lo 1 , M. O'Reilly 1,2 , A. Wilke 1 , K Seletto 1 , Yvette Gomez 1 , E. Wong 1 , C. McGinness 3 1. Cabrini, Malvern, VIC, Australia 2. Nursing and Health Sciences, Monash University Medicine, Melbourne, VIC, Australia 3. Northern Health, Melbourne, VIC, Australia Background:Standard 3 of the National Safety and Quality Healthcare Service Standards recommends that the rationale and planned duration of antimicrobial therapy is documented in the patient's record. This facilitates team communication, supports antimicrobial stewardship and improves patient care. Current compliance is below target. Objective:This pilot is a novel strategy designed to engage the nursing team to lead antimicrobial stewardship by requesting medical staff to outline an antimicrobial plan when antimicrobial agents are initiated. This is a quality initiative aligned with the National Standards. Method:An audit (Phase 1) was conducted on the Haematology /Oncology Unit to establish baseline data. Following this, education was provided to the Unit nursing team by the Nursing Educator and antimicrobial stewardship pharmacist to support active nursing intervention for the medical team to document indication and planned duration at the time of initiation of antimicrobial agents. In Phase 2, when an antimicrobial was prescribed, nursing staff and the clinical ward pharmacist were asked to request that the doctor document both indication and planned duration in the patient's history. The Project team provided mentoring and support for the nursing team during this phase. Full support was received from the Unit, and nursing and medical executive prior to commencement. Results:Feedback for the nursing team and compliance with documentation were reviewed and analysed. These findings will inform the roll out of this initiative across the Health Service. Conclusion:Awareness of indication and planned duration of antimicrobial therapy is key in managing patients clinically and assists all team members in optimising care. Documentation as required by the National Standards, further facilitates communication between the health professionals who are caring for the patient. The nursing team are well placed to lead antimicrobial stewardship and it can be incorporated as part of standard patient care and advocacy.

264 LUNG CANCER MDT ACTIVITY IN QUEENSLAND: ARE WE MAKING ANY PROGRESS? Tracey Guan 1 , Shoni Colquist 1 , Michael Blake 1 1. Qld Cancer Control Analysis Team, Qld Health, Brisbane, Qld, Australia Background:There is a long standing tradition of multidisciplinary team (MDT) review being routinely offered to lung cancer patients in Queensland (Qld). The establishment of Qld Integrated Lung Cancer Outcomes Project (QILCOP) and expansion to Qld Oncology On-line (QOOL) has allowed for the electronic capture of MDT activity and clinical data across Qld. The clinician led Qld Cancer Control Safety and Quality Partnership (CCSQP) has contributed initiatives which have supported the establishment and continuation of MDT review across Qld. This paper describes the trend in MDT activity and influence of these initiatives on MDT activity. Methods:Data were extracted from Qld Oncology Repository (QOR), a comprehensive repository which contains diagnosis, admission data, QILCOP and QOOL data on Qld lung cancer residents reviewed by MDT. Results:In the 14 years between 2000 and 2013 there have been over 12,000 cases presented at participating lung cancer MDTs in Qld. The review rate for primary lung cancer increased from 26% to 48% between 2000 and 2011. The introduction of Clinical Practice Improvement Payment (CPIP) project saw an increase in the capture of data, with an increase in stage rate from 77% to 88% during the project. Conclusion:With the support of the CCSQP, the provision of MDT coordinators to administer meetings, an online data capture tool more patients receive the benefit of MDT review and clinical data is able to be routinely captured by MDTs to be used to better understand clinical practice, patient outcomes and provide a valuable resource for research.

265 PARTNERING WITH PATIENTS: A SYMPTOM MANAGEMENT DIARY AND PASSPORT – CREATED BY OUR PATIENTS AND CLINICAL PARTNERS WITH CLEAR PURPOSE Bridget Gurry 1 , Briege O'Donnell 1 , Georgina Wiley 1 , Anne Johnson 1 , Candice Lo Ngok 1 , Jan Thyssen 1 , Amanda Proposch 1 , Mel Pritchard 1 1. Cabrini Hospital Malvern, Malvern, VIC, Australia Introduction:Results from an audit on chemotherapy induced nausea and vomiting indicated 41% of patients failed to inform their nurse of their symptoms but that they did record them in the diary provided. From these results it was determined that patients may benefit from a symptom management and care diary. Aims: 1. To develop a comprehensive Symptom Management and Care Diary in conjunction with patients to ensure their needs are being met. 2. To reduce post admission Hospital Emergency presentations in our oncology population Method:A literature review was undertaken. Medical, Nursing and Allied Health staff were engaged for their input. Patients were also surveyed and then an initial diary was drafted. The diary is currently being piloted by all Cycle 1 Day 1 patients. Result/Discussion:The results of this study will identify gaps in current service to assist with accurate and timely feedback of symptoms from patients to medical and nursing staff. Results from this work will hope to ensure patients have access to adequate and succinct information about appropriate management of their symptoms post treatment as well as helping to reduce emergency department admissions.

266 UNPLANNED ALLIED HEALTH ADMISSIONS TO HOSPITAL FOR PEOPLE NEWLY DIAGNOSED WITH CANCER Livia Haddow 1 , Angela Ives 1 , Ruth McConigley 2 , Violet Platt 3 1. The University of Western Australia, Nedlands, WA, Australia 2. School of Nursing and Midwifery, Curtin University, Perth, WA, Australia 3. WA Department of Health, Perth, WA, Australia Aims:This study aimed to identify what proportion of people diagnosed with cancer in Western Australia (WA) have an unplanned presentation to hospital, primarily for allied health care, in the first year after a cancer diagnosis and what care they required. Methods:All people in WA diagnosed with a primary invasive cancer in 2009 were identified from the WA Cancer Registry. People diagnosed with a non-malignant skin cancer were excluded. The WA Data Linkage Unit provided records on all eligible people from the Cancer Registry, Death Registry, Emergency Department Data Collection and Hospital Morbidity Data Collection. The data requested was for the period of the 1st January 2009 until the 31st December 2010 to identify episodes of care up to one year after cancer diagnosis. Data were analysed using descriptive and multinomial logistic regression methods. Results:10,858 Western Australians (58.1% male, median age 66 years) were diagnosed with a new primary cancer in 2009. There were 1,655 allied health unplanned admissions, which was 2.4% of all admissions and 15.7% of unplanned admissions. People requiring an admission for allied health services were older (t=−15.20, p>0.00) and less likely to have surgery or chemotherapy as part of their treatment in the first year post-cancer diagnosis. The most common allied health admissions were for physiotherapy (34.0%), occupational therapy (16.9%), social work (16.2%), dietetics (13.3%) and pharmacy (8.8%). Unplanned allied health admissions lasted for a mean of 7.7 days compared to unplanned non-allied health admissions of 6.9 days (t=−2.78, p<0.00). Conclusions:Almost 16% of unplanned admissions to hospital were primarily for allied health care. People admitted primarily for an allied health service were significantly different to other people who presented for unplanned permissions. This suggests that this group could be identified earlier in the course of the disease to ensure they receive the care they require and reduce the need for emergency interventions.

267 QUEENSLAND CANCER QUALITY INDEX: TRACKING QUEENSLAND'S PROGRESS IN IMPROVING CANCER CARE Hazel Harden 1 , Shoni Colquist 1 , Euan Walpole 2 , Michael Blake 1 1. Qld Cancer Control Analysis Team, Qld Health, Brisbane, Qld, Australia 2. Queensland Cancer Control Safety and Quality Partnership, Queensland Health, Brisbane, Qld, Australia Aims:To develop a Cancer Quality Index from routine data that tracks Queensland's progress in improving cancer care and shows where quality and performance improvements are needed. Methods:The Queensland Oncology Repository (QOR) compiles and collates administrative and clinical data including the Queensland Cancer Registry, hospital admissions, deaths, treatments, public and private pathology. QOR contains approximately 350,000 matched and linked records of cancer patients from 2000–2010. Using a clinical peer review process QOR data was used to develop a Queensland Cancer Quality Index (QCQI) for Cancer Surgery which reports on complex and high volume cancers. Results:The QCQI for Cancer Surgery reports on 12 process and outcome indicators across six quality dimensions: effective, efficient, accessible, safe, equitable and integrated for breast, colon, lung, oesophago-gastric, pancreatic and hepato-biliary and rectal cancers. Indicators are reported for two time periods (2001–2005, 2006–2010) and 2011 and public and private, indigenous and non-indigenous, rural, regional and metropolitan, >65 years and socially disadvantaged populations. Examples of indicators reported in the QCQI include: length of stay in public and private hospitals for major resections for colon cancer (11 days and 9 days); % rural, regional and metropolitan women that wait >30 days from diagnosis to first breast cancer surgery (32%, 31% and 21%); 30 day post-operative mortality for non-small cell lung cancer patients receiving lung resection in 2001–2005 and 2006–2010 and 2011 (2.5%, 1.2% and 1.1%). Conclusions:The QCQI is a tool, developed from routine data, for tracking the quality of cancer care in Queensland. The QCQI is a public report which will be published annually and disseminated to Hospital and Health Services. The QCQI highlights areas for improvement and identifies the areas of cancer care performing well. The QCQI is currently being expanded to incorporate quality indicators for radiotherapy and systemic therapy.

268 RESULTS OF AN ELECTRONIC ONCOLOGY PHARMACY OBSERVATIONAL QUALITY ASSURANCE AUDIT TOOL Russell Hill 1 , Chris Giles 1 , Stacy La Hood 1 1. Pharmacy Practice Unit, APHS, Brisbane, Queensland, Australia Aim:An oncology pharmacy observational “app” electronic audit tool was developed with the aim to improve quality and reduce the variance in quality across a multi-site hospital pharmacy provider. Method:A literature review of Australian and international oncology pharmacy practice standards was undertaken. Four domains were created; personnel, occupational health and safety, oncology pharmacist responsibilities, and cytotoxic transport and storage. Each domain was numerated to enable a scoring system which supported both intra- and inter-site quantitative analysis. A total of 17 oncology pharmacy services were audited twice over a two year period. The audits were completed by five senior and experienced oncology pharmacy staff who received training in application of the audit tool. Auditors were not permitted to undertake audit of sites where they had responsibility. Results:The baseline audit resulted in an organizational-wide mean compliance result of 71% (=13.9%). Following the second year of the audit cycle, organizational-wide compliance increased to a mean of 80% (=8.3%). The improvements in compliance at the end of the second year were statistically significant [paired t(16)=−2.57, p=.02]. Statistically significant improvements were evident across the domains of oncology pharmacist responsibilities [paired t(16)=−3.04, p=0.004] and cytotoxic transport and drug storage [paired t(16)=−2.56, p=0.01]. Improvements were also noted across the personal and occupational health and safety domains, although these did reach significance. Conclusions:This electronic audit tool provides a method for systematically assessing compliance with oncology pharmacy quality standards. Use of the electronic “app” has demonstrated significant improvements in compliance with quality standards over a two year period. Implementation of the tool has also facilitated the identification of support materials required such as group wide policies and mandatory training plans which aim to create consistency and reduce variation in practice among oncology pharmacy sites.

269 SUCCESSFUL MANAGEMENT OF ETOPOSIDE HYPERSENSITIVITY IN PATIENTS WITH GYNAECOLOGICAL MALIGNANCIES Marene Ter 1 , Huda Ismail 1 1. The Royal Women's Hospital, Parkville, VIC, Australia Introduction:Hypersensitivity reactions to etoposide are rare but can be life-threatening, and can impede the completion of chemotherapy regimen essential to curable malignancies. This case series highlights the management and outcomes of etoposide hypersensitivity reactions in four patients with gynaecological malignancies. Case series:Four patients with gynaecological malignancies experienced hypersensitivity reactions to etoposide within the last six months. All patients with etoposide hypersensitivity developed symptoms such as flushing, chest tightness, lower back pain and/or dyspnoea in the first few minutes of the initial infusion. Outcomes:Three patients with etoposide hypersensitivity had emergency treatment by ceasing the infusion and administering supportive therapy with hydrocortisone and fluids. These three patients were subsequently treated with etoposide phosphate; two of these patients were given additional pre-medications including a corticosteroid, H2 antagonist, and/or antihistamines, and one patient was successfully treated without any additional pre-medications. One of the four patients was successfully rechallenged with etoposide after a brief pause, at a slower infusion rate without requiring any supportive therapy. All four patients completed their chemotherapy regimens with no further issues. Conclusion:Etoposide is one of the essential components of therapy for potentially curable malignancies, thus it is crucial that these reactions are optimally managed to ensure positive patient treatment outcomes. This case series demonstrates our experience in successfully managing etoposide hypersensitivity reactions in our patients, by either rechallenging with the original etoposide formulation, with additional pre-medications and/or slowing infusion rate, or by switching to etoposide phosphate formulations.

270 HOW MUCH DO CANCER CARE CLINICIANS KNOW ABOUT CANCER MALNUTRITION? Amber Kelaart 1 , Lauren Muir 1 , Nicole Kiss 1 , Kathryn Marshall 1 1. Nutrition Department, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia In the oncology population, malnutrition is common, with a reported overall prevalence of 31%. The consequences malnutrition can include reduced performance status, quality of life, and tolerance to treatment. The aims of this study were to identify and understand oncology clinician's knowledge, attitudes, practices and perceived learning needs related to cancer malnutrition. A survey was distributed by Survey Monkey to clinicians working in oncology via discipline specific interest groups, professional associations and the Integrated Cancer Services network. The targeted disciplines were doctors, nursing, allied health and radiotherapists in the acute setting; general practioners and practice nurses in the community setting. A total of 325 clinicians across all surveyed craft groups completed the survey with a balanced distribution across all disciplines. Approximately 60% had greater than 5 years' experience working in oncology and almost 80% of participants were from a metropolitan setting. The results indicated that participants had inconsistent knowledge about the prevalence of cancer malnutrition, the criteria for diagnosing malnutrition and the validated screening and assessment tools available for this patient group Almost 40% of clinicians self-rated their knowledge as lacking/very poor. The survey highlighted that whilst the majority of clinicians felt patients should be screened for malnutrition throughout their journey, there is variation as to who they believe is responsible for this. A number of clinicians take on this task of nutrition assessment and monitoring, but this is inconsistent and many utilised non-validated measures or tools, which may give rise to inappropriate patient referrals or management. There is inconsistent knowledge, practices and opinions related to cancer malnutrition screening, assessment and management among clinicians. As a consequence cancer patients may not be receiving optimal nutrition care, which could affect their health and treatment outcomes. Multidisciplinary cancer clinician education is required to ensure consistency of knowledge and clinical practice.

271 PATIENTS WITH LOWER HEALTH LITERACY IN RADIATION ONCOLOGY: A NURSING PERSPECTIVE Aaron Kok 1 , Sian K Smith 2 , Chris Milross 1,3 , Georgia Halkett 4 , Haryana M Dhillon 5 1. University of Sydney, Sydney, NSW, Australia 2. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia 3. Chris O'Brien Lifehouse, Sydney, NSW, Australia 4. School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, WA, Australia 5. Centre for Medical Psychology & Evidence-based Decision-making, Sydney Medical School, University of Sydney Background:Health literacy is a crucial skill for people affected by cancer and is required to navigate complex health care systems. Aim:To (1) explore radiation oncology nurses' understanding and awareness of health literacy in radiotherapy patients; (2) examine strategies used to communicate with and support lower health literacy patients. Method:Semi-structured interviews were conducted with 19 radiation oncology nurses from radiation oncology departments in Sydney, Australia. Framework analysis was used to develop a coding schema of themes identified from interviews. This was used to code, chart and analyse data and compare and contrast how nurse perceptions of health literacy differ. Results:Five key themes were identified: (1) perceived role of radiation oncology nurses; (2) identifying lower health literacy in patients; (3) consequences of lower health literacy for patients; (4) strategies to improve patient understanding of health information; and (5) suggestions to improve health communication. Nurses made informal judgements about patient's health literacy skills, relying on intuition and experience. They used verbal and non-verbal cues, and objective outcome measures such as socio-demographic indicators to identify patients with health literacy challenges. Nurses perceived patients with lower health literacy to have difficulty integrating information; increased side-effects potentially alleviated with better self-management, and worse health outcomes including increased hospitalisations and late detection of recurrence resulting from low adherence with follow-up. Strategies used to improve communication among lower health literacy patients included using plain language to deliver information, reiterating and repeating information over the course of treatment, encouraging question asking, and open-ended questions to confirm understanding. Conclusion:Radiation oncology nurses had low awareness of health literacy, but responded to the needs of low health literacy patients intuitively and appropriately. A more structured approach including plain language prompt sheets to improve delivery and comprehension of information may enhance self-efficacy and result in better health outcomes.

272 EXAMINING DETERMINANTS OF “ACCESS” TO RADIOTHERAPY – DOES THE INTRODUCTION OF A LOCAL PUBLICLY FUNDED RADIOTHERAPY SERVICE TO REGIONAL NSW IMPACT ON THE UPTAKE OF BREAST CONSERVING TREATMENT FOR EARLY BREAST CANCER HERE? Johnson Lam 1 , Stephanie Foster 1 , Theresa Cook 1 , Puma Sundaresan 2,1 1. Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia 2. The University of Sydney, Sydney, NSW, Australia Background and Aims:The uptake of radiotherapy (RT) or combined approaches that include RT may be affected by multiple factors including availability of local RT services. Adjuvant RT is integral to breast conserving treatment (BCT) for early breast cancer. BCT offers equivalent disease outcomes as mastectomy. We aimed to compare uptake of BCT in the Central Coast Local Health district (CCLHD), NSW over 3 sequential 1 year time periods when patients and referrers had variable access to RT services: Period 1=Access to local private RT facility (at cost) or daily commute / relocation to publicly funded RT outside CCLHD (cost+inconvenience); Period 2=Free transport to publicly funded RT outside CCLHD available (Cost minimised but inconvenience remained); Period 3=local publicly funded RT available (no cost and inconvenience minimised). Methods:Female patients with T1-2N0M0 invasive or in-situ (<5cm) breast cancer were retrospectively identified from multidisciplinary team records and databases maintained by clinical nurse consultants. Demographic data, tumour characteristics and treatment details were checked against hospital records and reports of imaging, pathology and operations. Results:BCT rates for early invasive and in-situ breast cancer in periods 1, 2 and 3 were 61.5% (n=120/195), 60.5% (n=106/175) and 69.1% (n=163/236) respectively. Mastectomy rates for early invasive and in-situ breast cancer in periods 1, 2 and 3 were 38.5% (n=75/195), 39.5% (n=69/175) and 30.9% (n=73/236) respectively. Conclusions:There was an increase in the use of BCT for early breast cancer with the introduction of local, publicly funded RT to a region already serviced by the private sector and non-local public RT services. Although local availability and cost have been recognised as important determinants of “access” to RT, our findings suggest that factors such as service convenience may also be important.

273 PATIENT-REPORTED EXPERIENCE OF CARE BY PROSTATE CANCER SPECIALIST NURSING SERVICE Wei-Hong Liu 1 , Danette Langbecker 1 , Lynda Carnew 1 , Julie Sykes 2 , Leanne Monterosso 3 , Sanchia Aranda 4 , Ian Roos 5 , Patsy Yates 1 1. Queensland University of Technology, Kelvin Grove, QLD, Australia 2. Prostate Cancer Foundation of Australia, Sydney 3. School of Nursing and Midwifery, The University of Notre Dame Australia, Perth, Western Australia 4. Cancer Institute New South Wales, Sydney 5. Cancer Voices Australia, Melbourne Aims:The Prostate Cancer Specialist Nursing Program (PCSNP), which was established by the Prostate Cancer Foundation of Australia in 2012, aimed to provide nationwide direct care to men with prostate cancer and subsequently improve their experience. This report describes men's experience of the PCSN service during the program implementation. Methods:567 men with prostate cancer who had at least one contact with a Prostate Cancer Specialist Nurse (PCSN) were recruited from 12 health centres across Australia during the implementation period. Participants completed a questionnaire assessing the extent of their satisfaction and experience of the PCSN service in relation to information , treatment and care , practical support , general care , and communication with the nurse . Results:More than 90% of the participants agreed/strongly agreed that the PCSNs provided information to them. Regarding general care , 90% agreed/strongly agreed that their cancer treatment went smoothly at each stage. In terms of communication with the nurse , more than 95% agreed/strongly agreed that they were given helpful answers to questions about their cancer and treatment, and they could contact the PCSN when necessary. For treatment and care, participants agreed/strongly agreed that they were provided information about health services or health professionals (91%), and their concerns were heard and acted upon (89%). One quarter or more participants did not agree that the PCSNs provided practical support , such as bill paying, arranging transport or accommodation for treatment. Overall, nearly all participants were satisfied (78% very satisfied, 7% moderately satisfied and 13% satisfied) with the level of support provided by the PCSN. Conclusions:These results show that men with prostate cancer had a positive experience of care in their interaction with the prostate cancer specialist nurses. This was most evident in services related to information, treatment and general care, and communication.

274 WHY ARE A LARGE PROPORTION OF PROSTATE CANCER CASES RECORDED AS HAVING “UNKNOWN” STAGE OF DISEASE IN AN AUSTRALIAN POPULATION-BASED REGISTRY? A STUDY OF POSSIBLE HEALTH SERVICE FACTORS Qingwei Luo 2,1 , Xue Qin Yu 2,1 , David P Smith 1,3 , David Goldsbury 1 , Dianne L O'Connell 2,4,5,1 1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia 2. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia 3. Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia 4. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia 5. School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia Aim:To identify possible explanations for why stage at diagnosis was recorded as “unknown” for prostate cancer cases in an Australian population-based cancer registry. Methods:Linked data for prostate cancer cases registered in the New South Wales (NSW) Central Cancer Registry (CCR) in 2001–2007 and the NSW Admitted Patient Data Collection for 2000–2008 were analysed. Stage at diagnosis was determined by the CCR, using information received up to 4 months after diagnosis. We compared the inpatient hospital services received for up to one year after diagnosis by cases with stage recorded and with “unknown” stage and used multivariable logistic regression to examine factors associated with “unknown” stage. Results:Of 35213 prostate cancer cases included in the analysis, 40.9% were recorded as having “unknown” stage. For cases without a hospital-reported prostate cancer diagnosis within 4 months after diagnosis, 76.5% had “unknown” stage. In those with a hospital-reported prostate cancer diagnosis in the 4 months after diagnosis, 6.8% of cases who had a radical prostatectomy and 33.3% of the remaining cases had “unknown” stage. For the latter group, factors related to having “unknown” stage were: having prostate-related procedures other than “imaging and transurethral resection of the prostate (TURP)” (e.g. biopsy or TURP only, adjusted odds ratio (OR) ranged from 1.37 to 1.86); attending a private hospital (adjusted OR ranged from 1.48 to 2.03); or having a day-only admission (adjusted OR=1.19, 95% CI: 1.05–1.35). Conclusions:Nearly 60% of cases with “unknown” stage could be explained by a lack of a prostate cancer diagnosis in hospital records or by a lack of notifiable episodes of care for prostate cancer occurring up to 4 months after diagnosis. However, the available data did not provide an explanation for 31.9% of cases recorded as having “unknown” stage.

276 MELANOMA IN A RURAL AUSTRALIA, A RETROSPECTIVE 10 YEAR AUDIT OF DIAGNOSIS AND MANAGEMENT IN THE WIMMERA James A McCracken 1 , Alex D Gin 1 , Ian Campbell 2 , Shiran Wijeratne 2 1. Medicine, Royal Melbourne Hospital, Parkville, Victoria 2. Surgery, Wimmera Base Hospital, Horsham, Victoria, Australia The incidence of melanoma in Australia is the highest in the world. Rural Australian regions have higher incidences of melanoma and patients present with later stage disease compared with metropolitan areas, thus resulting in poorer survival rates. The Wimmera/Grampians region has the lowest five-year survival rate from melanoma in the State of Victoria, Australia. A retrospective audit spanning ten years was performed to determine patterns of presentation and assess the management of melanoma presenting to a regional Victorian hospital, in comparison to state-wide experience. In total, 110 melanoma diagnoses were identified from 2001 to 2010 and 89 included in the audit. Melanomas with a median thickness of 1.09mm were observed (t is =32, t 1 =34, t 2 =13, t 3 =5, t 4 =4, unknown=4). A large proportion of lentigo maligna (37%) were observed, with prevalence comparable to that of the superficial spreading subtype (38%) (nodular 10%, desmoplastic 2%, spindle cell 1%, not specified 11%). Nine of 65 melanomas had ulceration, with 24 not reported. Thirtytwo lesions had margins >2mm, whilst 18 were <2mm, 14 had positive margins on biopsy, and data not available for 25. Of those with biopsy margins >2mm, 13 (41%) went on to have a Wide Local Excision (WLE), as did 18 (100%) patients with biopsy margins <2mm, and 12 (86%) with positive margins. Anatomically, the most common site for females was head and neck (30%) and lower limb (30%), and for males head and neck (57%). The poor prognosis of head and neck tumours in an older population presenting with more advanced disease may account for the increased mortality seen in this population previously.

277 CETUXIMAB USE IN METASTATIC COLORECTAL CANCER AT FIVE LARGE QUEENSLAND PUBLIC HOSPITALS: COMPARISON TO KEY CLINICAL TRIALS Suzannah Chapman 1 , Daniel McKavanagh 2 , Matthew Burge 3 , Paul Klages 3 , Jeremy Long 4 , Jasotha Sanmugarajah 5 , Ian McPherson 6 , Julia Hasker 4 , Anita Connor 5 , Guranjan Grewal 6 , Euan Walpole 2 , Samantha Hollingworth 1 1. School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia 2. Princess Alexandra Hospital, Woolloongabba, QLD, Australia 3. Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia 4. Nambour General Hospital, Nambour, QLD, Australia 5. Gold Coast University Hospital, Southport, QLD, Australia 6. Toowoomba Health Service, Toowoomba, QLD, Australia Aims:Cetuximab is a novel monoclonal antibody used in the treatment of metastatic colorectal cancer (mCRC). Randomised clinical trials (RCTs) demonstrate that, in KRAS wild type patients, cetuximab improves survival after failure of first-line mCRC chemotherapy 1–4 . In Australia, cetuximab cost was government reimbursed from 2011, but there is little evidence that these trial results translate into real world improvements in patient outcomes. This project aimed to summarise data from the electronic prescribing system (Charm ® ) on cetuximab use in mCRC patients at five large metropolitan and regional Queensland public hospitals and to compare this data to published RCT results. Methods:Data was extracted from the central Charm ® database for mCRC patients assigned to cetuximab therapy during the period 01/09/2009-31/08/2013. Descriptive statistical analyses including Kaplan-Meier curves were calculated. Results:There were 208 cetuximab-containing protocols for mCRC planned, 2199 cetuximab doses ordered, and 134 patients received at least one cetuximab dose. 95 patients were deceased at the time of data extraction. Median patient age was 64yrs, and 60% were male. Patients were distributed into seven cetuximab-containing protocol groups, with most (72%) prescribed weekly cetuximab with or without irinotecan based chemotherapy. Median cetuximab maintenance dose was 458mg (weekly) and 975mg (biweekly). Median time on treatment was 174 days for the whole cohort. Median overall survival was 9.1 months from first cetuximab dose. Conclusions:Cetuximab use in this cohort of mCRC patients was similar to trial results, based on patient and treatment characteristics. The median survival was similar to that published in larger RCTs (6.9 to 9.2 months) 1–4 , providing reassurance that the local outcomes for patients treated at the Queensland sites studied is similar to the evidence. 1. Cunningham D, Humblet Y, Siena S, etal. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. The New England Journal of Medicine. 2004;351(4):337–345. 2. Jonker DJ, O'Callaghan CJ, Karapetis CS, etal. Cetuximab for the treatment of colorectal cancer. The New England Journal of Medicine. 2007;357(20):2040–2048. 3. Karapetis CS, Khambata-Ford S, Jonker DJ, etal. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. The New England Journal of Medicine. 2008;359(17):1757–1765. 4. Wilke H, Glynne-Jones R, Thaler J, etal. Cetuximab PLUS Irinotecan in heavily pretreated metastatic colorectal cancer progressing on irinotecan: MABEL study. American Society of Clinical Oncology. 2008;26(33):5335–5343.

278 EXAMINING THE GENERAL PRACTITIONER PERSPECTIVE ON UTILISING FAMILY HISTORY TO SCREEN FOR COLORECTAL CANCER Sundresan Naicker 1 , Bettina Meiser 2 , Danielle Mazza 3 , John Emory 4 , Annabel Goodwin 5 , Timothy Dobbins, Judy Kirkwood 6 , Kristin Barlow-Stewart 6 , Lyndal Trevena 7 1. University of sydney, Sydney, NSW, Australia 2. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia 3. Department of General Practice, Monash University, Melbourne, Victoria, Australia 4. School of Primary, Aboriginal and Rural Health Care (SPARHC), University of Western Australia, Perth, Western Australia, Australia 5. Sydney South West Area Health Service, NSW Department of health, Sydney, NSW, Australia 6. Northern Clinical School, University of Sydney, Sydney, NSW, Australia 7. University of sydney, University of Sydney, NSW, Australia Background:To date, there is no Australian data directly examining general practitioner (GP) attitudes towards the NHMRC guidelines for Colorectal Cancer (CRC) screening. However, a recent UK survey showed that GP perceived efficacy of CRC screening tests are a significant determinant of the likelihood of referral by the GP in clinical practice. This has significant implications for risk appropriate CRC screening since research shows that GP's have a significant influence on both their patients' likelihood to screen for CRC, in addition to their long term screening compliance. Methods and results:GP's (n=163) were administered an attitude and behaviour survey examining their CRC screening preferences, triage process and compliance with NHMRC CRC screening guidelines. A hierarchal linear regression model will be used to examine both GP and practice specific factors as independent predictors of their NHMRC CRC screening compliance. GP specific factors that will be reported are: GP's reported attitude regarding the efficacy of family history as a screening tool, personal screening history and practice employment arrangement. Practice specific factors that will be reported are: practice size, socioeconomic area, billing arrangement, and presence of a practice manager and presence of a practice nurse. In addition descriptive data will be obtained on the frequency of FOBT, colonoscopy and sigmoidoscopy referral in a typical month. Discussion:62 Surveys have been completed and returned, and this study will completed in August of 2014. It is hypothesised that GP attitudes toward using family history to triage screening for CRC are independent and significant predictors of GP NHMRC CRC screening compliance. Given the paucity of information on how GP and practice specific demographic factors may influence referral to CRC screening, this data may present insights into the future development of a CRC screening program that may improve patient uptake and compliance.

279 MUSIC'S RELEVANCE FOR PEOPLE AFFECTED BY CANCER ACROSS THE SPAN: IMPLICATIONS FOR CANCER CARE Clare O'Callaghan 1,2,3,4 , Fiona McDermott 5 , Peter Hudson 6,7 , Natasha Michael 2 , John Zalcberg 8 1. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia 2. Palliative Care Service, Cabrini Health, Melbourne, Victoria, Australia 3. Department of Medicine, St Vincent's Hospital, Faculty of Medicine, Dentistry and Health Sciences, and The Conservatorium of Music, The University of Melbourne, Melbourne, Victoria, Australia 4. Caritas Christi Hospice, St Vincent's Hospital, Melbourne, Victoria, Australia 5. Departments of Social Work, Monash University and Monash Health, Melbourne, Victoria, Australia 6. Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia 7. Queen's University, Belfast, United Kingdom 8. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia Publish consent withheld 1. O'Callaghan, C., Baron. A., Barry, P., & Dun, B. (2011). Music's relevance for pediatric cancer patients: A constructivist and mosaic research approach. Support Care Cancer, 17, 779–788. 2. O'Callaghan, C., Barry, P., & Thompson, K. (2012). “One of my friends”: Music's relevance for adolescents and young adults with cancer. Support Care Cancer, 20, 687–697. 3. O'Callaghan, C., Hudson, P., McDermott, F., & Zalcberg, J. (2011). Music amongst family caregivers of people with life threatening cancer. Music and Medicine, 3(1), 47–55. 4. O'Callaghan, C., McDermott, F., Hudson, P., & Zalcberg, J. (2013). Sound continuing bonds with the deceased: The relevance of music, including preloss music therapy, for eight bereaved caregivers. Death Studies, 37, 101–125. 5. O'Callaghan, C., McDermott, F., Michael, N., Daveson, B., Hudson, P., & Zalcberg, J. (2014). “A quiet still voice that just touches”: Music's relevance for adults living with life threatening cancer diagnoses. Support Care Cancer, 22, 1037–1047.

280 ALLIED HEALTH INTEGRATED REGIONAL PATHWAY FOR HEAD AND NECK CANCER PATIENTS Juanine Passfield 1 1. Queensland Health, CIRCS, Bowen Hills, QLD, Australia Background:Consumers use the analogy of a “train trip across Australia” to describe their cancer experience, emphasising that patients were the only ones to complete the whole cancer journey 2 . Care of head and neck cancer patients requires a multidisciplinary team including allied health. Frequent dietitian contact has been shown to improve nutrition outcomes and quality of life 1 and speech pathology rehabilitation follow up is recommended for up to 2 years 3 . Other allied health involvement may include audiologists, physiotherapists, psychologists, occupational therapists and social workers. As the patient moves from acute cancer services and returns to local communities there is potential for ‘falling through the cracks’ of care. Early introduction into local allied health community services assists in smoothing the transition and reducing the feelings of abandonment when active care ceases 4 . Tele-health services can support local clinicians to provide specialist allied health services, but are inconsistently integrated. The development of regional pathways for allied health will support the delivery of care across boundaries, provide consistency in practice, and improve service continuity and collaboration, thereby ensuring the equitable, safe and effective care needs of patients are met. Aims:To develop an allied health regional pathway, for head and neck cancer patients and thereby facilitate safe, effective, efficient, equitable access to care, in public health services, in Queensland, incorporating the consumer perspective. Methods:A small working party involving a consumer representative, Queensland Health metropolitan, regional, rural and remote allied health staff involved in the care of head and neck patients was formed. The group mapped the current patient journey identifying issues, variations, service gaps, opportunities for improving services. Results:The use of change management principles was integral to the development of the regional pathway, including recommendations that have been developed for demonstration across the central region of Queensland. 1. South Australian Head and Neck Cancer Pathway, September 2013 2. Health Workforce Australia [2013]: National Cancer Workforce Strategic Framework. 3. South Australian Head and Neck Cancer Pathway, September 2013 4. Cancer Follow-up; Towards A Personalised Approach to Aftercare Services. Review Of Current Practice and Selected Initiatives; Macmillan Cancer Support Nov 2009; NHS UK

281 OPTIMAL CARE PATHWAYS: ACHIEVEMENTS AND FUTURE DIRECTIONS Alexandra Philpott 1 , Elise Davies 2 , Kathryn Whitfield 2 , Spiridoula Galetakis 2 , Robert Thomas 2 1. Cancer Council Victoria, Melbourne, VIC, Australia 2. Cancer Strategy and Development, Department of Health, Melbourne, VIC, Australia The Victorian Cancer Services Framework (2003) recommended establishing tumour streams to reduce variations in practice. In response, the Department of Health developed the Optimal Care Pathways (formerly known as Patient Management Frameworks) to guide optimal management of people with cancer across fifteen tumour types. The OCPs aim to improve cancer outcomes by providing a state-wide consistent approach to care that facilitates the auditing of pathways and service planning. In 2013 the Department of Health Victoria partnered with the Cancer Council Victoria to undertake a review of the existing Patient Management Frameworks and consider the development of new additional pathways. The objectives of this update of the OCPs was to: ensure they reflect best contemporary evidence and practice; ensure their scope incorporates emerging areas of practice (for example, optimal communication and supportive care); develop consumer versions to assist patient and carers navigate the care pathway; and develop quick reference guides designed for use by General Practitioners to inform referral practices. Recommendations for improving the pathways were identified via stakeholder consultation and a review of the literature. A generic template has been developed and populated for four tumour streams. Multidisciplinary expert working groups for each tumour stream have met to review and agree the content for each framework. This was followed by waves of public consultation, key stakeholder review and consultation with relevant Colleges and peak organisations, before final publication. The tumour streams which have been updated to date are: colorectal cancer, lung cancer and prostate cancer. A new OCP has been developed for liver cancer. Work is commencing on updating OCPs for melanoma, lymphoma, paediatric cancer and pancreatic cancer. Work on patient navigation aids is also progressing. An implementation plan to guide their dissemination and use of OCP is being developed along with an evaluation strategy.

282 RESEARCH GOVERNANCE FOR REGIONAL CLINICAL TRIALS Sandra Robinson 1 , Theresa M Hayes 1 , Marcelle Hennig 1 , Anne Woollett 2 , Ian M Collins 1 1. South West Oncology, Warrnambool, VIC, Australia 2. Clinical Trials, Barwon Health, Geelong, VIC, Australia One Key Performance Indicator of The Victorian Government cancer action plan 2008–2011 was to increase regional patient participation in cancer clinical trials from 6% to 15% by 2020 [1]. Warrnambool Oncology Clinical trials unit was established in 2009 to service healthcare needs of the projected population of 115,000 individuals located within the Greater Green Triangle by 2026[2]. We aimed to identify barriers to clinical trial participation, as a unit and identified local governance as a major barrier. This issue is not limited to our site. A standardised national ethics process (SERP) was implemented throughout the Eastern Seaboard in 2011 in an attempt to meet the target of a 60 day ethics review, however ethics approval remains widely variable[3]. Governance and indemnity remain as barriers to activation of new studies. While trials of parenteral medication are often carried out in public hospitals, with an existing indemnity and oversight process, patients enrolled on a study involving an oral therapy do not require admission to a healthcare organization but may be reviewed by the investigator in a private setting, and thus fall in to a “grey area” of research Governance. Indemnity becomes the responsibility of the individual investigator, but the lack of local governance oversight then creates a barrier to centralized ethical approval. While a proposed national insurance scheme to mitigate risks and costs for private institutions would aid this, these national standards and processes are yet to be established. A recent Department of Health manual provides a detailed guide to governance and SERP but fails to identify a party for overseeing outpatient trial conduct in accordance with Good Clinical Practice (GCP)[4]. We feel funding and a streamlined approach to research governance at a National level, as for ethics approval, may assist many oncology centres to offer more clinical trials to their patients. 1. Department of Human Services. 2008, “Victoria's Cancer Action Plan 2008–2011”. 2. Ben Bowring. “A Clear Way Forward A Proposal for Radiotherapy Services on Victoria's Great South Coast”. University of Melbourne June 2009 3. Department of Health, Victoria. 2014. www.mckeonreview.org.au Accessed August 2014 4. Department of Health, Victoria. 2014. www.health.vic.gov.au/clinicaltrials/publications.htm Accessed August 2014.

283 THE ESTABLISHMENT OF CHEMO@HOME: AN INTEGRATED MODEL OF PATIENTCENTRED SERVICE DELIVERY FOR CHEMOTHERAPY PATIENTS Julie Wilkes 1 , Zelda Haskins 1 , Lorna Rogers 1 , S. McGreal 1 1. chemo@home, West Perth, WA, Australia A staggering one in two people will experience cancer by the time they reach 85 years of age. The impact on patients and the health system demands new service delivery models. Home based chemotherapy addresses not only hospital capacity issues, but also assists patients and their families, especially those at risk of sub optimal outcomes due to gaps in the current service delivery systems. In WA, a new model of care for home chemotherapy treatment has been established and evaluated. The aim of this project was to establish a safe, easily accessible, integrated and financially viable private home chemotherapy service in WA and to ensure the service met organisational expectations. The available evidence supporting the development of home-based chemotherapy was reviewed. In addition, key recommendations from WA Health's Cancer Services Plan 2012–2017 and other pivotal information related to consumer expectations, gaps in service delivery and the strategic direction of cancer services were identified. The service was established, accredited and evaluated against core values. Evaluation of the first 12 months of achievements against core values showed evidence of: Improved patient experience as 100% of patients found the experience of having their treatment at home excellent; Professionalism through ACHS accreditation; Empathy through patient comments; Partnerships with universities, health funds and many others; Innovation through being the first private chemotherapy and monoclonal antibody service in WA; Flexibility in expanding therapeutic areas; Research through initiating three projects. In conclusion, chemo@home has successfully established a safe, easily accessible, integrated and financially viable private home chemotherapy service in WA. The core values established prior to commencement of the service are currently being met.

284 EVALUATING AN EVIDENCE-BASED CARE PATHWAY FOR THE MANAGEMENT OF ANXIETY AND DEPRESSION IN CANCER CARE: A DELPHI CONSENSUS STUDY Joanne Shaw 1 , Melanie Price 2,1 , Phyllis Butow 2,1 , Josephine Clayton 2,3,4 , Peter Grimison 5,6 , Tim Shaw 7 , Nicole Rankin 8 1. Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia 2. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, Sydney, NSW, Australia 3. University of Sydney, The University Of Sydney, NSW, Australia 4. HammondCare, ImPaCCT (Improving Palliative Care through Clinical Trials), Sydney, nSW, australia 5. Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia 6. Chris O'Brien Lifehouse, Sydney, NSW, Australia 7. Workforce Education & Development Group (WEDG), Sydney Medical School, The University of Sydney, Sydney, NSW, Australia 8. Sydney Catalyst, NHMRC CTC,, The University of Sydney, Sydney, NSW, Australia Background:There is strong evidence that psychological interventions are effective in treatment of anxiety and depression experienced by cancer patients. Currently screening for distress in Australia occurs inconsistently and there is also a gap in care once screening identifies distress. To address the inherent variability of patterns of referral, treatment, and follow-up post-screening, the Psycho-oncology Cooperative Research Group (PoCoG) has developed an evidence-based clinical pathway. Through a consensus methodology, the aim of this study was to identify key referral and management recommendations necessary to improve patient outcomes. Method:A two round Delphi study was conducted to gain consensus among Australia oncology and psycho-oncology clinicians about the validity of 39 items related to screening, assessment, referral and management, including role definitions, timing and care coordination, within a stepped care model. The expert panel comprised 87 multidisciplinary clinician members of PoCoG. Respondents were asked to rate their level of agreement with each statement on a 5-point likert scale (from strongly disagree to strongly agree). Consensus was defined as >80% of respondents scoring within 2 points on the likert scale. Results:Consensus was reached for 21 of 39 items after 2 Delphi rounds. Formal screening for anxiety/depression was strongly endorsed and there was consensus that once identified, further assessment of the nature and severity of anxiety/ depression was required. Participants endorsed the proposed stepped care model of management incorporating recommendations for length of treatment and time to review. Consensus was not reached on items related to roles and responsibilities. Conclusions:This study identified a core set of evidence-based principles considered essential to the identification, referral and management of anxiety and depression in adult cancer patients. The clinical pathway outlines formalized screening and assessment to identify anxiety/depression and proposes a stepped care model for their management, based on the nature and severity of symptoms.

285 DEFINING AND PRIORITISING SUCCESS FACTORS FOR COORDINATED CANCER CARE Tim Shaw, Sarah York 2,1 , Kahren White 3 , Deborah McGregor 2,1 , Nicole Rankin 2 , Shelley Rushton 3 , Sanchia Aranda 3 1. Workforce Education and Development Group, The University of Sydney, Sydney 2. Sydney Catalyst Translational Cancer Research Centre, Sydney, NSW, Australia 3. Cancer Institute NSW, Sydney Aim:How to best coordinate cancer care remains a key challenge. The Cancer Institute NSW (CINSW) has moved its funding for coordinated care from a model that funds positions to one that focuses on improving performance in key areas across. CINSW commissioned the University of Sydney to identify and prioritise a set of key ‘success factors’ in the coordination of care that could be used to guide the development of Key Performance Indicators. Method:A systematic process was used to define a set of success factors. This included: a scoping review of the literature; and a broad invitation to stakeholders to submit their own success factors. Three cycles of review were then conducted on initial success factors to reduce duplication and exclude factors not related to the coordination of care. A final set of factors was then subjected to a prioritisation process previously developed by Sydney Catalyst. This consisted of a day-long priority setting workshop attended by a purposive selection of stakeholders. Factors were prioritised against significance and ease of measurement. Results:45 success factors were identified through the review of literature and stakeholder input. This was refined to a final set of 20 factors. 5 success factors were identified through the consensus priority setting process. Conclusion:This project was successful in obtaining consensus across a broad range of stakeholders in terms of the identification of success factors that are both significant and measurable. Further validation will be under taken with consumers and practitioners. This work lays strong foundations for the development of key performance indicators that can be used in funding reform being undertaken by CINSW. This is the first time such a piece of work has been performed and represents an important step in improving the coordination of cancer care and patient outcomes.

286 BARRIERS TO RADIOTHERAPY UTILIZATION: CONSUMER PERCEPTIONS OF ISSUES THAT MAY INFLUENCE RADIOTHERAPY RELATED DECISIONS Puma Sundaresan 1,3,2 , Madeleine King 1 , Martin Stockler 1,2 , Daniel Costa 1 , Christopher Milross 1,2 1. The University of Sydney, Sydney, NSW, Australia 2. Chris O'Brien Life House, Sydney, NSW, Australia 3. Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia Background and Aim:Consumers' (patients and carers) perceptions of radiotherapy (RT) and issues around its access may influence their decisions regarding RT and thus act as barriers to RT uptake. The current study aimed to examine consumers' perceptions of various factors that may influence decisions regarding RT. Methods:Current or past cancer patients (and carers) were invited to complete a custom survey which was administered in electronic (Survey Monkey) and hard copy formats. The electronic survey link was disseminated through multiple patient support and advocacy groups throughout NSW: Cancer Council and other support groups; Prostate Cancer Foundation Australia; Breast Cancer Network Australia; Kylie Johnson Lung Cancer Foundation; and Cancer Voices. Hard copy surveys were mailed to those who responded to study invitations placed in local newspapers across NSW. Results:1283 respondents participated via electronic (n=1245) and hard copy (n=38) surveys. 84% were female, 81% were current or past patients, and the majority (82%) had a breast cancer diagnosis. Overall 78% had been offered RT and had accepted it. 14 (1%) had declined RT due to practical difficulties or “inconvenience” and 87 (7%) had declined for other reasons. The issues perceived to be moderate to strong influencers of RT decisions were concern about acute and long term side effects of RT, management of side effects and fear and anxiety regarding RT. 20–25% of respondents rated lack of the following to be moderate to strong influencers of RT decisions: local RO services, local awareness of RT; transport and accommodation supports; information resources pertaining to RT. Conclusions:Fear and anxiety regarding RT and perceived side effects appear to feature prominently during RT decisions. There is perceived lack of awareness regarding RT, RT related information resources and supports services. Further understanding of these issues can inform appropriate interventions to improve RT utilization.

287 HEALTH PROFESSIONALS PERCEPTIONS OF THE IMPACT OF ACCESS AND TREATMENT RELATED PRACTICALITIES ON REFERRALS FOR RADIOTHERAPY AND ITS UPTAKE BY CONSUMERS Puma Sundaresan 1,2,3 , Madeleine King 1 , Martin Stockler 1,2 , Daniel Costa 1 , Christopher Milross 1,2 1. The University of Sydney, Sydney, NSW, Australia 2. Chris O'Brien Life House, Sydney, NSW, Australia 3. Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia Aims:Utilisation of radiotherapy (RT) in Australia is below recommended evidence based benchmarks. Barriers to the referral of patients for RT and the uptake of RT by patients may be affecting RT utilisation. The current study aimed to examine health professionals' (HPs) perceptions of potential barriers to RT referral and uptake. Methods:A custom survey was developed to assess perceptions regarding the degree to which a range of issues affect decisions regarding RT. Hard copy surveys were disseminated to HPs involved in the care of cancer patients across New South Wales (NSW): medical, radiation and surgical oncologists, palliative care clinicians and other physicians (including general practitioners) with an interest in oncology. Electronic versions of the survey were disseminated via oncology multidisciplinary teams and professional networks at participating hospitals. Results:254 HPs participated via hard copy (n=213) or electronic (n=31) surveys. Two thirds of HPs perceived acute side effects of RT, their management and impact on daily commitments, as well as fear and anxiety about RT, to exert moderate to significant influence on RT decisions. Treatment related travel, need for accommodation and relocation were also perceived by 64% of HPs to do the same. Over half of HPs rated concern regarding late effects of RT, disruption to family and work life, and the ability to organise family and work commitments around RT, as moderate to significant influences on RT uptake. Discussion:Perceptions of HPs in NSW reveal potential important influencers of RT decisions by patients and clinicians. Whilst some issues such as travel and relocation pertain to the availability of local RT services, issues unrelated to RT infrastructure, may also influence RT decisions. An understanding these additional issues and their actual impact on RT related decisions will inform future interventions aimed at improving RT utilization.

288 HEALTH SERVICE ACCESS FOR ABORIGINAL PEOPLE ASSOCIATED WITH LEVEL OF ABORIGINAL COMMUNITY ENGAGEMENT Patrick Rawstorne 1 , Rajah Supramaniam 2 , Anthony Dillon 3 , Dianne O'Connell 2,4,1,5 1. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia 2. Cancer Council NSW, Woolloomooloo, NSW, Australia 3. Institute of Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia 4. School of Public Health, University of Sydney, Sydney, NSW, Australia 5. School of Public Health and Community Medicine, Univeristy of NSW, Sydney, NSW, Australia Aim:We investigated whether a new three-item Aboriginal community engagement scale (ACES) and sociodemographic factors were associated with Aboriginal people's awareness of cancer symptoms as well as pre-diagnosis access to health services. Methods:We recruited 102 Aboriginal cancer survivors, diagnosed December 2010 to July 2013, from New South Wales hospitals and clinical cancer registries. Participants completed a telephone-administered questionnaire with trained Aboriginal interviewers. Internal consistency of ACES was assessed using Cronbach's Alpha. Higher ACES scores indicated greater Aboriginal community engagement. Associations between ACES, sociodemographic factors and awareness of cancer symptoms and pre-diagnosis access to health services were examined using Chi-squared tests and t-tests. Results:ACES was internally consistent (Cronbach's alpha=0.83). Sex, age, place of residence, employment status, relationship status and education level were not consistently associated with either a person's awareness of symptoms before a cancer diagnosis or with their access to health services. Higher ACES scores were positively associated (p=0.031) with an Aboriginal person being less aware of symptoms before their cancer diagnosis. People with higher ACES were also more likely to visit an Aboriginal Community Controlled Health Services (ACCHS) (p<0.001) and less likely to see a non-ACCHS GP (p=0.043) before their cancer diagnosis. ACES was not associated with accessing cancer screening or a hospital before a cancer diagnosis. People with lower ACES were more likely to be employed fulltime before diagnosis (p=0.025) but ACES did not vary with age, sex, place of residence, education level or relationship status. Conclusions:ACES was associated with types of health services accessed and with awareness of cancer symptoms before diagnosis. ACES showed good predictive validity and is distinctly different to most of the usual sociodemographic factors. More work is needed to investigate whether using the ACES can help health services tailor their information and services to improve cancer outcomes for Aboriginal people.

289 ONCOLOGY PATIENTS OVERWHELMINGLY SUPPORT TISSUE BANKING Jamie Bryant 1 , Rob Sanson-Fisher 1 , Liz Fradgley 1 , Tim Regan 1 , Bree Hobden 1 , Stephen Ackland 1,2,3 , Heidi Turon 4 1. University of Newcastle, Callaghan, NSW, Australia 2. Hunter Medical Research Institute, Newcastle, NSW, Australia 3. Hunter Cancer Biobank, Hunter Cancer Research Alliance, Newcastle, NSW, Australia 4. The University of Newcastle, Waratah, NSW, Australia Background:Translational biomedical research relies on the availability of human tissue to explore of disease aetiology and prognostic factors, with the objective of developing better targeted treatments. The establishment of biobanks pose ongoing ethical considerations in relation to donors. This is a quantitative study exploring medical oncology patients' preferences for contributing to tissue biobanks. Objective:To explore oncology patients' preferences about tissue banking, including: 1) willingness to donate; 2) factors influencing donation decisions; 3) preferences about the use of donated tissue including permission systems, data linkage, and communication about research findings to donors. Methods:A cross-sectional survey was conducted in two tertiary oncology outpatient clinics. Eligible patients were approached by volunteers to complete a touchscreen survey in waiting rooms or while receiving intravenous therapy. Consenting participants completed demographic questions and received up to 12 previously validated items exploring preferences for donating tissue. Results:224 oncology outpatients participated over a ten month period (69.1% consent rate; 64.4% completion rate). Most participants were female (54%), aged 62 years, and diagnosed with breast (26%) and bowel (20%) cancer. Most participants indicated willingness to donate tissue (84%) and for their sample to be stored for future use (96%). Participants preferred a blanket consent approach (71%), samples to be linked to medical records (62%) and for general results of the research (79%) to be provided to them. Factors influencing willingness to donate tissue included personal (85%) or familial health benefits (88%) and a sense of duty to future patients (82%). Conclusions:The overwhelming majority of oncology patients are willing to participate in a tissue bank, providing some support to explore ‘opt-out’ models of consent. To enhance patient acceptability, tissue banking programs should: (i) allow provision of blanket informed consent; (ii) develop protocols allowing feedback of information about samples in line with patient preferences; (iii) provide clear information to potential donors about the benefits to personal health, familial health, and future patients directly resulting from donation.

290 HOW GOOD IS THE QUALITY OF EVIDENCE FOR GRIEF COUNSELLING? A SYSTEMATIC REVIEW Heidi Turon 1 , Amy Waller 1 , Elise Mansfield 1 , Rob Sanson-Fisher 1 1. University of Newcastle, Callaghan, NSW, Australia Aims:Grief or bereavement counselling is a feature of many cancer services, both in Australia and internationally. Despite guidelines endorsing its provision to bereaved families and friends, this form of counselling has been the subject of much debate in the literature, with some arguing a lack of efficacy and even suggesting it could be harmful. The aim of this study was to examine the literature to determine a) the relative proportion of descriptive, measurement and intervention research in the field of grief counselling and b) the quality of intervention studies in this field. Methods:A systematic review of studies published between 2000 and 2013 in the area of grief counselling was conducted. Titles were screened for eligibility for inclusion in the review. Eligible papers were categorised into descriptive, measurement, review, commentaries and intervention studies. Intervention studies were assessed against the EPOC methodological criteria, and papers meeting EPOC design criteria were assessed for quality. Results:After removal of duplicates, 1092 papers were screened for eligibility, with 160 papers deemed eligible for inclusion in the review. Of these, 47 presented the results of descriptive studies, 3 reported measurement research, and 76 papers reported grief counselling interventions. However only 59% (n=45) of the intervention studies met the EPOC design criteria. These papers included 19 papers reporting the primary results of an intervention, and the remainder reported secondary analyses of the primary studies. Overall, study quality was poor, with the majority of interventions showing a risk of bias in several key areas. Evidence for the effectiveness of grief counselling on grief symptoms was mixed. Conclusions:There is a lack of well-designed, methodologically rigorous intervention studies in the area of grief counselling. While there is limited evidence that counselling can be effective, especially for those with complicated grief, further work is necessary to ensure practice is based on good quality evidence.

291 EMPOWERING YOUTH ENGAGEMENT THROUGH THE VICTORIAN AND TASMANIAN YOUTH CANCER ADVISORY BOARD (YCAB) Samantha A Van Staalduinen 1 , Ediz Babacan 2 , Kate Thompson 1 , Lisa Orme 1 1. ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, East Melbourne, VIC, Australia 2. Victorian & Tasmanian Youth Cancer Advisory Board, Melbourne, VIC, Australia Background:Recognition is growing that adolescents and young adults (AYA) have specific and unique needs related to a diagnosis of cancer. They face worse medical outcomes and often experience enduring physical and psychosocial impacts. ONTrac at Peter Mac supports young people with cancer and their families through direct clinical care, education/training, secondary consultation and research. The Victorian and Tasmanian Youth Cancer Advisory Board (YCAB) was established in 2010 with support from the Victorian Department of Health as a mechanism for ensuring meaningful youth consumer engagement in the development of AYA cancer services and initiatives. Aim:YCAB operates with the vision of improving the lives of young people affected by cancer and their families. Method:The establishment and operation of YCAB is evidence and experience based. Membership comprises a demographically, diagnostically and experientially diverse group of 10–12 young people who have experienced cancer during the AYA years as patients, partners or siblings. Evaluation of each term of the Board is completed annually. Outcomes:To date YCAB have achieved systemic national and jurisdictional change in a range of areas, including AYA service models of care; youth friendly hospital infrastructure; health professional education and training; resources for young people and AYA research. In recognition of their work, the Board received the 2011 Victorian Public Healthcare award for responsive governance, and in 2013 were awarded independent funding from the Victorian Department of Health in relation to several key priority areas. Discussion:This poster will discuss the importance of AYA consumer engagement, the rationale behind Board development, process of establishment and outcomes to date. It will reflect on international models of youth inclusion and the reasons for success in this venture.

292 A PROCESS-BASED IT SYSTEM TO MANAGE MULTIDISCIPLINARY MEETINGS IN A MORE FLEXIBLE WAY Casper Stoel 1 , Stephen Vaughan 1 1. Pallas Athena, Newtown, VIC, Australia Multidisciplinary meetings have been become a key part of the management of complex diseases like cancer. As well as recording relevant input from medical and other healthcare professionals into decision making about individual cases they provide a significant opportunity for enhanced care coordination. They often have to function outside or across traditional organisational boundaries involving different hospitals, primary, secondary and tertiary care as well as the public and private sector. For this reason they require their own specific IT solution as organisationally based IT systems usually cannot span this range of stakeholders. The system needs to address both the traditional administrative functions of running any clinical case based meeting as well as recording and disseminating the specific information in a structured format about a particular disease like cancer and recommendations about its management. Information needs to be seamlessly retrieved from other IT systems for review at the meeting and the recommendations then need to be returned to an EHR or other medical record with the whole process being accessible to audit. It needs to be sufficiently flexible to adjust to advances in knowledge like the explosion of genomic information relevant to clinical decision-making in cancer. Our IT system (MDMone) addresses all these issues and is based on business process management software which has been modified to mirror the clinical process involved in the operation of multidisciplinary meetings. The collaborative staging system is used so the system is sufficiently open-ended to cope with newly available information in cancer like genomics. It is web-based for reasons of accessibility and interoperable with other health care information repositories for both the purposes of receiving and sending clinical information.

293 RURAL ONCOLOGY CARE VIA TELEONCOLOGY AND OUTREACH CLINICS: PATIENT AND STAFF PERSPECTIVES AND COMPARISONS Holly Wyeth 2,1 , Bryan Chan 2,1 , Matthew Burge 2,1 , David Wyld 2,1 , Melissa Eastgate 2,1 1. Medical Oncology Department, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia 2. School of Medicine, University of Queensland, St Lucia, Queensland, Australia Aims:To evaluate patient and staff perspectives on the quality of teleoncology and outreach services in Central Queensland. Methods:A survey was implemented in 2 rural outposts of Royal Brisbane and Women's Hospital where medical oncologists run a teleoncology service to Bundaberg and rural outreach clinics in both Bundaberg and Rockhampton. The survey was voluntary and anonymous and responses were graded using a Likert scale from 1 to 5. The surveys evaluated patient and staff perspectives on the quality, interactions and logistics of delivering health services in this manner. Results:The survey tabled responses from 21 staff and 165 patients (44% of patients were over the age of 65). It found that 80% of staff agreed or strongly agreed, that teleoncology and outreach services were a positive option. Lack of familiarity with the equipment was the main negative from staff. Across centres, the majority of patients were within 25 kilometres of the clinic, however 15% travelled over 200 kilometres to attend. Over 80% of surveyed respondents either agreed or strongly agreed that local programs were favourable when compared to travelling to Brisbane, and there was no difficulty building rapport, although most preferred to have a local nurse present during the consultation. Only one respondent felt uncomfortable discussing prognosis via teleoncology. Conclusions:The survey showed, that both teleoncology, and an outreach clinical model are acceptable options to most patients and staff. It showed that in a discipline that involves complex decisions and discussions, patients favour attending services closer to home rather than travelling to Brisbane and despite the majority of patients being over 65, they had little issue with the non-traditional methods. Further expansion of these programs should be implemented, as novel approaches such as teleoncology will improve timely access to subspecialty care in a largely rural state.

294 NIVOLUMAB AND IPILIMUMAB IN FIRST-LINE NON-SMALL-CELL LUNG CARCINOMA (NSCLC): INTERIM PHASE I RESULTS Scott J Antonia 1 , Scott Gettinger 2 , Laura Q Chow 3 , Rosalyn Juergens 4 , Hossein Borghaei 5 , Yun Shen 6 , Christopher Harbison 6 , Allen C Chen 6 , Neal E Ready 7 , Naiyer A Rizvi 8 1. H. Lee Moffitt Cancer Centre & Research Institute, Tampa, FL, USA 2. Yale Cancer Centre, New Haven, CT, USA 3. University of Washington, Seattle, WA, USA 4. Juravinski Cancer Centre at McMaster University, Hamilton, ON, Canada 5. Fox Chase Cancer Centre, Philadelphia, PA, USA 6. Bristol-Myers Squibb, Princeton, NJ, USA 7. Duke University Medical Centre, Durham, NC, USA 8. Memorial Sloan-Kettering Cancer Centre, New York, NY, USA Aims:Nivolumab, a fully human IgG4 programmed death-1 (PD-1) immune checkpoint inhibitor antibody, and ipilimumab, a fully human IgG1 Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) immune checkpoint receptor blocking antibody, have shown activity in advanced NSCLC; clinical data in melanoma showed improvement in survival and manageable safety profile when combined. We report interim results from phase I study evaluating first-line nivolumab+ipilimumab (N+I) combination in advanced NSCLC patients (pts). Methods:Chemotherapy-naïve pts (n=46) with squamous (sq) or non-sq NSCLC received the 3N+1Img/kg or 1N+3Img/kg combination dose IV every 3 weeks for 4 cycles followed by nivolumab 3mg/kg IV fortnightly until progression/unacceptable toxicity. Safety and Objective response rate (ORR; RECIST 1.1) were evaluated overall and by baseline tumour PD-ligand-1 (PD-L1) status (Dako immunohistochemistry assay). Results:In the 4 cohorts with≥4 months follow up, any-grade treatment-related adverse events (managed with protocol algorithms) were reported in 39 pts (85%; grade 3–4 in 22 pts [48%]) and led to discontinuation in 16 pts. Treatment-related deaths (n=3) were due to respiratory failure following colitis, bronchopulmonary hemorrhage and toxic epidermal necrolysis. Across all cohorts:1+3mg/kg sq, 1+3mg/kg non-sq, 3+1mg/kg sq, 3+1mg/kg non-sq, the confirmed objective response rates (ORR) were 11%, 13%, 33% and 13%, respectively. Overall ORR (confirmed and unconfirmed) was 22% (median duration of response [mDOR] not reached [NR]) and stable disease (SD) 33% (range 22–56 weeks); 3 pts exhibited unconventional “immune related” responses. In 38 evaluable tumour samples from the study, ORR did not correlate with PD-L1 status. Conclusions:These interim data in pts with advanced NSCLC suggest that a nivolumab+ipilimumab immunotherapy regimen is feasible and demonstrates antitumor activity in both PD-L1+and PD-L1– pts. Safety will be further assessed at additional specified doses and schedules.

295 DHMEQ MAY PROVIDE A THERPEUTIC OPTION IN TARGETING INFLAMMATORY MEDIATED ACQUIRED AND INTRINSIC CISPLATIN RESISTANCE IN NON-SMALL CELL LUNG CANCER Anne-Marie Baird 1,2 , Peter Godwin 1 , Susan Heavey 1 , Kazuo Umezawa 3 , Martin Barr 1 , Derek Richard 2 , Kathy Gately 1 , Kenneth O'Byrne 1,4,2 1. Thoracic Oncology Research Group, St. James's Hospital, Trinity College Dublin, Dublin, Ireland 2. Cancer and Ageing Research Program, Queensland University of Technology, Brisbane, Australia 3. Aichi Medical University, Aichi, Japan 4. Divison of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia Aims:Cisplatin based doublet-chemotherapy is the backbone of lung cancer treatment, as the majority of patients present with advanced disease. Both inherent and acquired drug resistance are significant clinical obstacles as objective responses are observed in less than 50% of patients. The aim of this project is to characterise the role of NF-kappaB mediators in cisplatin resistant non-small cell lung cancer (NSCLC). Methods:Cisplatin resistant (CisR) NSCLC cells were derived from original age-matched parent cells (PT) (H460/H1299/A549/SKMES-1/MOR). Basal levels of NF-kappaB mediators were examined using qPCR arrays (168 genes) and validated using RT-PCR. Proliferation assays (BrdU ELISA) were performed to assess whether the selective inhibition of NFkappaB with DHMEQ, could re-sensitize cells to cisplatin. Comet assays (DNA damage) were also performed to determine the effect of DHMEQ alone or in combination with irradiation (6 Gy). Results:The glucocorticoid receptor signalling pathway scored highly using Ingenuity® with 34% of differentially regulated genes involved in this pathway. Significant increases were observed in TNF and TNFSF1A with a concomitant decrease in IL-1B in the H460 cells (p<0.05, CisR vs . PT). CCL2 and CCL5 were consistently elevated throughout the entire CisR panel (p<0.05, CisR vs . PT). Simultaneous addition of DHMEQ and cisplatin augmented both PT and CisR sensitivity to cisplatin (p<0.05, DHMEQ/Cisplatin vs. cisplatin). Pretreatment with DHMEQ further improved cisplatin sensitivity. In addition, DHMEQ enhanced the effect of irradiation in PT and CisR cells. Conclusions:NF-kappaB pathways are de-regulated in cisplatin resistant NSCLC. Data suggests that the development of chemo-resistance may be driven in part through an upregulation of TNF and CCL chemokines. DHMEQ may be a viable option in addressing acquired and inherent chemo-resistance given its ability to improve cisplatin sensitivity. Ultimately this project will provide novel targets for therapy and predictive biomarkers to stratify lung cancer patients to cisplatin treatment.

296 SUSTAINED EXPOSURE TO TNF- AND IL-1 INCREASES THE INVASION, ADHESION AND PROLIFERATIVE POTENTIAL OF A NORMAL BRONCHIAL EPITHELIAL CELL LINE Anne-Marie Baird 1,2 , Steven Gray 1 , Derek Richard 2 , Kenneth O'Byrne 3,4,2 1. Thoracic Oncology Research Group, St. James's Hospital, Trinity College Dublin, Dublin, Ireland 2. Cancer and Ageing Research Program, Queensland University of Technology, Brisbane, Australia 3. Thoracic Oncology Research Group, St. James's Hospital, Trinity College Dublin, Dublin, Ireland 4. Divison of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia Aims:Hypoxia and chronic inflammation are key triggers in the transformation process with at least 20% of all malignancies initiated or exacerbated by inflammation. The aim of this study was to examine inflammation as a contributory factor in non-small cell lung cancer (NSCLC) carcinogenesis, concentrating primarily on the pathological involvement of the proinflammatory cytokines, TNF-/IL-1, and hypoxia. Methods:A normal bronchial epithelial cell line was modified to stably and functionally over-express TNF- and IL-1 (alone or in combination). Cells were cultured continuously for three months under normoxic and hypoxic conditions. Functional assays were performed to assess cellular change: transformation assay (soft agar), proliferation (BrdU ELISA), invasion (matrigel), adhesion (FACS) and angiogenesis (endothelial tube formation). Gene expression alterations were also assessed using qPCR Cancer PathwayFinder arrays. Results:Although anchorage independent growth was not evident by soft agar, the expression of ICAM and VCAM were up regulated and the cellular proliferative rate has increased. Under normoxia, the IL-1 and TNF-/IL-1 clones displayed an increased invasive capacity compared with the empty vector control (p<0.05). Differences were also detected in the gene expression profile implicated in pathways involved in the hallmarks of cancer – cell signalling ( FOS , JUN ), apoptosis ( BAD , BAX , BCL2 ), angiogenesis ( CXCL8 ), adhesion, invasion and cell cycle regulation ( p53 , c-myc ). Conclusion:This study provides a valuable isogenic cell line model in which to study the effect of prolonged chronic inflammation. Although the cells have not developed anchorage independent growth, there are distinct indications that phenotypic changes occurred within the three-month time frame. As pro-longed chronic exposure to inflammation is a prerequisite for many disease states, these results warrant extended growth studies to further delineate the complex roles of TNF-, IL-1 and hypoxia in the process of lung carcinogenesis. This will assist in the development of novel targeted therapeutics and clinically relevant biomarkers.

297 EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) CO-MUTATED ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC) AND RESPONSE TO EGFR TYROSINE KINASE INHIBITORS (TKIS) Megan B Barnet 1,2 , Sandra O'Toole 3 , Lisa' G Horvath 1,2 , Christina Selinger 3 , Bing Yu 2,4 , Ronald Trent 2 , Chiu Chin Ng 4 , Michael J Boyer 1,2 , Wendy Cooper 2,3,5 , Steven Kao 1,2 1. Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia 2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia 3. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia 4. Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia 5. School of Medicine, University of Western Sydney, Parramatta, NSW, Australia Background:Response to EGFR TKIs in NSCLC harbouring EGFR co-mutations is not well described. We aimed to examine the response rate to EGFR TKIs in a series of metastatic NSCLC patients with tumours harbouring EGFR mutation(s). Methods:We reviewed mutation profiles of non-squamous NSCLC tested at Royal Prince Alfred Hospital from March 2012 to March 2014 by MassArray using OncoCarta v1.0 Panel. Patients with metastatic disease whose tumours had EGFR mutation(s) were included and their clinical characteristics, treatment and outcome details were obtained and analysed. Results:245 tumours were profiled and an EGFR mutation was identified in 53 (22%) of these. 48 cases were metastatic, with 83% having common mutations (24 exon 21 L858R and 16 exon 19 deletions); some were co-mutated with either T790M substitution (n=2) or forms of PIK3CA mutation (n=3). 35 patients received initial treatment with a TKI (18 gefitinib, 14 erlotinib, 2 afatinib and 1 dacomitinib). 11 displayed either progressive or stable disease; which included both T790M substitutions, one PIK3CA co-mutation, five single L858R mutations, both single exon 18 mutations (G719A and E709K) and an exon 20 insertion mutation. 22 patients had partial (63%) and two had complete response (one exon 19 deletion and one L858R). Patients with an EGFR co-mutation tended to have lower response rates (40%) compared to those with a single EGFR mutation (80%), without reaching statistical significance (p=0.06). Conclusion:Most patients with a single EGFR L858R or exon 19 deletion responded to treatment with a TKI. A proportion of tumours (10%) exhibited co-mutation with a resistant gene. Taking into account the small number of patients included in this study, response rates in patients with co-mutations appeared low. More work is needed to define subgroups likely to display primary resistance to TKIs, who may benefit from an alternative first line therapy.

298 THE FREQUENCY OF ALLIED HEALTH INTERVENTIONS TO LUNG CANCER PATIENTS AT SUNSHINE HOSPITAL RADIOTHERAPY CENTRE: DATA TO GUIDE FUTURE SERVICE DELIVERY Hollie Bevans 1 , Karina Coffey 1 , Anna Gallagher 1 , Karen Kessner 1 , Simone Libeau 1 , Hunter Mulcare 1 , Laurelle Stalker 1 , Jessica Valentine 1 1. Western Health, St. Albans, Vic, Australia Aims:Lung cancer patients experience a high symptom burden and high levels of psychological distress. As a result this is a patient group that regularly require allied health intervention. There is, however, only limited data on allied health utilisation upon which evidence based recommendations can be made to inform service delivery to this patient cohort into the future. Since it opened in March 2011, the Sunshine Hospital Radiotherapy centre has treated 174 lung patients. These numbers are set to increase in the future as the centre is located in an area with one of the fastest population growth in Australia. Further, the western region of Melbourne encompasses a diverse social, economic, cultural and linguistic population which results in high patient needs for allied health and additional challenges in service delivery. This study will be to identify the type and prevalence of allied health interventions with patients diagnosed with lung cancer over a period of 12 months in the radiotherapy setting. Methods:Electronic appointment data for every lung cancer patient treated at the Sunshine Hospital Radiotherapy Centre over 12 months from 1/1/2013 to 31/12/2013 will be analysed to examine the number and type of allied health interventions. The allied health team is comprised of nutrition, occupational therapy, physiotherapy, psychology, speech therapy and social work staff. Results:It is intended that this study will provide a breakdown of use of each allied health service for lung cancer patients. Analysis will also be conducted to determine how demographic factors (eg. age, gender, culturally and linguistically diverse status) and clinical factors (eg. disease stage, length of treatment, radical or palliative intent, and treatment modalities) influence allied health utilisation amongst lung cancer patients. Conclusions:Recommendations for allied health service delivery into the future.

299 NIVOLUMAB IN PATIENTS WITH ADVANCED NON-SMALL-CELL LUNG CANCER (NSCLC): SURVIVAL AND CLINICAL ACTIVITY BY SUBGROUP ANALYSIS Julie R Brahmer 1 , Leora Horn 2 , Leena Gandhi 3 , David R Spigel 4 , Scott J Antonia 5 , Naiyer A Rizvi 6 , John D Powderly 7 , Rebecca S Heist 8 , Richard D Carvajal 6 , David M Jackman 3 , Lecia V Sequist 9 , David C Smith 9 , Philip D Leming 10 , Suzanne L Topalian 1 , Stephen Hodi 3 , Mario Snzol 11 , Christopher T Harbison 12 , Gerogia D Kollia 12 , Ashok Gupta 12 , Scott N Gettinger 11 1. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA 2. Vanderbilt University Medical Center,, Nashville, TN, USA 3. Dana-Farber Cancer Institute, Boston, MA, USA 4. Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN, USA 5. H. Lee Moffitt Cancer Centre & Research Institute, Tampa, FL, USA 6. Memorial Sloan-Kettering Cancer Centre, New York, NY, USA 7. Carolina BioOncology Institute, Huntersville, NC, USA 8. Massachusetts General Hospital Cancer Center, Boston, MA, USA 9. University of Michigan, Ann Arbor, MI, USA 10. Christ Hospital Cancer Center, Cincinnati, Ohio, USA 11. Yale Cancer Centre, New Haven, CT, USA 12. Bristol-Myers Squibb, Princeton, NJ, USA Aim:Nivolumab, a fully human immunoglobulin-G4 (IgG4), Programmed death-1 (PD-1) immune-checkpoint inhibitor antibody, has shown durable clinical activity in phase I trial of patients with advanced solid tumours. Methods:Previously treated advanced NSCLC patients received nivolumab (1, 3, or 10mg/kg, i.v.) fortnightly for ≤96 weeks with tumour evaluation (RECIST v1.0). PD-ligand 1 (PDL1) tumour cell membrane expression was measured (n=68) by immunohistochemistry (positive≥5% tumour cells). Clinical activity including overall survival (OS) of NSCLC patients by dose, histology (squamous [sq] and non-sq), and PD-L1 tumour status were evaluated. Results:Across doses and histologies, NSCLC patients (N=129, 54% with≥3 prior therapies) had median overall survival (mOS) (95% CI) of 9.9 months (7.8–12.4) and 1- and 2year OS (95% CI) rates of 42% (34, 51) and 24 % (16, 32), respectively. The mOS (95% CI) for sq and non-sq histology was 9.2 months (7.3, 12.5) and 10.1 months (5.7, 13.7), respectively. At 3mg/kg dose, mOS was 14.9 months (7.3, NE); 1- and 2-year OS rates were 56% (38, 71) and 45% (27, 61). Across doses objective response rate was 17% (22/129); median response duration was 17 months. In patients with PD-L1(+) and (–) tumours, mOS was 7.8 months (5.6, 21.7) and 10.5 months (5.2, 21.2), respectively. Grade 3–4 treatment-related adverse events occurred in 14% of patients; most common was fatigue (3%). Conclusions:Nivolumab demonstrated encouraging clinical activity across NSCLC patient subgroups with a manageable safety profile. Phase III trials are evaluating 3mg/kg nivolumab in patients with NSCLC.

300 EXPLORING THE COST-EFFECTIVENESS OF NEXT-GENERATION SEQUENCING IN LUNG ADENOCARCINOMA: WHAT IS THE EFFECT OF A MATURING EVIDENCE BASE? Brett Doble 1 , Paula Lorgelly 1 1. Centre for Health Economics, Clayton, VIC, Australia Background:Advancements in next-generation sequencing (NGS) show promise in further individualizing cancer therapy. To ensure appropriate diffusion and use of NGS in clinical practice it is necessary to assess the value of NGS in supporting evidence-based decision making. Aim:To identify parameters that are important drivers of the cost-effectiveness of NGS, by comparing the use of NGS to select targeted therapy based on an individual's genomic profile versus no (further) testing and best supportive care in lung adenocarcinoma patients who have progressed on standard treatment regimes. Methods:A combined decision tree and Markov model was developed to compare costs and quality-adjusted life-years over a life-time horizon from the Australian health-care payer perspective. A population-based molecular cohort (Cancer 2015) and the published literature were used as the main sources of data. Comprehensive sensitivity and scenario analyses were used to explore the impact of uncertainty on cost-effective estimates and which parameters are key drivers of uncertainty. Results:Given the current evidence base, the cost-effectiveness of NGS is questionable. Uncertainty surrounding a number of parameters likely to impact the cost-effectiveness of NGS has been identified, including the probability of having an actionable mutation, NGS turn-around time, survival after entering genomic directed trials and the personal utility of genomic information. Evidence concerning these parameters is currently naïve but this is likely to change. The effect of the expanding evidence base will be tested by re-running the analysis just prior to the meeting; highlighting how a maturing evidence base can impact the results of a cost-effectiveness analysis over time. Conclusions:Innovative funding approaches are likely to be required in facilitating the most appropriate diffusion of NGS into clinical care. An iterative process to the economic evaluation of NGS will be necessary as our understanding of its impact on health outcomes (and the health budget) improves.

301 PREDICTORS OF POSTOPERATIVE MORTALITY AFTER LUNG CANCER SURGERY Nathan Dunn 1 , Shoni Colquist 1 , Tracey Guan 1 , Nancy Tran 1 , Morgan Windsor 2 1. Qld Cancer Control Analysis Team, Qld Health, Brisbane, Qld, Australia 2. The Prince Charles Hospital, Qld Health, Brisbane, Qld, Australia Background:This study analysed the predictors of 30 day postoperative mortality following lung cancer resection in Queensland, the third most populous state in Australia. Methods:Data on all Queensland residents diagnosed with non-small cell lung cancer (NSCLC) between 2001 and 2011 and who subsequently underwent surgery for lung cancer was obtained from the Queensland Oncology Repository. Thirty day postoperative mortality was modelled using multivariate Cox proportional hazards regression controlling for annual surgical volume of hospital, gender, age, remoteness of residence, socioeconomic status, anaesthetic score, comorbidity and surgery in a public facility. Results:A total of 2,857 NSCLC patients who underwent resection for lung cancer in 17 hospitals across the state were included in the analysis; the median age was 67 years and 61% were males. Overall crude 30-day mortality was 1.7%. In multivariate modelling, independent predictors of death within 30 days of lung cancer surgery included male gender (HR 2.7, 95% confidence interval [CI] 1.3–5.9, p=0.011), presence of one or more comorbidities (HR 2.5, CI 1.3–4.7, p=0.005) and low surgical volume of hospital (<27/yr, HR 2.2, CI 1.0–4.6, p= 0.042). Age, remoteness of residence, socioeconomic status, anaesthetic score and surgery in a public facility were non-significant factors in the model. Conclusions:Demographic and clinical patient characteristics, along with surgical volume of hospital are significant prognostic factors for 30 day postoperative mortality following lung cancer surgery. This study suggests that socioeconomic status and remoteness of residence do not influence the quality of surgical care for lung cancer in Queensland.

302 PATTERNS OF MDT REVIEW VARY BY HHS OF RESIDENCE FOR NSCLC PATIENTS IN QUEENSLAND Tracey Guan 1 , Shoni Colquist 1 , Michael Blake 1 1. Qld Cancer Control Analysis Team, Qld Health, Brisbane, Qld, Australia Background:Multidisciplinary team (MDT) meetings are an important element in the management of lung cancer patients in Queensland (Qld). There are seven lung cancer MDTs, based in public facilities in the Central and Southern areas of Qld, who use Qld Oncology Online (QOOL) to support their meetings. The aim of this project is to measure the rate of MDT review for public non-small cell lung cancer (NSCLC) patients diagnosed in 2011 and identify patterns of MDT review by Hospital and Health Service (HHS) of residence. Methods:Diagnosis and admission data on residents living in Qld Central and Southern areas, diagnosed with NSCLC in 2011 were derived from the Queensland Oncology Repository, Queensland Cancer Control Analysis Team. Patients were divided into public and non-public groups based on the hospital type of the admission closest to the date of cancer diagnosis. Public patient rates of MDT review were compared across HHS of residence. Results:There were 1,281 patients diagnosed with NSCLC in 2011. Of these patients 859 (67%) were classified as public patients and 422 (33%) non-public patients. For the public group 700 (81%) were reviewed by a MDT. MDT review by HHS of residence ranged between 45% and 93% with the median rate 80%. Conclusion:It is commendable that 81% of NSCLC public patients are being reviewed at MDT. Further investigation is required to understand factors that contribute to the variation of MDT review across HHS of residence, as the greatest variation is in rural areas.

303 SYSTEMIC TREATMENTS IN ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC): A SYSTEMATIC REVIEW James P Harrison 1 , Teresa Goncalves 1 , Hansoo Kim 1 1. Bristol-Myers Squibb Australia, Melbourne, VIC, Australia Aims:Systemic treatment for advanced NSCLC has changed radically the past years with the availability of new drug classes such as monoclonal antibodies, tyrosine kinase inhibitors and newer chemotherapies like pemetrexed. This has introduced complexity into treatment decisions and in particular, the relative efficacies of these treatments are not clear. The aim of this study was to establish and assess the evidence base of systemic treatments for advanced NSCLC following progression on first line therapy. Methods:Clinical trials of systemic treatments for advanced NSCLC were identified by literature search using Embase. The search strategy was determined by two authors and reviewed by the third. Results were reviewed independently for inclusion with differences resolved by discussion. Data informing progression free survival (PFS) and overall survival (OS) were independently extracted then synthesised using meta-analysis. Results:The search retrieved 249 results: 2 were duplicates; 164 were excluded on title and abstract review; 48 were excluded on full text review. 35 were included in the final analysis 1 informing 34 distinct comparisons. Compared to docetaxel monotherapy: crizotinib, aflibercept+docetaxel, nintendanib+docetaxel and vandetinib+docetaxel showed superiority in PFS (HR[95%CI]: 0.30 [0.21,0.43], 0.82 [0.72,0.93], 0.79 [0.68,0.92] and 0.78 [0.69,0.88] respectively); nintendanib+docetaxel showed superiority in OS (HR [95%CI]: 0.88 [0.78,0.99]). Compared to pemetrexed monotherapy: crizotinib, erlotinib+pemetrexed and gefitinib showed superiority in PFS (HR[95%CI]: 0.59 [0.43,0.81], 0.61 [0.47,0.79], 0.53 [0.36,0.78] respectively); erlotinib+pemetrexed showed superiority in OS (HR[95%CI]: 0.71 [0.53,0.95]). Compared to erlotinib monotherapy: bevacizumab and erlotinib+ pemetrexed showed superiority in PFS (HR[95%CI]: 0.62 [0.52,0.74], 0.57 [0.40,0.81] respectively); erlotinib+chemotherapy showed superiority in OS (HR[95%CI]: 0.67 [0.49,0.92]). Conclusions:Despite a large volume of studies, results herein suggest few interventions show superiority over standard of care comprising docetaxel, pemetrexed or erlotinib in terms of PFS and OS. Further differences may exist regarding comparative safety profiles and should be the subject for future research.

304 PROGNOSIS OF DYNAMIC MR IMAGING AND DIFFUSION WEIGHTED IMAGING FOR STAGE III NON-SMALL CELL LUNG CANCER PATIENTS TREATED WITH CONCURRENT CHEMORADIOTHERAPY Baosheng Li 1 , Yinxia Wang 1 , Zhaoqiu Chen 1 1. Shandong Cancer Hospital, Jinan, China To determine the prognostic value of dynamic contrast-enhanced MRI (DCE)and diffusion-weighed imaging (DWI) for stage III non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiotherapy(CRT). 55 stage III NSCLC patients treated with CRT underwent DCE and DWI . The patients were divided into two groups (local control (n=11) and local failure (n=44)). From the signal intensity-time course curve in each subject, the maximum enhancement ratio and slope of enhancement were calculated, while gained the apparent diffusion coefficients from DWI and compared between two groups by t test. To determine the feasible threshold values of both MR indexes for group differentiation, ROC-based positive tests were performed. The maximum enhancement ratio and the slope of enhancement in the local control group were significantly lower than those in the local failure one (P=0.017, 0.033). The apparent diffusion coefficients in the local control group were significantly higher than those in the local failure one (P=0.017, 0.003). Using 0.028/sec as the threshold value of the slope of enhancement, the sensitivity and specificity for differentiation between the two groups were 90.9% and 93.2%, respectively. When the slope of enhancement was adopted for estimation of prognosis after therapy, the mean survival period of the slope of enhancement≥0.028/sec group was significantly longer than that seen in the other group(P=0.009). Using 1.676×10 −3 mm 2 /s as the threshold value of the apparent diffusion coefficients (b=300s/ mm 2 ), the sensitivity and specificity for differentiation between the two groups were 90.9% and 93.2%, respectively. When the apparent diffusion coefficients (b=300s/mm 2 ) was adopted for estimation of prognosis after therapy, the mean survival period of the apparent diffusion coefficients<1.676×10 −3 mm 2 /s group was significantly longer than that seen in the other group (P=0.033). DCE and DWI may be as a prognostic factor for patients with stage III NSCLC undergone CRT.

305 CIRCULATING TUMOR CELLS IN PERIPHERAL AND PULMONARY VENOUS BLOOD PREDICT POOR LONG-TERM SURVIVAL IN SURGICALLY RESECTED NON-SMALL CELL LUNG CANCER PATIENTS Zhidong Liu 1 , Ruidong Zhang 2 , Yunsong Li 1 , Zhong Chen 3 , Chongyu Su 1 , Yi Han 1 1. Beijing Chest Hospital, Capital Medical University, Beijing, China 2. Beijing Children's Hospital, Beijing, China 3. Tumor Biology Section, Head and Neck Surgery Branch, NIDCD, National Institutes of Health, Bethesda, MD, USA Background:We tested the hypothesis that the circulating tumor cells (CTCs) in preoperative peripheral blood (PPB) and intraoperative pulmonary venous blood (IPVB) could predict poor long term survival in surgically resected NSCLC patients. Method:CTCs were separated from the blood using magnetic beads coated by antibody against epithelial-cell adhesion molecule (EpCAM) through magnetic activated cell sorting (MACS). The CTCs were quantified with fluorescence labeled antibodies against pan-cytokeratin through flow cytometry. CTCs were prospectively quantified in PPB and IPVB in 23 consecutive stage I-IIIA patients with surgically resected NSCLC. Association between CTCs and prognosis of these patients was evaluated after 5-year follow-up. Results:In the NSCLC patients, outcomes were assessed according to levels of CTCs at surgery, and compared with CTCs detected in benign pulmonary diseases, and healthy volunteers, where the mean and 95%CI of CTCs counts were all<1.0 CTCs/15mL. In cancer patients, the median of PPB-CTCs was 5/15mL, and the median of IPVB-CTCs was 28/15mL. NSCLC patients were identified as high-risk groups, as >5 CTCs/15mL in PPB and >50 CTCs/15mL in IPVB. Univariate Cox proportional-hazards regression analysis showed that CTCs count in PPB or IPVB was an independent risk factor for tumor-free and overall survivals. The high risk group of patients had a shorter median tumor-free survival (22 months vs. >60.0 months, P<0.0012) and shorter overall survival (27 months vs. >60 months, P<0.0015). Conclusions:CTCs count in PPB and IPVB was an independent risk factor for tumor-free and overall survival in surgically resected NSCLC patients.

306 THE FEASIBILITY OF A PRAGMATIC DISTANCE-BASED INTERVENTION TO INCREASE PHYSICAL ACTIVITY IN LUNG CANCER SURVIVORS Carolyn McIntyre 1 , Michael Baker 2 , YC Gary Lee 3 , Prue Cormie 1 , Daniel A Galvão 1 , Vickie Graham 1 , Robert U Newton 1 1. Edith Cowan University Health & Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia 2. Australian Catholic University, Strathfield, New South Wales 2135, Australia 3. Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Aims:To investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase moderate intensity physical activity participation in lung cancer survivors. Methods:Lung cancer survivors (stage I-IIIB non-small cell lung cancer) were recruited via invitation from the state Cancer Registry to join a physical activity intervention. At baseline participants received a personalized folder with a physical activity logbook. Over the 12-week intervention participants received eight mail-outs of print material with brief telephone follow-up. Each scripted call was tailored to compliment the print-materials. Questionnaire assessments were administered via telephone at baseline and post-intervention. Primary outcomes measured feasibility: eligibility and recruitment rate, loss to follow-up, adherence to telephone follow-up, ratings of participation burden and trial evaluation. Secondary outcomes measured changes in physical activity (Godin Leisure-Time Exercise Questionnaire), quality of life (QoL; SF-36, FACT-L), and dyspnea (Cancer Dyspnea Scale). The Wilcoxon Signed Rank Test was used to assess changes over time. Results:128 lung cancer survivors were screened, 29 were eligible (23%) and 14 recruited (43%), of which 50% lived in rural Western Australia. Eleven participants (79%) completed the entire intervention; ten (71%) completed the post-intervention assessment. Mean adherence to telephone follow-up was 90%. For those completing post-testing, mean ratings of participation burden were low (i.e., all items<3/7), and trial evaluations were high (i.e., all items >6/7). Post-intervention there was a non-significant mean improvement of 77 minutes per week of moderate intensity physical activity (p=0.279). Dyspnea discomfort was significantly reduced following the intervention (p=0.042). Several domains of QoL significantly improved including general health (p=0.007), emotional well-being (p=0.042), and lung cancer concerns (p=0.011). Conclusion:This pragmatic distance-based intervention had a high adherence rate and was reviewed favourably by participants. The post-intervention improvements in physical activity participation, quality of life, and dyspnea are likely meaningful for lung cancer survivors.

307 SURVIVAL TIMES OF PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER (NSCLC) STARTING FIRST-LINE CHEMOTHERAPY IN ROUTINE CLINICAL PRACTICE VERSUS CONTEMPORARY RANDOMISED TRIALS Jane L Parry 1 , Stephen A Della-Fiorentina 1 , Po Yee Yip 1 , Victoria Bray 2 , Belinda E Kiely 1 1. Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia 2. Medical Oncology, Liverpool Cancer Centre, Liverpool, NSW, Australia Aims:To compare survival times for patients starting first-line chemotherapy for metastatic NSCLC in routine clinical practice with survival of patients enrolled in first-line chemotherapy clinical trials. Methods:We identified all patients at Macarthur and Liverpool Cancer Centres who were diagnosed with metastatic NSCLC between July 2011 and July 2013 and subsequently started first-line chemotherapy. We recorded demographics, tumour and treatment characteristics, and survival times from the start of chemotherapy. Their survival distribution was summarized by the following percentiles (representative scenario for survival); 90th (worst-case), 75th (lower-typical), 25th (upper-typical) and 10th (best-case) which were compared with the same percentiles from a recent systematic review of first-line chemotherapy trials. 1 Results:Characteristics of the 67 eligible patients were: median age, 62 years (range 31–81); male, 64%; ECOG performance status 0–1, 81%; liver metastases, 15% and brain metastases, 18%. The majority of tumours were adenocarcinomas (69%) and squamous cell carcinomas (12%) and 9% had documented EGFR mutations. The median time from diagnosis to starting chemotherapy was 45 days. Carboplatin and gemcitabine was the commonest chemotherapy regimen (97%) and the median number of cycles completed was 3. After 16 months median follow-up there were 47 deaths. Survival times in months (vs the systematic review) were: 90th percentile 2 (2); 75th percentile 3 (5); median 9 (9); 25th percentile 17 (16); 10th percentile 24 (25). Independent predictors of survival were age (HR 1.9, p=0.03), ECOG performance status 0–1 (HR 0.4, p=0.008) and adenocarcinoma (HR 0.4, p=0.006). Conclusion:Median and better survival times in routine practice were similar to those from clinical trials; however, the shortest 25% of survival times (lower-typical scenario) was shorter in routine practice, likely reflecting patient selection in trials. Oncologists should adjust trial-based survival estimates for patients in routine practice not meeting typical trial eligibility criteria. 1. BE Kiely, M Alam, P Blinman, MHN Tattersall, MR Stockler. Estimating typical, best-case and worst-case life expectancy scenarios for patients starting chemotherapyfor advance non-small-cell lung cancer: A systematic review of contemporary randomised trials. Lung Cancer 77 ( 2012) 537–544.

308 DESIGN AND STUDY OF HEART SPARING DEVICE FOR THE LEFT BREAST CANCER PATIENT DURING RADIATION TREATMENT Senthilkumar Shanmugam 1 1. Government Rajaji Hospital & Madurai Medical College, Madurai, Tamil Nadu, India Background and Context:Breast radiotherapy is now part of the routine care of patients with early breast cancer. Patients with left-sided breast cancer who receive chest wall radiation have increased risk of treatment related cardiovascular morbidity. Aim:The aim of this study was to develop a heart sparing device(HSD) and to decrease the irradiated cardiac volume to improve radiation treatment for left-sided breast cancer patient by reducing the risk of long term complications to the heart. Strategy/Tactics:We have developed indigenously HSD, which consist of laser sensor, in-house software, video goggles, a breath hold signal device, alarm and visual indicator. The sensor is used to display the breath-hold position of the chest wall in the computer monitor as graphical signal as well as digital. Patients can able to see their breath hold position while using the video goggles and maintain the uniform level without reducing the lung volume. Once the threshold level reduces, patient starts to exhale the radiation will be stopped, simultaneously alarm will produce sound and visual indicator glows. Programme/Policy Process:HSD has been used for 35 patients during the radiotherapy in deep inspiration breath-hold. The tangential fields were planned for each respiratory-gated CT image. The dose-volume histograms (DVHs) of the heart, lung, and breast of each respiratory phase were compared. Patient's position during each breath hold was carefully monitored and make sure the heart is positioned away from the chest wall. Radiation was delivered during these repeated breath holds. Outcomes/What was learned:A deep breath pulls the diaphragm and heart down and out of the radiation beam path. Delivering radiation treatment during these deep breath holds protects the heart from radiation. We concluded that radiotherapy using HSD facilitates a reduction of the irradiated heart volume which enables more complete cardiac sparing without any compromise of PTV coverage.

309 INTRODUCTION OF EBUS REDUCES NUMBER OF INVASIVE DIAGNOSTIC INVESTIGATIONS AND DOES NOT IMPACT ON TIME TO MANAGEMENT DECISION FOR LUNG CANCER Neli Slavova-Azmanova 1 , Claire Johnson 1 , Catalina Lizama 1 , Martin Phillips 2 1. Cancer and Palliative Care Research and Evaluation Unit, The University of Western Australia, Crawley, WA, Australia 2. Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia Background and objectives:Endobronchial ultrasound (EBUS) is a relatively new procedure for diagnosis and staging of lung cancer. EBUS is available as EBUS-transbronchial needle aspiration (EBUS-TBNA) for sampling mediastinal lymph nodes and masses and EBUS guide sheath (EBUS-GS) for transbronchial biopsy and brushings of peripheral parenchymal lesions. This study compares the number and type of procedures undertaken to diagnose and stage lung cancer, and the time to management decision (TMD) (time from first presentation at the hospital to establishment of a management decision) before and after the introduction of EBUS at a tertiary hospital in Western Australia. Methods:Hospital data and medical records of new primary lung cancer cases presenting between January 2007 and December 2008 (Pre-EBUS cohort) and between January 2010 and December 2011 (Post-EBUS cohort) were reviewed. Results:A total of 560 patients were included in the study: 234 in the Pre-EBUS cohort and 326 in the Post-EBUS cohort. EBUS was performed on 91 patients in the Post-EBUS cohort (EBUS-TBNA for 19.3% of cases and EBUS-GS for 9.5% of cases). The number of CT- guided fine needle aspirations (CT-FNA) and bronchoscopies decreased following the introduction of EBUS ( p =0.015 and p <0.001 respectively). Logistic regression analysis revealed that greater numbers of imaging events and inpatient and outpatient visits were significant predictors of TMD of >28 days. Approximately half of patients with an EBUS investigation underwent additional invasive procedures. TMD was significantly longer (45 days for EBUS-GS and 28 days for EBUS-TBNA) for these patients when compared to patients without an EBUS investigation (10 days) and patients who had only an EBUS investigation (8.5 days for EBUS-GS and 10 days for EBUS-TBNA). Conclusions:The introduction of EBUS led to reduced numbers of CT-FNAs and bronchoscopies and did not impact on TMD. It appears that EBUS was used in diagnostically challenging cases.

310 UNDER HYPOXIC TUMOR MICROENVIRONMENT, DT-13 INHIBITED HUMAN LUNG ADENOCARCINOMA GROWTH AND METASTASIS VIA CHANGING THE DISTRIBUTION AND DOWN-REGULATION EXPRESSION OF NMIIA Xiaowen Yu 1 , Li Sun 1 , Shengtao Yuan 1 , Sensen Lin 1 , Renping Zhao 1 1. China Pharmaceutical University, Jiangsu, No. 24 Tong Jia Xiang Street, China Background:Hypoxic tumor microenvironment facilitate the process of tumor metastasis, and cancer cell and tumor-associated cells express and excreted more inducible tumorgrowth and -metastasis factors under hypoxia. The main target of traditional anti-cancer drug focused on anti-cancer cell proliferation. But how to prevent cancer from the “help” provided by tumor-associated cells especially under hypoxia would be a new way in clinic. DT-13, the saponin monomer of dwarf lilyturf tuber, effectively inhibited tumor metastasis under hypoxia in vitro and in vivo . Moreover, DT-13 exhibited stronger effect on antiangiogenesis in endothelial cell and anti-cancer metastasis under hypoxia. Aim:Considering the role of non-muscle myosin type IIA (NMIIA) in cancer cell migration, and the anti-cancer and anti-angiogenesis effect of DT-13 under hypoxia, we would investigate whether DT-13 inhibits tumor metastasis on NMIIA via tumor-associated cells under hypoxia. Methods:Evaluating human lung cancer 95D cell proliferation by Brdu labeling assay; evaluating cell migration by would healing and Transwell assay; evaluating protein expression and location by Western blots and Immunofluorescence immunofluorescence separately; evaluating tumor-associated growth factors secreted by tumor associated cells by EnzymeLinked ImmunoSorbent Assay (ELISA). Results:Pre-treatment with DT-13 (0.1, 1, 10 µM), adipocyte and fibroblast hypoxia CM reduced 95D cell proliferation and migration in vitro compared with no-treatment hypoxia CM. hypoxia CM altered NMIIA and Vinculin distribution, and down-regulated expression in 95D cell. Moreover, knocking-out NMIIA induce the level of paxillin, p-paxillin, FAK, p-ERK1/2 and p-c-RAF. The CM pretreated with DT-13 could reverse the phenomenon. DT-13 also reduce the level tumor-associated growth factors (eg: Leptin, VEGF) secreted by adipocyte and fibroblast under hypoxia. Conclusions:Under hypoxic tumor microenvironment, DT-13, hitting tumor-associated cells as a target, inhibited human lung adenocarcinoma growth and metastasis via changing the distribution and down-regulation expression of NMIIA.

311 HEAD AND NECK CANCER (HNC) PATIENTS BEYOND 2 YEARS OF DISEASE CONTROL: PRELIMINARY ANALYSIS OF ILEA (INTENSITY MODULATED RADIOTHERAPY LATE EFFECT ASSESSMENT) SCALE Trinanjan Basu 1 , Tejinder Kataria 1 , Shikha Goyal 1 , Deepak Gupta 1 , Shyam Bisht 1 , Ashu Abhishek 1 , Anurita Srivastava 1 1. Medanta, The Medicity Hospital, Gurgaon, India, Gurgaon, India Objective:Since last 10 years intensity modulated radiotherapy (IMRT) came into practice in HNC management. The randomized data supported benefit regarding long term side effects of radiotherapy. However patients controlled on their disease beyond 2 years and expecting probable cure has other concerns. This study aims at assessing these concerns through an indigenous ILEA scale combining quality of life (QOL) and organs at risk (OAR) specific late toxicities. Materials and methods:This single institution study was conducted upon HNC patients on routine follow up and disease free for at least 2 years. Indigenous ILEA questionnaire with10 topics were used. The most troublesome response was selected. Total 18 patients were analyzed based on the 10 topics like skin,oral cavity, dental status, swallowing, speech, nutrition, general physical aspects, personal life, professional life and other specific aspects. Results:There were 18 patients (15 male and 3 female) with median age 62.5 years with both early (7) and advanced (11) stages. As perceived from the ILEA scale major responses were sub cutaneous edema, dryness of mouth and sticky saliva,dental sensitivity, increased time to swallow, change in voice quality,dietary modifications and fatigue. The most troublesome though was either dryness in mouth or sticky saliva resulting in modifications in diet, swallowing and speech abilities. Conclusion:The study with small sample size and indigenous ILEA scale could indicate major concerns with HNC IMRT beyond 2 years of disease control. Even after 2 years xerostomia and its sequelae troubles patient. With experience in IMRT OAR's like dysphagia structures, minor salivary glands, laryngeal architecture, CNS structures or brachial plexus are equally important in reducing late toxicities and a better QOL. The non-availability of IMRT specific scales for late toxicity and QOL along with future validation and prospective documentation would resolve issues pertaining to IMRT specific late toxicities and QOL.

312 SHIFTS IN PERCEPTIONS OF SELF ASSOCIATED WITH THE EXPERIENCE OF OVARIAN CANCER Rebecca Carlson 1 , Joanne Brooker 2,3 , Lyndel Shand 1 , Tess Knight 1 , Sue Burney 2,4 , Lina Ricciardelli 1 1. School of Psychology, Deakin University, Melbourne, Victoria, Australia 2. Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia 3. Department of Psychiatry, Monash University, Melbourne, VIC, Australia 4. School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia Aims:Women diagnosed with ovarian cancer typically contend with a range of factors such as treatment side-effects, potentially including hair loss, scarring, infertility and treatmentinduced menopause, which may impact their sense of self 1,2 . In addition, perceptions of self may be influenced by psychosocial factors including depression, altered relationships and increased dependence on others. Despite the importance of sense of self for psychosocial wellbeing, there is little research on this construct in women with ovarian cancer. The aim of this qualitative study was to understand perceived shifts in women's sense of self following diagnosis with ovarian cancer. Methods:Women who had been diagnosed with ovarian cancer at least 12 months prior to the study were recruited Australia-wide. Sixty three women who had participated in a prior quantitative study 3 and provided consent to be contacted for a qualitative study were invited to participate. Thirty-five women with a mean age of 57.4 ( SD 11.0) years completed a semi-structured interview conducted via telephone. Thematic analysis will be focused on the exploration of women's perception of their sense of self following treatment for ovarian cancer and the ways in which the experience of ovarian cancer may have altered this construct. Results:Preliminary analysis indicates a diverse range of experiences with regard to sense of self among participants. These included negative experiences which focussed on physical and psychological losses (e.g., loss of functions; loss of self-confidence) but also positive experiences such as becoming more accepting and assertive. A more in-depth analysis will examine the complex interplay of the biopsychosocial factors that influence perceptions of self in women diagnosed with ovarian cancer. Conclusions:Increased understanding of the factors that influence sense of self in this patient group may inform the development and implementation of psychosocial interventions that could improve the wellbeing of women living with ovarian cancer. 1. Jayde, V., Boughton, M., & Blomfield, P. (2013). The experience of chemotherapy-induced alopecia for Australian women with ovarian cancer. European Journal of Cancer Care, 22, 503–512. 2. Carter, J., Chi, D. S., Brown, C. L., Abu-Rustum, N. R., Sonoda, Y., Aghajanian, C., Levine, D. A., Baser, R. E., Raviv, L., & Barakat, R. R. (2010). Cancer-related infertility in survivorship. International Journal of Gynecological Cancer, 20(1), 2–8. 3. Shand, L., Brooker, J., Burney, S., Fletcher, J., & Ricciardelli, L. (E-pub ahead of print). Symptoms of posttraumatic stress in Australian women with ovarian cancer. Psychooncology, DOI: 10.1002/pon.3627.

313 FAMILY FUNCTIONING DURING ONCOLOGY TREATMENT: INTERNATIONAL PERSPECTIVES Elisabeth Coyne 1 , Karin B Dieperink 2 , Debra K Creedy 1 , Birte Oestergaard 2 1. Griffith University, Meadowbrook, QLD, Australia 2. Oncology, Odense University Hospital, Odense, Denmark Aims:Family has a strong influence on the health of individuals, providing support in a health crisis and a buffering from the pressures of society during illness. However, family functioning and perceptions vary across different cultural groups and settings. This study aimed to investigate the needs of adult oncology patients and their families in Australia and Denmark. The study explored changes to patient and family functioning when a member is receiving oncology care; and family perceptions of how nurses could best meet their needs. Methods:A descriptive, cross sectional design was used. Patients and their family members from the Odense University Hospital Oncology Unit in Denmark (n=50+100 family); and Gold Coast Hospital Oncology Unit in Australia (n=50+100 family) will be recruited. The survey includes the ICE Family Perceived Support Questionnaire (ICE-FPSQ), ICE Expressive Family Functioning Questionnaire (ICE-EFFQ), Family Hardiness Index (FHI), and Family Crisis Orientated Personal Evaluation Scales (F-COPES). Results:Preliminary results of 69 participants represent equal numbers of patients / family members, male / female, mean age 55 years. Participants are predominantly from Denmark (80%) [Ethics clearance earlier] and 86% were treated in day oncology. Cancer types were 30% breast, 17% lung, 13% colon, 9% haematological, 26% other. There were strong correlations between all scales. Patients reported lower sense of control in FHI than family; and females reported higher levels of emotional support needs than males according to ICE-FPSQ. Conclusion:The preliminary results suggest differences in the needs of patients and their family, and gender. Early analysis suggests no difference between cultural settings. Differences in education level between the countries may influence information needs however more Australian data needs to be collected. The findings will inform the development of appropriate family nursing models of assessment and care that are acceptable and applicable across different cultures, disease stages and recovery.

314 DEVELOPMENT OF AN EVIDENCE BASED SYMPTOM CHECKLIST FOR DETECTING SYMPTOMS OF RECURRENCE IN WOMEN WITH ENDOMETRIAL CANCER Audra de Witt 1 , Andreas Obermair 2 , Monika Janda 3 1. Cancer Epidemiology and Health Services Division, Menzies School of Health Research, Brisbane, QLD, Australia 2. Cancer Care Services, Royal Brisbane and Women's Hospitals, Queensland Centre for Gynaecological Cancer, Brisbane, QLD, Australia 3. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia Aims:There is a need to explore alternative models of follow-up care for women diagnosed with endometrial cancer. Currently, patients are commonly followed up using clinic based examinations for a five year period. However, the effectiveness of this follow-up plan in detecting cancer recurrence has been a contentious issue among some health professionals due to lack of supporting evidence. Asking women regularly about their possible symptoms may be an alternative option. This study aimed to identify currently available symptom checklists, determine the comprehensiveness of identified checklists, and generate an updated list of symptoms that potentially may be associated with a recurrence of endometrial cancer for future testing. Methods:A systematic review of the literature was conducted extracting; routine follow-up schedules, proportions of patients that were symptomatic and asymptomatic, symptoms of recurrence and prevalence of these symptoms at recurrence. Results:Three previous symptom checklists and 12 retrospective studies were identified as meeting the selection criteria. The average rate of recurrence across the identified studies was 13% (range 3% to 19%). The proportion of patients identified with a symptomatic recurrence varied across the studies with the overall average rate of 67% (range 41% to 91%). Vaginal bleeding (25%), pain [not further described] (16%) and abdominal pain and/or discomfort and swelling (15%) were the most commonly reported symptoms in this study, and combined, represented 56% of the total reported symptoms. This review identified an additional 24 symptoms to the previously identified 14 common symptoms from the three previous checklists. This included vaginal discharge, leg pain, constipation and headache. Conclusion:The newly developed symptom checklist provides an update to the previous ones by an additional 24 symptoms. It will be used in a prospective cohort study to assess whether it is sensitive and specific enough to identify recurrence compared to current standard follow-up examinations.

315 PREVALENCE AND ASSOCIATES OF THE TOP HIGH/VERY HIGH UNMET NEEDS OF AUSTRALIAN HAEMATOLOGICAL CANCER SURVIVORS Alix Hall 1 , Flora Tzelepis 1,2 , Marita Lynagh 1 , Rob Sanson-Fisher 1 , Catherine D'Este 3 1. University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia 2. Hunter New England Population Health, Wallsend 3. National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, Australia Aims:To identify the top 10 “high/very high” unmet needs reported by haematological cancer survivors; and identify characteristics associated with the top three unmet needs. Methods:Adults aged 18 to 80 years at time of study and diagnosed with a haematological cancer were recruited from four Australian state cancer registries. Survivors completed a self-report questionnaire containing the Survivor Unmet Needs Survey (SUNS). The SUNS is an 89-item measure of cancer survivor unmet needs in the last month, across five domains. The top ten “high/very high” unmet needs items endorsed by the highest percentage of survivors were identified. Survivor characteristics associated with the top three unmet needs were also explored. Results:1,957 eligible survivors were contacted by the registries, of which 715 returned a completed survey (37% response rate). The items “ dealing with feeling tired ” (17% (n= 116); 95%CI: 0.14%, 0.19%), “ coping with having a bad memory or lack of focus ” (14% (n=99); 95%CI: 0.12%, 0.17%) and “ dealing with feeling worried (anxious) ” (13% (n=94); 95%CI: 0.11%, 0.16%) were endorsed by the highest percentage of survivors as a “high/very high” unmet need. Seven of the top ten unmet needs were from the emotional health domain, two from the relationships domain and one from the financial concerns domain. Higher levels of psychological symptoms (for example anxiety, depression and stress) and indicators of financial burden (for example having used up savings and had trouble meeting day-to-day expenses due to their cancer) were commonly identified characteristics found to be associated with a number of the top three “high/very high” unmet needs. Conclusions:Many of the most prevalent “high/very high” unmet needs of adult haematological cancer survivors tend to relate to emotional issues. Survivors reporting high levels of psychological distress or who experience increased financial burden as a result of their cancer diagnosis may need additional support.

316 A COMPARISON OF THE UNMET NEEDS OF YOUNGER AND OLDER ADULT HAEMATOLOGICAL CANCER SURVIVORS Alix Hall 1 , Rob Sanson-Fisher 1 , Marita Lynagh 1 , Flora Tzelepis 1,2 , Catherine D'Este 3 1. University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia 2. Hunter New England Population Health, Wallsend 3. National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, Australia Aims:Compare the unmet needs of older (≥60 years at diagnosis) and younger (<60 years at diagnosis) haematological cancer survivors. Methods:Haematological cancer survivors, aged 18 to 80 years (at time of study) were recruited from four Australian cancer registries. Survivors were sent a self-report pen-andpaper survey containing the Survivors Unmet Needs Survey (SUNS). The SUNS assesses cancer survivors unmet needs over the last month, across five domains of supportive care, using a five-point Likert scale (0 “no unmet need” to 4 “very high unmet need”). Domain scores were calculated and compared between younger and older haematological cancer survivors. The percentage of younger and older survivors reporting no unmet needs across all 89-items of the SUNS was also compared. Results:1,957 eligible survivors were contacted by the registries, of which 715 (37%) returned a completed survey. A total of 298 younger and 367 older haematological cancer survivors were identified as having returned a completed survey. Younger survivors compared to older survivors reported a significantly higher level of unmet needs on all five domains of the SUNS: information (Median=0.63 vs. 0.13; z=5.75, p<0.001), financial concerns (Median=0.36 vs. 0.09; z=5.57, p<0.001), access and continuity of care (Median=0.14 vs. 0.05; z=3.81, p<0.001), relationships (Median=0.53 vs. 0.07; z=6.50, p<0.001) and emotional health (Median=0.55 vs. 0.21; z=4.57, p<0.001). A significantly higher 2 =12.38, df=1, p<0.001). percentage of older survivors (n=68, 26%) reported no unmet needs on all 89 items compared to younger survivors (n=33, 14%; Conclusions:Younger haematological cancer survivors seem to be a vulnerable patient group, who may be in need of additional support. Future research should aim to develop and test the effectiveness of intervention strategies tailored to addressing the specific concerns of younger haematological cancers.

317 EMOTION-REGULATING COPING PROCESSES IN MEN WITH CANCER Michael A Hoyt 1 1. Hunter College, City University of New York, Brooklyn, NY, United States The experience of cancer diagnosis and treatment exposes individuals to myriad physical and emotional stressors. Emotional perturbations and chronic negative affective states associated with stressors can confer increased risk for depression, sleep disturbance, and declining physical health, as well as invoke potent negative effects on cellular immune processes. Use of coping strategies that lead one to focus on and regulate difficult emotions (emotional approach coping) related to one's cancer experience has potential for modifying the affective response and improving psychological and physical health outcomes in men with cancer. Emotional approach coping (EAC) is comprised of two distinct but related emotion-regulating strategies: emotional processing and emotional expression. A series of studies conducted with men with mixed cancer types, including a study of men with prostate cancer and a multi-phase study of young adults with testicular cancer, will be presented. Findings will identify contextual factors that condition the use and utility of EAC to psychological adjustment. Results point to gender role norms and cancer-related masculine threat as limiting men from benefiting from emotion-regulating coping efforts, particularly in less open interpersonal environments and in younger men. In addition to evidence suggesting a benefit of EAC on cancer-related psychological outcomes, findings will also point to associations with physical functioning and biological processes. In a study of prostate cancer patients (N=66), decreased emotional processing predicted declining prostate-related functioning, including sexual functioning and urinary and bowel incontinence. Likewise, emotional processing predicted a decline in two inflammatory markers: IL-6 ( B =−.63, p <.05) and CRP ( B =−.47, p <.05). Finally, associations of EAC to cancer-related sleep disturbance will be discussed. EAC is associated with lower sleep quality across studies. Taken together, these findings focus on an understudied patient population and point to emotional processing and emotional expression as key emotion-regulation processes with significant potential as targets of clinical intervention.

318 DEVELOPMENT AND EVALUATION OF AN ONLINE EDUCATION MODEL ON CANCER SURVIVORSHIP & SUPPORTIVE NURSING CARE Tim Shaw 1 , Patsy Yates 2 , Mei Krishnasamy 3 , Kylie Ash 2 , Linda Nolte 4 , Meg Rynderman 4 , Bobbi Moore 1 , James Nicholson 1 , Jennifer Avery 1 , Michael Jefford 4 1. Workforce Education and Development Group, The University of Sydney, Sydney 2. Queensland University of Technology, Brisbane 3. Peter MacCallum Cancer Centre, Melbourne 4. Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne Aims:With oncology patients increasingly completing treatment and living longer post-therapy, cancer survivorship has become a rapidly expanding healthcare field. Being a relatively new area, educational resources on survivorship for health professionals are limited. The purpose of this study is to describe the development and evaluation of an online survivorship resource to improve care and inform future educational development in this area. Methods:The Australian Cancer Survivorship Centre commissioned the development of an educational resource to enhance nurses' ability to support survivorship care. A multidisciplinary team developed an educational framework and modules linking theory with practice. Health professionals have been recruited to review the site by e-mail from centres involved in the study including the Peter MacCallum Cancer Centre and the Queensland University of Technology. After completing at least one educational module, participants were asked to complete an online evaluation survey and/or register for a telephone interview to provide qualitative feedback. Results:The Cancer Survivorship resource contains 6 modules: Cancer Survivorship Fundamentals, Key Elements of Cancer Survivorship Care, Toolbox for providing cancer survivorship care, Managing Common Health Concerns, Promoting Self-Management and Promoting Wellness. Preliminary interview feedback is positive on the applicability of the modules as well as the multimedia presentation formats. Most participants emphasized that obtaining Continuing Professional Development (CPD) points was an important motivator to completing CPD. Constructive comments were provided around the overload of information in some areas and technical issues at times. Conclusion:The Cancer Survivorship site fills a significant gap in current survivorship care resources. Importantly, the resource makes strong linkages between education and practice. The findings from this study will provide data regarding participants' reasons for engaging in survivorship education and optimal content and presentation formats for CPD in this field. Preliminary analysis supports the value of developing well-structured, current survivorship resources.

319 LIVING WITH MULTIPLE MYELOMA: A FOCUS GROUP STUDY OF CONCERNS AND UNMET NEEDS Leanne Monterosso 1,2 , Violet Platt 4,3 , David Joske 5,6 , Toni Musiello 5,7 , Karen M Taylor 4,3 1. School of Nursing and Midwifery/Centre for Nursing and Midwifery Research, University of Notre Dame Australia/St John of God Murdoch Hospital, Fremantle, WA, Australia 2. School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia 3. School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, WA, Australia 4. Cancer and Palliative Care Network, WA Department of Health, Perth, WA, Australia 5. Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia 6. School of Medicine, University of Western Australia, Nedlands, WA, Australia 7. Cancer and Palliative Care Research Evaluation Unit, WA Cancer and Palliative Care Network, Nedlands, WA, Australia Background:Multiple myeloma is a non-curable haematological cancer. Patients therefore must adapt to living with a cancer that requires periods of intensive and maintenance therapies. While treatment has improved outcomes, it remains aggressive and results in numerous physical, psychosocial and existential effects that can be debilitating and change over time. The needs of these patients is largely unexplored and impacts on the delivery of tailored care. Aim:A haematology survivorship team sought to understand the psychosocial, practical and educational and practical needs from the perspectives of survivors of multiple myeloma. Methods:Patients >25 years of age who had been diagnosed with multiple myeloma 6–52 months previously were invited to participate in one of two focus groups. A psychologist experienced in focus group moderation with cancer patients led each 90 minute audio recorded focus group using a semi structured interview guide. Transcripts were coded using thematic analysis with NVivo software. Results:Seven females and seven males participated. Three themes emerged: 1) participants felt sad and isolated as nobody including family and friends understood that living with myeloma is living with “lifelong cancer” and is quite different to living after treatment for other cancers; 2) participants wanted to build a relationship with a known health professional (e.g. nurse) to whom they could ask “any” questions and contact for advice and support; and 3) participants felt a lack of myeloma-specific practical and emotional support. Conclusion:Adults living with multiple myeloma have unmet needs for emotional, practical and educational support and care coordination. Results suggest the addition of a specialist nurse or other health professional may improve patients' transition to living with multiple myeloma, particularly for emotional, educational and practical support.

320 UNDERSTANDING LYMPHOMA AND LEUKEMIA SURVIVORS' CONCERNS: A FOCUS GROUP STUDY Leanne Monterosso 1 , Violet Platt 2,3 , David Joske 4,5 , Toni Musiello 4,6 , Karen M Taylor 2,1 1. University of Notre Dame Australia / St John of God Murdoch Hospital, Fremantle, WA, Australia 2. Cancer and Palliative Care Network, WA Department of Health, Perth, WA, Australia 3. School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia 4. Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia 5. School of Medicine, University of Western Australia, Nedlands, WA, Australia 6. Cancer and Palliative Care Research Evaluation Unit, WA Cancer and Palliative Care Network, Nedlands, WA, Australia Background:Haematological cancers are a unique group of cancers. Treatment is aggressive and complex, resulting in debilitating side effects from multi-modal therapies and disease-related problems. Many people are left with physical, psychological, social and existential needs that affect general health and well-being. These concepts are not new in cancer survivorship literature, yet remain relatively unexplored in relation to people who have completed treatment for lymphoma/leukaemia. Objective:A survivorship team sought to understand the psychosocial, practical and educational and practical needs from the perspectives of survivors of lymphoma/leukaemia. Methods:19 patients >25 years of age who had completed treatment for leukaemia/lymphoma 6–48 months previously participated in one of two focus groups. A psychologist experienced in focus group moderation with cancer patients led each 90 minute audio recorded focus group using a semi structured interview guide. Transcripts were coded using thematic analysis with NVivo software. Results:Ten females and nine males participated. Four themes emerged; participants (1) wanted to build a relationship with someone (e.g. nurse coordinator) to whom they could ask questions and contact for advice/support; (2) were still treatment-focused, feeling “stuck” and unable to move on; (3) felt a sense of loss as their “normal” had forever changed and they were experiencing difficulty adjusting and/or finding a “new normal”; and (4) felt a lack of practical and emotional support and wanted to build a connection with someone that cared about them and could help them put their life back together. Conclusion:Adult of leukaemia/lymphoma survivors have unmet needs for emotional support and survivorship care coordination. Results suggest the addition of a specialist survivorship coordinator for follow-up care may improve survivors' transition to post treatment life, particularly for emotional and practical support.

321 QUALITATIVE RESULTS OF THE EXERCISE PROGRAMMING PREFERENCES AND ACTIVITY LEVELS AMONG ADOLESCENTS AND YOUNG ADULTS WHO HAVE HAD AN EXPERIENCE OF CANCER Andrew Murnane 1 , Kate Thompson 1 , Lucy Holland 1 , Olivia Doidge 1 , Rachel Conyers 1,2 1. ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia 2. The Royal Children's Hospital, Parkville, VIC, Australia Introduction:Given the possible decades of post-treatment survivorship for adolescents and young adult (AYA) cancer survivors, it is important that health services promote behaviours that enhance physical/mental well-being and quality of life (QoL). AYA are less physically active than non-diagnosed siblings or peers and their unmet need for exercise information is greater than reported for older cancer survivors. This study explored the exercise programming preferences and information needs of AYA patients through two components; 1) a self-administered questionnaire and 2) focus group. This paper reports on the qualitative, focus group component of the study which aimed to explore in detail the impact a cancer diagnosis had on participant's exercise and physcial activity levels. Methods:From the 74 responders to the self-administered questionnaire, 12 expressed an interest to participate in a focus group. 8 male and 4 female cancer survivors (>1 year posttreatment completion) aged 18–25 years at the time of diagnosis participated in a semi-structured focus group. Interview questions targeted; i) experience of exercising with cancer and ii) exercise information provision. Focus groups were recorded and transcribed and a thematic analysis was conducted using a framework approach. Results:The following main themes emerged through qualitative analysis; 1) barriers to exercise include, treatment related side effects (i.e. fatigue), family and lack of information provision, 2) AYA attitudes regarding enablers to exercise include medical team, hospital supports and previous exercise history, 3) access to services (pre and post treatment), 4) preferred content, timing and delivery of exercise interventions, 5) impact on QoL. Conclusion:Findings illustrate the significant impact a diagnosis of cancer has on AYA ability to undertake regular exercise and that a lack of exercise impacts on mood, sense of worth and QoL. Moreover, interventions promoting physical activity and healthy lifestyle behaviours would be well accepted within this population and may be essential to improve long term health and QoL into post-treatment survivorship.

322 CLINICAL ASSESSMENT OF CANCER-RELATED FATIGUE: CURRENT PRACTICE VS. CLINICAL GUIDELINES Elizabeth JM Pearson 1,2 , Carol McKinstry 2 1. La Trobe University, Melbourne 2. La Trobe University, Bendigo Introduction:Cancer-related fatigue (CRF) is a common and distressing problem. Guidelines for assessment and management of CRF are available; however limited research investigating clinical application of these guidelines was identified. Objectives:To describe how Australian health professionals assess CRF and to compare this to current international guidelines. Methods:An on-line survey of Australian health professionals working in oncology gathered information about CRF assessment in clinical practice. Results:The 129 respondents included 92 allied health practitioners: 73% worked in metropolitan areas and 40% in acute hospital settings. Three quarters of participants worked daily in oncology, most indicating moderate knowledge and expertise. There was a wide variation in how services manage people referred with CRF. Barriers to service delivery were identified and compared to current published guidelines. Conclusion:Few standardized assessment tools and variable consistency in service delivery across surveyed health professionals compromised rehabilitation for people with CRF.

323 BONE HEALTH MANAGEMENT OF BREAST AND PROSTATE CANCER SURVIVORS RECEIVING HORMONAL THERAPY Rachel Roberts 1 , Michelle Miller 1 , Michael O'Callaghan 2 , Bogda Koczwara 3 1. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA 2. SA Health, Repatriation General Hospital, Urology Unit; South Australian Prostate Cancer Clinical Outcomes Collaborative; University of Adelaide, School of Paediatrics and Reproductive Health, Adelaide, SA 3. Department of Medical Oncology, Flinders University, Flinders Medical Centre & Flinders Centre for Innovation in Cancer, Adelaide, SA Aim:Breast and prostate cancer survivors, receiving aromatase inhibitors or androgen deprivation therapy respectively, are at increased risk of bone loss. The aim of this study was to investigate patterns of care and barriers to management of bone health in breast and prostate cancer survivors. Method:We conducted two retrospective case note audits of breast and prostate cancer survivors between 1 st July 2011 and 30 th June 2012. Patients were being treated for curative intent at a metropolitan tertiary referral hospital. An online national survey of health care providers managing breast or prostate cancer patients was also conducted. Results:Forty-two women commenced hormone therapy. Fourteen women commenced an aromatase inhibitor; all received a bone mineral density scan. Nine (32%) of the 28 women who received Tamoxifen had a scan. Eleven (26%) were found to have osteopenia and four (9.5%), osteoporosis. Zoledronic acid was commenced by four. Six men received androgen deprivation therapy, with none receiving a Dual Energy X-ray Absorptiometry scan. Forty-one health care providers responded to the online survey, an 11% response rate. Lack of time, training and reimbursement were identified as main barriers to bone health care delivery. Conclusion:Bone health management for breast and prostate cancer survivors is variable and in some cases suboptimal. Diverse barriers to care delivery have been identified by providers.

324 WHICH STRATEGIES HAVE BEEN DEMONSTRATED TO BE EFFECTIVE IN MANAGING BONE LOSS IN BREAST AND PROSTATE CANCER SURVIVORS POST HORMONE THERAPY, AND HOW WELL ARE THEY EMPLOYED IN CLINICAL PRACTICE? Rachel Roberts 1 , Michelle Miller 1 , Bogda Koczwara 2 1. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA 2. Department of Medical Oncology, Flinders University, Flinders Medical Centre & Flinders Centre for Innovation in Cancer, Adelaide, SA Aim:Aromatase inhibitors and androgen deprivation therapy, as hormone therapy treatment for breast and prostate cancer respectively, increase risk of osteoporosis in cancer survivors due to accelerated bone loss. A literature review was conducted to examine evidence supporting bone health management strategies and identify current practice patterns in implementing these strategies. Method:Cochrane, MEDLINE, PubMed and Scopus were searched for relevant literature. Results:Randomised controlled trials on third generation bisphosphonates were reviewed. Participants in these trials who received alendronate, risedronate or zoledronic acid had significant increases to bone mineral density compared to those on placebo. The loss of bone mineral density for those taking placebo was despite standard procedure of calcium and vitamin D supplementation. Observational studies on bone health management adherence were also reviewed. Suboptimal care was provided in the form on bone mineral density screening, nutritional supplementation advice and bisphosphonate prescription. Conclusion:Further research into the safety and efficacy of bisphosphonates from studies of longer duration are required, which may inform on fracture prevention. Easily accessible guidelines and strategies to address barriers to improved bone health management of breast and prostate cancer patients are required.

325 NUTRITIONAL STATUS AS A DETERMINANT OF SURVIVAL IN WOMEN WITH GYNECOLOGICAL TUMORS Camila S Rodrigues, Marina S Lacerda, Gabriela V Chaves Instituto Nacional do Câncer – INCA – Rio de Janeiro/Brazil Background:Negative consequences nutritional status depletion imposes on clinical progress of cancer patients include increased risk of infection, worsened side effects of treatment and lowered survival rate. Aim:To identify factors related to nutritional status as determinants of survival of hospitalized women with gynecological tumors. Methods:146 women diagnosed with gynecological tumors admitted to a referral oncological hospital during November 2012 were included. Information related to medical history, duration and reason for admission were collected. One year survival data were obtained from institutional databases. Nutritional diagnosis were assessed by Patient-Generated Subjective Global Assessment (PG-SGA) as follows: A-well nourished, B-moderately malnourished and C-severely malnourished, beyond the score value that directs the nutritional intervention. Kaplan-Meier survival curve was used to study the survival status, and the log-rank test and Cox proportional hazards model were used to identify the independent factors for survival. Results:62.4% of women had some degree of malnutrition (PG-SGA B and C). The median duration days of hospitalization was statistically higher in patients classified as malnourished (p=0,002). The best cutoff score of PG-SGA to predict one year mortality was 10 (AUC=0,875, CI 95%: 0,816–0,935, p<0,001). Patients with a score above this value were 30.7 times more likely (95% CI: 11.8–79.4) to death. The median survival of patients with PG-SGA A was 334.09+11.20 (95% CI 312.13 to 356.04). Patients with PG-SGA B and C had significantly lower median survival: 137.94+17.67 (95% CI 103.30 to 172.57) and 113.30+27.90 (95% CI 58, 61 to 167.99), respectively (log-rank test, p<0.001). After the Cox regression analysis, severe malnutrition and site tumor in cervix was considered a risk factor for survival. Conclusions:Survival was influenced by nutritional status. PG-SGA is a good parameter for prognostic and may be enough to identify those patients who need nutritional intervention.

326 INTEGRATIVE LITERATURE REVIEW OF INSTRUMENTS USED TO ASSESS INFORMATIONAL AND PRACTICAL NEEDS OF ACUTE LEUKAEMIA AND LYMPHOMA SURVIVORS Karen M Taylor 1,2 , Leanne Monterosso 2,3,4 1. Western Australia Cancer and Palliative Care Network, East Perth, WA, Australia 2. School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia 3. Centre for Nursing & Midwifery Research, St John of God Hospital, Murdoch, Western Australia, Australia 4. School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia Aims:To identify validated measurement instruments that will assess informational and practical concerns of leukaemia and lymphoma survivors. Haematology cancer nurses have the potential to lead the way in providing excellent post treatment survivorship care for the increasing number of haematology survivors. An important element of care is assessment of haematology survivors' perceived needs for the provision of appropriate resources and support. Unlike other cancers, haematological cancers are highly variable in disease type and treatment. Methods:This Integrative literature review utilised a search of electronic databases (CINAHL, Medline, PsychInfo, PubMed, EMBASE, PsychArticles, Cochrane Library) for eligible articles published between 1970 and 2014. Articles were included if they described an instrument to assess informational and practical concerns of leukaemia and/or lymphoma survivors. Results:Ten full text articles were identified that described cancer-specific instruments used to assess informational and/or practical needs of the haematology cancer survivor. There was variation in use of cancer survivor-specific instruments and generic quality of life cancer instruments. Most studies reported instruments to measure ongoing concerns around cancer recurrence and screening, and the necessity to identify patients at higher risk of unmet needs along the cancer survivor continuum. Conclusions:No identified instrument was haematology-survivor specific. It is therefore difficult to determine the best instrument to use with haematology survivors. The development of a reliable and validated haematology survivor instrument that assesses supportive care needs and survivors' desire for support and resources is warranted. This could be used in conjunction with nurse-led survivorship clinics.

327 USING WEB-ENABLED TECHNOLOGY TO SUPPORT MEN WITH PROSTATE CANCER Addie Wootten 1,2 , David Blashki 1 , Helen Crowe 3 , Nicholas Howard 3 1. Australian Prostate Cancer Research, Richmond, VIC, Australia 2. Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia 3. Epworth Prostate Centre, Epworth Healthcare, Richmond, VIC, Australia Introduction:Access to appropriate information and support remains problematic for many men diagnosed with prostate cancer, especially in rural and remote areas of Australia. We have developed an online clinical support program, PROSTMATE, which aims to overcome these barriers to access. Aims:PROSTMATE is a secure portal that provides telehealth consultations with nurses and psychologists, tailored information, a place to record treatments, test results and appointments, online tracking tools and self-directed support programs to improve health and wellbeing. Methodology:PROSTMATE (www.prostmate.org.au) is freely accessible to men affected by prostate cancer, their families and others interested in prostate cancer. PROSTMATE launched in November 2013 and we have monitored its uptake, user engagement and participant feedback. Results:Over 750 people have registered. 72% of members are from metropolitan areas, 22.5% from regional or remote areas. The majority of members (56.5%) are men who have been diagnosed with prostate cancer. Self-reported problems at registration indicated that 17.2% of men with prostate cancer reported at risk levels of mood problems and 41.4% reported at risk levels of sexual intimacy problems. 23.5% of partners reported at risk levels of relationship problems and 41.2% reported at risk levels of sexual intimacy problems. Telehealth consultations have steadily grown and appear to be an acceptable delivery mode for men and their families. Conclusions:PROSTMATE shows promise in supporting men and offering access to specialist prostate cancer nurses and allied health services. This paper will explore how PROSTMATE could provide a novel way of improving care, and potentially see the integration of these systems into routine care.

328 PREDICTORS OF COPING MECHANISMS IN PROSTATE, BREAST AND COLORECTAL CANCER PATIENTS FOLLOWING ACTIVE THERAPY Mari P Lashbrook 1 1. The Riverina Cancer Care Centre, Wagga Wagga, NSW, Australia Background:Improvements in cancer therapies is reflected in the number of survivors. These patients are left with issues on how to cope with body changes and psychosocial concerns. Identification of vulnerable individuals for early and timely intervention efforts may influence the adjustment to life following therapy. Objectives:This research aims to describe how psychosocial concerns following active cancer therapy may change over time and identify the precursors of negative coping implications. The research questions were formed from known gaps in knowledge involving gender-specific malignancies (prostate and breast) and gender non-specific malignancies (CRC) undertaken through a study conducted within the same timeframe and with participants completing therapy at the same cancer centre and from the same region. Methods:The planned accrual was 200 and actual was 223. The study aligned with perspectives associated with the triangulation methodology to show the potential to discover areas of both convergence and divergence. There are two study arms. Arm one will complete a series of three paper questionnaires using the quantitative PROMIS-29 tool. A small subset of 30 patients in this arm will also undertake semi-structured, recorded interviews. Arm two includes 100 patients who completed therapy for one of the three malignancies 5 years previously, to gain longitudinal knowledge of coping mechanisms over the longer term. A convenience sample of 10 patients from each tumour group are to be randomly selected from cohort one for audiotaped semi-structured interviews. The CI chosen is 95% with an level of 0.05. Results:The first 2 questionnaires and data entry are complete. The third questionnaire and the questionnaire for cohort two have commenced. Conclusion:This research will recommend proactive strategies for identifying and managing psychosocial issues surrounding coping mechanisms in individual patients. Implications for research may be the re-evaluation of individual survivorship plans.

329 THE PSYCHOLOGICAL IMPACT OF A PILOT WHOLE-BODY SCREENING TRIAL (SMOC) ON INDIVIDUALS WITH LI – FRAUMENI SYNDROME Kate A McBride 1,2 , Mary-Anne Young 3 , Timothy E Schlub 1 , Mandy L Ballinger 4 , Judy Kirk 5 , Martin H Tattersall 2 , David M Thomas 6 , Gillian Mitchell 7 1. Sydney School of Pubic Health, Sydney, NSW 2. The Chris O'Brien Lifehouse, Sydney Medical School, Sydney, NSW 3. Familial Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 4. Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 5. The Crown Princess Mary Cancer Centre, Centre for Cancer Research, Westmead, Westmead, NSW 6. The Kinghorn Cancer Centre, Garvan Institute for Medical Research, Darlinghurst, NSW 7. Familial Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC Individuals who have a germline TP53 mutation have Li-Fraumeni Syndrome (LFS) and a high risk of cancer-related morbidity and mortality. Effective cancer risk management is an important issue. A whole-body (WB) surveillance trial (SMOC) in adults with TP53 mutations has been established to estimate the prevalence and incidence of investigable lesions in these carriers. The psychosocial impact of using WB MRI in individuals with LFS is unknown. To assess the psychosocial effects of participation in a WB screening program. Fourteen individuals with germline TP53 mutations are enrolled. Participants have completed psychological questionnaires at baseline, and several time points post WB-MRI. They are also take part in two in-depth semi-structured interviews. The interviews explore factors influencing participants' decisions to take part and evaluates their hopes for screening.. Interview recruitment will be ceased when data saturation is reached. The content of the transcripts are being analysed by thematic analysis, which is informed by grounded theory methodology. 48/54 (89%) of questionnaires have so far been completed by 12 participants. Hospital and Anxiety Depression Scales data indicates reductions in anxiety and depression from baseline. One participant scored highly on the scale at baseline, was found to have metastatic sarcoma on MRI and was withdrawn from the trial. Cancer Worry Scale scores either reduced slightly or remained the same. No participants had frequent cancer worry post-MRI, though two participants scored highly initially. Emerging themes from the interviews (N= 16) indicate that the trial gives some TP53 carriers a sense of control and the reassurance that ‘something is being done’. However, participants are still realistic about their chances of being diagnosed with cancer. Conversely, some feel overwhelmed by the screening intensity. Preliminary data suggest that the surveillance program is not adding to the psychological burden experienced by individuals with a TP53 mutation. Furthermore, the WB-MRI screening appears to be giving participants a sense of control though all participants are still realistic about their cancer risk.

330 PARAGON- PHASE II STUDY OF AROMATASE INHIBITORS IN WOMEN WITH POTENTIALLY HORMONE RESPONSIVE RECURRENT/METASTATIC GYNAECOLOGICAL NEOPLASMS: ANZGOG 0903 Linda Mileshkin 1 , Katrin M Sjoquist 2 , Dirkje w Sommeijer 3 , Dave Cannan 2 , Julie Martyn 2 , Kim Gillies 2 , Rachel O'Connell 2 , Val Gebski 2 , Peter Sykes 4 , Penny Blomfield 5 , Phillip Beale 6 , Michael Quinn 7 , Janine Lombard 8 , Alison Hadley 9 , Peter Grant 10 , Yoland Antill 11 , Martin Stockler 2 , Frederic Amant 12 , Richard J Edmondson 13 , Michael Friedlander 14 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia 3. Academic Medical Centre, Amsterdam, The Netherlands 4. Christchurch Women's Hospital, Christchurch, New Zealand 5. Royal Hobart Hospital, Hobart, Australia 6. Royal Prince Alfred Hospital, Sydney, Australia 7. Royal Women's Hospital, Melbourne, Australia 8. Calvary Mater Newcastle, Newcastle, Australia 9. Royal Brisbane and Women's Hospital, Brisbane, Australia 10. Mercy Hospital for Women, Melbourne, Australia 11. Frankston Medical Centre, Frankston, Australia 12. UZ Gasthusisberg, Leuven, Belgium 13. University of Manchester, Manchester, UK 14. Royal Hospital for Women/Prince of Wales Hospital, Sydney, Australia Background:Many gynaecological cancers of different pathological type express estrogen and/or progesterone hormone receptors (ER/PR). Reports of tumour response and clinical benefit with hormonal therapies exist showing variable rates of activity. There is a need to prospectively study the role of aromatase inhibitors in women with potentially hormone responsive recurrent gynaecological cancers to establish response rates, clinical benefit, quality of life (QoL), and identify predictors of response. Methods:PARAGON is phase II Gynecologic Cancer InterGroup trial lead by the Australia New Zealand Gynaecological Oncology Group, Cancer Research UK and the Belgian Gynaecological Oncology Group. The study is designed to facilitate research in rare tumours. The protocol allows postmenopausal women with recurrent gynaecological cancers to enrol into one of 7 subgroups; epithelial ovarian cancer (EOC) with only rising CA125 after first line chemotherapy, platinum resistant/refractory EOC, low grade EOC, endometrial carcinomas, endometrial stromal sarcomas, miscellaneous sarcomas and granulosa cell tumours and other sex cord stromal tumours. ER/PR positivity must be confirmed by immunohistochemistry. Each subgroup will enrol 25–50 patients with defined stopping rules based on response and reviewed by independent data monitoring committee (IDMC). Eligible patients receive 1mg anastrozole daily until disease progression or unacceptable toxicity. Primary objective: clinical benefit (partial or complete response or stable disease). Secondary objectives: progression free survival, response duration, QoL, toxicity. Blood and tumour samples are being collected for translational studies and confirmation of ER/PR positivity. ACTRN12610000796088 Recruitment commenced in 2011 in Australia, New Zealand and the United Kingdom. 260 of 350 planned patients have been enrolled to July 2014. Accrual to the platinum resistant/refractory and endometrial cancer subgroups closed on 9 December 2013 and 3 April 2014 respectively.

331 THE INHERITED CANCER CONNECT (ICCON) MUTATION-CARRIER DATABASE Paul A James 1 , Lara Petelin 1 , Ian Campbell 1 , Hugh Dawkins 2 , Stephen Fox 1 , Janet Hiller 3 , Judy Kirk 4 , Geoffrey Lindeman 5 , Finlay Macrae 6 , Lyon Mascarenhas 1 , Julie McGaughran 7 , Bettina Meiser 8 , April Morrow 9 , Cassandra Nichols 10 , Nicholas Pachter 10 , Christobel Saunders 11 , Clare Scott 5 , Nicola Poplawski 12 , Letitia Thrupp 1 , Alison Trainer 1 , Robyn Ward 9 , Mary-Anne Young 1 , Gillian Mitchell 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. University of Western Australia, Perth, WA 3. Swinburne University of Technology, Melbourne, VIC, Australia 4. Westmead Hospital, Sydney, NSW 5. Walter and Eliza Hall Institute, Melbourne, VIC 6. Royal Melbourne Hospital, Melbourne, VIC 7. Royal Brisbane and Women's Hospital, Brisbane, QLD 8. Prince of Wales Clinical School, Sydney, NSW 9. Prince of Wales Hospital, Sydney, NSW, Australia 10. King Edward Memorial Hospital for Women, Perth, WA 11. QEII Medical Centre, Perth, WA, Australia 12. SA Pathology, Adelaide, SA, Australia The ICCon Partnership was formed in 2013 through the support of a CCNSW STREP grant. A principal goal of this collaboration is to build a national database of individuals with germline mutations causing hereditary cancer syndromes to promote translational research and improve the health of people with a hereditary predisposition to cancer. The ICCon database is currently in development and will comprise of de-identified clinical data that can be extracted for the purposes of linking families across Australia, providing supportive data for health policy applications, responding to feasibility enquiries for clinical trials, or to identify those patients who are eligible to participate in specific trials, or who may benefit from new advances in therapeutic interventions. The ICCon database will include all known carriers of pathogenic mutations in a cancer predisposition gene who have attended a familial cancer clinic (FCC). It will cover the range of hereditary cancer syndromes and include data collected as part of routine clinical care within the FCC. Data that is planned to be stored include mutation type, cancer diagnosis (if appropriate), cancer treatment (if known), family pedigree (de-identified) and cancer risk management information (if known). FCC patients will have the opportunity to provide additional consent for their treatment information to be linked to ICCon through the CART-WHEEL rare cancer registry. In addition to enabling HREC-approved projects and providing data to inform national policy in the hereditary cancer arena, data from the ICCon database will be able to contribute to both clinical and translational research activities. In the translational research arena the ICCon database will be able to contribute data to the international initiatives aiming to amalgamate mutation data, such as BIC (the Breast Cancer Information Core http://research.nhgri.nih.gov/bic/) and InSiGHT (the International Society for Gastrointestinal Hereditary Tumours http://www.insight-group.org/).

351 A REVIEW OF THE EPIDEMIOLOGY, PATHOLOGY, TREATMENT AND OUTCOMES IN PATIENTS WITH HEAD AND NECK CANCER WITH FOCUS ON OROPHARYNGEAL SQUAMOUS CELL CARCINOMA (OPSCC) PRESENTED AT GOLD COAST UNIVERSITY HOSPITAL FROM 2011–2012 Pawan Bajaj 1 , Marco Matos 1 , Venkat Vangaveti 2 , Bhaskar Karki 1 1. Medical Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia 2. James Cook university, Townsville, QLD, Australia Purpose:Oropharyngeal cancer incidence significantly increased recently in developed countries; in 2009 3,031 new cases of H&N cancer were reported in Australia. In this study, we evaluated epidemiology, pathology including p16 incidence, clinical characteristics and outcomes of patients with OPSCC presented at Gold Coast university Hospital from 2011–2012. Method:Retrospective analysis of patient presented at GCUH Head and Neck Multidisciplinary meeting from 2011–2012 was carried out. Data including diagnosis, smoking status, site of disease, p16 status, staging and recurrence were analysed. Results:A total 210 patients with H&N cancer were identified, 39% with OPSCC, 23% with oral cavity, 15% with laryngeal SCC, 10% with parotid tumor, 7% with nasopharyngeal SCC and 6% hypo pharyngeal SCC. OPSCC was more common in males (68%) and smokers (66%). Most common primary site of OPSCC was base of tongue (45%) followed by tonsil (40%). 65% of patients had P16 positive tumour. 50% presented with stage IVA disease and had definitive chemo-radiation as treatment. Approximately 20% patient presented with stage I/II and III disease. In comparison with P 16 negative OPSCC tumour, p16 positive OPSCC tumour in our study was associated with non smokers (57% vs. 20%; P=.009), higher staging (74% vs. 27%; P=.0001), higher nodal status (64% vs 11%; P .0001), lower T staging (42 vs. 57% P; 0.57) and lower incidence of recurrence (12% vs. 34%; P .01) at the time of analysis. Conclusion:P16 incidence in OPSCC in our population is similar to previous reports. Although p16+ patient presented with higher staging and nodal status; had lower incidence of recurrence compared to p16- population.

352 GENETIC TEST DECLINING AND HIGH CANCER RISK PERCEPTION IN DNA MISMATCH REPAIR GENE MUTATION FAMILIES Louisa Flander 1 , Antony Ugoni 1 , Louise Keogh 2 , Driss Ait Ouakrim 1 , Aung K. Win 1 , Clara Gaff 3 , Ingrid Winship 4 , Mark Jenkins 1 1. Centre for Epidemiology & Biostatistics, University of Melbourne, Melbourne, VIC, Australia 2. Centre for Women's Health, University of Melbourne, Melbourne, VIC, Australia 3. Paediatrics, Royal Melbourne Hospital, Melbourne, VIC, Australia 4. Clinical Genetics, Royal Melbourne Hospital, Melbourne, VIC, Australia Genetic counselling and/or testing to identify mutation status and risk of colorectal cancer (CRC) is not utilised in approximately half of people from mutation-carrying families. We studied perceived CRC risk and reasons for declining in 26 participants (mean age 43.1 years, 14 women) in the Australasian Colorectal Cancer Family Registry. All were relatives of mismatch repair gene mutation carriers, who had not been diagnosed with any cancer and had declined an invitation to attend genetic counselling and/or testing. Bounded estimates of perceived CRC risk over the next 10 years, understanding of genetic testing and CRC risk, reasons for declining testing and self-reported colonoscopy screening were elicited during a face-to-face semi-structured interview. A sub-group of decliners (31%) unconditionally rejected genetic testing compared to conditional decliners who would consider genetic testing in the future. Mean perceived 10-year risk of CRC was 54% [95% CI 37, 71] in unconditional decliners, compared with 20% [95% CI 5,36] in people who conditionally decline genetic testing, after adjusting for potential confounding factors (age, gender and reported screening colonoscopy). The unconditional decliner group perceive themselves to be at 3.26 times higher risk than conditional decliners. General practice interventions may increase testing uptake and/or screening for high-risk under-serviced individuals, whose health behaviours are inconsistent with their risk perceptions.

353 AN INTERNATIONAL SURVEY OF AWARENESS OF GENETIC RISK IN THE ADULT AND PAEDIATRIC CLINICAL SARCOMA COMMUNITY Kate McBride 1,2 , Timothy E Schlub 1 , Mandy L Ballinger 3 , David M Thomas 4 , Martin H Tattersall 2 1. Sydney School of Pubic Health, Sydney, NSW 2. The Chris O'Brien Lifehouse, Sydney Medical School, Sydney, NSW 3. Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 4. The Kinghorn Cancer Centre, Garvan Institute for Medical Research, Darlinghurst, NSW Integration of clinical genetics into oncology is variable. Sarcomas have a strong genetic component, with 1/30 patients carrying germline mutations in TP53. Identification of risk alleles is important for young sarcoma patients for future surveillance measures and for reproductive decisions. We aim to define genetic risk awareness amongst sarcoma clinicians. An online survey was developed and assessed for validity. The survey was emailed to the Connective Tissue Oncology Society and the Australasian Sarcoma Study Group. 159/2000 responded. Only clinicians were included in the analysis (N=124). Primary outcomes were attitudes towards genetic testing, knowledge of cancer risk, and awareness of risk reduction measures. 40% of clinicians favoured TP53 mutation testing in children regardless of family history, increasing to 80% if a family history was present and 87% if multiple primary cancers were present. Being an Australian clinician was significantly associated with being in favour of referral for genetic testing in sarcoma patients over 16yrs ( 2 =8.09, 1df p =0.017). 33% of clinicians weren't aware that screening of at-risk individuals may identify cancers at a more curable stage. Being a paediatrician was significantly associated with favouring WBMRI <16yrs ( 2 =16.49, 1df p =0.001). 57% of clinicians weren't aware of strategies to reduce the risk of having a baby with a mutation, though most clinicians (75%) considered them to be acceptable when told what the options were. Being an Australian clinician was significantly associated with being in favour of pre-natal diagnosis ( 2 =13.68, 1df p =0.037). When asked to estimate the chance of TP53 mutation carriers developing cancer 50yrs, 41% of clinicians estimated cancer risk accurately (above 60% by age 50). Sarcoma specialists don't have detailed knowledge of hereditary aspects of sarcoma. We know that ~1/30 adult sarcoma patients carry a germline TP53 mutation. Routine access to clinical genetics services is needed by the sarcoma clinics so that potential germline TP53 mutation carriers are identified. These mutations may then be taken into consideration for clinical management of carriers.

354 OUTCOMES OF MEDICAL ONCOLOGY PATIENTS ADMITTED TO ICU/HDU COMPARED TO NON-CANCER PATIENTS IN A TERTIARY CARE CENTRE Mihitha H Ariyapperuma 1 , Hilary Martin 1 , Andrew Davidson 1 , Adnan Khattak 1 1. medical oncology, Royal Perth Hospital, Perth, WA, Australia Background:Recent data suggest that the outcome of patients with solid tumours admitted to ICU/HDU is similar to non-cancer patients. However, there remains a perception in clinical practice that intensive care units are reluctant to accept medical oncology patients. The aim of our study was to compare the length of ICU/HDU stay and short term outcomes of medical oncology patients versus non-cancer patients. Methods:Data was retrospectively collected from medical case notes, RPH Cancer Registry and electronic patients' records between 8th Feb 2010 and 30th May 2014. All medical oncology patients admitted to ICU/HDU during this period were included. A separate cohort of non-cancer patients from different medical specialties admitted to ICU/HDU between 1st Jan 2014 and 30th May 2014 was used as the control arm. Results:58 medical oncology patients and 100 non-cancer patients were identified. The median age of both groups was 61 years. The median length of ICU/HDU stay was 2.1 vs. 2.6 days for cancer and non-cancer patients respectively. Common tumor types included: head & neck 20%, breast cancer 15%, oesophageal 11% & lung cancer 11%. Common reasons for admissions were septic shock (22%) respiratory failure (22%) and post surgery (13%). Interventions at ICU/HDA included inotropic support (18%), non-invasive ventilation (18%) and mechanical ventilation (13%). Mean APACHEII score for the patients with a malignancy was 17. The 30-day mortality rates were 30% for the cancer patients and 35% non-cancer patients. For the cancer group, the 3 month survival rate was 53% and the 6 month survival rate was 34%. Conclusion:The similar length of stay and short term outcomes of medical oncology patients and non-cancer patients admitted to ICU/HDU in our study support their admission to ICU/HDU during an acute illness.

355 PHARMACIST ADVICE ON THE SAFETY OF COMPLEMENTARY AND ALTERNATIVE MEDICINES (CAM) DURING CONVENTIONAL ANTICANCER TREATMENT Arti Thakerar 1 , Julie Sanders 1 , Michael Moloney 1 , Marliese Alexander 1 , Sue Kirsa 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Background:Complementary and Alternative Medicines (CAM) use is increasing, particularly in patients with a cancer diagnosis. When taken alone, many CAM are safe, but when taken concurrently with chemotherapy, radiotherapy, or prior to surgery, serious side effects or interactions may occur. Aim:To determine the incidence of CAM use among patients receiving chemotherapy at a metropolitan hospital, and to evaluate the effectiveness of pharmacist advice on the safety of CAM use during conventional anticancer treatment. Method:Between April and June 2013 all patients commencing their first cycle of chemotherapy on the Chemotherapy Day Unit (CDU) were interviewed by the pharmacist to evaluate ingested and injected CAM use. All patients using CAM were given comprehensive, personalised verbal information on safety and potential drug interactions with their conventional treatment. Consenting patients were followed-up to evaluate adherence to pharmacist recommendations. Results:152 patients were interviewed regarding CAM use. 39% (95% CI 32% to 47%) of patients were taking CAM; median number taken was 2 (range: 1–11) and total number of CAM was 141. 41% of CAM investigated had identified interactions with conventional anticancer treatments. 98% (95% CI 96% to 100%) of patients followed pharmacist recommendations relating to the safety of (dis)continuing CAM. Conclusion:Nearly 40% of patients commencing chemotherapy were concurrently taking CAM. Of the investigated CAM, over 40% had identified interactions, presenting a significant risk to patients both in terms of toxicities and treatment efficacy. Provision of personalised advice from an oncology pharmacist is a highly effective intervention to improve patient safety.

356 I-COPE: PILOT TESTING AN INNOVATIVE MODEL OF SUPPORTIVE AND PALLIATIVE CARE FOR PATIENTS WITH HIGH GRADE GLIOMA AND THEIR CARERS Anna Collins 1 , Michael Murphy 2 , Michelle Gold 3 , Vijaya Sundararajan 4 , Caroline Brand 5 , Carrie Lethborg 6 , Anthony Dowling 7 , Gaye Moore 8 , Jane Staker 9 , Jennifer Philip 10 1. Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia 2. Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy 3. Palliative Care Service, Alfred Hospital, Melbourne, VIC, Australia 4. Department of Medicine, St Vincent's Hospital & University of Melbourne, Fitzroy, VIC, Australia 5. Melbourne EpiCentre, University of Melbourne & Melbourne Health, Parkville, VIC, Australia 6. Social Work Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia 7. Department of Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia 8. Department of Psychiatry, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia 9. Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia 10. Centre for Palliative Care, St Vincent's Hospital, Melbourne, VIC, Australia Aims:This study aims to conduct a pilot implementation and evaluation study of an innovative model (I-CoPE) designed to support patients with newly diagnosed high-grade glioma and their carers. I-CoPE involves the provision of staged information, coordination, preparation through regular screening, and emotional support based upon stages reached in the illness course. Method: Design: Pilot implementation and program evaluation study of a complex intervention for patients with high grade malignant glioma and their carers. At key timepoints, routine screening and provision of structured information will occur, including: 1) During diagnosis admission; 2) Prior to commencing chemo-radiotherapy; 3) Completion of chemoradiotherapy. Outcomes of interest: (1) Acceptability and feasibility: enrolment and retention rates, screening and referral outcomes, health service utilization data (summarised by descriptive statistics); (2) Patient and carer outcomes: psychological distress, unmet supportive care and information needs, quality of life, satisfaction with care and preparedness to care (change from baseline to post-intervention assessed using paired sample t tests ( p <.05)). Results:I-CoPE is an acceptable and feasible intervention, with 95% enrolment rate of eligible patients (n=24) and their carers (n=20). Post I-CoPE: (1) Patients reported fewer unmet supportive care ( d =2. 7, p <0.001) and information ( d =0.8 , p =.06) needs and improved brain-cancer specific quality of life ( d =0.8 , p =.05). (2) Carers reported fewer unmet supportive care ( d =1. 0, p =.01) and information ( d =0.6 , p =.08) needs, improved quality of life ( d =0.7 , p =.08), lower carer burden ( d =1.1 , p =.0009), and increased preparedness to care ( d =0.7 , p =.06). Conclusions:The positive preliminary results of this pilot implementation of the I-CoPE model into a tertiary neuro-oncology service – both in terms of feasibility and short-term efficacy with improved patient and carer reported outcomes – show promise for further testing via a randomised controlled trial and the potential for broader dissemination.

358 PSYCHOMETRIC PROPERTIES OF AN AUSTRALIAN SUPPORTIVE CARE NEEDS ASSESSMENT TOOL FOR INDIGENOUS PEOPLE (SCNAT-IP) WITH CANCER Gail Garvey 1 , Vanessa L Beesley 2,3 , Monika Janda 3 , Peter O'Rourke 4 , Vincent YF He 1 , Anna L Hawkes 3 , Jacinta Elston 5,6 , Adele C Green 7,8 , Joan Cunningham 1 , Patricia C Valery 1 1. Menzies School of Health Research, Spring Hill, Qld, Australia 2. Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia 3. School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia 4. Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia 5. Faculty of Medicine, James Cook University, Townsville, Qld, Australia 6. Faculty of Medicine, James Cook University, Townsville, Qld, Australia 7. Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia 8. Manchester Academic Health Sciences Centre, Cancer Research UK Manchester Institute and University of Manchester, Manchester, UK Aims:There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of this study was to test the psychometric properties of a supportive care needs assessment tool for Indigenous Australian people (SCNAT-IP) with cancer. Methods:The SCNAT-IP was administered to 248 Indigenous Australian patients diagnosed with a range of cancer types and stages and all were receiving treatment in one of four Queensland hospitals. All original 39 items of the SCNAT-IP were assessed for ceiling and floor effects and analysed using exploratory factor analysis to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. Results:The SCNAT-IP retained 26 items in four factors (physical and psychological, hospital care, information and communication, and practical and cultural needs). This model was deemed the most clinically meaningful and accounted for 51% of the total variance. Internal consistency of the factors was good with Cronbach Alpha reliability coefficients ranging from 0.70–0.89. The SCNAT-IP showed a moderately strong positive correlation with the Distress Thermometer (r=0.60, p<0.001), The Cancer Worry Chart (r=0.58, p<0.001) and a moderately strong negative correlation with quality of life (AQoL-4D) (r=−0.56, p<0.001). Conclusion:The SCNAT-IP is a valid and reliable measure of multiple supportive care need domains specific to Indigenous Australian cancer patients and could be used in routine cancer care.

359 AN AUDIT AND EVALUATION OF THE LUNG CANCER JOURNEY: METROPOLITAN AND NON-METROPOLITAN Barbara Page 1,2,3 , Phoebe Shields 1 , Alison Hanks 4 , Henry Marshall 1,3 , Rayleen Bowman 1,3 , Ian Yang 1,3 , Kwun Fong 1,3 1. Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia 2. Central Integrated Regional Cancer Service, Department of Health, Bowen Hills, Queensland, Australia 3. Northside School of Medicine, The University of Queensland, Herston, QLD, Australia 4. School of Medicine, University of Queensland, St Lucia, Queensland, Australia Studies have shown that remoteness of residence is associated with an increase of lung cancer incidence and mortality. 1 The Department of Thoracic Medicine at The Prince Charles Hospital (TPCH) in partnership with Central Integrated Regional Cancer Services, Queensland is exploring whether differences exist in the lung cancer pathway for patients living within 50km of TPCH (metropolitan) to those living more than 50km from TPCH (non-metropolitan). We described and compared the time from referral to diagnosis and up to commencement of treatment for metropolitan and non – metropolitan patients with suspected lung cancer referred to TPCH from December 2010 to 31 May 2013. Data was obtained from various Queensland Health patient information systems. 562 patient records were reviewed and categorised according to distance from TPCH (metropolitan patients N=345 and non-metropolitan patients N=217). 51% of metropolitan patients (N=204) and 52% of non-metropolitan patients (N=106) commenced definitive treatment (surgery, chemoradiation or radiation alone) within 62 days from receipt of referral (UK NHS benchmark 62 days). The most significant difference was time to chemoradiation or radiation where metropolitan patients waited 26 days longer. Findings from this retrospective audit and evaluation study suggest that non-metropolitan patients are not placed at any significant disadvantage than their metropolitan counterparts in this service delivery model. The reasons why metropolitan patients in this study had a longer wait for chemoradiation or radiation is being explored. The authors acknowledge Central Integrated Regional Cancer Service's support in undertaking this study. 1. Queensland Government, Lung cancer in Queensland: an overview 2012. Brisbane Queensland Health 2012.

360 PATIENT AND CLINICIAN PERCEPTIONS OF THE FEASIBILITY AND UTILITY OF ROUTINE UNMET NEEDS SCREENING FOR INDIGENOUS AUSTRALIANS WITH CANCER Gail Garvey 1 , Belinda Thewes 1 , Vincent He 1 , Esther Davis 1 , Afaf Girgis 2,3 , Patricia Valery 1 , Kar Giam 4 , Alison Hocking 5 , Jackie Jackson 6 , Victoria Jones 7 , Desmond Yip 8 1. Menzies School of Health Research, Brisbane, QLD, Australia 2. South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia 3. Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia 4. Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia 5. Department of Social Work, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia 6. Aboriginal Health, Southern NSW Local Health District, Moruya, NSW, Australia 7. Psycho-oncology Service, Southern NSW Local Health District, Queanbeyan, NSW, Australia 8. Department of Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia Background:Indigenous Australians have poorer cancer outcomes than other Australians. Unmet needs assessment can help clinicians identify and manage patient concerns and are particularly useful for underserved populations. Despite this, few studies have evaluated the feasibility and acceptability of needs screening in routine care settings. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) assesses the unmet supportive care needs of Indigenous cancer patients. This study evaluates the clinical implementation of SCNAT-IP in routine care. Methods:Four metropolitan/regional oncology clinics in three Australian States and territories participated. Participants included 10 clinical staff and 36 adult Indigenous cancer patients (mean age 54 years) with heterogeneous tumours. Patients and clinicians completed brief purpose-designed questionnaires and interviews. Results:Patients reported high ratings (means>8/10) for acceptability, helpfulness and timing items. Higher education, awaiting surgery and comorbidity were significantly associated with higher patient acceptability (p<0.05). The majority (≥80%) of staff agreed that the SCNAT-IP was useful to clinical practice, should be used in routine care, and was acceptable to their patients. Patient and staff qualitative data suggests the SCNAT-IP improves patient-clinician communication, may detect issues not identified by current care protocols, and may be most appropriate early in the treatment trajectory. Qualitative data from staff identified areas for scale improvement. Clinical Implications:The results of this study provide empirical support for use of the SCNAT-IP in routine cancer care with Indigenous Australians. Strategies to promote the dissemination and uptake of the SCNAT-IP are currently underway. A large nationwide study using the SCNAT-IP to explore the unmet needs of Indigenous Australian cancer patients is underway. Routine use of the SCNAT-IP has the potential to improve cancer outcomes for Indigenous people with cancer.

361 QUALITY OF INFORMED CONSENT IN CLINICAL TRIALS Kim Adler 1 , Catherine L Johnson 1 , Sue Brew 1 , Louise Plowman 1 , Kirrilee Askew 1 1. Calvary Mater Newcastle, Waratah, NSW, Australia Introduction:Current data demonstrate that understanding of cancer clinical trials (CT) is variable with an estimated 40% of potential trial participants not understanding the essential elements of informed consent in the first instance. In 2008 the Medical Oncology Clinical Trials Unit at Calvary Mater Newcastle (CMN) commenced a quality project to assess participant's post-decision understanding of the study to which they consented. We used a validated post-decision survey, the Quality of Informed Consent (QUiC), to measure participants' actual (objective) and perceived (subjective) understanding of cancer CT. Methods:HREC approval as a quality project was granted prior to starting. Participants who consented to a randomised CT between July 2008 and July 2014 were invited to complete the survey 2–4 weeks post decision. The QUiC survey was introduced by an independent trial coordinator not involved in the participant's consent process. Completed questionnaires were reviewed by the responsible trial coordinator to clarify areas of uncertainty with participants. Results:100 participants completed the QUiC survey. Results show that all participants knew they were participating in a CT and that participation was voluntary. Participant understanding was variable in the following areas: dosing schedules, standard of care treatments, additional risks and discomforts, proven treatments and compensation if injured as a participant in a CT. The average objective score of participants was 78% and the average subjective score was 91%. These scores indicate that although some deficits in participants' objective understanding exist, subjectively they generally perceive their understanding of the clinical trial to be good. Conclusion:The QUiC survey proved to be a particularly useful tool in identifying participants with inadequate understanding of the essential elements of CT participation. This enabled us to identify and address weaknesses in departmental consent processes. Survey findings indicate that the majority of participants in our department had a good understanding of their CT.

362 RAINBOW: A GLOBAL, PHASE 3, DOUBLE-BLIND STUDY OF RAMUCIRUMAB (RAM) PLUS PACLITAXEL (PTX) VERSUS PLACEBO (PL)+PTX IN THE TREATMENT OF ADVANCED GASTRIC AND GASTROESOPHAGEAL JUNCTION (GEJ) ADENOCARCINOMA FOLLOWING DISEASE PROGRESSION ON FIRST-LINE PLATINUM- AND FLUOROPYRIMIDINE-CONTAINING COMBINATION THERAPY: A SUBGROUP ANALYSIS OF WESTERN POPULATION Hansjochen Wilke 1 , Philip Clingan 2 , Sumi Ananda 3 , galina kurteva 4 , Tiit Suuroja 5 , Gunnar Folprecht 6 , Alexander Beny 7 , Davide Pastorelli 8 , Alvydas Cesas 9 , Zbigniew Nowecki 10 , Cornelia Toganel 11 , György Bodoky 12 , Oleg Lipatov 13 , Maria Limon Miron 14 , David Cunningham 15 , Sebastian Cummins 16 , Zev Wainberg 17 , Andrew Ko 18 , Michael Emig 19 , Kumari Chandrawansa 20 , Eric van Cutsem 21 1. Kliniken Essen-Mitte, Essen, Germany 2. Southern Medical Day Care Centre, Wollongong, NSW, Australia 3. Western Health, Melbourne, Victoria, Australia 4. Specialised Hospital For Active Treatment in Oncology, Sofia, Bulgaria 5. North Estonia Medical Centre, Tallinn, Estonia 6. Universitaetsklinikum Carl Gustav Carus, Dresden, Germany 7. Rambam Health Care Campus, Haifa, Israel 8. Istituto Oncologico Veneto IRCCS, Padova, Italy 9. Klaipeda University Hospital, Klaipeda, Lithuania 10. Centrum Onkologii Instytut M. Sklodowskiej-Curie, Warszawa, Poland 11. Spitalul Clinic Judetean Mures, Targu-Mures, Romania 12. St. László Hospital, Dept. of Oncology, Budapest, Hungary 13. Republican Clinical Oncology Dispensary, Ufa, Ufa, Russia 14. H.U.V. del Rocío, Seville, Spain 15. Royal Marsden Hospital, London, United kingdom 16. Royal Surrey County Hospital, Guilford, United Kingdom 17. Ronald Reagan UCLA Medical Center, Los Angeles, USA 18. University of California, San francisco, United States 19. Eli Lilly and Co , Homburg, Germany GmBH 20. Eli Lilly, Indianapolis, USA 21. Digestive Oncology, University Hospitals Gasthuisberg/Leuven, Leuven, belgium Aims:RAINBOW, a global, placebo-controlled, double-blind, phase III trial, demonstrated significant improvements in overall survival (OS), progression-free survival (PFS), and response rates (ORR) in advanced gastric or GEJ adenocarcinoma patients receiving ramucirumab (RAM), a human IgG1 VEGF receptor 2 targeted antibody, plus paclitaxel (PTX). We present the pre-planned subgroup analysis of Western patients (Region 1). Methods: Pts received RAM (8mg/kg IV q2w) or placebo (PL) plus PTX (80mg/m2 d1, 8, 15 of a 4 week cycle) until disease progression, unacceptable toxicity, or until other discontinuation criteria were met. Eligible pts had ECOG PS≤1; and adequate organ function. Randomization was stratified by geographic region (Region 1: Europe, Israel, Australia, and United States, Region 2: Argentina, Brazil, Chile, and Mexico, and Region 3: Asia), time to progression after first dose of first line therapy, and disease measurability. OS and PFS were compared between treatment arms using a stratified log-rank test. ORR was analyzed using a CMH test. Results: Of the 665 randomized patients, 398 (RAM+PTX: 198; PTX: 200) were Western patients. Baseline characteristics were generally balanced between arms. The OS Hazard Ratio (HR) was 0.726 (95% CI 0.580, 0.909; p=0.0050). Median OS was 8.57m for RAM+PTX and 5.91m for PTX. The HR for PFS was 0.631 (95% CI 0.506, 0.786; p<0.0001). Median PFS was 4.24m and 2.83m. Grade≥3 adverse events (AEs) occurring in >5% of patients on RAM+PTX were: neutropenia, hypertension, leukopenia, fatigue, asthenia, anemia, abdominal pain, and general physical health deterioration. Conclusions: In the Western population of the RAINBOW study, the significant benefits observed in OS, PFS, and ORR were consistent with those in the overall ITT population. The adverse event profile was similar to the overall population.

363 ANALYSIS OF ADJUVANT CHEMOTHERAPY IN EARLY STAGE MERKEL CELL CARCINOMA Zia Ansari 1 , Ina IC Nordman 1 1. Calvary Mater Newcastle, Waratah, NSW, Australia Aim:Merkel Cell Carcinoma (MCC) is a rare, aggressive and highly metastatic neuroendocrine tumour of the skin. Role of adjuvant chemotherapy is controversial in early stage MCC. Methods:A retrospective review of electronic and paper medical records was conducted of patients with MCC localised to primary cutaneous (PC) site and lymph nodes treated with radiotherapy (RT) or chemoradiotherapy (CRT) with weekly carboplatin (AUC 2) followed by 3 cycles of adjuvant chemotherapy (CT) with carboplatin and etoposide at our institution between 2008 and 2013. Results:17 patients identified of whom 12 completed the entire protocol. Of these 12, 75% were male, 50% ex-smokers; with median age 69 years (48–84), predominantly stage III of which −18% presented with PC site and 82% with an unknown primary (UP) site involving nodal basin (cervical/parotid 67%, axillary 11%, and inguinal 22%). Patients presenting with PC sites involving upper limb, lower limb and trunk were 1, 1, and 1 respectively. Median size of PC site was 2.9cm (0.9–6). 5 patients (42%) underwent complete lymph node dissection (LND); 2 had LND followed by RT then adjuvant CT, 3 had LND followed by CRT then adjuvant CT. Definitive CRT followed by adjuvant CT was provided to 6 (50%) patients; 1 patient had primary resected but regional lymph node (LN) was unresectable and 1 patient had unresectable primary. 67% achieved complete radiologic response and 33% had partial response. 1 patient had primary with one positive sentinel lymph node resected and received CRT followed by adjuvant CT. Complications were generally minimal. Median time to progression 10.3 months (6–16). Median overall survival 22.6 months (15–35), however, 75% of patients remain disease free on follow up. Conclusion:In our practice multimodality approach was well tolerated and resulted in better outcomes. The above data are significant to clinical management of patients presenting with this rare cancer subtype.

364 P16 PREVALENCE AND INCIDENCE OF RECURRENCE IN DIFFERENT SUBSITES OF OROPHARYNGEAL CANCER: RETROSPECTIVE ANALYSIS AT SINGLE LEVEL INSTITUTION FROM 2011–2012 Pawan Bajaj 1 , Viral Upadhyay 1 1. Gold Coast University Hospital, Gold Coast, QLD, Australia Purpose:P16 is the single most important prognostic variable in oropharyngeal squmaous cell cancer (OPSCC), surpassing traditional prognostic factors for both cancer specific survival and recurrence free survival. Disease stage has no prognostic significance in p16-positive OPSCC 1 . OPSCC patients are often reported as one group in articles and studies regardless that within the subsites of the oropharynx there are possible differences regarding P 16 prevalence and incidence of disease recurrence. We further analysed P16 prevalence in different sub-sites of oropharynx and rates of recurrence in Local population. Methods:We identified patients presented at Head and Neck Multidisplinary meeting from 2011–2012 at Gold Coast University Hospital. Patients with Oropharyngeal SCC were included in study. Retrospective analysis of P 16 status at different subsites of oropharyngeal cavity and recurrence was carried out. Result:80 patients diagnosed with oropharyngeal cancer presented at Gold Coast University Hospital Head and Neck Multidisciplinary meeting from 2011–2012 were identified. 36 patients (45%) were diagnosed with base of tongue cancer (BOT), 32 (40%) with tonsil and 12 (15%) patients with other oropharyngeal sites. Of these 80 patients P16 status was available for 76 (95%) patients. In the BOT group 25 biopsies (69%) were P 16 positive, in tonsil group 15 (46%) and in other oropharyngeal group 9 (75%). Recurrence rates in P 16 positive were 5% in BOT/ other OPSCC and 6% in tonsillar SCC at the time of study. Conclusion:P 16 prevalence in our group was lowest in tonsillar OPSSC (46%) and recurrence rates were similar in all subsites of oropharynx. Larger study with longer follw up is required to analyses outcomes at different subsites of p16 positive OPSCC. Our study was limited by small number and retrospective nature.

365 SIGNIFICANT RELATIONSHIP BETWEEN MTHFR C677T POLYMORPHISM AND GASTRIC CANCER IN FARS Aboozar Barzegar 1 1. Motahary hospital, Shiraz, Fars, Iran Background:Gastric Cancer (GC)as the third most common malignancy in Iran, accounts for ~50% of all GI cancers who cause 55% of all cancer-related deaths in Iran. Upper gastrointestinal cancer accounts for more than 50% of all cancer deaths in this area. Methylenetetrahydrofolatereductase (MTHFR) enzyme reductase catalyzes the conversion of 5, 10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, a cosubstrate for homocysteineremethylation to methionine. Genetic variation in this gene influences susceptibility to occlusive vascular disease, neural tube defects, and some types of cancer, and mutations in this gene are associated with methylenetetrahydrofolatereductase deficiency. Individual with two copies of 677C (677CC) have the “normal” or “wildtype” genotype. Individuals of 677TT are predisposed to mild hyperhomocysteinemia, because they have less active MTHFR available to produce 5-methyltetrahydrofolate (which is used to decrease homocysteine). We aimed to study the association between this polymorphism and GC in our province. Methods:We enrolled 100 patients with mean age 65.9Yrs. affected with primary GC and same age- and sex- matched healthy control participants. The analysis has been carried out by PCR-RFLP on DNA extractions from peripheral blood. Results:In the case group, the genotype was 45%, 515%, and 4% for CC, CT, and TT, respectively. And for controls were 62%, 33%, and 5%. In comparing case and control group, a significant association was found (P=0.006). Conclusion:Because of high frequency of GC in our province, the investigations about the role of genetic susceptibilities for GC are very important. Finding relationships could help us to find prognostic factors for persons who are at the risk of affecting to GC in.

366 SERUM VITAMIN A, E, C AND CATALASE IN ACTIVE AND PASSIVE SMOKERS IN NIGERIA Iya Eze Bassey 1,2 , Alphonsus E. Udoh 1,2 1. Nigerian Cancer Society, Calabar, Cross River State, Nigeria 2. Department of Medical Laboratory Science, University of Calabar, Calabar, Cross River State, Nigeria Background:Smoking is a very deadly act with a very high mortality rate associated with smoking-related illnesses. Recently, there has been major concern that passive smokers face the same health risk as active smokers. Cotinine is a major nicotine metabolite that may be used as a marker for both active smoking and as an index to environmental tobacco smoke exposure. Animal studies show that nicotine inhibits anti-oxidant enzymes and is associated with low levels of vitamins. Research objectives:To estimate the levels of cotinine, Vitamin A, E, C and catalase and establish a relationship between them in the two groups of smokers. Methods:Serum levels of cotinine, Vitamin A, E and C and catalase were estimated in 30 cigarette smokers, 30 passive smokers and 30 non-smokers recruited from Calabar metropolis. Results and conclusion:Serum cotinine levels were significantly (p>0.05) higher in active smokers who had a mean cotinine value of 67.67±11.50ng/ml than in passive smokers that had a mean cotinine level of 2.44±0.36ng/ml and controls whose mean cotinine levels were 0.96±0.24ng/ml. Serum vitamins A and E were significantly (p<0.05) lower in active (with mean values of 53.99±1.99µg/dl and 31.67±2.59mg/ml respectively) and passive smokers (with mean values of 51.14±0.80µg/dl and 37.30±1.68mg/ml respectively) when compared to that of controls (67.49±1.50µg/dl and 55.81±1.67mg/ml respectively). However there was no significant difference in the serum Vitamin C levels among the three groups. The mean catalase level of active smokers was 48.55±11.80µmol/ml/min and was significantly (p<0.05) lower than that of the controls (53.32±7.59 µmol/ml/min). There was a significant positive correlation between Vitamins A and E in both active smokers (r=0.443; p<0.05) and passive smokers (r=0.513; p<0.05). Passive and active smoking depletes vitamins A and E and catalase, this may be a contributing factor to the diseases linked to cigarette smoking.

367 GENETIC AND EPIGENETIC CHANGES AND THEIR EFFECT ON PROGNOSIS AND PREDICTION OF COLORECTAL CANCER Arpad Bóday 1 , Spiros Tavandzis 1 , Veronika Krhutova 1 , Kateřina Horka 1 , Hana Dvorakova 1 , Pavla Vanickova 1 , Jarmila Ryskova 2 , Alice Janeckova 2 , Martin Nemecek 3 , Ivo Kaspercik 3 1. Laboratory of Medical Genetics – Department of Molecular Biology, AGEL Research and Training Institute – Nový Jičín Branch, AGEL Laboratories, Nový Jičín, Czech Republic 2. Radiotherapy and Clinical Oncology, Comprehensive Cancer Center, AGEL a.s., Nový Jičín, Czech Republic 3. Laboratory of Pathology, AGEL Research and Training Institute – Nový Jičín Branch, AGEL Laboratories, Nový Jičín, Czech Republic Background:Development of colorectal cancer (CRC) is a multi-step process. It includes a range of different molecular events that are causing gradual conversion of epithelium to carcinoma by three relatively well defined pathways. Aim:The aim of this work was the genetic and epigenetic characterization of CRC in group of 267 patients. Methods:DNA was isolated from frozen tumor and healthy tissues. MSI and LOH were studied in 8 loci. Mutation analysis were focused on genes K-ras, BRAF, PIK3CA, APC and TP53. Methylation status was analyzed in genes hMLH1, APC, CDKN2A, TP53, MGMT and loci MINT1, MINT2, MINT17, MINT31. The effect of various genetic and epigenetic changes in relation to the survival length was evaluated by Kaplan-Meier survival analysis. Results:Pathogenic mutations in genes K-ras, BRAF, PIK3CA, APC and TP53 were detected in the analyzed group of 267 CRC patients with mutation frequencies of 38.5%, 6.8%, 7.2%, 39% and 12%, respectively. MSI was found in the 10.5% of carcinomas. LOH was determined in genes APC, hMSH2, BRCA1, DCC, c-Kit and HSD3B1 with the following frequencies: 11.6%, 3.4%, 3.4%, 4.1%, 1% and 0.8%. Hypermethylation was detected in APC (37.2%), hMLH1 (18.5%), TP53 (11.8%), CDKN2A (15.7%), MGMT (31.5%) genes and MINT1 (27.1%), MINT2 (42.9%), MINT17 (8.9%), MINT31 (17.8%) loci. Conclusions:In this study, we present results of genetic and epigenetic analysis performed on tumor samples and we speculate about the classification of the CRC patients into different molecular subtypes within the context of pathological, histological and immunohistochemical results. Results are consistent with published data and they confirm that the biological nature and progression of colorectal cancer is determined by total accumulation of molecular changes, rather than a sequence of events. CRC does not have its own unique methylation status, but a combination of several epigenetic features can successfully predict the prognosis of the disease.

368 THE IMPACT OF MEDICAL EMERGENCY TEAM RESPONSE ON PATTERNS OF CARE AT THE END-OF-LIFE FOR PEOPLE WITH INCURABLE CANCER Christine Brown 1 , Allison Drosdowsky 1 , Meinir Krishnasamy 1 1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia Introduction:Medical emergency teams (MET) were introduced to respond to clinical deterioration usually in the form of vital sign abnormalities 1 . These abnormalities are also present in the dying patient where aggressive intervention may not be in the patient's best interest 2 . Methods:Patterns of care received by two cohorts of cancer patients, those who experienced at least one MET call within their final week of life (n=50) and those who did not (n=50) were compared in a cross sectional study. Medical charts were reviewed for the occurrence of identified positive and negative quality of death indicators. Quality of death scores were derived by attributing one point for each positive indicator received and each negative indicator not received, a higher score corresponded with a greater quality of death. Results:Patients who did not receive a MET call had a significantly higher median quality of death score when compared with the patients who did receive a MET call (10.0 versus 9.0, p=0.01). For patients who had a MET call, the MET directly influenced end-of-life care for 38% (n=19). This subgroup had a higher quality of death score (9.6 versus 8.2, p=0.02) than patients where the MET did not influence their end-of-life care (n=31). Amongst patients who received a MET call, initial outcome was significantly different (p=0.01) with 5% of patients where the MET team directly influenced end-of-life admitted to the intensive care unit (ICU) compared to 39% of patients whose end-of-life care was not directly influenced by the MET. Conclusion:These results support existing evidence that ICU is not an appropriate environment for optimal care of a dying cancer patient. End-of-life care made up a substantial part of the role of the MET within this study setting and as such, comprehensive training in aspects of palliative care may be of benefit to members of the MET.

369 ASSESSMENT OF TIME TO COMMENCEMENT OF NEOADJUVANT LONG COURSE CHEMORADIOTHERAPY (LCCRT) FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA PATIENTS IN A TERTIARY REFERRAL HOSPITAL Hayden Christie 1 , Matthew Burge 1 , Melissa Eastgate 1 , David Wyld 1 1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia Background:Neo-adjuvant LCCRT is a standard treatment for stage 2 and 3 rectal cancer. To what extent delays in commencing treatment influences outcome is unknown. However such delays may exacerbate patient anxiety and prolong symptoms, which often significantly impacts quality of life. Currently the only identifiable guidelines are the National Health Service general cancer treatment targets of 2 months from urgent referral or 31 days from seeing a specialist. We assessed how long nonmetastatic rectal cancer patients at our institution waited to commence chemoradiotherapy. Methods:Patients treated concurrently with 5-fluorouracil and radiation from January 2011 to December 2013 at the Royal Brisbane and Women's Hospital were identified. Dates were retrospectively collected for multi-disciplinary team (MDT) discussion, or first radiation oncology outpatient appointment (if no MDT prior to treatment), and the start of radiation and chemotherapy. Results:A total of 113 patients were treated during this period, of whom 25 were not discussed at MDT (18 were discussed after commencement) and 11 ultimately didn't undergo surgery (metastases, comorbidities, patient choice). The median time from MDT discussion to start of chemoradiation was 32 days (95% CI 29–34) (range 1–69). 6 patients were found to have a reason for a longer than expected delay (co-morbid complications, floods, and patient uncertainty). Conclusion:Currently there are no national benchmarks as to recommended time to start neo-adjuvant treatment. Development of such recommendations may assist with audit and comparison of the quality of care provided across institutions. High demand on finite services and planning requirements likely contribute to the waiting time. There is increasing interest in, and data supporting, induction chemotherapy which may be one method of shortening this time interval.

370 ASSESSMENT OF LONG COURSE CHEMORADIOTHERAPY (LCCRT) IN REGARDS TO COMPLETION OF CHEMOTHERAPY. THE EXPERIENCE OF A TERTIARY REFERRAL HOSPITAL Hayden Christie 1 , Matthew Burge 1 , Melissa Eastgate 1 , David Wyld 1 1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia Background:When treating rectal adenocarcinoma, preoperative LCCRT has been shown to reduce local recurrence rates. However adding chemotherapy increases toxicity. We reviewed patients undertaking LCCRT to assess rates of treatment compliance and the influence of specific adverse effects. Methods:A retrospective assessment of all patients treated with LCCRT using infusional 5-fluorouracil from January 2011 to December 2013 was conducted. Data was extracted for radiation and chemotherapy start and finish dates including treatment delays. Results:131 patients were identified. 113 were treated with curative intent and 18 palliatively. The median duration of chemotherapy was 5 weeks (5 weeks for curative, 5.5 weeks for palliative). 13 (10%) of patients received ≤3 weeks, 10 (8%) 4 weeks, 45 (34%) 5 weeks, 63 (48%) all 6 weeks. Toxicity was the reason for cessation in all. 120 (92%) completed all fractions of radiation therapy, 8 (6%) 25 fractions and 3 (2%) patients received 20 fractions or less. Conclusion:LCCRT is associated with well recognised toxicity. Data from our cohort shows that the proportion of patients unable to complete the prescribed 6 weeks of combined modality treatment is not insignificant. This is despite being treated in a unit that treats large numbers of these patients. As the majority still received 30 fractions of radiation therapy, chemotherapy cessation to avoid worsening toxicity may have limited any compromise to radiation delivery.

371 PATHOLOGIC RESPONSE OF RECTAL ADENOCARCINOMA TO PREOPERATIVE LONG COURSE CHEMORADIOTHERAPY (LCCRT). AN ASSESSMENT AT A TERTIARY REFERRAL HOSPITAL Hayden Christie 1 , Matthew Burge 1 , Melissa Eastgate 1 , David Wyld 1 1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia Background:LCCRT reduces local recurrence rates but its impact on sphincter preservation and survival are debated. An improved pathologic response is associated with better prognosis for an individual patient. The optimal chemotherapy regimen is unknown but our standard is continuous infusion 5-fluorouracil (FU) at 225/mg/m2/day. We compared the pathologic response rate in our population to that published in the literature. In addition, we audited the quality of the surgical specimens. Methods:113 consecutive patients from January 2011 to December 2013 were identified as being treated at the Royal Brisbane and Women's Hospital with LCCRT. Data was extracted for clinical and pathological staging, sphincter preservation and surgical quality as defined by grade of total mesorectal excision (TME). Results:107 patients had a recorded clinical staging. 5 (5%) stage 1, 21 (20%) stage 2, 81 (76%) stage 3. 100 patients underwent surgery. Pathological staging showed 18% had a pCR, 30% were stage 1, 17% stage 2, 34% stage 3 and 13% not recorded. Pathological staging was increased in 7%, unchanged in 30%, improved by 1 stage in 23% and 2 stages in 20% for an overall downstaging of 59%. Sphincter preservation occurred in 58%. Complete TME occurred in 62% and nearly complete in 21%. Median time from LCCRT to surgery was 54 days. Conclusion:Our outcomes, using continuous infusion FU with LCCRT in regards to downstaging were comparable to those reported in the literature. Surgical quality in regards to TME was comparable and timing of surgery after completion of LCCRT occurred within the 6–8 week timeframe recommended by international guidelines. Of note is that treatment occurred in a tertiary referral centre with a specialised colorectal service where difficult tumours, eg. low and locally advanced, and patients with significant comorbidities are referred. This may have had an influence on this data.

372 LOCALLY ADVANCED AND METASTATIC PANCREATIC CANCER: AN ASSESSMENT OF THE PROVISION OF CHEMOTHERAPY AT A TERTIARY REFERRAL HOSPITAL Hayden Christie 1 , Matthew Burge 1 , Melissa Eastgate 1 , David Wyld 1 1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia Background:Recently, chemotherapy options have expanded for patients with advanced pancreatic cancer. FOLFIRINOX has recently become the standard first line regimen at our institution. We therefore analysed chemotherapy delivery, toxicity, patient characteristics and outcome prior to this time as a reference for future comparison. Methods:A chart review was conducted on 34 consecutive patients with inoperable advanced pancreatic adenocarcinoma treated with chemotherapy at the Royal Brisbane and Women's Hospital from January 2011 to December 2013. Data was collected on patient characteristics, chemotherapy duration, clinical trial enrolment, subsequent treatment lines, response (CA19.9, CT) and survival. Dose reductions and hospital admissions were measured as indicators of treatment toxicity. Results:Patients received a median 14 weeks of 1 st line treatment with 6 (18%) on a clinical trial. 30 (88%) received gemcitabine, 3 (9%) FOLFOX and 1 (3%) FOLFIRINOX. 10 (29%) received second line treatment, 3 (9%) 3 rd line treatment. 21 (62%) required admission during chemotherapy for 40 admissions in total with 9 (26%) for treatment toxicity. 11 (32%) required dose reduction during first line treatment. 23 (68%) had tumour in the head of the pancreas with 16 requiring stenting (13 prior, 3 during chemotherapy). Baseline characteristics were: 50% were ≥70 years old; 44% ECOG 0-1, 3% ECOG 2, 53% not recorded; median bilirubin 17micromol/L, albumin 35g/L, and LDH 265U/L; 41% had a recorded reduction in CA19.9 and 26% a CT response. Median survival was 7.5 months (evaluable for 20 patients). Conclusion:We now have an accurate baseline of our advanced pancreatic cancer patients and their characteristics which we can compare to going forward. Given we are a tertiary referral centre we were surprised at the small number of patients seen over a 3 year period, further research could look at reasons for this. Our department has a strong track record of clinical trial work and this data will be used to help guide our involvement in and development of future clinical trials.

373 CIRCULATING TUMOUR CELLS IN EARLY STAGE BREAST CANCER THE EMP ATHY BREAST CANCER NETWORK Anthony Dowling 1 , Michael Henderson 1,2 , Christobel Saunders 3 , Linda McInnes 3 , Kym Berchtenbreiter 4 , Tony Blick 5,6 , Vijani Dissanayake 5 , Anthony Tachtsidis 5,2 , Dexing Huang 5 , Vijaya Sundararajan 7 , Alexander Dobrovic 9,8 , Erik (Rik) Thompson 5,2, 6 1. St. Vincent's Hospital, Melbourne 2. Department of Surgery, The University of Melbourne, Melbourne 3. School of Surgery, The University of Western Australia, Perth 4. Breast Cancer Network Australia, Melbourne 5. St. Vincent's Institute, Melbourne 6. Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane 7. Department of Medicine, The University of Melbourne, Melbourne 8. Ludwig Institute for Cancer Research, Melbourne 9. Olivia Newton-John Centre for Wellness and Cancer, Melbourne http://www.empathybcn.org.au The EMP athy Breast Cancer Network (BCN) is a national collaboration including scientists, breast surgeons, medical oncologists and a consumer advocate investigating the role of circulating tumour cells (CTC) and epithelial mesenchymal plasticity in breast cancer recurrence. Aim:To assay CTC from the blood and disseminated tumour cells (DTC) from the bone marrow in a prospective cohort of women with early stage breast cancer (EBC) at diagnosis and during follow-up. Methods:Women with EBC treated at St Vincent's Hospital Melbourne were recruited from Oct 10–Jun 14. Bone marrow and blood were taken at diagnosis, with blood samples repeated at 3, 6, 12 and 24 months. CTCs and DTCs were isolated using in-house anti-EpCAM and anti-EGFR immunobeads in parallel and sequentially. Following RNA extraction a 43 gene assay panel was assessed by quantitative RT-PCR, and the results compared with healthy volunteer controls. Results:Forty nine women were recruited. The median age was 62 years (34–87 years), 76% had T1-2 tumours, the rest being T3/4, 45% were node positive, 77% had IDC while 20% had lobular cancers. Eighty-six per cent were ER+/PR+, 10% HER 2+, and 8% were triple negative. Fifty-nine per cent received adjuvant chemotherapy, 10% trastuzumab, and 85% received adjuvant hormonal therapy. Seventy per cent have received adjuvant radiation. Median follow-up is 15 months (1–39 months). The first 29 cases have been analysed. Graphs of trial samples versus controls have been generated, and examples of positive and negative samples will be shown. Analysis of all 49 cases and follow up bloods is ongoing. Conclusion:The women involved are keen to participate in clinical research. CTC and DTC appear present in some women with early stage breast cancer. Some molecular markers appear more prominently. The EMP athy BCN gratefully acknowledges the support of the National Breast Cancer Foundation.

374 IPILIMUMAB VERSUS PLACEBO AFTER COMPLETE RESECTION OF STAGE III MELANOMA: EFFICACY AND SAFETY RESULTS FROM THE EORTC 18071 PHASE III TRIAL Alexander M Eggermont 1 , Vanna Chiarion-Sileni 2 , Jean J Grob 3 , Reinhard Dummer 4 , Jedd D Wolchok 5 , Henrik Schmidt 6 , Omid Hamid 7 , Caroline Robert 8 , Paolo A Ascierto 9 , Jon M Richards 10 , Virginia Ferraresi 11 , Michael Smylie 12 , Jeff S Weber 13 , Michele Maio 14 , Cyril Konto 15 , Veerle de Pril 16 , Stefan Suciu 17 , Alessandro Testori 18 1. Cancer Institute Gustave Roussy, Villejuif, France 2. Melanoma Oncology Unit, IOV-IRCCS, Padova, Italy 3. Hôpital de la Timone, Marseille, France 4. University of Zürich Hospital,, Zürich, Switzerland 5. Memorial Sloan-Kettering Cancer Centre, New York, NY, USA 6. Aarhus University Hospital, Aarhus, Denmark 7. The Angeles Clinic and Research Institute, Los Angeles, CA, USA 8. Institut Gustave Roussy, Villejuif, France 9. Istitute Nazionale Tumori Fondazione “G. Pascale”, Naples, Italy 10. Oncology Specialists S.C., Park Ridge, IL, USA 11. Istituti Fisioterapici Ospitalieri, Rome, Italy 12. Cross Cancer Institute, Edmonton, Alberta, Canada 13. H. Lee Moffitt Cancer Centre & Research Institute, Tampa, FL, USA 14. University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy 15. Bristol-Myers Squibb, Wallingford, CT, USA 16. Bristol-Myers Squibb, Braine-l'Alleud, Belgium 17. EORTC Headquarters, Brussels, Belgium 18. European Institute of Oncology, Milan, Italy Aims:Ipilimumab is a fully human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen-4 to augment antitumor immune responses. We report a phase III trial that evaluated Ipilimumab as an adjuvant therapy for resected stage III melanoma at high risk of recurrence. Methods:In this randomised, double-blind trial, eligible patients included those ≥18 years of age who underwent complete resection of stage III cutaneous melanoma (excluding lymph node metastasis ≤1mm or in-transit metastasis). 951 patients were randomised (stratified by stage and region) to receive Ipilimumab 10mg/kg (n=475) or placebo (n=476) every 3 weeks for 4 doses, then every 3 months for up to 3 years until completion, disease recurrence, or unacceptable toxicity. Primary endpoint was recurrence-free survival (RFS), analysed on the intent-to-treat population. 512 RFS events (recurrence or death) were needed to provide 90% power to detect an Ipilimumab vs Placebo hazard ratio (HR) of 0.75 (2-sided = 5%). Results:Overall, 20%/44%/36% of patients had stage IIIA/IIIB/IIIC. At a median follow-up of 2.7yrs, Ipilimumab (234 events) significantly improved RFS vs Placebo (294 events): median RFS was 26.1 vs 17.1 months, HR was 0.75 (95% CI; 0.64, 0.90), P=0.0013. RFS benefit was consistent across subgroups. Most common grade 3/4 immune-related adverse events (irAEs) in Ipilimumab and Placebo were gastrointestinal (15.9% vs 0.8%), hepatic (10.6% vs 0.2%), and endocrine (8.5% vs 0%). Most irAEs were managed and resolved using established algorithms. Of 471 patients on Ipilimumab, 52% discontinued due to AEs [182 (38.6%) within 12 weeks]; 5 (1.1%) died due to drug-related AEs. Conclusions:In this phase III trial, Ipilimumab as adjuvant therapy provided a clinically and statistically significant improvement in RFS vs placebo for patients with stage III melanoma at high risk of recurrence. AE profile was generally consistent with that observed in advanced melanoma, with a higher incidence of endocrinopathies.

375 SAFETY OF COMBINED EXEMESTANE AND EVEROLIMUS IN POSTMENOPAUSAL HORMONE RECEPTOR POSITIVE METASTATIC BREAST CANCER PATIENTS – A RETROSPECTIVE ANALYSIS Jenny Gilchrist 1 , J Todd 2 , R Kefford 1, 2 1. Macquarie University Hospital, Macquarie University, NSW, Australia 2. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia Background:Combination therapy with exemestane and everolimus prolongs progression-free survival in patients with metastatic breast cancer but carries significant and novel toxicities with up to 19% of patients ceasing treatment due to adverse events. Aims:To assess the rate of adverse events in metastatic breast cancer patients commencing exemestane and everolimus combination treatment in the Western Sydney Oncology Network. Methods:Over a period of 12 months, thirty-four women on combination therapy were identified. Adverse events were identified as documented in the medical records. The records held by the Clinical Nurse Consultant were analysed for additional adverse events. Maximum follow-up is 15 months. Results:In a more heavily pre-treated population than in previously published trials, 41% of patients ceased therapy due to toxicities associated with treatment and 60% patients ceased due to progressive disease. The incidence of all grades of stomatitis was 56% with grade 3/4 toxicity 6%. The incidence of pneumonitis was 12%. A total of 56% patients required dose interruptions or reductions whilst on combination therapy. Conclusions:In a more heavily pretreated population of metastatic breast cancer patients than in the reported Bolero-2 study, more patients ceased treatment due to toxicities. Excepting this, our data was similar to that in the previously reported Bolero-2 Trial.

376 MERKEL CELL CARCINOMA: A CASE OF PALLIATIVE UPPER LIMB AMPUTATION IN A PATIENT WITH REFRACTORY IN-TRANSIT METASTASES Dakshika A Gunaratne 2,1 , Julie Howle 2,1 , Michael J Veness 3,4 1. Surgery, University of Sydney, Sydney, NSW, Australia 2. Surgical Oncology, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia 3. Radiation Oncology, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia 4. Medicine, University of Sydney, Sydney, NSW, Australia Background:Merkel cell carcinoma is a rare and often aggressive neuroendocrine cutaneous malignancy typically arising in older Caucasians. Immunosuppression, exposure to ultraviolet radiation and Merkel cell polyomavirus are implicated in its pathogenesis. In-transit metastases, secondary to dermal lymphatic vessel invasion, may occur in the subcutaneous tissues between the primary site and draining lymph nodes. Methods:We report an unusual case of a Merkel cell carcinoma, presenting initially on the hand of a 70 year old female with the rapid development of liver metastases and in-transit metastases that eventually involved the entire left upper limb. The patient had previously undergone left axillary dissection and irradiation for breast cancer. Results:Initial palliative chemotherapy with Carboplatin and Etoposide produced a minimal response from the in-transit metastases, but resolution of the liver metastases and she proceeded to a Docetaxel regime. Palliative whole limb radiotherapy was also ineffective. The in-transit metastases rapidly progressed and were refractory to treatment leading to a marked impact on her quality of life secondary to infection and bleeding. She ultimately proceeded to an uncomplicated palliative above elbow amputation with marked improvement in her well-being. Detailed photographic imaging of her clinical course will be provided. Conclusion:Merkel cell carcinoma can be rapidly progressive with a propensity for regional metastases via lymphatic vessels. We postulate that previous axillary treatment markedly disrupted the upper limb lymphatic vessel drainage and resulted in refractory and rapidly progressive in-transit metastases. In this case, we believe that palliative amputation of the involved arm was justified and beneficial to the patient.

377 COMPARISON AND CORRELATION OF VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) EXPRESSION IN NON MALIGNANT LESION, PREMALIGNANT LESION AND SQUAMOUS CELL CARCINOMA (SCC) OF ORAL CAVITY Mayank Gupta 1 , Manika Varshney 1 1. Christian Medical College, Vellore, TAMIL, India Metastasis in head neck cancer can occur by local infiltration, lymphatic and hematogenous route. VEGF has been implicated as one of the factor for angiogenesis which aids in dissemination of tumour cells from primary to a distant site. Aims and objectives:To compare VEGF expression in non malignant (stratified squamous epithelium overlying pyogenic granuloma), premalignant lesion (leukoplakia) and SCC of oral cavity and further to evaluate expression in relation to grade of the tumour. Material and methods:Immunohistochemical expression of VEGF in 90 cases of oral SCC [30 cases each of well differentiated (WD), moderately differentiated (MD) and poorly differentiated (PD) carcinoma] and 30 cases each of leukoplakia and pyogenic granuloma evaluated. VEGF expression observed as brown intracytoplasmic staining and was counted in tumour cells on basis of intensity and percentage positivity and expressed as VEGF score. VEGF grade was also calculated. Result:The VEGF score in WD SCC was maximum with VEGF grade 3. The VEGF grade in MD SCC was less than WD SCC but more than PD SCC, with VEGF grade 2 in MD SCC and VEGF grade 1 in PD SCC. VEGF score and VEGF grade in leukoplakia and epithelium overlying pyogenic granuloma were similar but less than that of WD & MD SCC. VEGF grade of PD SCC was similar to leukoplakia & epithelium overlying pyogenic granuloma. Conclusion:We observed significant decrease in VEGF expression as the degree of differentiation declined in oral SCC with poorly differentiated tumors demonstrating negligible VEGF expression. There is controversy in literature regarding the expression of VEGF in relation to the grade of the tumor. It is speculated that vascular proliferation in poorly differentiated SCC occurs through a different mechanism.

378 LONG-TERM SURVIVAL OF IPILIMUMAB-NAÏVE PATIENTS WITH ADVANCED MELANOMA (MEL) TREATED WITH NIVOLUMAB (ANTI-PROGRAMMED DEATH-1; ANTI-PD-1; BMS-936558; ONO-4538) IN A PHASE I TRIAL Stephen Hodi 1 , Mario Sznol 2 , Harriet M Kluger 2 , David F McDermott 3 , Richard D Carvajal 4 , Donald P Lawrence 5 , Suzanne L Topalian 6 , Michael B Atkins 7 , John D Powderly 8 , William H Sharfman 5 , Igor Puzanov 9 , David C Smith 10 , Philip D Leming 11 , Evan J Lipson 6 , Janis M Taube 6 , Robert A Anders 6 , Christine E Horak 12 , Georgia Kollia 12 , Ashok Gupta 12 , Jeffrey A Sosman 9 1. Dana-Farber Cancer Institute, Boston, MA, USA 2. Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT, USA 3. Beth Israel Deaconess Medical Center, Boston, MA, USA 4. Memorial Sloan-Kettering Cancer Centre, New York, NY, USA 5. Massachusetts General Hospital Cancer Center, Boston, MA, USA 6. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA 7. Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA 8. Carolina BioOncology Institute, Huntersville, NC, USA 9. Vanderbilt University Medical Center,, Nashville, TN, USA 10. University of Michigan, Ann Arbor, MI, USA 11. Christ Hospital Cancer Center, Cincinnati, Ohio, USA 12. Bristol-Myers Squibb, Princeton, NJ, USA Aims:Nivolumab, a fully human immunoglobulin G4 PD-1 immune-checkpoint inhibitor antibody, is tolerable and active in patients with advanced solid tumors. In this trial, long-term clinical activity, response off therapy, association of tumor PD-1 ligand 1 (PD-L1) expression with survival endpoints, and 3-year overall survival (OS) were investigated in patients with advanced MEL. Methods:107 previously treated ipilimumab-naïve advanced MEL patients received nivolumab (0.1, 0.3, 1, 3, or 10mg/kg IV) every fortnight for ≤96 weeks and were evaluated for OS and progression-free survival (PFS). Tumour cell PD-L1 expression was assessed by a Dako immunohistochemistry assay. Results:Among patients who initiated treatment with nivolumab, 25% had ≥3 prior therapies. Across doses, 1-, 2- and 3-year OS (95% CI) rates were 63% (53, 71), 48% (38, 57) and 41% (31, 51), respectively; and numbers of patients at risk were 63, 44 and 22, respectively. Thirty-four patients demonstrated objective responses by RECIST, 24 of whom stopped nivolumab for reasons other than disease progression. Of those 11 maintained responses for ≥24 weeks off drug (range: 24, 56+ weeks); and 4 had unconventional “immune-related” responses. Median response duration was 22.9 months. In a subset of patients with evaluable tumor samples (41/107), patients with PD-L1(+) (i.e. ≥5% on tumour cells) and (–) tumours (n=18 and 23, respectively) had median OS of not reached and 12.5 months, respectively; median PFS was 9.1 months and 1.9 months, respectively. Safety was previously reported. Conclusions:In advanced MEL patients, nivolumab demonstrated favorable 2- and 3-year OS rates, durable responses with a number persisting off therapy, and an acceptable safety profile. Additional analyses will be presented by patients' characteristics across the full population, long-term survival subgroup, and PD-L1(+/–) tumor subgroups. Ongoing phase III trials are further evaluating nivolumab in MEL and PD-L1 as a potential predictive biomarker for response.

379 SAFETY OF TREATMENT OF LIVER CARCINOMA BY PERCUTANEOUS ACETIC ACID INJECTION: A PRELIMINARY REPORT Yuxin Hu 1 , Kehua Wu 1 , Ying Jiang 2 1. Shangrao Cancer Hospital, Shangrao City, China 2. Medical Oncology, Shanghai Jiading Cntral Hospital, Shanghai, China Background:Although surgical resection and interventional therapy by transarterial chemoembolization are considered therapy of main choice for liver carcinoma (LC), the relatively low percentage of patients who are candidates for this treatment in our country due to economical, technical reasons, and disease status. On the other hand, a number of minimally invasive methods existed, such as percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), and radiorequerency (RF) have been developed as alternatives to surgical resection for LC in some countries. Aim:This abstract mainly discusses safety of treatment for LC by PAI. Methods:A total of 171 treatment sessions in 57 consecutive patients, including 29 primary hepatic carcinomas, and 28 second liver cancers metastazied from gastrointestinal track (diameter range, 1.5–13cm) undergoing PAI were prospectively studied. 0.5–13mL of 50% acetic acid was injected into the center of the nodule under ultrasound guidance. Complications were recorded and analyzed. Results:Complete or partial necrosis with or without some cavernous seen on the CT image and/or ultrasound in all tumor masses given of acetic acid. The most common side effect is transient pain from minor to severity and happened in 53 patients (93.0%), and among them 4 patients (7.8%) having to stop continous administration of acetic acid and moreover could not be tolerated even after additional injection of analgesic due to severe pain with upper abdominal discomfort. Fever (>37°C to 39°C) was another common side effect after PAI, occurring in 25 patients (43.9%), and generally returning to normal within 3–5 days, and high fever (>39°C) occurred and lasted about a week in 3 patients (5.9%) with large-sized tumor and a higher injection volume of acetic acid (8–11mL). Conclusions:PAI is a less invasive local therapy for LC and there hasno complication requiring special treatment.

380 CLINICAL SIGNIFICANCE OF P53 AND 4E MOLECULAR MARKER EXPRESSION IN HEAD AND NECK SQUAMOUS CELL CARCINOMA OF NORTHERN TERRITORY PATIENTS: AN AUSTRALIAN RETROSPECTIVE STUDY Rama Dr Jayaraj 1 , Jagtar Singh 1 , Mahiban Thomas 2 1. Charles Darwin University, Darwin, NT, Australia 2. Head and Neck Surgery Department, Royal Dawin Hospital, Darwin, NT, Australia Background:Molecular markers can be used to identify tumour at the surgical margins of head and neck squamous cell carcinoma (HNSCC) and assist in evaluating complete resection of the tumour. The purpose of this study was to investigate the prognostic significance of molecular markers at the tumour free surgical margins of HNSCC patients in the Northern Territory. Methods:This is a retrospective study and 48 HNSCC patients met inclusion criteria. On the based on hematoxylin and eosin (H&E) staining, 24 patients showed positive margins and 24 showed negative margins respectively. We have selected 24 patients with negative margins for further analysis with immunohistochemical staining (IHC). A total of 77 surgical margins were obtained from 24 patients and subsequently analysed by IHC staining with monoclonal mouse p53 and polyclonal rabbit eIF4E antibodies. Contingency tables and Fisher's exact tests were used to investigate the association of p53 and eIF4E expression with clinical outcomes (recurrence and overall survival) for HNSCC patients. Results:The expression of p53 and eIF4E was 54.2% and 87.5% respectively in the surgical margins of HNSCC patients. Three out of seven cancer recurrent patients (42.8%) were identified with p53 positive margins and significantly six (85.7%) patients had recurrence with eIF4E positive margins. There was no statistically significant difference identified for recurrence risk between p53 and eIF4E overexpression in the surgical margins (P=0.88, P=0.99 respectively). Conclusions:The molecular marker eIF4E appears to be a stronger prognosticator than p53 because overexpression of eIF4E was found in the margins of six out of seven patients with local recurrence.

381 BASIC PHYSICAL FITNESS TESTING PROTOCOL: WHAT CAN IT TELL US ABOUT WOMEN TOUCHED BY BREAST CANCER? John Keyserlingk 1 , David H Jones 1,2,3 , Melissa Nestore 1 , Sara Henophy 1 , Julia Cousin 1 , Alain S Comtois 4 1. VMmed, Montréal, QUéBE, Canada 2. Biology, University of Quebec in Montreal, Montreal 3. Exercise Science, Concordia University, Montreal 4. Kinanthropology, University of Quebec in Montreal, Montreal Purpose:To determine the physical fitness level of women consulting a Wellness Centre implemented within a clinical environment. Methods:Physical activity and fitness evaluation of 157 regular patients and breast cancer survivors was performed at the Wellness Centre of the VM Medical Breast and Oncology Centre. All patients were evaluated for muscular strength in the lower back, abdominal, upper body and forearm regions. Their aerobic fitness was also evaluated on a treadmill using a Bruce protocol. The women's level of strength and fitness levels were compared to the CPAFLA normative aged matched data. Results: Table1: Participant score distribution using the CPAFLA scale

Excellent (n)

Back Extension

PartialCurl up

Hand grip Strength

PartialPush up

Trunk forward flexion

Aerobic Fitness Bruce test

Very good (n)

Good (n)

Fair (n)

Need improvement (n)

Not done (n)

46

31

27

19

7

27

(29.3)

(19.7)

(17.2)

(12.1)

(4.5)

(17.2)

59

27

37

6

28

0

(37.6)

(17.2)

(23.6)

(3.8)

(17.8)

(0)

13

28

22

29

51

14

(8.3)

(17.8)

(14.0)

(18.5)

(32.5)

(8.9)

40

50

26

10

3

28

(25.5)

(31.8)

(16.6)

(6.4)

(1.9)

(17.8)

16

19

21

32

43

26

(10.2)

(12.1)

(13.4)

(20.4)

(27.4)

(16.6)

6

3

29

19

58

42

(3.8)

(1.9)

(18.5)

(12.1)

(36.9)

(26.8)

Numbers represent n patients in each category. Numbers in parentheses represent relative (%) to total group.

Conclusion:Many of the participants scored well on the lower back (back extension) and abdominal (partial curl up) strength but scored poorly on handgrip strength. Most of the participants were classified as needing improvement in cardiovascular fitness. The CPFLA testing protocol in women touched by breast cancer appears to be an effective tool to identify strengths and weaknesses and may provide a source of extrinsic motivation to become more physically active.

382 BARRIERS TO PARTICIPATION IN BREAST AND CERVICAL CANCER SCREENING (ANALYSIS OF INTERNATIONAL RESEARCH) Aleksandra Kizior 1 , Piotr Kizior 1 , Janusz Spisz 1 1. not for profit, LODZ, WA, Poland Background:For cancers of the breast, cervix leading causes of cancer death worldwide.Regular screening can reduce mortality Unfortunately, screening participation is variables even in health systems with adequate resources. Aim:What are the common barriers that are perceived as a big impediment to participate in regular screening and If cultural differences play a role in cancer screening behavior in a culturally diverse population? Methods:To systematically review the literature on perceived individual barriers and benefits associated with participation in screening studies aimed at preventing cervical cancer, the methodology Cochrane Group, from 1979 and January 2011.Revision of the database: Medline, Academic Search Premiere, Psych LIT. Results:Obtained 655 publications, with abstract in English. Pre-101 publications were selected that meet the criteria for inclusion. Then evaluated 4 quality publications using the indications TREND which led to the emergence of 66 publications, of at least average methodological quality. Most scientific papers selected for analysis in our systematic review of 54 studies are correlational, including 52 cross-sectional and longitudinal 2 correlational studies (39) conducted in the U.S. (72% of all work), 2 in Canada, 1 in Mexico, 3 in Australia, 2 in the UK, 1 Denmark, 1 in Sweden and 1 in the Netherlands. In Eastern Europe, published so far only four studies that raised the barriers and benefits of participating in cytological screening. Were taken into account cultural factors, socio demographic, psychological (mood, depression, support, conversation, barriers, individual factors indicated by women). Summary:Little is known about what factors influence women to participate in trials designed for women at high risk for cervical cancer. There have been no systematic cross-national research in this area, but so far collected data suggest no significant differences between populations living in different regions of North America and Europe The most commonly cited motivator to participate in screening studies, which showed a woman's social support and conversation.

383 COMPLIANCE WITH INTERNATIONAL GUIDELINES AND READABILITY OF INFORMED CONSENT FORMS FOR CANCER CLINICAL TRIALS James C Kuo 1 , Laeeq Malik 2 , Alex Mejia 2 , Desmond Yip 1,3 1. Department of Medical Oncology, The Canberra Hospital, Garran, ACT 2605, Australia 2. Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Science Center, San Antonio, Texas, USA 3. ANU Medical School, Australian National University, Canberra, ACT 0200, Australia Background:Informed consent forms (ICFs) provide information about clinical trials and assist patients in making an informed decision regarding their participation. The International Conference on Harmonization guidelines for Good Clinical Practice (ICH-GCP) recommended addressing 20 aspects of the consent process in ICFs, and using layman's language in a document less than 15 pages to improve readability. We analysed the content of ICFs for cancer clinical trials to determine their compliance with ICH-GCP guidelines and readability. Methods:ICFs for trials for metastatic cancer conducted at two institutions between 2011 and 2013 were reviewed. Non-therapeutic, observational, adjuvant and neoadjuvant trials were excluded. Contents were reviewed for inclusion of elements recommended by ICH-GCP. Page count and Flesch-Kincaid Reading Ease (FRE) score were used to assess readability. Results:Of 154 ICFs screened, 112 ICFs met the eligibility criteria for inclusion. The majority were Phase I trials (n=57, 51.8%) and pharmaceutical industry sponsored (n=92, 82.1%). All ICFs stated the voluntary nature of participation, explained the purpose and the experimental aspect of the trial, discussed confidentiality aspects and provided an estimate of the potential risk and benefit. Fourteen of the 20 recommended elements were addressed by all ICFs. Areas of deficiency were statement about provision of up-to-date trial information after enrolment, the study schema, dose escalation, possibility of serious harm or death, and risks to pregnant/lactating women. The median length of ICFs was 20 pages and the median FRE score was 55.5, equivalent to a 10 th grade reading level. Less than 15% of ICFs were written at the 8 th grade reading level. Conclusion:ICFs for cancer clinical trials were mostly compliant with ICH-GCP guidelines. However, these ICFs were lengthy and as suggested by the FRE score, fairly difficult to comprehend. Improvement in readability could be made by simplifying the language used and reducing the page count.

384 ADMINISTRATION OF CHEMOTHERAPY IN PATIENTS ON DIALYSIS James Kuo 1 , Paul Craft 1, 2 1. Department of Medical Oncology, The Canberra Hospital, Garran, ACT 2605, Australia 2. ANU Medical School, Australian National University, Canberra, ACT 0200, Australia Background:Prevalence of patients with end-stage renal disease (ESRD) receiving dialysis has continued to increase over the year and such patients may increasingly require chemotherapy on diagnosis of malignancy. ESRD as a significant medical comorbidity may deter medical oncologists from offering chemotherapy. Furthermore, a consensus on the dosage and timing of chemotherapy administration has not been established due to a paucity of data. We described the pattern of care for cancer patients on dialysis in our institution. Methods:The dataset from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) of dialysis-dependent patients who had a diagnosis of cancer was obtained and matched to the electronic records in Medical Oncology, The Canberra Hospital to identify patients who had a consultation to discuss chemotherapy. A manual search of correspondence over the same time period was also conducted to identify patients who had received chemotherapy while receiving dialysis. Clinical records of these patients were reviewed to extract relevant information relating to patient characteristics, details of the dialysis regimen and the details of chemotherapy administration, in particular the timing relating to dialysis and dose adjustment or delay. Results:21 dialysis-dependent patients were identified to have a cancer diagnosis from July 1999 to July 2014. Ten patients were referred to discuss chemotherapy, eight were offered chemotherapy, and five (23.8%) received chemotherapy. Most cycles administered were given immediately prior to dialysis. One patient discontinued treatment due to adverse events; the rest tolerated the planned treatment well. Two patients required either dose reduction or delay due to adverse events. Conclusion:Chemotherapy administration is feasible in dialysis-dependent cancer patients. Chemotherapy receipt remained low in our institution but is consistent with that reported in the literature. A better understanding of the pharmacokinetics of chemotherapeutic agents will facilitate an improvement in chemotherapy practice for these patients in the future.

385 IMPROVING DELIVERY OF AMBULATORY CARE FOR CANCER PATIENTS: EXPERIENCE OF THE RAPID ASSESSMENT CLINIC IN A TERTIARY INSTITUTION James Kuo 1 , Madhawa De Silva 1 , Desmond Yip 1,2 1. Department of Medical Oncology, The Canberra Hospital, Garran, ACT 2605, Australia 2. ANU Medical School, Australian National University, Canberra, ACT 0200, Australia Background:It can be challenging for cancer patients to receive timely advice and care in between scheduled treatment or review clinic due to the complexity of their care need. A Rapid Assessment Clinic (RAC) was established in September 2013 at The Canberra Hospital to improve access to care for cancer patients. We evaluated its effectiveness in the delivery of ambulatory care. Methods:Patients who were receiving chemotherapy and who presented for assessment at the RAC from September 2013 to June 2014 were included for review. Relevant clinical data including patient and tumour characteristics, presenting complaints, time to assessment and total time spent at the RAC, and assessment outcome were extracted. Similar data for cancer patients who presented to the Emergency Department (ED) but would have been appropriate for RAC assessment from February 2012 to August 2012 were reviewed for comparison. Results:77 cancer patients presented to ED over the 7-month period; 19 (24.7%) were appropriate for RAC assessment. The median time to review and total time spent for these patients were 127.5 minutes and 495 minutes respectively. 15 patients (78.9%) required hospital admission and had an average length of stay (LOS) of 12.4 days. 217 patients were reviewed at the RAC over the first ten month of its establishment. The majority presented with new symptoms (n=46, 21.2%); 123 patients (56.7%) presented with symptoms unrelated to chemotherapy. These patients had an improved median time to review (28.3 minutes) and total time spent (183 minutes) in comparison to those reviewed in ED. The rate of hospital admission via RAC was 14.3% (n=31) with an average LOS of 6.5 days. Conclusion:Establishment of RAC had improved delivery of ambulatory care to cancer patients by reducing the waiting time for assessment and rate of hospital admission, despite a high rate of presentations with new or non-chemotherapy related symptoms.

386 ADJUVANT CHEMOTHERAPY IN STAGE III COLON CANCER: A REGIONAL CANCER CARE CENTRE EXPERIENCE Khageshwor Pokharel 1 , Andrew Lee 1 , Kate Haigh 1 , Amit Sharma 1 , Natacha Sorour 1 , Guranjan Grewal 1 1. Medical Oncology, Toowoomba Hospital, Toowoomba, QLD, Australia Background:Adjuvant chemotherapy for colon cancer encompassing a fluorouracil backbone±oxaliplatin has contributed to improved five-year disease free and overall survival. 2–4 Delivery of evidence based cancer care has been a challenge for patients in rural and remote Australia. 5 There is minimal data regarding adjuvant chemotherapy for colon cancer in regional and remote areas. Aim:To examine factors influencing selection, timing of delivery and dose intensity of adjuvant chemotherapy for colon cancer in a regional Australian hospital. Methods:Patients who received adjuvant chemotherapy for stage III colon cancer between September 2010 and June 2014 were identified using chemotherapy prescribing software. Patient demographics, comorbidities, TNM stage, and relevant chemotherapy data was collected by retrospective chart review. Patients were grouped by age (<70, ≥70) and location (<25km, 25–99km, ≥100km from treatment centre). Pearson-X 2 and logistic regression analyses were used to examine association between demographic factors and treatment regimen, and between demographic factors and dose intensity respectively. Results:44 patients, median age 66 (range=29–84) were included in the study. 39% of patients (n=17) resided >100km from the treatment centre and 25% (n=11) resided within 25km. Age >70 (n=18) was associated with selection of non-oxaliplatin based regimens, (p=0.001). Patients age >70 were less likely to commence adjuvant treatment within 56 days postoperatively, (p=0.073) and more likely to experience dose delay (p=0.066). Female patients were less likely to complete the target number of cycles (p=0.032). Conclusion:Older patients were treated with oxaliplatin-based regimens significantly less frequently than younger patients. Older patients commencement of adjuvant treatment appeared to be delayed and were also more likely to experience dose delay after commencement however these trends did not reach statistical significance. Female patients were less likely to complete the target number of cycles. Demographic factors, comorbidities and chemotherapy regimen were not associated with reduction in dose intensity or completion rates.

387 INTEGRATION OF SCIENTISTS AND CLINICAL EXPERTS IN AUSTRALIA'S FIRST MOLECULAR TUMOUR BOARD FROM THE VICTORIAN COMPREHENSIVE CANCER CENTRE (VCCC) Belinda M Lee 1 , Jennifer Mooi 1 , Stephen Fox 1 , Graham R Taylor 2 , Andrew Fellowes 1 , Arthur L Hsu 2 , Jayesh Desai 1 , Paul Ekert 3 , Clara Gaff 4 , Dishan Gunawardana 5 , Anne Hamilton 6 , Paul James 7 , Raymond Snyder 8 , Paul Waring 2 , Grant McArthur 1 , Ben Tran 7 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. Centre for Translational Pathology, University of Melbourne, Melbourne, VIC, Australia 3. The Royal Childrens Hospital, Melbourne, VIC, Australia 4. Walter and Eliza Hall Institute, Melbourne, VIC, Australia 5. Western Health, Melbourne, VIC, Australia 6. The Royal Women's Hospital, Melbourne, VIC, Australia 7. Melbourne Health, Melbourne, VIC, Australia 8. St Vincents Hospital, Melbourne, VIC, Australia Objective:Rapid technological advances in DNA sequencing and molecular profiling have brought personalised cancer medicine from the lab bench into the consultation room. Physicians increasingly need to navigate complex genomic landscapes to find the most effective, individualised therapy for patients. However, most oncologists are not trained in interpreting complex cancer genomics. We initiated a molecular tumour board (MTB) involving all clinical institutions of the VCCC, the Walter and Eliza Hall Institute and the University of Melbourne. Method:Clinicians were invited to submit cases with potential for molecular profiling to alter clinical management. A team of oncologists, clinician-scientists, bioinformaticians, basic scientists, pathologists and geneticists with expertise across a variety of tumour types attended monthly MTB meetings. Clinical case histories, molecular tests and pathology reports were reviewed. Outcome reports were fed back to the referring clinicians. Results:From July 2013 16 cases involving 11 different tumour types were reviewed by an average of 15 clinicians and 8 non-clinical scientists. Patients had received a median of 2 prior therapies. Reports from 5 different DNA sequencing platforms were reviewed. A total of 39 mutations were discussed in detail, with 27 distinct abnormalities. Patients had a median of 2 molecular abnormalities of potential clinical impact (range: 1–5 abnormalities). The MTB offered additional clinical input in 81% of cases (13 of 16 cases), with a change in management occurring in 31% (5 cases) and referral for clinical trials in 19% (3 cases). Conclusion:Engaging clinical and scientific experts in molecular and cell biology of cancer to translate genomic data is feasible to assist clinical interpretation of molecular profiling. Personalised medicine is coming of age and clinicians need support to optimally incorporate advancing technologies and targeted therapies in the management of their patients.

388 AN INITIAL ANALYSIS OF PREOPERATIVE SERUM MICRORNA-21 LEVELS FOR THE DETECTION OF OVARIAN CARCINOMA IN PATIENTS WITH A PELVIC MASS Wei Li 1 , Liang Wan 1 1. Department of Gynecology, Nanjing Medical University of Hangzhou Hospital, Hangzhou, Zhejiang, China Background:Ovarian cancer is an insidious disease that has few specific symptoms in the early stages and most women with this disease present with an advanced stage at the time of diagnosis. MicroRNAs (miRs) are a class of small noncoding RNAs whose expression changes have been associated with cancer development and progression. Aim:The objective of this trial was to validate whether serum microRNA-21 can be used as a biomarker for the detection of ovarian carcinoma in patients with a pelvic mass. Methods:Serum samples were obtained preoperatively from women undergoing for an adnexal mass. We measured the levels of microRNA-21 in serum samples from patients with a pelvic mass and healthy controls using real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR). CA125 concentrations were determined in serum samples by ELISA analysis. Results:Mean serum concentration of microRNA-21 was significantly higher in serum samples of patients with ovarian cancer ( p< 0.01) but not with ovarian endometriomas or other types of benign tumors as compared with healthy controls. As a single marker, microRNA-21 had the highest sensitivity at 68%. The serum CA125 concentration were elevated in patients with ovarian cancer and ovarian endometriomas. Comparatively, combined microRNA-21 and CA125 yielded the highest sensitivity 73%. Conclusions:As a single tumor marker, microRNA-21 is potentially useful tools as novel noninvasive biomarker for the diagnosis of ovarian carcinoma. Combined microRNA-21 and CA125 is a more accurate predictor of malignancy than either alone.

389 KI67 EXPRESSION HAS PROGNOSTIC SIGNIFICANCE IN RELATION TO HUMAN PAPILLOMAVIRUS STATUS IN OROPHARYNGEAL SQUAMOUS CELL CARCINOMA Jia Jenny Liu 2,3,1 , Mei Zhang 2,1 , Barbara Rose 4 , Anne-Sophie Veillard 5 , Deanna Jones 4 , Soon Lee 6,7 , Angela Hong 2,1 1. Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia 2. Central Clinical School, University of Sydney, Sydney, NSW, Australia 3. Prince of Wales Clinical School and Lowy Cancer Research Centre, University of New South Wales, Kensington, NSW, Australia 4. Department of Infectious Diseases and Immunology, University of Sydney, Sydney, NSW, Australia 5. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia 6. Department of Anatomical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia 7. Bosch Institute, University of Sydney, Sydney, NSW, Australia Aims:Human papillomavirus (HPV) is the major predictor of outcome in oropharyngeal squamous cell carcinoma but the disease is heterogeneous and there is limited understanding of the prognostic significance of other molecular markers in relation to HPV. This multi-institutional retrospective study examined the prognostic significance of Ki67 expression in association with HPV status in oropharyngeal squamous cell carcinoma. Methods:The 105 patients recruited had a median follow-up of 70 months. Tumour HPV status was determined by HPV E6-targeted multiplex real-time PCR/p16 semiquantitative immunohistochemistry and Ki67 expression by semiquantitative immunohistochemistry. Determinants of recurrence and mortality hazards were modelled using Cox regression with censoring at dates of last follow-up. Results:HPV and Ki67 positivity rates were 46% and 44% respectively. HPV-positive cancers were more likely to be Ki67-positive (P=0.015). On univariate and multivariate analysis, HPV positivity was a strong predictor of better outcome. Patients with HPV-positive tumours had better disease-specific (HR 0.27 95% CI 0.11–0.66, P=0.004) and overall survival (HR 0.33 95% CI 0.15–0.70, P=0.004) compared to those with HPV-negative tumours. Ki67-positive cancers were associated with a 3.1-fold increased risk of disease-related death compared to Ki67-negative cancers (95% CI 1.27–7.72; P=0.014). Ki67 status was a predictor of outcome especially in the HPV-negative subgroup. Among HPV-negative patients, Ki67-positivity was associated with 5.6-fold increased risk of disease-related death (95% CI 1.87–16.96, P=0.002), 5.5-fold increased risk of death from any cause (95% CI 2.07– 14.62, P=0.001), and 2.9-fold increase in risk of any event (95% CI 1.26–6.76, P=0.013). Conclusions:Ki67 predicts disease-related death in oropharyngeal cancer independent of HPV status. A combination of Ki67 and HPV status provides improved prognostic information relative to HPV alone. Our data suggest for the first time that Ki67 status has prognostic value particularly in HPV-negative oropharyngeal cancer.

390 PLASMA MIR-320, MIR-LET-7E AND MIR-21 AS NOVEL POTENTIAL BIOMARKER FOR RETINOBLASTOMA DETECTION Qiuling Liu 1 1. The General Hospital of the Chinese People's Armed Police Forces, Beijing, China Publish consent withheld

391 EVALUATION OF PATIENT CHARACTERISTICS, CLINICAL PROFILE AND TREATMENT OUTCOMES IN GLIOBLASTOMA MULTIFORME: AN INSTITUTIONAL ANALYSIS Robert Mason 1 , Clare Owens 1 , Vlad Andelkovic 1 , Jasotha Sanmugarajah 1 1. QLD health, Gold Coast, QLD, Australia Background:The standard treatment of glioblastoma multiforme involves surgical resection followed by concurrent chemoradiation therapy and adjuvant temozolomide. The aim of this study was to evaluate the epidemiological and survival features of patients with glioblastoma multiforme treated at a community hospital. Methods:We retrospectively analysed demographic details and outcome of 126 patients with biopsy proven glioblastoma from 2007 to 2012. Results:126 patients were identified. Complete survival data was available on 106 patients. Patients were divided into age group (<50; 50–70; >70) with an average age of 61 years. The majority had an ECOG PS of 0–1 (56%). 81% of patients underwent debulking surgery initially with 52% receiving adjuvant temozolomide. 24 patients had disease in the frontal lobes. Average survival across all patients was 412 days from histological diagnosis. Age was inversely proportional to survival: patients <50 years having an overall survival of 753 days; 50– 70 years 365 days; and >70 years 280 days. Patients receiving adjuvant temozolomide had a survival advantage over those who did not (581 versus 235 days). This was more pronounced in younger patients (survival 862 days in <50yrs; 492 days in 50–70yrs; 328 days in >70yrs group). In patients who received adjuvant temozolamide, survival was significantly better in patients with lower ECOG PS: ECOG 0-1(644 days) versus ECOG 3-4(378 days). Those patients that proceeded to have further redo de-bulking surgery showed a significant survival advantage over patients not having further surgery (572 versus 375 days). Average survival for frontal tumours was 630 versus 360 days for non frontal tumours. Conclusion:In comparison to the pivotal trial by Stupp etall [1] our patients were older although the survival benefit of temozolomide and radiation therapy was still present. Younger patients, patients with frontal lobe tumours, and patients who underwent redo surgery had a better prognosis. 1. Stupp R, Mason W, vam den Bent M, etal. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10; 352(1):987–996

392 NUTRITION SCREENING AND ASSOCIATION WITH CHEMOTHERAPY OUTCOMES IN OLDER CANCER PATIENTS Alexandra McCarthy 1 , Sally Baumann, Elisabeth Isenring, Kerri Gillespie, Patsy Yates 1. Princess Alexandra Hospital, Kelvin Grove, QLD, Australia Aims:To explore whether malnutrition risk and body mass index (BMI) a) can predict chemotherapy outcomes in geriatric oncology patients and b) are associated with variables elicited with a Comprehensive Geriatric Assessment (CGA). Methods:Patients with solid tumours aged ≥65 years underwent a baseline CGA before commencement of chemotherapy. Malnutrition risk was assessed using the Malnutrition Screening Tool (MST). BMI was calculated using anthropometric data. Nutritional risk and BMI were compared with other CGA variables, e.g. functional ability, vulnerability and comorbidities; as well as with chemotherapy outcomes (completion, modification or non-completion of the treatment planned at baseline). Results:56.5% of the 175 participants were at risk of malnutrition. BMI ranged from 15.5–50.9kg/m2, with 36.6% of the cohort overweight compared to geriatric cutoffs. Malnutrition risk was more prevalent in underweight (70.4%) participants, although many healthy (60.6%) and overweight participants (32.8%) also presented at risk. Malnutrition risk was associated with greater risk of depression (p<0.001), higher ratings of vulnerability according to the Vulnerable Elder's Survey (VES-13) (p=.042), and less functional independence (Barthel Index, p=0.007 and IADL, p=0.001). Higher BMI was associated with more comorbidities (p=0.001). Patients with a high risk of malnutrition had the best odds of completing the treatment prescribed at baseline; whereas medium risk patients had a 60% reduction in the odds of completing treatment compared to those screened as having a low risk of malnutrition. High risk patients were, however, less likely to receive intensive chemotherapy. Conclusions:In this study overweight older patients, as determined by BMI, were more likely to complete the chemotherapy planned at baseline; however BMI in this treatment context has many limitations. Malnutrition risk, as measured by the MST, is a more valid and reliable indicator of older patients' ability to complete planned chemotherapy.

393 HIGH-RISK CUTANEOUS SQUAMOUS CELL CARCINOMA OF HEAD AND NECK WITH PAROTID METASTASIS: A REVIEW OF 151 PATIENTS TREATED AT A TERTIARY REFERRAL CENTRE Lachlan McDowell 1 , T J Tan 1 , Mathias Bressel 2 , Vanessa Estall 1 , Stephen Kleid 3 , June Corry 1 , Meredith Johnston 1 1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia 2. Centre for Biostatistics and Clinical Trials , Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia 3. Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Aims:To review oncological outcomes in patients with high risk head and neck cutaneous SCC (HNcSCC) – as defined by the presence of metastatic involvement of the parotid lymph nodes. To correlate clinical data with pathological review in order to identify predictors of disease behaviour, and potential therapeutic targets. Methods:A search of our institutional database was undertaken to identify patients with regional parotid nodal involvement from likely HNcSCC, treated with radical intent between January 2000 and June 2014. Patients were excluded if (1) the parotid mass represented local recurrence / direct invasion from tumour, or (2) there was a previous history of, or subsequent development at <2 years of a head and neck mucosal SCC. Results:151 patients were identified as suitable for inclusion. Median follow-up was 4 years. 89 % were male. Median age was 75 years. 21% were immunosuppressed. Parotidectomy was superficial in 68% and total/subtotal in 32% and 64% also underwent neck dissection. All patients underwent post-operative radiotherapy to a median dose of 60Gy (range 45–70). At 2 and 5 years: LRC was 81% and 73%, DFS was 58% and 41%, and OS was 69 and 48% respectively. The 5 year distant metastatic free rate was 81%. Conclusions:Regionally metastatic high-risk HNcSCC is an aggressive disease. Despite radical treatment, there is a moderate rate of locoregional recurrence, and 5yr survival rates are <50% due to both disease recurrence and other causes in this population. Further study of molecular changes in this cohort of high-risk HNcSCC, including p16 / HPV/ EGFR overexpression studies, may predict disease behaviour and identify targets for more effective therapies.

394 IS BEVACIZUMAB IN METASTATIC COLORECTAL CANCER EFFECTIVENESS COMPARABLE TO KEY PHARMACEUTICAL BENEFITS SCHEME SUBMISSION CLINICAL TRIALS? USAGE RESULTS FROM FIVE LARGE QUEENSLAND PUBLIC HOSPITALS Suzannah Chapman 1 , Daniel McKavanagh 2 , Matthew Burge 1 , Jasotha Sanmugarajah 3 , Jeremy Long 4 , Paul Klages 5 , Ian McPherson 6 , Anita Connor 3 , Julia Hasker 4 , Euan Walpole 2 , Samantha Hollingworth 1 1. School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia 2. Princess Alexandra Hospital, Woolloongabba, QLD, Australia 3. Gold Coast University Hospital, Southport, QLD, Australia 4. Nambour General Hospital, Nambour, QLD, Australia 5. Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia 6. Toowoomba Health Service, Toowoomba, QLD, Australia Aims:Randomised clinical trial (RCT) evidence supporting bevacizumab use in metastatic colorectal cancer (mCRC) has shown variable benefits in terms of overall survival (OS; 17– 24 months) 1–6 . In Australia, bevacizumab is government subsidised for treatment of mCRC in combination with first-line chemotherapy, however there is little published evidence of effectiveness for this approach in the Australian context. This project aimed to: i. collate and analyse the use of bevacizumab in mCRC from the centralised electronic prescribing system (Charm®) at five large metropolitan and regional Queensland public hospitals, and; ii. to compare this OS to trials used for reimbursement decisions. Methods:Data was extracted from the Charm® database for mCRC patients assigned to bevacizumab therapy during the period 01/09/2009–31/08/2013. Descriptive statistical analyses including Kaplan-Meier curves were calculated. Results:During the study period 490 bevacizumab-containing protocols for mCRC were planned, 3750 bevacizumab doses were ordered and 292 patients received at least one bevacizumab dose. 158 patients died. Median patient age was 63yrs, and 58% were male. Patients were distributed into eight different bevacizumab-containing protocol groups, with most (49%) prescribed bevacizumab with oxaliplatin- based chemotherapy. A small number of patients (4%) received treatment beyond disease progression. Median bevacizumab dose was 375mg (2-weekly) and 562.5mg (3-weekly). Median time on treatment was 256 days for the whole cohort. Median overall survival was 17.2 months from first bevacizumab dose. Conclusions:Bevacizumab use in this cohort of mCRC patients was similar to published RCT results, based on patient and treatment characteristics. The median survival was slightly lower compared to OS in the trials (17–24 months) 1–6 , possibly explained by shorter follow-up and the methodology (retrospective audit vs controlled prospective trials). 1. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, etal. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med (2004) 350(23):2335–2342. doi: 10.1056/NEJMoa032691. 2. Kabbinavar FF, Schulz J, McCleod M, Patel T, Hamm JT, Hecht JR, etal. Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer: results of a randomized phase II trial. J Clin Oncol (2005) 23(16):3697–3705. doi: 10.1200/jco.2005.05.112. 3. Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, etal. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol (2008) 26(12):2013–2019. doi: 10.1200/JCO.2007.14.9930. 4. Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, etal. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol (2007) 25(30):4779–4786. doi: 10.1200/JCO.2007.11.3357. 5. Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL, etal. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol (2008) 26(21):3523–3529. doi: 10.1200/jco.2007.15.4138. 6. Kabbinavar F, Hurwitz HI, Fehrenbacher L, Meropol NJ, Novotny WF, Lieberman G, etal. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol (2003) 21(1):60–65.

395 INTRAVENOUS VERSUS ORAL FLOUROPYRAMIDINE: POST GASTRECTOMY CHEMORADIATION Hamza Mohammed 1 , Shimaa Ahmed 1 , Wesam Elsherief 2 , Mohamed A.E. Salem 1 , Ahmed A.S. Salem 1 , Mahmoud H. Elshoiby 1 1. South Egypt Cancer Institute, Assiut, Egypt 2. Qasr El-Einy, Cairo University, Cairo Purpose:Aim of this prospective, phase III trial was to compare the efficacy and toxicity of intravenous fluorouracil and oral capecitabine when given concurrently with radiation in adjuvant sitting for adenocarcinoma of the stomach after surgery. Patients and method:The study included 60 patients having histologically proven adenocarcinoma of the stomach or gastroesophageal junction; stage T2-4 N0-3 M0 after gastrectomy with D2 lymph node dissection. Eligible patients were randomly assigned to receive adjuvant radiotherapy concurrently with intravenous fluorouracil [arm A] or oral capecitabine [arm B]. Results:Ten patients cannot complete their whole treatment course because of either progressive [4 patients; 2 arm A and 2 arm B ] or G 3 toxicity [1 patient] or refuse to complete their treatment [5 patients; 3 arm A and 2 arm B]. Patients received fluorouracil have significant increase grade 3 or 4 hematological [neutropenia] and gastrointestinal (diarrhoea, anorexia, and vomiting). During a median follow-up period of 24 months, the 2-year disease free and overall survivals in this study were 60% and 63.3%, for group A and B respectively, while overall survival were 63.3% and 70% for group A and B respectively without significant differences. Conclusion:Oral capecitabine concurrently with radiation therapy has comparable efficacy and favourable toxicity profile when compared to infusion fluorouracil as postoperative adjuvant therapy for gastric adenocarcinoma.

396 DOCTOR-DOCTOR COMMUNICATION OF PROGNOSIS IN METASTATIC CANCER: A REVIEW OF LETTERS FROM MEDICAL ONCOLOGISTS TO REFERRING DOCTORS Erin B Moth 1 , Philip Beale 1,3,2 , Prunella Blinman 1,3 , Stephen Della-Fiorentina 4 , Jane Parry 4 , Martin R Stockler 1,5 , Belinda E Kiely 4,1,5 1. Concord Cancer Centre, Concord, NSW, Australia 2. Cancer Services and Palliative Care, Sydney Local Health District, Sydney, NSW, Australia 3. University of Sydney, Sydney, NSW, Australia 4. Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia 5. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia Aims:To describe the prognostic information included in written correspondence from medical oncologists to referring doctors for patients with metastatic cancer. Methods:We reviewed initial and subsequent consultation letters for all new patients with metastatic cancer presenting to 13 medical oncologists and 16 registrars at Concord and Macarthur Cancer Centres between June 2012 and June 2013. We recorded the presence and nature of prognostic information in the letters, and patients' baseline characteristics. We explored characteristics associated with the inclusion of prognostic information. Results:We analysed 1344 letters pertaining to 272 patients. Patients' characteristics were: male 64%; median age 68; primary cancer of lung 28%, upper gastrointestinal 21%, genitourinary 14%, colorectal 14%, and other 23%. Systemic therapy was planned in 77%. After a median follow up of 15 months, 145 patients had died with a median overall survival of 13 months. The average number of letters per patient was 5, with 50% written by consultants. The terms “metastatic” or “stage IV” cancer were included in the letters for most patients (93%), treatment was described as “palliative” for 64% and the word “incurable” was included for 34%. Only 31 patients (11%) had a quantitative estimate of their prognosis in any correspondence: median/average survival in 14; general time frame in 12; and, best-case, typical and worst-case scenarios in 5. For 16 of these 31 patients the quantitative estimate was in their initial letter. The inclusion of quantitative prognostic information was not associated with patient age, cancer type, treatment plan, consultant authoring letter, or survival. Conclusion:While most written correspondence from medical oncologists regarding their patients with metastatic cancer included qualitative prognostic information, few letters included quantitative prognostic information. We propose that communication between medical oncologists, referring doctors, and patients would be improved if medical oncologists included quantitative prognostic information in their consultation letters.

397 COMMUNICATION AND INFORMATION PROCESSING IN PATIENTS WITH PRIMARY OR METASTATIC BRAIN MALIGNANCY – A SURVEY OF PRACTICE IN TWO NSW METROPOLITAN RADIOTHERAPY CENTRES Diana N Naehrig 2,1 , Eng-Siew Koh 4,3 , Monica Vogiatzis 5 , Waka Yanagisawa 3 , Heather L Shepherd 5,6 , Chris G Milross 2,1 , Haryanah M Dhillon 7 1. Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia 2. Chris O'Brien Lifehouse, Camperdown, NSW, Australia 3. University of NSW, Sydney, NSW, Australia 4. Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia 5. University of Sydney, Camperdown, NSW, Australia 6. Royal Prince Alfred Hospital, Camperdown, NSW, Australia 7. CeMPED, Central Clinical School, Sydney Medical School, Camperdown, NSW, Australia Aims:Patients with brain malignancy can experience deteriorating cognitive function, with reduced capacity to process and recall complex information. It is unknown if health professionals (HPs) are aware and adapt communication accordingly. We aimed to assess patients' cognitive function and health literacy, describe current HP practices, and patient perception of communication. Methods:At baseline: HPs completed an 11-item questionnaire; patients a 14-item questionnaire and follow-up at 1–2 weeks. Items covered clarity of explanation, information recall, health literacy and surrogate questions for cognitive function using Likert scales. HP use of communication tools was assessed. Patients completed the Montreal cognitive assessment (MoCA) covering 8 cognitive domains; score ≥26/30 implying normal cognition. Results:Of the 47 patients recruited, with median age 61 years, 42 (89%) ECOG 0-2, 36 (76%) had secondary brain metastasis. Eighteen patients reported needing help to read medical information and 21 were somewhat, a little bit or not at all confident filling out forms. On MoCA 13/44 (29%) patients had normal cognition (MoCA score ≥26/30). The average score was 22. HPs reported using tools during 11 (23%) consultations. They also reported that most patients understood information with verbal explanation alone when speech, jargon, tempo were adapted. At baseline, patients reported some difficulty with concentration, memory and communication. 35/44 (79%) patients reported the HP explanation was quite or extremely clear. Patients indicated being mostly content with the information received. At follow-up, 28/39 (71%) patients reported the HP explanation as quite or extremely clear. Although patients recalled illness and treatment details, treatment-related side effects and their management were recalled by 78% and 42% respectively. Conclusion:Most of this population had measureable cognitive impairment. Few communication support tools are used by HPs. Despite patients and HP being content with communication, recall of information about treatment toxicity and its management appears impaired. Improved strategies to aid communication and recall are warranted.

398 CYTOKINE RECEPTOR EXPRESSION IN ACUTE MYELOID LEUKEMIA: HIGH EXPRESSION OF INTERLEUKIN-2 RECEPTOR A-CHAIN PREDICTS A POOR PROGNOSIS Kazunori Nakase 1 , Kenkichi Kita 2 , Taiichi Kyo 3 , Isao Tanaka 4 , Naoyuki Katayama 5 , Kazuo Tajima 6 1. Cancer Center, Mie University Hospital, Tsu, Japan 2. Department of Internal Medicine, Japan Baptist Hospital, Kyoto, Japan 3. Department of Internal Medicine, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan 4. Department of Internal Medicine, Suzuka Kaisei Hospital, Suzuka, Japan 5. Department of Hematology and Oncology, Mie University Hospital, Tsu, Japan 6. Department of Public Health, Mie University School of Medicine, Tsu, Japan Background:A variety of cytokines have been demonstrated to regulate the growth, survival, differentiation and apoptosis of leukemia cells. However, little is known about the expression of cytokine receptors on acute myeloid leukemia (AML) cells and their prognostic relevance. Aim:We aimed to determine the prevalence and the prognostic significance of various cytokine receptor expressions in adult AML. Methods:Using flow cytometry, we quantitatively examined the expression of interleukin-2 receptor -chain (IL-2R), IL-2R, IL-3R, IL-4R, IL-5R, IL-6R, IL-7R, common (c), c, granulocyte-macrophage colony-stimulating factor (GM-CSF)R, G-CSFR, c-fms, c-mpl, c-kit, FLT3, and GP130 on cells from 676 adult patients with AML, and evaluated their prognostic relevance. Results:All cytokine receptors examined were expressed to various degrees, whereas the levels of IL-3R, GM-CSFR, IL-2R, c, c-kit, and G-CSFR exhibited a wide spectrum of more than 10,000 sites/cell. In younger patients (less than 60 years), high levels of IL-3R, GM-CSFR, and IL-2R correlated with low responses to conventional chemotherapy, but only IL-2R was associated with a shorter overall survival (OS). Multivariate analysis including other prognostic markers, CD4, CD7, and CD11b revealed IL-2R as an independent adverse factor for OS, and its expression status also remained prognostic within the ctogenetic-risk stratification for AML which is currently recognized as the most powerful risk information for AML. Incorporation of IL-2R status into this system could clearly separate the intermediate-risk patients into additionally two prognostic subgroups. Older patients (over 60 years) did not have any such findings. Conclusions:Among various cytokine receptors we examined, expression of IL-2R was solely correlated with a poor outcome in patients with AML (less than 60 years), and its prognosice value was independent of other adverse factors. Assessment of IL-2R should be added to current risk evaluation system as a valuable phenotypic marker to provide better prognostication of AML.

399 FOUR YEAR OUTCOMES AFTER REGIONAL LYMPHADENECTOMY FOR STAGE III MELANOMA Prathyusha Nakka 1 , Christopher Allan 2,3 1. Princess Alexandra Hospital, Brisbane, QLD, Australia 2. Mater Adult and Private Hospitals, Brisbane, QLD, Australia 3. Princess Alexandra Hospital Melanoma Unit, Brisbane, QLD, Australia Purpose:To determine the 4-year-outcomes for resected stage III melanoma patients treated by a specialist melanoma surgeon. Methods:Between July 2008 and June 2010, 39 regional lymphadenectomies were undertaken on 37 patients. At least 4-year follow-up data was collected with a retrospective chart review and Kaplan-Meier survival analysis was performed. Results:The site of lymphadenectomy was the axilla and ilioinguinal (groin and pelvis) basin in 18 and 11 cases respectively while neck, groin and pelvis constituted 4, 4 and 2 cases respectively. 7 patients presented with an unknown primary, 3 with distant metastases, 4 with recurrence after lymphadenectomy and 2 following a positive sentinel lymph node biopsy. The median duration of follow-up was 46.6 months (range: 3.5 to 70.3 months). Seroma and lymphoedema were treated in 30% and 46% respectively. Infection required antibiotics in 20% and abscess drainage in 1. Wound dehiscence was reported in 10%, DVT and haematoma were reported in 1 case each. 2 patients had adjuvant radiotherapy and chemotherapy while 5 had adjuvant radiotherapy alone. 2 patients remained disease-free but 4 developed distal metastases, 1 developed nodal recurrence with a median survival of 8.9 months. 51% (19) developed new recurrences with multi-site metastases, distal metastases, isolated regional and local disease accounting for 6, 9, 1 and 3 cases respectively. 62.2% of the patients were alive with a median disease-free-survival and overall survival of 52.1 months of 56.6 months respectively. 14 patients have died with a mean survival of 26.3 months. Conclusion:Lymphadenectomy caused acceptable post-operative morbidity and resulted in significant 4-year overall survival. In this study, adjuvant radiotherapy does not appear to make a significant contribution to the overall survival.

400 RESPONSE TO CHEMOTHERAPY IN PATIENTS WITH GESTATIONAL TROPHOBLASTIC NEOPLASIA AND SUBSEQUENT FERTILITY Muralidhar V Pai 1 , Jayaraman Nambiar 1 , Amruta Chandramouli 1 1. Kasturba Medical College, Manipal, Karnataka, India Gestational Trophoblastic tumors are generally responsive to chemotherapy. Low risk disease is often cured with single-agent chemotherapy and high risk disease requires multiagent chemotherapy. This study was undertaken to evaluate the response of gestational trophoblastic neoplasia to chemotherapy and future fertility. A total of 33 gestational trophoblastic neoplasia treated at Kasturba Medical College Hospital, Manipal India, were followed up. The outcome in terms of response rate, recurrence, side effects and subsequent fertility were noted. Out of 33, 21 (63.6%) belonged to low risk, 10 (30.3%) belonged to high risk and 2 (6%) were placental site trophoblastic tumors. All low risk patients received single agent (Methotrexate) regimen. High risk patients and one with placental site tumor (other lost for follow up) received multi agent (EMACO) regimen. Out of 21 low risk patients 16 (76%) totally recovered, 2 (9%) has plateauing and 2 (9%) had recurrence and 1 (4.5%) had resistance to treatment. Out of 11 that received EMACO 10 (91%) recovered and 1 (9%) had plateauing. Those that had plateauing and resistance in low risk group responded after adding actinomycin and those that had recurrence were treated with EMACO. A total of 9 patients, 6 (28.5%) in single agent group and 3 (23%) in EMACO group, conceived after the successful treatment. There were minimal side effects. One patient in EMACO group had premature menopause and one in Methotrexate group had hepatitis.

401 COMPARISON OF CLINICAL PROFILE OF ORAL CANCERS IN YOUNG AND ELDERLY PATIENTS – A SINGLE INSTITUTION SERIES FROM SOUTH INDIA Ramya Rangarajan 1 , Kannan Jayaraman 1 1. Government Royapettah Hospital, Chennai, Tamil Nadu, India Background:The risk factors and disease behavior are not the same in young and elderly oral cancer patients. Aim:To compare the clinical profile, smoking habits and biologic behavior of oral cavity cancers in the young and elderly patients. Methods:Gender distribution, site of oral cavity cancer, stage at presentation, smoking habits, treatment modality employed, compliance to treatment, response rates and toxicity profiles were analyzed and compared for oral cancer patients less than 40 years of age and more than 65 years of age. 31 younger patients and 33 elderly patients were identified between the year 2012 and 2013. Results:Cancer of Buccal mucosa was the most common site involved in younger patients (58%) whereas carcinoma of alveolus was commonly found in elderly patients (39%). There were more female patients in the elderly age group when compared to younger population (42% Vs 19%). Smokeless tobacco usage was common in the younger patients (87%) whereas cigarette smoking (66.7%) was common in the elderly. Younger patients had shorter duration of symptoms (median 3 months Vs 7 months respectively) and more advanced T stage and N stage at presentation compared to elderly patients. More than 80% of patients in both the groups were treated with chemoradiation. The disease was found to be aggressive in younger patients with poor response rates (38% Vs 85% respectively) and rapid progression rates (58% Vs 9% respectively) when compared to elderly population. Grade 3 toxicity was more commonly seen in elderly patients than younger patients. (75.5% Vs 48% respectively). Conclusions:This study reveals an inherently aggressive disease in young patients with oral cancers. Further research to analyze the genetic profile of these younger patients is needed. More aggressive treatment may benefit these patients.

402 FERTILITY PRESERVATION TOOLKIT: IMPLEMENTING & EVALUATING A RESOURCE TO ASSIST CLINICAL DISCUSSION & DECISION MAKING REGARDING FERTILITY IN PAEDIATRIC ONCOLOGY Harene Ranjithakumaran 1,2 , Yasmin Jayasinghe 2 , Lynn Gillam 3,4 , Maria McCarthy 5 , Leanne Super 5 , Jayne Harrison 5 , Sarah Drew 6 , Sarah McQuillan 7 , Lisa Orme 5,8 1. University of Melbourne, Melbourne, Victoria, Australia 2. Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia 3. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia 4. Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia 5. Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia 6. Centre for Adolescent Health, Department of Paediatrics, Royal Children's Hospital , University of Melbourne, Melbourne, Victoria, Australia 7. Obstetrics & Gynecology Pediatric Gynecology , Alberta Health Services, South Health Campus, Calgary, Alberta, Canada 8. Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Aims:As over 80% of paediatric patients are cured of cancer, survivorship issues including fertility preservation are of great importance. Oncology clinicians find fertility discussions difficult due to a range of factors including urgency to commence treatment, and lack of: specific training, knowledge, clinical pathway, policy and long term efficacy data. We are evaluating a tool-kit resource for clinicians involved in fertility preservation discussions with young oncology patients/parents. By providing a suite of reference information alongside a practical guide for fertility discussion and referral, we aim to promote consistent, up-to-date knowledge among clinicians and clearer conversations about fertility risk and preservation. Methods:Clinician surveys at 3 timepoints: 1. Baseline: To determine understanding, perceived strengths/ weaknesses prior to implementation. 2. After each toolkit use. 3. End of evaluation period, to assess feasibility, sustainability and impact of the toolkit on clinical practice Results:Fifty-nine multidisciplinary clinicians completed the baseline survey anonymously after toolkit education. Dissatisfaction with the “current system of fertility information, referral and preservation was reported by 64.96% clinicians (31/47) ”; 56.65% (34/57) did not feel confident in their ability to provide up-to-date knowledge regarding fertility preservation; 100% (58/58) agreed to use and/or promote the kit. Potential weaknesses of the toolkit were perceived to be potentially poor compliance, poor access to the kit, and lack of use due to physicians' personal views. However over 90% of staff surveyed agreed the kit is an acceptable tool to improve: adherence to policy and consistent clinical pathway; clinician knowledge and consistency in verbal/written fertility information; patient/family understanding, decision making and experience. Conclusions:This is the first study to evaluate a fertility preservation toolkit. Baseline data demonstrates desired improvement among staff and perception that the toolkit is an appropriate vehicle for change. Subsequent surveys will assess toolkit utility, feasibility and impact on clinical practice in fertility discussion for paediatric oncology patients and families. Acknowledgments:Financial support by the Victorian Government through the Victorian Cancer Agency Research Funding.

403 MELANOMA IN THE ELDERLY, A DIFFERENT SPECTRUM OF DISEASE? Matthew J Rees 1 , Henry Liao 1 , Imogen Walpole 1 , Alexandra Sanelli 1 , David Gyorki 1 , John Spillane 1 , Angela Webb 1 , Chris McCormack 1 , Michael Henderson 1 1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Introduction:Australia has the highest incidence of melanoma worldwide. Current evidence suggests elderly patients experience a different spectrum of disease and a significantly worse prognosis than younger patients. Aim:This study describes the demographics, presentation, and care of elderly Australians with melanoma. Methods:A retrospective review of all patients aged ≥65 years (n=595) who presented with clinical AJCC stage 0, I or II melanoma, to Peter MacCallum Cancer Centre between the years 2000–2008. These patients were then compared with a randomly selected cohort of melanoma patients aged <65 years (n=331). Results:188 in-situ melanomas in 149 patients were identified. The incidence of in-situ melanoma increased significantly with age (p=0.015), and elderly patients experienced a significantly higher proportion of lentigo maligna (p<0.0001) and head and neck disease (p<0.001). 832 cases of stage I -II disease in 777 patients were identified. The proportion of patients with nodular melanoma increased significantly with age (p=0.0078). Melanomas affected the head and neck region in 12.3% of patients <65 years, compared to 28.8% in patient's ≥65 years, with a significant trend towards more head and neck melanomas with age (p<0.0001). The median Breslow thickness of patients ≥65 years was 3.09mm compared to 1.92mm in patients <65 years, and there was a significant increase in thickness with advancing age (p<0.0001). Older patients had significantly more ulcerated melanomas (p<0.0001, OR=1.03, 95% CI=1.02–1.04) and were significantly more likely to have an elevated mitotic rate (p-0.0007, OR=1.02, 95% CI=1.03–1.01). Conclusion:Major differences in the characteristics of melanoma in the elderly compared to younger patients (<65) were seen in this study. The increased proportion of high-risk melanomas should be considered in planning the care of elderly patients.

404 OPERABLE COLORECTAL LIVER METASTASES: AN AUSTRALIAN INSTITUTION EXPERIENCE Dhanusha Sabanathan 1 , Sulman Ahmed 2 , Guy D Eslick 3 , Michael Cox 2 , Jennifer A Shannon 1 1. Medical Oncology, Nepean Cancer Care Centre, Sydney 2. Department of Surgery, Nepean Hospital, Sydney 3. Department of Surgery, University of Sydney, Sydney Background:Molecular targeted therapy (MTT) is an established treatment for patients with metastatic colorectal cancer. However, its role as neoadjuvant therapy in curative resection of colorectal liver metastases (CLM) remains controversial. The new EPOC study has raised further questions regarding the use of MTT for operable liver metastases. Methods:Patients undergoing surgical resection with curative intent for CLM treated with or without neoadjuvant therapy including molecular targeted therapy were included in this study. Patient characteristics and survival outcomes were analysed. Results:Between 2008 to 2013, 60 patients from a single institution who underwent resection of CLM with curative intent, were analysed. Median age was 62. 35 patients had preoperative chemotherapy, of which 18 had MTT. 48 patients had postoperative chemotherapy, 12 combined with MTT. Objective response rate was achieved in 26 (74%) of patients receiving neoadjuvant therapy. Pathological complete response was achieved in 6 patients (10%). 44 out of 60 patients (73%) were alive and 27 patients (45%) were disease free at time of analysis. Patients who had post operative MTT had a worse PFS than those who did not (HR 5.43, 95% CI: 1.07–27.47). Effects of pre operative chemotherapy, pre operative MTT and post operative chemotherapy were variable (HR 1.62, 95% CI: 0.58–4.58; HR 2.00, 95% CI: 0.63–6.33; HR 1.18, 95% CI: 0.61–5.38). Presence of more than 4 liver metastases on initial assessment conferred a poorer PFS (HR 4.2, 95% CI: 1.35–13.09). Pre-operative CEA was not prognostic (HR 1.00, 95% CI: 0.99–1.01). Of those who progressed, median PFS was 15.9 months. Conclusion:Adjuvant systemic therapy is standard of care in the management of CLM. The optimal incorporation of MTT is yet to be established. This single institution series shows a detrimental effect with the addition of postoperative MTT.

405 PUNCHING ABOVE THE WEIGHT – HIGH-DOSE METHOTREXATE CHEMOTHERAPY IN EXTREMES OF BODY SIZE Geeta Sandhu 2,1 , Julia Korell 3 , Sally Mapp 2 , Christine Carrington 2 1. School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia 2. Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia 3. Model Answers Pty Ltd, Brisbane, Queensland, Australia Aim:To investigate the pharmacokinetic plausibility of capped body surface area (BSA) dosing in obese and overweight adult non-Hodgkin lymphoma (NHL) patients being treated with high-dose methotrexate (HD MTX). Methods:A HD MTX population pharmacokinetic model incorporating renal function and body size was developed from retrospectively collected observations of 108 adults who received HD MTX as part of the Hyper-CVAD chemotherapy for aggressive NHL during 2002 to 2012 at a tertiary referral metropolitan hospital. The model was used to simulate MTX plasma concentrations and overall exposure in a virtual population of 1000 individuals, randomly sampled with stratification for body size from the National Health and Nutrition Examination databases. Simulations were conducted with MTX dosing (200mg/m 2 over 2 hours followed by 800mg/m 2 over 22 hours) based on i) actual BSA, and ii) dose capped at 2m 2 in individuals with a BSA >2m 2 . Results:Simulated MTX plasma concentrations in obese and overweight individuals did not differ significantly from normal weight patients (p=0.024 and p=0.114 respectively) and with 95% of the simulated concentrations falling below the toxicity levels at 48 and 72 hours. Dose capped obese individuals displayed a reduced mean MTX exposure compared to dose capped overweight individuals (278µmol*hr/L versus 297µmol*hr/L). Renal function demonstrated a clear impact on the pharmacokinetics in all individuals and the best methods for estimation of renal function to guide HD MTX dosing in a population of diverse weights were determined. Conclusions:Pharmacokinetic changes with HD MTX in NHL appear to be marginal in obese and overweight individuals, suggesting dose cappingpurely based on body size may be unnecessary. Instead dosing adjustments in extremes of body size should appropriately account for renal function to avoid toxicity.

406 CHARACTERISTICS AND CLINICAL OUTCOMES OF INVASIVE LOBULAR CARCINOMA OF THE BREAST Ayesha Saqib 1 , Melissa Moore 1 1. Oncology, St Vincent Hospital , Melbourne, Vic, Australia Background/Aim:Invasive lobular carcinoma (ILC) is the second most common type of breast cancer. It accounts for 5% to 15 % of all breast cancers. The biological behaviour of ILC is distinct. There is conflicting data available on outcomes and optimal management of lobular carcinoma of the breast. We aim to collect information on baseline characteristics and clinical outcome of patients diagnosed and treated for invasive lobular carcinoma at St Vincent's Cancer Centre, Melbourne. Methods:We performed a retrospective data analysis. Patients diagnosed and treated for ILC were identified from the Oncology Department database at St Vincent's Hospital, Melbourne. Information was collected on baseline patient and tumour characteristics, type of treatment received and clinical outcome. Results:There were 165 patients identified from January 1977 to 2012 who were diagnosed and treated for ILC. All patients were female and the mean age was 57.7 years (range 33–86). Sixty nine percent were fifty years of age or older patients. Histopathological grade was known in 122 patients. Among them 93% had moderate to poorly differentiated carcinoma. Patients diagnosed with stage I to stage IV were included, 41 (24.8%) had stage I, 74 (44.8%) stage II, 30 (18.2%) stage III and 15 (9.1%) had stage IV disease. Nodal status was not known in 17.6 %, 43% had node negative and 39.4% had node positive disease. Eighty four percent of patients had ER and 64% had PR positive ILC. Of the 145 patients with early stage disease, 28% had disease recurrence and among them 21.9% had stage I, 51% had stage II and 26.8% had stage III disease at diagnosis. Of patients with recurrent disease 63.4% received adjuvant chemotherapy and 75.6% received adjuvant endocrine treatment. Conclusion:Our reported findings are similar to other published studies. ILC has a distinct biological behaviour hence management decisions should be individualised based on patient and tumour characteristics.

407 IMPACT OF HISTOPATHOLOGICAL PROFILE ON 1.5-YEARS DISEASE PROGRESSION OF BREAST CANCER PATIENTS: EVIDENCE FROM THE PHILIPPINE DOH-BREAST CANCER MEDICINE ACCESS PROGRAM IN MEDICAL ONCOLOGY CLINICS OF TWO TERTIARY HOSPITALS Marie Christine G. Semira 1 , Joanne Marie L. Balbuena 1 , Vanina H. Javier 2 , Jennifer Sandoval-Tan 1 , Corazon A. Ngelangel 2,4,3 1. Section of Medical Oncology, Philippine General Hospital, Ermita, Philippines 2. Section of Medical Oncology, Jose Reyes Memorial Medical Center , Manila, Philippines 3. Philippine Cancer Society, Manila, Philippines 4. Section of Medical Oncology, Philippine General Hospital, Ermita, Manila, Philippines Aims:Current international consensus confirms that certain histopathologic factors such as tumor morphology, histologic grade and presence of lymphovascular invasion are correlated with prognosis. This study evaluated the correlation between histopathologic profile and time to disease progression over 1.5 years among Filipino Stage I-III early breast cancer patients given chemotherapy. Methods:This retrospective cohort study included all eligible Stage I-III breast cancer patients enrolled in the Department of Health (DOH) Breast Cancer Medicine Access Program at the medical oncology clinics of two tertiary hospitals in Manila from April 2011 to December 2012. Histopathologic factors of interest such as histologic type/grade, lymphovascular invasion, and axillary lymph node involvement were gathered from patient records. The patients were grouped according to the St. Gallen definition of risk categories for patients with breast cancer. Kaplan-Meier survival analysis determined the average time to disease progression as well as progression-free survival over 1.5-years follow-up, while multivariate logistic regression determined independent clinical and histopathologic factors contributing to disease progression. Results:A total of 326 patients were included in the study. Eighteen percent (18%) showed progression, with a median time-to-progression of 14 months. Time-to-progression was comparable among the low-, intermediate- and high-risk groups. Progression-free survival at 1.5 years was estimated to be at 78% for the high-risk group, 83% for the intermediaterisk group, and 86% for the low-risk group. At 1.5-years follow-up, no studied clinical or histopathologic factors of interest were shown significantly correlated with outcome. Conclusion:Filipinas with Stage I-III breast cancer who completed chemotherapy showed a favorable 1.5-years progression-free survival, regardless of histopathologic profile, or St. Gallen risk stratification. Other factors (such as ER/PR/HER2neu profile, or compliance to schedule of treatment) that may contribute to disease progression need to be further explored; follow-up of these patients up to 5 or more years would define sustained gains from the DOH Breast Cancer Medicines Access Program.

408 QUALITY OF LIFE AFTER CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR PERITONEAL CARCINOMATOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS Leonard L. Shan 1 , Akshat Saxena 2 , Bernard L. Shan 3 , David L. Morris 2 1. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia 2. Department of Surgery, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW, Australia 3. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia Publish consent withheld

409 GASTRECTOMY FOR GASTRIC CARCINOMA: A SYSTEMATIC REVIEW OF QUALITY OF LIFE Bernard L. Shan 1 , Leonard L. Shan 2 , Akshat Saxena 3 , David Morris 3 1. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia 2. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia 3. Department of Surgery, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW, Australia Publish consent withheld

410 TRANS-ARTERIAL EMBOLISATION THERAPIES FOR UNRESECTABLE INTRAHEPATIC CHOLANGIOCARCINOMA: A SYSTEMATIC REVIEW Jocelyn Shan 1 1. Monash University, Doncaster, VIC, Australia Linda Yang 1 MBBS, Jocelyn Shan 2 , Leonard Shan 1 MBBS, Akshat Saxena 3 MBBS MS, David Morris 3 MBBS FRACS PHD 1. Melbourne Medical School, The University of Melbourne, Victoria, Australia 2. Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia 3. Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia Purpose:Unresectable intrahepatic cholangiocarcinoma portends a poor prognosis despite standard systemic treatments which confer minimal survival benefits and significant adverse effects. This study aimed to assess clinical outcomes, complications and prognostic factors of trans-arterial embolization therapies using chemotherapeutic agents or radiation. Methodology:Original articles published after January 2000 on trans-arterial therapies for unresectable intrahepatic cholangiocarcinoma were selected using strict eligibility criteria. Radiological response, overall survival, progression-free survival, safety profile, and prognostic factors for overall survival were assessed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesized by narrative review and quantitative analysis. Results:Twenty articles were included (n=929 patients). Thirty three percent of patients presented with extrahepatic metastases. After treatment, the average rate of complete and partial radiological response was 10% and 22.2%, respectively. Overall median survival time was 12.4 months with a median 30-day mortality and 1-year survival rate of 0.6% and 53%, respectively. Acute treatment toxicity (within 30 days) was reported in 34.9% of patients, of which 64.3% were mild to moderate in severity. The most common clinical toxicities were abdominal pain, nausea and vomiting, and fatigue. Multiplicity, localization and vascularity of the tumor may predict worse overall survival. Conclusions:Trans-arterial therapies are safe and effective treatment options which should be considered routinely for unresectable intrahepatic cholangiocarcinoma. Consistent and standardized methodology and data collection is required to facilitate a meta-analysis. Randomized controlled trials will be valuable in the future.

411 ASSESSMENT OF SURGICAL DOWNSTAGING IN AN OPEN-LABEL PHASE 2 TRIAL OF DENOSUMAB IN PATIENTS WITH GIANT CELL TUMOUR OF BONE Paul D Stalley 1 , Stefano Ferrari 2 , Piotr Rutkowski 3 , Robert J Grimer 4 , Sander PD Dijkstra 5 , Andrzej Pienkowski 3 , Gualter Vaz 6 , Leanne L Seeger 7 , Amy Feng 8 , Bruce A Bach 8 1. Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia 2. Chemotherapy Unit, Istituto Ortopedico Rizzoli, Bologna, Italy 3. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Center and Institute of Oncology, Warsaw, Poland 4. Orthopaedic Oncology Unit, Royal Orthopaedic Hospital, Birmingham, UK 5. Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands 6. Department of Orthopedic Surgery, Edouard Herriot Hospital, Lyon, France 7. Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA 8. Amgen Inc, Thousand Oaks, California, USA Aims:Surgical resection, the standard treatment for giant cell tumour of bone (GCTB), may be associated with severe morbidity and may not be curative for all lesions. In an openlabel phase 2 study, treatment with denosumab was associated with delayed surgery and/or a less morbid procedure in most patients with resectable GCTB. We report an unplanned, interim analysis of surgical downstaging in patients with resectable GCTB whose initially planned surgery was associated with severe morbidity. Methods:Adults or skeletally mature adolescents with resectable GCTB received denosumab 120mg SC every 4 weeks and on study days 8 and 15. Planned and actual GCTB surgical procedures following treatment are reported. Procedure selection and timing were based on review of radiographic imaging and clinical response. Results:Overall, 222 patients enrolled and were evaluable for surgical downstaging (men, 46%; median age, 34 years); most had lesions in the lower (n=117) and upper (n=62) extremities or pelvis/sacrum (n=33). In total, 193 (86%) patients either had no surgery (n=109; 48%) or had a less morbid procedure (n=84; 37%). All 222 patients received denosumab; median (range) time on denosumab was 14.1 (1.0−57.1) months for all patients and 17.5 (1.0−57.1) months for the 109 patients with no surgery. The proportions of patients with a planned surgical procedure who had not undergone surgery were: hemipelvectomy (n=8/10; 80%), amputation (n=32/40; 80%), joint/prosthesis replacement (n= 6/25; 24%), joint resection/fusion (n=14/35; 56%), en bloc resection (n=31/85; 36%), en bloc excision (n=7/8; 88%), curettage (n=8/18; 44%). The native joint preservation rate was 96% in the 25 patients with a planned joint/prosthesis replacement and 86% in 35 patients with a planned joint resection/fusion. Conclusions:Consistent with initial results, treatment with denosumab was associated with delayed invasive surgery or a less morbid procedure than was planned in most patients with resectable GCTB.

412 SURVIVAL, RESPONSE DURATION, AND ACTIVITY BY BRAF MUTATION (MT) STATUS OF NIVOLUMAB (NIVO, ANTI-PROGRAMMED DEATH-1) AND IPILIMUMAB (IPI) CONCURRENT THERAPY IN ADVANCED MELANOMA (MEL) Mario Sznol 1 , Harriet Kluger 1 , Margaret K Callahan 2 , Michael A Postow 2 , RuthAnn Gordon 2 , Neil H Seal 2 , Naiyer A Rizvi 2 , Alexander M Lesokhin 2 , Michael B Atkins 3 , John M Kirkwood 4 , Matthew M Burke 1 , Amanda Ralabate 1 , Angel Rivera 1 , Stephanie A Kronenberg 2 , Blessing U Agunwamba 2 , William Feely 5 , Hong Quan 5 , Suba Krishnan 5 , Ashok Gupta 5 , Jedd D Wolchok 2 1. Yale Cancer Centre, New Haven, CT, USA 2. Memorial Sloan-Kettering Cancer Centre, New York, NY, USA 3. Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA 4. University of Pittsburgh Medical Centre, Pittsburgh, PA, USA 5. Bristol-Myers Squibb, Princeton, NJ, USA Aims:We report updated survival and clinical activity in initially enrolled cohorts and activity by BRAF MT status in a phase I trial of concurrent and sequenced NIVO+IPI. Methods: MEL patients (n=53) with ≤3 prior therapies received concurrent NIVO+IPI (i.v.), every 3 weeks for 4 doses, followed by NIVO every 3 weeks for 4 doses. At week 24, NIVO+IPI continued every 12 weeks for 8 doses in patients with disease control and no dose-limiting toxicity. Tumour responses were evaluated by World Health Organisation (WHO) and immune-related criteria. Results:Patient characteristics included 55% with stage M1c on study entry and 45% with prior systemic therapy. On concurrent therapy cohorts, across doses, 1- and 2-years overall survival (OS) rates were 85% and 79%, aggregate clinical activity rate (ACAR) was 72% with more complete responses 9/53 (17%) compared to previous reports. ACAR among patients with BRAF mutant status was 67% (8/12) and 72% (28/39) among BRAF wildtype. By week 36, 42% demonstrated ≥80% tumour reduction. Median duration of response (DOR) was not reached. Of 22pts with objective response, 20 (91%) had DOR ≥24wk (range: 31, 141). Treatment-related adverse events were as reported previously: grade 3–4, 62% of patients; most common: increased lipase(19%) and AST (13%). Data for sequenced cohorts showed a median OS of 13 months and ACAR of 52%; there was similar activity in patients regardless of tumour BRAF MT status. Conclusions: Concurrent NIVO+IPI therapy showed encouraging survival and a manageable safety profile in advanced MEL patients. Responses were observed regardless of BRAF MT status and were durable in the majority of patients. Phase 2 and 3 trials investigating concurrent NIVO+IPI in MEL patients are currently underway and the NIVO+IPI combination is also being investigated in other tumour types.

413 COMPARING THE IMPACT OF MELATONIN AND CAPTOPRIL ON EARLY EFFECTS OF RADIATION ON THE HEART TISSUE BY STUDYING GSH, MDA AND LDH ENZYME ACTIVITY IN RATS Farnaz Tabatabaie 1 , Alireza Shirazi 2 , Hamidreza Mirzaei 3 , Mahmoud Ghazi-Khansari 4 1. Department of Biomedical Engineering, Science and Research Branch, Azad University, Tehran, Iran 2. Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran 3. Department of Radiation & Oncology, Cancer Research Center, Shohadaye-Tajrish Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran 4. Departments of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Background:Prevention of secondary malignancy while the patient is receiving radiotherapy for the management of primary cancer has been a mammoth challenge for biological and medical safety. The risk of heart damage related to the adjuvant breast cancer radiotherapy is the issue that was considered in this study. Aim:The aim of the study is to compare Protective Effects of Melatonin and Captopril on Early Effects of Radiation on the Heart tissue of Rats. Method:60 adult male Wistar rats weighing 180–220g were used. We divided rats in 6 groups: 1 – Control group, 2 – Group Irradiated with 8Gy and without treatment with Melatonin or Captopril, 3 – Group treated with Melatonin with no gamma radiation, 4 – Group treated with Captopril with no gamma radiation, 5 – Group irradiated with 8Gy and treated with melatonin, 6 – Group Irradiated with 8Gy and treated with Captopril. Rats were exposed to 8Gy whole body dose from Co-60 sources. 30min prior to irradiation, 6 animals received melatonin (100mg/kg body weight) and 6 animals received Captopril (50mg/kg body weight). All groups were sacrificed 10 days post irradiation and hearts were collected. Malondialdehyde (MDA), lactate dehydrogenase (LDH) and glutathione (GSH) were measured to evaluate cellular oxidative stress induced injury. Results:Treatment with Captopril resulted in a significant increase in LDH and MDA, although the level of GSH was decreased (P<0.05). MDA and LDH levels were decreased after Melatonin treatment whilst GSH level was increased (P<0.005). Conclusions:Melatonin have protective effects following radiation, while treatment with Captopril post-irradiation is radio sensitizing and does not have protective effects against radiation. 1. Meinardi, M. T., etal. “ Prospective evaluation of early cardiac damage induced by epirubicin-containing adjuvant chemotherapy and locoregional radiotherapy in breast cancer patients.” Journal of Clinical Oncology 19.10 (2001): 2746–2753. 2. Vijayalaxmi, Russel JR, Dun-Xian T, Terence SH, Charles RTJ. Melatonin as a radioprotective agent: a review. Int J Rad Oncol. 2004;59(3). 3. Lagneux C, Joyeux M, Demenge P, Ribuot C, Godin-Ribuot D. Protective effects of melatonin against ischemia-reperfusion injury in the isolated rat heart. Life Sci. 2000;66(6):503–509. 4. Davis TA, Landauer MR, Mog SR, Barshishat-Kupper M, Zins SR, Amare MF, etal. Timing of captopril administration determines radiation protection or radiation sensitization in a murine model of total body irradiation. Exp Hematol. 2010;38(4):270–281.

414 APPLYING SOCIAL-COGNITION MODELS TO UNDERSTAND WOMEN'S HYPOTHETICAL INTENTIONS FOR CONTRALATERAL PROPHYLACTIC MASTECTOMY Phyllis Butow 1 , imogen Richards 2 , Stephanie Tesson 2 , David Porter 3 , Kelly-Anne Phillips 4 , Toni Musiello 5,6 , Nicole Rankin 7 , Michelle Marven 8 1. CeMPED/ PoCoG, The University of Sydney, NSW, Australia 2. School of Psychology, University of Sydney, Sydney, NSW, Australia 3. Dept of Oncology, Aukland Hospital, Aukland, New Zealand 4. Dept of Medical Oncology, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia 5. University of Western Australia, Perth, Western Australia, Australia 6. University of Western Australia, Perth, Western Australia, Australia 7. Sydney Catalyst, University of Sydney, Sydney, NSW, Australia 8. Breast Cancer Network of Australia (BCNA), Sydney Aims:Women with unilateral breast cancer (BC) without BRCA1/2-mutations face increased risk of contralateral breast cancer (CBC), albeit low (0.50–0.75% annually). Contralateral Prophylactic Mastectomy (CPM) reduces CBC risk by >90%, and its uptake is increasing. Yet CPM may not increase life-expectancy in low-risk women, necessitating exploration of factors influencing CPM decision-making. This study assessed the validity of the Theory of Planned Behaviour (TPB) and Protection Motivation Theory (PMT) to predict low-risk BC patients' hypothetical CPM intentions. Methods:Women were recruited through Breast Cancer Network Australia's research database, comprising 2,229 women. Eligibility criteria included i) BRCA1/2 -mutation negative, ii) aged 18–70 years, iii) diagnosed within 10 years prior, iv) completed primary treatment. A sample of 127 was required for sufficient power. Participants responded to an online survey eliciting demographic / disease characteristics, and TPB/PMT items pertaining to a common hypothetical CPM decision-making scenario. Results:400 women consented, and 368 completed the survey. Participants' mean age was 53 years ( SD =8.15). 102 women (26%) had undergone CPM, and 12% also had reconstruction. All women who had CPM and 9% who had not, discussed it with their surgeon, and 30% who had CPM and 9% who had not, discussed it with an oncologist. CPM discussions were predominantly patient-initiated (75%). Main reasons cited for having CPM were CBC risk-reduction (79%), breast symmetry (56%) and mortality risk-reduction (49%). TPB variables (attitudes, subjective norms, perceived behavioural control) and most PMT variables (self-efficacy, response-efficacy, costs, severity) correlated highly with hypothetical CPM intentions ( r =.24-.58, all p <0.01), as did anticipated regret, uncertainty attitudes, screening self-efficacy and fear of recurrence (| r |=.24-.92, all p <0.01). Conclusions:CPMappears patient-driven, with few women gaining other than surgical perspectives on risk management. Women may be over-estimating risk reduction offered by CPM. Social-cognitive and emotional variables need to be considered to holistically understand this complex decision.

415 SINGLE INSTITUTION REVIEW OF THE TOLERABILITY AND EFFICACY OF POST CHEMOTHERAPY ABIRATERONE ACETATE IN A REGIONAL CANCER CENTRE Padmini thanayankezhil 1 , suzanne allan 1. GCUH, Southport, QLD, Australia Aim:Abiraterone acetate has been approved by the PBS in Australia since mid 2013 as a treatment for men with castrate-refractory prostate cancer post-taxane based chemotherapy. This approval was based on the promising results from the COU AA 301 study which demonstrated a statistically significant 4.6 month improvement in median overall survival. This audit was conducted to look at the efficacy and tolerability of abiraterone acetate in the post chemotherapy setting in a regional cancer centre. Methods:A retrospective chart audit was done in Gold Coast University Hospital of patients who have been treated with Abiraterone from August 2013 till July 2014 A total of 22 patients were audited. Variables assessed included age, ECOG, disease burden, tissue diagnosis, and treatment prior to abiraterone. Outcomes assessed included side effects, PSA halving time, progression-free survival and treatment beyond progression. Findings:Twelve patients progressed on the treatment, with the duration of treatment ranging from two to ten cycles. Five patients subsequently discontinued therapy, and three were rechallenged with chemotherapy. Seven patients had stable disease, with the treatment duration ranging from one to eleven cycles of Abiraterone. The majority of the patients had one course of docetaxel prior to abiraterone, two patients having been rechallenged with docetaxel and cabazitaxel prior to starting abiraterone. Cycles of prior chemotherapy ranged from one to fourteen, with only two patients receiving more than ten cycles. Bone disease was predominant, followed by lymph node and visceral metastases. Eight patient ceased the medication, four of them due to progression and four due to side effects. Fluid retention was the most common side effect, followed by fatigue,and dermatological toxicities. The median progression-free survival was 6 months, with overall survival being presented later. Conclusion:Abiraterone was generally well tolerated, with only four patients ceasing the medication secondary to side effects. The median progression free survival was six months which was comparable to the original study.

416 RAPID FLUORODEOXYGLUCOSE-POSITRON EMISSION TOMOGRAPHY (FDG-PET) RESPONSE TO DENOSUMAB TREATMENT IN PATIENTS WITH GIANT CELL TUMOUR OF BONE (GCTB): RESULTS FROM TWO PHASE 2 TRIALS David Thomas 1 , Rodney J Hicks 2 , Keith Skubitz 3 , Sant Chawla 4 , Arthur Staddon 5 , Jacob Engellau 6 , Amy Feng 7 , Bruce A Bach 7 1. The Kinghorn Cancer Centre and Garvan Institute of Medical Research, Sydney, Australia 2. Peter MacCallum Cancer Centre, Melbourne, Australia 3. Division of Hematology, Oncology, and Transplantation and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA 4. Sarcoma Oncology Center, Santa Monica, CA, USA 5. Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA 6. Skåne Universitetssjukhus, Lund, Sweden 7. Amgen Inc, Thousand Oaks, California, USA Aims:GCTB is a primary osteolytic tumour characterised by local invasiveness and limited non-surgical treatment options. Osteoclast-like giant cells expressing surface RANK, and stromal cells expressing RANK ligand, are features of GCTB. We report sequential FDG-PET as a sensitive early indicator of GCTB response to denosumab from two phase 2 trials. Methods:Adult or skeletally mature GCTB patients (N=360) received subcutaneous denosumab 120mg on days 1, 8 and 15 and Q4W thereafter. In some centres, combination FDG-PET and CT images were obtained sequentially as part of routine care. All evaluable scans were reviewed by central independent treatment-blinded reviewers. Results:Paired pre- and post-treatment FDG-PET scans from 26 patients (144 evaluable scans) showed marked reductions in FDG-PET avidity and reductions in standardised uptake values (SUV) early in response to denosumab at the first post-treatment scan (median [Q1, Q3] 68.5 [50, 84] days from first dose). Results for all lesions (n=26 patients; 144 evaluable scans), lung (n=5; 49 evaluable scans), axial skeleton (n=11; 49 evaluable scans) and appendicular skeleton lesions (n=11; 46 evaluable scans) were: 9.8, 6.5, 9.2, and 10.0 for baseline median SUVmax; 2.7, 1.8, 2.7, 4.0 for best on-study median SUVmax; 1.8, 1.4, 1.7, and 2.1 for mean EORTC Standard Uptake; −64%, −64%, −64% and −66% for best SUVmax response (mean % change from baseline). All paired samples showed a best EORTC response of >25% reduction in SUV uptake following initiation of denosumab treatment. Sequential FDG-PET imaging studies revealed a sustained and progressive SUVmax reduction in GCTB lesions with continued denosumab treatment. Conclusions:This is the largest GCTB FDG-PET imaging data set from an interventional clinical trial reported to date. FDG-PET is a sensitive early indicator of tumour response to denosumab, preceding both cytoreduction (RECIST) and new bone formation/calcification (HU density). Most importantly, denosumab-induced response was sustained for GCTB patients.

417 HAEMATOLOGICAL CANCER PATIENTS' VIEWS ON TISSUE BANKING Heidi Turon 1 , Amy Waller 1 , Tara Clinton-McHarg 2 , Jennifer Fleming 3 , Paula Marlton 4 , Rob Sanson-Fisher 1 1. University of Newcastle, Callaghan, NSW, Australia 2. Hunter New England Health, Wallsend, NSW, Australia 3. University of Sydney, Sydney, NSW, Australia 4. Princess Alexandra Hospital, Brisbane, QLD, Australia Aims:Tissue banks, also known as biobanks or biorepositories, are valuable resources allowing the causes and mechanisms of cancer to be studied, and more effective treatments developed. However there remains much debate about the regulatory structure of tissue banks, especially in terms of how samples should be used. The limited studies to date among the general public, potential donors and actual (cancer) tissue bank donors (1, 2), have generally shown high levels of support for tissue banks. The aim of this study was to investigate the views and preferences of a sample of haematological cancer patients on the topic of tissue banking. Methods:Patients presenting for an outpatient appointment at one of three haematological cancer clinics in Australia were invited to complete a baseline and follow-up survey, one month apart. Demographics, diagnosis and treatment information were collected at baseline. Participants were asked a series of questions regarding their views on tissue banking at follow-up. Results:213 participants completed both the baseline and the follow-up survey. Overall, support for tissue banking was very high, with 92% (n=196) of participants indicating they would be willing to donate tissue for research if asked. Preferences for a tissue bank consent model (consent given once vs. consent for each new study vs. individual preference) were more varied. Conclusions:There is overwhelming support for tissue bank donation amongst a sample of haematological cancer patients; however their views regarding consent models for tissue sample use are more heterogeneous. These data can inform debate about the regulatory structure of tissue banks. 1. Fleming J. Issues with tissues: Perspective of tissue bank donors and the public towards biobanks and related genetic research. In: Stranger ME, editor. Human biotechnology and Public Trust: Trends, Perceptions and Regulation. Hobart: Centre for Law and Genetics, Uni Tas; 2007. p. 184–201. 2. Young MA, Herlihy A, Mitchell G, Thomas DM, Ballinger M, Tucker K, etal. The attitudes of people with sarcoma and their family towards genomics and incidental information arising from genetic research. Clinical sarcoma research. 2013;3(1):11. Epub 2013/08/01.

418 MULTIMODALITY IMAGING IN RADIOTHERAPY AT RGCI & RC INDIA Gurvinder Singh Wadhawan 1 1. Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India Background and Context:work of Nobel Prize-winning scientists Antoine-Henri Becquerel, Marie Curie and Pierre Curie, the field of radiation therapy grew quickly in the early 1900s. A new era in medical treatment and research began based on their clinical practice & benefits of radiation could be applied for treatment for cancer patients. Aim:Accurate image guided radiotherapy (IGRT) using MVCBCT is essential prerequisite to practice IMRT or 3DCRT and forms an important factor in the quality of actual radiation delivery. The capability of generating an entire volumetric MV-CBCT data set in a single-gantry rotation, allows 3D visualization of the tumor prior to the delivery of treatment and correlation with reference plan CT data. This permits corrections of shifts beyond an acceptable limit. Strategy/Tactics:Prior to treatment, 2D and/or CBCT on ARTISTE (Siemens and Varian) was acquired and setup errors with reference to X, Y, Z were corrected online in 20 patients of breast, head & neck and prostate. A second CBCT was acquired after the correction process and coordinates for daily set-up and images were obtained. Programme/Policy Process:A total number of 211 CBCT/ or 2D images were performed in 20 patients. The sites included – breast (n=10), H&N (n=6) and prostate (n=4). Images were evaluated for 95, 58 and 58 fractions respectively. The shifts observed in X, Y and Z axes are summarized below: In addition, rotational errors were observed in 7% (15/211 images). These include breast (2%), H&N (1%) and prostate (4%), which were also corrected by IGRT. Outcomes/What was learned:Despite immobilization devices, shifts beyond the acceptable limits of 2mm were observed during online CBCT or 2D imaging with IGRT in breast (79.9%), H&N (49.2%) and prostate (96.6%). IGRT permits detection and online corrections of these shifts which would have been gone unnoticed leading to dosimetric errors during radiation therapy

420 IMPLEMENTING A PROTOCOL FOR VITAMIN-D SCREENING AND REPLACEMENT IN CANCER PATIENTS Wen Xu 1,2 , Janet Hardy 1,2 , Zarnie Lwin 3 , Natasha Woodward 1,2 , Catherine Shannon 1,2 1. Mater Hospital, South Brisbane, QLD, Australia 2. Mater research/University of Queensland, Brisbane, QLD, Australia 3. Cancer Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia Aims:A recent meta-analysis showed improved outcomes for cancer patients with higher serum 25(OH)D levels 1 . We explored the implementation of a vitamin-D screening and replacement protocol in an oncology ambulatory-care setting. Methods:Our protocol encouraged routine vitamin-D screening of all new patients presenting to oncology outpatients. Patients found to be vitamin-D deficient were to be treated with a standardised replacement protocol: 25(OH)D levels: 25–50nmol/L – to receive 2000IU oral cholecalciferol daily; <25nmol/L – to receive 4000IU oral cholecalciferol daily. Follow up vitamin-D levels were checked at 3 months to assess adequacy of replacement. We audited the first 100 new oncology outpatients at a single centre, over a 10 week period (Nov 2013-Jan 2014), post introduction of vitamin-D screening, to assess adherence to protocol. Results:Of 100 consecutive outpatients, the median age was 63 (median ECOG 1). The majority of patients were female (79%), in keeping with the predominant cancers seen (breast 38%, gynaecological 27%). 61% of patients were treated with curative intent, with 73% of patients receiving chemotherapy. 9% of patients had bone metastases at presentation. 56/100 new patients were screened according to protocol. Of these, 14 (25%) were found to be vitamin-D deficient, with 13/14 commencing 25-OHD replacement at our centre. As of July 2014, 100% (9/9) of patients who had a followup 25-OHD level checked ≥3 months post commencing replacement, achieved adequate replacement. Conclusions:A lower rate of vitamin-D deficiency was seen (25%) in the implementation phase of our study compared to a previous pilot study 2 (37%). This may reflect the relatively high performance status of the implementation cohort; with a greater proportion of patients with early-stage disease. Within the limited sample-size, the proposed vitamin-D replacement protocol appeared to be successful. Compliance with our vitamin-D screening protocol (56%) was sub-optimal. Better processes need to be adopted to translate research into practice. 1. Li M, Chen P, Li J etal. J Clin Endocrinol Metab 2014;99:1–10 2. Morton A, Hardy J, Morton A. etal. Supportive Care in Cancer, 2014 (in press)

421 TRAINING BENEFITS OF A LEARNING MANAGEMENT SYSTEM (LMS) Eliza Bott 1 , Leisa Brown 1 , Maree Bransdon 1 1. Central Integrated Regional Cancer Service, Queensland Health, Brisbane, QLD, Australia Need:Queensland Health's LMS has provided a functional technological interface that suits the individual abilities of nursing staff, predominantly in a cancer care setting. CIRCS facilitates two courses on the platform which are contributing to the development of sustainable levels of service in settings where face-to-face education is difficult to provide. Reach:Seventy percent of Queensland's land surface area is rural and remote, including 162 public health service facilities. The LMS has allowed CIRCS to expand its educational reach into these geographically restricted areas. So far, 652 nurses in 46 facilities in rural, regional, remote and metro Queensland have participated in these courses. CIRCS hopes to eventually reach 7,000 nurses and standardise the way cancer care is provided. Benefits:The LMS enables immediate and synchronous communication, content development and delivery, formative and summative assessment and data collection. CIRCS defined objectives and goals to align with Queensland Health policies and address the challenges magnified by geographical distance and unique community characteristics. The absolute reach into rural, regional and remote areas allowed priority goals to be achieved with acceptable quality and minimal resources. Approach:The nature of the LMS enables a fast and efficient response to changing trends and demands. The LMS is supplemented by education sessions using Telehealth. This enables CIRCS' Nurse Educator to video link with nurses in rural, regional and remote Queensland. This blended learning approach empowers the delivery of course content to most people in an efficient time. Conclusion:Queensland Health's LMS has enabled CIRCS to provide standardised education and resources to nurses who would otherwise be unable to attend face-to-face education sessions. This practice is helping to provide a highly-skilled, capable and sustainable workforce through flexible education delivery.

422 A RANDOMISED CONTROLLED TRIAL OF A COUPLES-BASED SEXUALITY INTERVENTION FOR MEN WITH LOCALISED PROSTATE CANCER WHO RECEIVE RADICAL PROSTATECTOMY AND THEIR FEMALE PARTNERS Suzanne K Chambers 2,4,1,3,5 , Stefano Occhipinti 6 , Leslie Schover 7 , Lisa Nielsen 2 , Leah Zajdlewicz 2 , Samantha Clutton 2 , Kim Halford 8 , Robert (‘Frank’) A Gardiner 4,9 , Jeff Dunn 2,1,10,11 1. Griffith Health Institute, Griffith University, Brisbane, QLD, Australia 2. Cancer Council Queensland, Spring Hill, QLD, Australia 3. Prostate Cancer Foundation of Australia, Sydney, NSW, Australia 4. University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia 5. Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia 6. School of Psychology, Griffith University, Brisbane, QLD, Australia 7. Department of Behavioral Science, University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States 8. School of Psychology, University of Queensland, Brisbane, Qld, Australia 9. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia 10. School of Public Health, Griffith University, Brisbane, QLD, Australia 11. School of Social Science, University of Queenslane, Brisbane, QLD, Australia Background:The diagnosis and treatment of prostate cancer is followed by substantial sexual morbidity. However, the optimal approach for intervening remains unclear. Methods/design:A three arm randomised control trial with 189 heterosexual couples in which the man had been previously diagnosed with prostate cancer compared the efficacy of peer-delivered telephone support vs. nurse-delivered telephone counselling vs. usual care in improving both men's and women's sexual and psychosocial adjustment. Assessments were undertaken at baseline (pre-test) and 3, 6, and 12 months after the initial assessment. Results:At the 12 months post- assessment men in the nurse intervention more frequently used tablets for erectile dysfunction compared with men in the peer intervention ( p =0.049) or usual care ( p =0.001); and men in usual care used medical treatments for sexual problems less than men in the peer ( p= 0.014) and nurse intervention ( p =0.006). No significant effects were found for the other primary outcomes of sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy for either male or female participants. For secondary outcomes, men in the peer intervention reported less improvement over time for cancer-specific distress, compared with men in usual care (b= 0.02, p =0.032; d for peers=0.23, d for usual care=0.70); women in the nurse intervention reported less improvement over time for cancer-specific distress (b=.016, p =0.022; d for nurse=0.40, d for usual care=0.68) compared to women in usual care. No differences in psychological distress or quality of life were observed. Conclusion:Although peer and nurse couples based interventions may increase use of sexual aids this may not translate into better sexual outcomes. Timing within the treatment trajectory may be crucial for sexuality intervention studies after prostate cancer treatment.

423 APPETITE FOR E-LEARNING – EDUCATING CLINICIANS ON CANCER MALNUTRITION Lauren Muir 1 , Amber Kelaart 1 , Karen Donald 2 1. Nutrition Department, Peter MacCallum Cancer Centre, East Melbourne, VIC 2. Peter MacCallum Cancer Centre, East Melbourne, VIC A recent point prevalence study completed across 15 Victorian Health Services identified malnutrition as highly prevalent in the inpatient and ambulatory oncology settings. A core recommendation from this study was to develop a resource to increase awareness, understanding and the appropriate management of malnutrition amongst multidisciplinary cancer clinicians. E-learning resources were the selected medium, with the goal to optimise the accessibility, reach and impact. E-learning presents benefits in cost effectiveness; enhanced audience engagement and response; consistency and currency of information; accessibility and flexibility in time, pace and location; monitoring capacity; and opportunity for innovative, interactive, active learning. Focussed, discipline specific cancer malnutrition E-learning packages were developed for medical, allied health, nursing, general practitioners and practice nurse domains to promote awareness, identification, early intervention and management. Through education and enhanced management, patient outcomes are expected to benefit. Development of the packages considered key theories in adult learning given the diverse target audience. Kolb's Experiential Learning theory was consulted and a range of visual, auditory and kinaesthetic information modalities utilised to enhance educational impact on cancer clinicians. Videos, images, maps and charts were utilised throughout to engage visual learners. Auditory learners will benefit from consistent written and verbal information presented by a narrator, clinicians and patients as well as a range of written information as factsheets, education resources, clinical tools and a comprehensive literature review. The resource includes a range of interactive activities throughout to engage those who learn kinaesthetically. In many cases, a combination of visual, auditory and kinaesthetic information was presented to optimise the influence of the information provided. This e-learning package is an example of an innovative, interactive, evidence-based health education package. A number of pedagogic strategies and theories have been employed to meet the learning needs of a wide and diverse audience to ultimate enhance patient care and outcomes.

424 AFLIBERCEPT IN METASTATIC COLORECTAL CANCER (MCRC): DATA FROM CLINICAL TRIALS, LESSONS FROM CLINICAL PRACTICE Kynan Feeney 1 , Melvin Chin 2 , Siobhan Ng 3 , Marco Matos 4 , Gabriel Mak 2 , Joseph McKendrick 5 1. Cancer Centre, St John of God Hospital, Murdoch, WA, Australia 2. Prince of Wales Hospital, Randwick, NSW, Australia 3. St John of God Private Hospital, Subiaco, WA, Australia 4. Pacific Private Clinic, Southport, QLD, Australia 5. Epworth Eastern Hospital, Box Hill, VIC, Australia Aflibercept was registered in Australia, based on the VELOUR pivotal registration trial in second line mCRC. 1 In VELOUR, the addition of aflibercept to FOLFIRI chemotherapy resulted in statistically significant increases in overall survival (OS, HR 0.82; median 12.1 vs 13.5 months), progression free survival (PFS, HR 0.76; median 4.7 vs 6.9 months), and response rate (ORR, 19.8% vs 11.1%). Clinical experience with aflibercept in Australia is now accumulating, enabling clinicians to begin to answer key clinical questions and share their experiences through case presentations. 1.Patient selection: Decisions are further guided by patient-focused factors (disease status, tumour biology, performance status, KRAS mutation status, patient preferences, prior therapy, treatment goals) and practical factors (ease of access, costs, PBS listing). 2.Dose and duration of therapy: In the VELOUR trial, aflibercept patients received a median of nine cycles overall (21.4 weeks). In practice, Australian clinicians aim to have a minimum of 2–3 months on treatment before re-staging to assess response. There is no maximum number of cycles provided the patient is deriving clinical benefit, is tolerating treatment and wishes to continue. Standard approaches after stopping aflibercept would be to consider clinical trials, third-line treatment options including re-challenge with previous chemotherapy and targeted therapy, and cessation of systemic therapy. 3.Proactive management of adverse events In VELOUR, adverse events (all grades) leading most frequently to permanent discontinuation of study treatment were asthenic conditions (3.8% v 1.3%, respectively), infections (3.4% v 1.7%), diarrhoea (2.3% v 0.7%), and hypertension (2.3% v 0%). Adverse events are well documented. They can be minimised through proactive management strategies, making sure they are known to all staff involved in patient care and providing adequate patient education. Funding:Editorial support for this abstract was provided by Hazel Palmer (Scius Solutions Pty Ltd) and funded by Sanofi Australia Pty Ltd. 1. Van CE, etal. J Clin Oncol 2012 October 1;30(28):3499–3506.

425 DEVELOPMENT AND IMPLEMENTATION OF THE “INTRODUCTION TO ONCOLOGY FOR PHYSIOTHERAPISTS” STUDY DAY Sharni L Patchell 1 , Marie Coulombe 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Aim:As physiotherapists working in a specialised oncology setting, we regularly answer queries from physiotherapists nationally, to provide education on how to manage the oncology patient population. We identified a lack of resources and education for physiotherapists working with oncology patients and wanted to develop a comprehensive education day to improve knowledge. Method:The Peter MacCallum Physiotherapy department implemented the “Introduction to Oncology for Physiotherapists” study day. The one day course was designed for recent graduates or those with limited oncology experience, and covered the following topics: Introduction to cancer, chemotherapy, radiotherapy, cancer surgery, haematology, oncology emergencies, exercise in oncology, lymphoedema management and palliative/end of life care. It was open to public and private hospital physiotherapists throughout Victoria as well as associated community rehabilitation centres. We collected post course feedback from participants to evaluate knowledge gained in each topic and overall confidence in applying knowledge to clinical practice. Results:From 98 participants, 80 responses were collected and analysed. Prior to the course, 95% of participants indicated absent to average levels of confidence in applying oncology knowledge to practice. Post course, 100% of participants indicated average or higher levels of confidence in applying oncology knowledge to practice, with 69% indicating high to very high levels of confidence. Areas with lowest pre course knowledge and biggest difference in pre/post course knowledge acquisition included haematology, oncology emergencies and chemotherapy. All topics covered reported significant improvement in overall knowledge from pre to post course. Conclusion:Our study day improved participant's knowledge in oncology and provided increased confidence to apply this knowledge in clinical practice. We aim to conduct this study day annually and intend to expand to a broader audience including private practice physiotherapists, allied health assistants, exercise physiologists and fitness educators.

426 BRIDGING THE GAP BETWEEN CITY AND COUNTRY: A REGIONAL INTERDISCIPLINARY EDUCATIONAL WORKSHOP AND DVD PRODUCTION IN HEAD AND NECK AND UPPER GASTROINTESTINAL CANCER MANAGEMENT Belinda Steer 1 , Penny Chapman 2 , Emily Gunning 3 1. Peter MacCallum Cancer Centre, East Melbourne, Vic, Australia 2. St Vincent's Hospital , Melbourne, Vic, Australia 3. Gippsland Regional Integrated Cancer Services, Traralgon, Vic, Australia Aims:Increasing numbers of rural patients receive treatment for head and neck (H&N) and upper gastrointestinal (UGI) cancer at major metropolitan centres resulting in clinicians in regional centres being required to provide long term management to patients with complex needs without skills or training to support this. Gippsland Regional Integrated Cancer Services supported a senior speech pathologist from St. Vincent's Hospital, Melbourne, and a senior dietitian from Peter MacCallum Cancer Centre to facilitate a workshop in the Gippsland region on evidence based management of H&N and UGI cancer. The workshop aimed to up-skill current regional clinicians ensuring higher quality care to Gippsland patients with H&N and UGI cancer, as well as to produce a DVD of the workshops to provide a sustainable education tool. Methods:Metropolitan clinicians developed and conducted a 2 day workshop that included both interdisciplinary didactic style lectures and discipline specific interactive sessions. All sessions were filmed. An evaluation was conducted at the completion of the workshops. Results:Eleven regional clinicians attended (7 dietitians, 4 speech pathologists) and evaluated the workshops. One hundred percent of the participants deemed the interdisciplinary didactic style lectures either useful or very useful, and 100% of the participants found the discipline specific interactive sessions very useful. All participants reported their clinical practice would change as a result of the workshops, that their learning needs were met, and that they made contacts with metropolitan and regional clinicians that would benefit their practice and patients care. A DVD of the workshops was produced following the workshops. Conclusions:These regional workshops were highly successful, highlighting the importance of ongoing professional development opportunities for regional clinicians in areas of complex patient care. Producing a DVD of the workshop enhances the sustainability of the education and enables future clinicians across the region access to the content.

427 AN EXAMINATION OF PROSTATE CANCER TRENDS IN AUSTRALIA, ENGLAND, CANADA AND USA: IS THE AUSTRALIAN DEATH RATE TOO HIGH? Eleonora Feletto 1 , Dane Cole-Clark 2 , Albert Bang 1 , Venu Chalasani 3,4,5 , Kris Rasiah 5,6 , David Smith 1,7 1. Cancer Research Division, Cancer Council, Sydney, NSW, Australia 2. Department of Surgery, Royal North Shore Hospital, Sydney, NSW, Australia 3. Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney 4. Discipline of Surgery, University of Sydney, Sydney, NSW, Australia 5. Northern Sydney Local Health District, Sydney, NSW, Australia 6. Garvan Institute of Medical Research & Kinghorn Cancer Centre, Sydney, NSW, Australia 7. Griffith Health Institute Queensland, Griffith University, Griffith, QLD, Australia Objectives:To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using USA mortality rates. Subjects/patients (or materials) and methods:Analysis of age standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developing countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using USA mortality rates, were calculated and compared to observed deaths in Australia (1994–2010). Results:In all four countries, incidence rates initially peaked between 1992 and 1994 but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8% (1998–2008). Mortality rates in the USA (APC −2.9%; 2004–2010), Canada (APC −2.9%; 2006–2011) and England (APC −2.6%; 2003–2008) decreased at a faster rate compared to Australia (APC: −1.7%; 1997–2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared to USA rates over 17 preceding years. Conclusion:Prostate cancer incidence rates are likely heavily influenced by Prostate Specific Antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.

428 CARCINOMA TONGUE A RETROSPECTIVE REVIEW OF TREATMENT AND OUTCOME IN 643 PATIENTS WHO HAD SURGERY AS A PRIMARY MODALITY OF TREATMENT Nebu George 1 1. Regional Cancer Centre, Trivandrum, Keral, India The aim of this study is to describe the clinical profile, treatment, patterns of failure and factors predictive for recurrence in patients with carcinoma tongue. Methods:643 patients who underwent surgery for squamous cell carcinoma of the tongue atRegional Cancer Centre, Trivandrum, India from April 2002 to December 2007 wereretrospectively reviewed. The clinical profile, treatment details, pathology findings, adjuvanttreatment and pattern of recurrences which developed on follow up were analyzed. Comparisons of survival time between strata ofcategorical variables were made with the Kaplan-Meier method and log-rank test. Results:There were 405 men and 238 women. Mean age of the study group was 56 years. Median follow up was 43 months and the maximal follow up was 103 months. 169 patientswere stage I, 227 were stage II, 156 were stage III and 91 were in stage IV disease. 490 patients had a neck dissection on the ipsilateral side while 15 patients also had a contralateral neck dissection. 92% of tumors were well to moderately differentiated squamous cell carcinomas. 107 patients had a close margin of excision, 79 had perineural infiltration, 15 had dysplasia at margins and 20 had extra capsular spread. 186 patients (29%) had pathological node positivity. Lower levels of neck nodes (level 4 and 5) were involved in 8 patients (1.2%) 291 patients received post operative radiotherapy. On follow up, 74 patients (11.5%) recurred at the primary site, while 49 patients recurred in the neck nodes. 30.2% females and 20.4% males had loco regional recurrence, 11 patients had distant metastasisand 30 patients developed a second primary during the follow up. The study group had 71.2% 5 year disease free survival. Conclusion:On univariate analysis significant factors for recurrence were female sex, Tstage, composite staging, extracpsular spread and dysplasia at the resected margins and onmultivariate analysis sex and extra capsular spread were found to be significant.

429 RISK FACTORS FOR METACHRONOUS COLORECTAL NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS Harindra Jayasekara 1 , Jeanette Reece 1 , Susan Parry 2 , Mark Jenkins 1 , Aung Ko Win 1 1. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia 2. Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand Aims:An individual's risk of developing a metachronous colorectal neoplasm has implications on the extent of colonic resection for the initial tumour and the intensity of colonoscopy surveillance. Our aim was to conduct a systematic review and meta-analysis of risk factors for metachronous colorectal neoplasia. Methods:An electronic database search was conducted using PUBMED and Web of Science for potentially relevant original publications reporting an association between metachronous colorectal neoplasia and its predictors, published through May 2014. We used broad search criteria and keywords: “colorectal neoplasms”, “metachronous”, “second primary”, “risk factors”. A metachronous neoplasm was defined as a new (primary) adenoma or carcinoma of the colon or rectum occurring at least 6 months after a previous diagnosis of colorectal carcinoma. Pooled relative risks were derived for selected risk factors using DerSimonian-Laird random effects models. Study heterogeneity was assessed by the I 2 statistic. Publication bias was assessed using Egger's regression test. Results:One-hundred-and-eighty-seven full-text articles were selected after excluding the others on the basis of their titles and abstracts. Of these, 80 were excluded because they did not examine an association between metachronous colorectal cancer and its risk factors, 11 as they were reviews, conference abstracts or meta-analyses, and a further 4 that were duplicate analyses of the same study population. A manual search of reference lists captured one further study, leaving us with 93 unique articles for review at this stage. These were predominantly cohort studies, with most conducted in Europe followed by North America and Asia. To date, extraction of data including risk factors assessed, measures of association and covariates included in analysis, has been completed. Conclusions:So far, we have identified studies that have reported an association between metachronous colorectal neoplasia and its risk factors. They will be reviewed systematically and summarized, next.

430 POSTTRAUMATIC STRESS DISORDER AND POSTTRAUMATIC GROWTH IN BREAST CANCER PATIENTS – A LOGICAL ANALYSIS Darshit Parikh 1 , Rama Jayaraj 1 1. Charles Darwin University, Darwin, NT, Australia Aims:Breast cancer, potentially a traumatic stressor, may be associated with negative outcomes, such as posttraumatic stress disorder or positive changes, such as posttraumatic growth. This study is aimed to analyse studies that measured post-traumatic stress disorder (PTSD), posttraumatic growth (PTG) and psychological distress associated with breast cancer survivors. This paper explains why PTG may interact with this ecology of circumstances in different ways. Methods:The authors reviewed 75 studies published from 1985–2014 that discussed about breast cancer patients' post-traumatic stress disorder, psychological distress and posttraumatic growth (PTG) in women in terms of frequency rates and factors. Results:Multiple studies demonstrated that women with breast cancer have PTSD presents in initial stage of diagnosis, whereas, PTG develops once the patients gets use to treatment and the prognosis of the disease. Research has shown that PTSD Checklist Civilian Version (PCL-C) in diagnosing PTSD in women with breast cancer. This study indicates needs for the early diagnosis of PTSD and provides psychological interventions designed for women with breast cancer. However, literature regarding characteristics of PTSD in patients with cancer is cross-sectional in nature. Conclusions:Future research focusing on prospective studies to identify patients at risk, determines casual or aggravating factors, and develops preventive interventions is needed.

431 A STUDY ON CANCER INCIDENCE IN NEPAL FROM 2003–2010 Kishore Preadhananga 1 1. BPKM National Cancer Hospital, Chitwan, Nepal Background:This study gives overview to reliable information of the cancer incidence in Nepal for a 8yrs period from 2003–2010. It helps to make some prevention and control plan and policies to the clinicians, policies makers to give priorities for the cancer prevention and control activities. Methods:This was descriptive type of study and all cases were collected form medical record section of seven collaborative hospitals for data analysis. A breakdown of the incidence by year, age and gender has been analysed. Age standard incidence of common cancers and age specific rate has been tabulated. Results:The total 41,713 cases were included in this study to know the burden of cancer patients in 7 major hospitals of Nepal where cancer diagnosed and treated from 2003–2010. In this study Female (53.3%) cases were diagnosed more than males (46.7%). Overall, the most common cancer sites in Males were lung, stomach and leukemia but in Females Caner of cervix uteri, breast and lung. More cancer cases (67.7%) seen in Female but in Males found 52.5% in the broad age group 35 to 64yrs. In young age leukemia and lymphoma were more common replaced by lung, oral and stomach cancer in middle age but in older lung, stomach and larynx cancer were found in males but in females breast cancer in young, cervix uteri cancer in middle and followed by lung cancer in older age. Conclusions:This type of study is the first time in Nepal to know the burden across a greater proportion of cancer from 7 major hospitals where cancer is diagnosed and treated, but the coverage may not represent the whole country. Keywords:incidence, cancer registry, burden of cancer, prevention and control policies.

432 THE PREVALENCE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE USE AMONG PATIENTS WITH MALIGNANCY AT ROYAL HOBART HOSPITALLOWENTHAL, R, VERMA, N 2013 Nidhi Verma 1 , Ray Lowenthal 1 1. Royal Hobart Hospital, Sandy Bay, TAS, Australia Introduction:Complementary and alternative medicines (CAM) use is increasingly popular globally and poses potential interactions with conventional treatments. Our study aims to identify the current prevalence of CAM use within Tasmania and potential predictive patient demographic factors. Methods:100 patients were recruited from oncology clinics and the chemotherapy unit of Royal Hobart Hospital. All participants were approached in person by the researchers and asked to complete a questionnaire which they mailed back to our research centre in the reply-paid envelope supplied. The data was compiled in an excel sheet and the chi square analysis method was used to calculate all p-values and test statistics (x 2 ). Results:38 patients responded – 4 had to be excluded as their consent form was not signed. Therefore, the study sample consisted of 34 patients (20 female and 14 male) of which 76% used at least one CAM. The most popular CAMs for females were meditation and multivitamins versus prayer and multivitamins for males. There was a strong correlation of CAM use with the female gender (p-value 0.0001, x 2 =14.945) with all females using at least one CAM versus 43% of males. Private health insurance was not a predictive factor of CAM (32% versus 29%) giving a p-value of 0.6012, x 2 =0.2732. Higher levels of education did not correlate with CAM use either (p-value 0.8487, x 2 =0.036). Conclusion:This study demonstrates a high CAM use prevalence among the Tasmanian patient population with malignancy with multivitamins, meditation and prayer being the most popular. Being of female gender was a strong predictive factor for CAM use however, higher levels of education and presence of private health insurance were not. We hope the data from this study will prompt health professionals to engage in meaningful discussions with all patients with malignancy to ensure accurate and quality medical care provision. 1. Kremser, T, Evans, A, Moore A, Luxford, K, Begbie, S, Bensoussan, A, Marigliani, R & Zorbas, H 2008, ‘Use of Complementary Therapies by Australian Women with Breast Cancer’, The Breast, vol. 17, pp. 387–394. 2. Xue, C, Zhang, A, Lin, V, Costa, DC, Story, DF 2007, ‘Complementary and Alternative Medicine Use in Australia: A National Population-Based Survey’, The Journal of Alternative and Complementary Medicine, vol. 13, no. 6, pp. 643–650. 3. Xue, C, Zhang, A, Lin, V, Costa, DC, Story, DF 2007, ‘Complementary and Alternative Medicine Use in Australia: A National Population-Based Survey’, The Journal of Alternative and Complementary Medicine, vol. 13, no. 6, pp. 643–650. 4. Begbie, SD, Kerestes, ZL & Bell, DR 1996, ‘Patterns of Alternative Medicine Use by Cancer Patients’, The Medical Journal of Australia, vol. 165, no. 5, p 545. 5. Lowenthal, RM 2005, ‘Public illness: how the community recommended complementary and alternative medicine for a prominent politician with cancer’, The Medical Journal of Australia, vol. 183, no. 11, pp 576–579.

433 COMMENCEMENT OF AN ALLIED HEALTH LED, PRE-RADIATION TREATMENT GROUP EDUCATION SESSION FOR HEAD AND NECK CANCER PATIENTS AND CARERS Jessica Abbott 1 , Sallyanne Scudamore 1 , Tara Redemski 1 , Kate Hudson 1 , Nicole Rampton 1 , Dean Vuksanovic 1 1. Gold Coast University Hospital , Southport, QLD, Australia In 2014, a new public radiation oncology service was established at the Gold Coast University Hospital. To support the service, a multidisciplinary allied health team was recruited consisting of a Speech Pathologist, Dietitian, Social Worker, Physiotherapist, Occupational Therapist and Clinical Psychologist. Head and neck cancer (HNC) patients have known high rates of malnutrition, psychosocial morbidity and interrelated physical problems, including speech and swallowing difficulties, lymphoedema, musculoskeletal dysfunction and fatigue 1 . Multidisciplinary management is essential in the provision of best practice care. Information needs in this population are high, which poses challenges for practitioners aiming to provide an efficient and effective service that targets patient needs. The literature supports patient education prior to radiotherapy, demonstrating benefits including improved decision making, compliance, self-efficacy and reduced anxiety 2,3 . Current literature also indicates that patients report a deficit in pretreatment information regarding side-effects of treatment, how treatment may impact quality of life and how to access financial support 4 . State-wide benchmarking revealed the majority of pre-treatment education focussed on treatment side-effects pertaining to oral intake and nutrition. Our allied health team identified an opportunity to expand on existing education models to address information deficits reported in the literature. The multidisciplinary team collaboratively developed a 90 minute presentation which introduces the role of each team member, addresses strategies for the prevention and management of treatment side-effects, lymphoedema, musculoskeletal dysfunction, fatigue and practical social and psychological needs. Patients also receive a written information package, which includes information on how to access individual services. All HNC patients and carers are invited to attend prior to commencing treatment. Consumer and staff feedback and attendance records are being collected for future analysis. It is expected that the pre-treatment education session will improve patient outcomes in the HNC population, in addition to enhancing efficacy and reducing the demand for individualised treatment sessions. 1. Findlay, M., Bauer, J., Brown, T., & Head and Neck Guideline Steering Committee. (2014). Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Retrieved August 11th 2014, from http://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines 2. Canil, T., Cashell, A., Papadakos, J., Abdelmutti, N., & Friedman, A. (2012). Evaluation of the Effects of Pre-Treatment Education on Self-Efficacy and Anxiety in Patients Receiving Radiation Therapy: A Pilot Study. Journal Of Medical Imaging & Radiation Sciences, 43(4), 221–227. doi:10.1016/j.jmir.2012.05.002 3. Morley, L. L., McAndrew, A. A., Tse, K. K., Rakaric, P. P., Cummings, B. B., & Cashell, A. A. (2013). Patient and Staff Assessment of an Audiovisual Education Tool for Head and Neck Radiation Therapy. Journal Of Cancer Education, 28(3), 474–480 4. Llewellyn, C. D., McGurk, M. M., & Weinman, J. J. (2006). How satisfied are head and neck cancer (HNC) patients with the information they receive pre-treatment? Results from the satisfaction with cancer information profile (SCIP). Oral Oncology, (7), 726. doi:10.1016/j.oraloncology.2005.11.013

434 LEARNING MANAGEMENT SYSTEM (LMS), THE BENEFITS OF REPORTING Eliza Bott 1 , Leisa Brown 1 , Maree Bransdon 1. Central Integrated Regional Cancer Service, Queensland Health, Brisbane, QLD, Australia Queensland Health's LMS enables comprehensive reporting of education delivery and participation rates. Data collection and recording utilising the LMS enables accurate and comparative reports on the following:

Participant Position (student, nurse, doctor) Professional group (medical, nursing, allied health) Location (HHS, hospital) Topic (in-service, preceptor) Presenter (who conducted the education – peer, superior, by name or role) Length of session (time) Learning activity (online, course work, lecture, presentation) Delivery method (face-to-face, videoconference, individual, group)

Presenter Number of attendees Topic Location Length of session (time) Learning activity Delivery method CIRCS's Reporting Officer acts as the iLearn Administrator and is able to access, upload and display education data and staff access directly. This control allows for data to be highlighted and presented instantly without having to request it through an intermediary. It can be tailored to suit the needs of the individual or HHS making the request which minimises receiving and sorting irrelevant information. CIRCS's Reporting Officer has full Administrator rights in the LMS and so is able to modify and create reporting templates. The LMS allows information such as enrolment dates, number of attempts, grades, locations and completion progress to be filtered, exported and collated in Excel. This is then manipulated into pivot tables and graphs to compare and contrast against different months, HHSs and staff. The ability to present data in both written and visual capacities means CIRCS is able to identify areas of progress or delay in standardising education. This reaches all stakeholders who are able to modify their uptake to improve the delivery of cancer care.

435 PAZOPANIB TOXICITY MONITORING Elizabeth A Connolly 1 , Girish Mallesara 1 , Fiona Abell 1 , Tony Bonaventura 1 1. Calvary Mater Newcastle, Newcastle, NSW, Australia Oral chemotherapy agents present new challenges as the regimens can be complex and patients may not be monitored as frequently as those receiving intravenous chemotherapy. 19% of our centre's patients receive oral chemotherapy agents. Pazopanib is an oral agent that has been PBS approved since 2012 for use in the treatment of advanced and/or metastatic renal cell carcinoma. Following an adverse event an audit was undertaken to assess adherence to toxicity monitoring. Adherence to NSW cancer Institute eviQ guidelines and ASCO Chemotherapy Administration Safety Standards was assessed. The notes of all patients who received pazopanib between March 2012 and June 2014 were auditted. 13 patients and 87 clinic reviews were reviewed. 69% of patients were female. The median age was 60 years (38–77). The mean duration of treatment was 5.2 months (1–12 months) with 6 patients still receiving pazopanib at the time of analysis. Pazopanib was ceased in 2 patients following hepatic toxicity and in 5 patients after disease progression. Baseline investigations had been completed as follows; ECG for QTC prolongation 0%, blood pressure 69%, urinanalysis for proteinuria 0%, routine bloods including liver function 100%, thyroid function 69%. Analysis of follow-up reviews revealed blood pressure was assessed at least once in 85% of patients and in 59% of reviews. 0% had an ECG, urinanalysis or echocardiogram at any point. Thyroid function was assessed at least once throughout treatment in 69% of patients however in only 17% of all clinic reviews. There was poor compliance with ASCO monitoring recommendations; of reviewing current medication and allergies at each review, with 54% patients taking interacting or contraindicated medication. Monitoring of hypertension, proteinuria and QTC prolongation can be improved. Drug interactions occur commonly and may have contributed to an adverse outcome in one of our patients. Current medication and allergies should be assessed at every review appointment. 1.‘Pazopanib, tablet, 200mg and 400mg (as hydrochloride), Votrient® – March 2012’ Pharmaceutical Benefits Scheme (PBS) Accessed 12th August 2014. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2012-03/pazopanib 2.ASCO-ONS Standards for Safe Chemotherapy Administration. American Society of Clinical Oncology. Accessed 12th August 2014. http://www.asco.org/quality-guidelines/asco-onsstandards-safe-chemotherapy-administration 3.Renal Cell Metastatic Pazopanib. eviQ Cancer Treatment Online. Accessed 12th August 2014. https://www.eviq.org.au/Protocol/tabid/66/id/820/Default.aspx

436 A DIFFERENT DIRECTION FOR SOCIAL WORK IN ASSISTING THOSE AFFECTED BY MESOTHELIOMA Olga Gountras 1 1. Slater & Gordon Lawyers, Melbourne, VIC, Australia The Social Work Service at Slater & Gordon is in a unique position to support people with mesothelioma and their family members as they navigate the legal system and seek compensation. Making a claim is usually important for the person with mesothelioma as they are often angered by their situation and want to seek restitution for the injustice done to them and ease current or future financial burdens for their families. It is quite common for people affected by mesothelioma to feel angry at the producers of asbestos, or at past employers for having to work in environments that exposed them to asbestos. People commonly express randomised anger, towards others who were more fortunate. Many bereaved families also feel their grief is complicated by anger, knowing that this death and many others were preventable. A number of bereaved people have described their family member as having been ‘murdered’ rather than dying of cancer. We have found that the clients and their families referred to us have not been accessing any support services available to them, and as a result are often isolated in their grief and anger. Our service aims to reduce this isolation, by providing regular telephone contact and counselling, and case work to link people in with their community. A network of support is subsequently developed for clients and families to assist them through their complex grief experience. Clients and their families often report that the combination of the pursuit of justice and the social work support provided are what keeps them going. By providing social work support in a setting that it is not traditionally found in, we are able to meet the needs of cancer patients who would otherwise have fallen through a gap in service delivery.

437 PROSTATECTOMY CLINIC Sonya Imbesi 1 1. Peter MacCallum Cancer Centre, East Melbourne Prostate cancer accounts for approximately 30% of all cancers diagnosed in men per year. Robotic Prostatectomy is a increasingly common surgery performed at Peter MacCallum Cancer Centre. Post operatively, numerous side effects have been well documented throughout the literature, including incontinence. Pelvic floor exercises are a common treatment option for patients to assist with loss of continence. The physiotherapy department at Peter MacCallum have not been involved with the education nor care of Robotic Prostatectomy patients. A literature review was commenced to investigate the relationship between pelvic floor muscle training and incontinence post prostatectomy. Current evidence does not suggest that pelvic floor exercises prior to prostatectomy improves incontinence, however, studies do show that pelvic floor muscle training is effective in reducing incontinence post prostatectomy. This information was presented to the physiotherapy department. The Robotic Prostatectomy Nurse Co-ordinator was contacted to gain insight into level of education patients currently receive on post operative side effects, and specifically incontinence. Prior to surgery, patients attend a clinic with the Nurse Co-ordinator who provides information on expectations of incontinence, and suggests techniques for pelvic floor exercises. The Nurse Co-ordinator was supportive of physiotherapy involvement in the clinic. to assist with education of incontinence. Early in 2014, Peter MacCallum Physiotherapy commenced presentations at the Robotic Prostatectomy Clinic, with the aim to increase education, awareness and emphasise the importance of seeing a continence physiotherapist. Patients are educated on how the urinary system works, how this is impacted by surgery, the role of the pelvic floor and importance of pelvic floor exercises to maintain continence. Patients are provided with locations of continence clinics both within the metropolitan and rural areas, as well as provision of question time with the physiotherapist to ensure consolidation of knowledge.

438 A RETROSPECTIVE STUDY ON RURAL ONCOLOGY PATIENT o PATHWAYS Talvika Kooblal 1 , Mahesh Iddawela 3,2,4 , Kelsey Broom 2 , Damian Johnson 2 , Olivia Denham 2 , C Ryan 4 , L Smith 3 , K Emmanuelli 3 , A Hartney 3 , M Dunne 3 , Z W Wong 3, 2 1. Goulburn Valley Health, Shepparton, Victoria, Australia 2. Rural Health Academic Centre, University of Melbourne, Shepparton, Victoria, Australia 3. Goulburn Valley Health, Shepparton, VIC, Australia 4. West Hume Integrated Cancer Services, Shepparton, Victoria, Australia Introduction:Approximately one third of Australians with a cancer diagnosis live outside metropolitan centres. Overall cancer mortality rates have reduced in Australia however, patients in regional areas have poor outcomes. This study was initiated to capture patient data, to assess patient pathways, to improve patient flow and avoid delays. Information on cancer patients living in West Hume was analysed. Methods:Retrospective data of patients with a cancer diagnosis was collected using the Goulburn Valley Hospital (GVH) automated electronic records. Data collected included diagnosis, disease stage, date of initial referral to oncology, date first seen by an oncologist at GVH, date of surgery and date of treatment commencement. Results:All 158 oncology patients seen at GVH from 01 October 2013–31 May 2014 were included. A breakdown of the cancer types included 59 breast, 33 colon, 15 lung, 10 prostate and 27 others. The median time to medical oncology treatment from diagnosis was 61 days (range 6–39686). The median time to surgery for breast cancer was 13 days (range 0–731) and colon cancer 14 days (range 0–231). The median time to oncology treatment for breast cancer was 75 days for chemotherapy (range 6–39686) and 139 days for radiotherapy (range 50–826), colon cancer 66 days for chemotherapy (range 10–351) and 72 days for radiotherapy (range 42–429) and lung cancer 80 days for chemotherapy (range 26–106) and 33 days for radiotherapy (range 8–395). Conclusion:Electronic patient records provide us with a tool to assess patient pathways, to avoid unnecessary delays and improve patient flow and outcomes efficiently.

439 THE EVOLUTION OF A MULTIDISCIPLINARY CANCER CACHEXIA CLINIC Meg Harrison 1 , Donna Chapman 1 , Kate van Berkel 1 , Peter Martin 1 1. Barwon Health, Geelong, VIC, Australia The Barwon Health Cancer Cachexia Clinic was established in 2007 and is the only multidisciplinary clinic of its type in Australia. Treating cachexia can improve overall quality of life and function for patients. “Patients with cancer cachexia have poor appetites and significant weight loss, leading to weakness and fatigue as well as potentially life-threatening metabolic disturbances. In addition, impaired nutritional status and protein deficiency can affect response to chemotherapy and increase toxicity to therapy, leading to increased morbidity and mortality.”(Granda-Cameron etal, 2010, p.72). Acknowledging the impact of cancer cachexia on patients and carers, the clinic's focus is on assessing symptoms and developing a customised nutritional, exercise and pharmacological regime. The specialist clinical team now includes a Palliative Care Physician, Nurse Practitioner Candidate, Physiotherapist and Dietitian. Initially the clinic operated fortnightly with a combination of forty minute initial assessments and twenty minute reviews with each of the three clinicians. Assessment included anthropometry, PG-SGA nutritional self-assessment, upper and lower limb strength and relevant pathology. It has now evolved to weekly clinics, one hour initial assessments and thirty minute reviews. The significant changes have been to introduce self-assessments of quality of life (EORCT QOL), and functional assessment of anorexia/cachexia (FAACT). There is now a streamlined multidisciplinary assessment for patients with advanced/refractory cachexia with deteriorating condition. Including the Nurse Practitioner Candidate (NPC) in the clinic resulted in triaging referrals to assess suitability for standard or streamlined clinic and development of improved communication and information delivery. With increased session length there is time for patients and clinicians to explore all symptoms and issues that may be impacting on their quality of life. Dyar etal. (2012) acknowledged cancer patients frequently have unmet psychosocial needs including social, financial and spiritual needs. The new clinic questionnaires' results have highlighted symptoms and concerns that may not have been expressed by patients and can trigger a referral to the extended Supportive Care Team. 1. Dyar M, Lesperance M, Shannon R, Sloan J, & Colon-Otero, G 2012, ‘A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study’, Journal of Palliative Medicine, Vol.15, no.8, pp. 890–895. 2. Granda-Cameron, C, DeMille, D, Lynch, MP, Huntzinger, C, Alcorn, T, Levicoff, J, Roop, C, & Mintzer, D 2010, An interdisciplinary Approach to Manage Cancer Cachexia’, Clinical Journal of Oncology Nursing, vol.14, no.1, pp. 72–81.

440 THE NORTHERN HEALTH OUTPATIENT PSYCHO-ONCOLOGY SERVICE: REFERRAL PATTERNS AND CHANGE IN PSYCHOLOGICAL DISTRESS OVER TIME Hunter Mulcare 1 1. Northern Health, Epping, Vic, Australia Aims:Only a small proportion of cancer patients access psychological help despite one third of patients experiencing significant psychological distress following their diagnosis. Data on the use of psychological services can help identify patient groups that are under serviced. This poster will present preliminary data on a project aiming to identify which patients attend the psycho-oncology service, what psychological problems they present with, and how these change over time. Methods:Patients attending the service are given a Hospital Anxiety and Depression Scale and a 12-item measure of psychological adjustment at their first, third and sixth appointments with the psychologist. Disease and demographic data are collected as well. Results:Preliminary results from 13 of 18 patients referred between March and August 2014 (2 non English speaking, 3 declined) indicate that patients referred were predominantly females (10), without metastatic disease (10), middle aged (average 53.1 years), and had breast cancer (8) or colorectal cancer (2). At first appointment, two-thirds (8) of patients reported significant anxiety; one-third (4) had significant depressive symptoms, whilst one-third (4) reported significant symptoms of both. Longitudinal data available for 10 participants indicates significant decreases in both anxiety (11.1 to 9, p=.04) and depression symptoms (8.5 to 6,p=.03) at Time 2. Cognitive distress decreased at time 2 (p=0.03) whilst fighting spirit, emotional distress and cognitive avoidance had not changed significantly (FS p=0.77, ED p=0.12, CA p=0.09). Discussion:The majority of patients referred for psychology have significant levels of psychological distress, particularly anxiety. This suggests either anxiety is the most prevalent form of distress in patients treated at the hospital, or that it is more easily recognised by referrers and depressed patients are less commonly referred. Longitudinal data indicates distress decreases over time. The over representation of breast cancer patients referred likely reflects the role of the breast cancer nurses and the lack of similar effective screening in other tumour streams.

441 THE HIGHS AND LOWS OF THE MDT: EXPERIENCES OF WORKING IN A MULTIDISCIPLINARY TEAM FROM THE PERSPECTIVE OF THE PROSTATE CANCER SPECIALIST NURSE IN TAMWORTH, NSW Sharon L.E. Slack 1 1. Tamworth Rural Referral Hospital, TAMWORTH, NSW, Australia Context:The benefits to the patient who is cared for by a multidisciplinary team (MDT) have been proven time and time again. However, when there is a team of people caring for a patient, this increases the chances of issues arising both helpful and harmful. With this in mind, the experiences of the Prostate Cancer Specialist Nurse in Tamworth, NSW will be described. Process:When experiences are shared, the opportunities for others to learn from these experiences, both positive and negative, are an invaluable source of information and education. By joining forces and avoiding pitfalls of others experiences, a successful and effective multidisciplinary team approach to patient care can be achieved. From a regional/rural perspective, it is often difficult to refer a patient to various specialists, regardless of whether doctor, nurse or allied health, as these specialists are either not available locally, have long waiting lists or work in private practice which can create financial hardship. Moreover, if the patient would like a second opinion or further care, this waiting time and lack of specialists can compound both the length of waiting time and the anxiety of the patient. Specific and direct referral pathways have been introduced by various departments to reduce waiting times by allowing health professionals triage the patient. Additionally, the referral forms allow for information to be shared between departments/specialists and encourage communication between departments/ specialists. Furthermore, a weekly meeting has been setup between coordinators and allied health to allow for specific sharing of patient information when many members of the team are involved. Outcomes:Networking and having an understanding of position roles within any given area is vital when working within a MDT. Additionally, communication is of the upmost importance, both with the patient and with each member of the MDT. Working together is the only way forward.

442 OUTREACH CLINIC VS. COMMUNITY OUTREACH: WHAT'S IN A NAME? A SERVICE PROVISION REVIEW FROM THE PROSTATE CANCER SPECIALIST NURSE IN TAMWORTH, NSW Sharon LE Slack 1 1. Tamworth Rural Referral Hospital, TAMWORTH, NSW, Australia Background and Context:For almost two years, the Prostate Cancer Specialist Nurse in Tamworth, NSW has conducted regular Outreach Clinics to the far reaching expanses of the New England Area Health Clusters in the NW of NSW. While there has always been plenty of support for these clinics, patient numbers utilising appointments have not always been encouraging. Anecdotally, comments have been reported as negative connotations to the term “clinics”. That is, “sick people go to clinics”. As the Prostate Cancer Specialist Nurse can discuss all facets of prostate cancer including, treatment options, side effects of treatment and the management of such, not all issues mean the patient is acutely unwell, or indeed, unwell at all. Aim:To offer a service which includes those patients who are seeking individualised information and support while reaching out to the greater community to support and inform those men who are pursuing general information. Additionally, informing and supporting General Practioners and their staff about the Prostate Cancer Specialist Nursing Service and what that offers their patients with a prostate cancer diagnosis. Plan:To work with other services such as Medicare Local and Cancer Council NSW and attend community events with a view to raising the profile of the Prostate Cancer Nursing Service within the given community. Allowing time for appointments while visiting each centre will permit men with a diagnosis of prostate cancer to gain the maximum benefit from the services of the Prostate Cancer Specialist Nursing Service. Outcomes:As the renaming of the clinics to Prostate Cancer Specialist Nurse Community Outreach is only in its early stages, outcome data is limited although, patient numbers and patient feedback have been promising.

443 A MODEL OF YOUTH FRIENDLY GENETIC COUNSELLING Kate Thompson 1 , Lucy Holland 1 , Mary-Anne Young 2 1. ONTrac at Peter Mac Victorian AYA Cancer Service, East Melbourne, VIC, Australia 2. Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne , Victoria Background:Advances in genetics technology have led to an increasing repertoire of options to modify genetic predisposition and improve health outcomes. Traditionally, adults have comprised the main group presenting for genetic testing. However, with advances in knowledge of genetic risk and growing public awareness of testing options, adolescents and young adults (AYAs) are increasingly accessing genetic services, particularly for the assessment of hereditary cancer risk. Individuals presenting for genetic testing are supported by genetic counsellors; professionals primarily trained to working within adult-centred models of care. Increasing evidence highlights practice complexities faced in genetics work with AYAs including those related to engagement/communication, client versus family centred models of care, adherence and ethics. Evidence also illustrates deficits in education for genetic counsellors working with this client group. Youth friendly genetic counselling is a new and emerging field characterised by this practice complexity and increasing understanding of the unique implications of genetic counselling on AYA psychosocial wellbeing. Methods:A reference group was formed in 2012 comprising experts in adolescent health and genetics and comprehensive literature review into genetic testing/counselling with AYAs was undertaken. Subsequently, a world first model of Youth Friendly Genetic Counselling was developed based on combined principles, theory and practice in AYA care and genetic counselling. Results & Discussion:Processes of model development will be delineated. The model will be presented with emphasis on principles of AYA care and their application to genetic counselling practice. This model is being trialled with young people presenting for assessment of hereditary cancer risk. The anticipated impacts in improving the experience of care and outcomes for young people and up-skilling genetic counsellors will be described.

444 BLOOMHILL CANCER HELP: A UNIQUE COMMUNITY OWNED AND OPERATED CANCER SUPPORT SERVICE MODEL Merran Z Williams 1 1. Bloomhill Cacer Help, BUDERIM, QLD, Australia Bloomhill provides supportive care to over 800 cancer survivors and their families on the Sunshine coast. 450 volunteers provide transport, respite services and “buddying”. They also work in the grounds, op-shops and in administration. Funded 80% by op-shops, this unique community model does not receive any government funding. Experienced oncology registered nurses assess all new clients (cancer patients, their carers or children). A detailed cancer history is obtained, and a wellness plan developed together with the client. The RN may recommend several Bloomhill services such as counselling, oncology massage, manual lymphatic drainage, reflexology, meditation, yoga or support groups or nutrition consult. Wellbeing education is in the form of workshops, seminars and small group forums. Subjects range from Spirituality, Grief and Loss, Nutrition and Motivational Morning Teas. Groups of clients are also taken away on retreats where the focus is on building resilience and strengthening relationships. Bloomhill receives referrals from social workers, GPs and nurses. RNs make home visits to those who are too unwell to attend the centre, and may arrange for a home oncology massage to help alleviate any pain and discomfort. Carers are able to access the same physical therapies as well as mind-body classes. Bloomhill has a healing environment and creative workshops and craft classes are held every Friday on the large deck. Writer's workshops allow clients to write their memoirs. Counsellors facilitate Children's Fun days during school holidays. The children are either cancer patients or the child of a cancer survivor. Bloomhill provides supportive care to families at a time of crisis. We care for body, mind and spirit. This service is provided by the community, for the community and is a supreme example of community self reliance and connectedness.

445 INVESTIGATION OF THE TOTAL AND SHORT FORM PATIENT GENERATED SUBJECTIVE GLOBAL ASSESSMENT (SHORT FORM PG-SGA) SCORE AS A SCREENING TOOL IN CHEMOTHERAPY OUTPATIENTS Jessica Abbott 1,2 , Laisa Teleni 3 , Daniel McKavanagh 1 , Jaimie Watson 1 , Alexandra McCarthy 1,4 , Elizabeth Isenring 1,3 1. Princess Alexandra Hospital, Woolloongabba, QLD, Australia 2. Gold Coast University Hospital , Southport, QLD, Australia 3. Bond University, Robina, QLD, Australia 4. Queensland University of Technology, Kelvin Grove, QLD, Australia An abridged or Short Form PG-SGA score has recently been validated in the chemotherapy outpatient setting in place of the Malnutrition Screening Tool (MST) as a means of providing additional clinically relevant information during screening. The aim of this study was to identify the most relevant information contributing to the PG-SGA score to identify malnutrition with 80% sensitivity and 60% specificity. A cross-sectional study recruited patients actively receiving treatment in the oncology day unit. Patients self-administered the MST. A dietitian blinded to the MST score administered the PG-SGA. Receiver operating characteristic curves were generated to determine the optimal cut off scores of PG-SGA sections with the greatest sensitivity and specificity for predicting malnutrition according to SGA category. 300 participants were recruited (96.2% response rate), 51.7% male, 58.6±13.3yrs. Participants represented both solid tumours and haematological diagnoses. Scores calculated from weight (box 1), dietary intake (box 2) and symptom data (box 3) with or without activity/function (box 4) data were comparable (AUC=0.85, 95% CI=0.80–0.89; AUC=0.85, 95% CI=0.81–0.89, respectively) and had higher diagnostic value than the MST (AUC=0.77, 95% CI=0.72–0.82) or box 3 data alone (AUC=0.78, 95% CI=0.73–0.83). Using boxes 1-3, a PG-SGA score of ≥2 was 90% sensitive and 67% specific at identifying those at risk of malnutrition. Although PG-SGA scores from boxes 1-4 had been validated previously, our study, with a larger sample and more diverse diagnoses, determined additional information provided by the functional capacity question did not improve the overall discriminatory value of the PG-SGA.

446 A PHASE III STUDY OF THE IMPACT OF A PHYSICAL ACTIVITY PROGRAM ON DISEASEFREE SURVIVAL IN PATIENTS WITH HIGH-RISK STAGE II OR STAGE III COLON CANCER: A RANDOMIZED CONTROLLED TRIAL (NCIC CTG CO.21) Brandi Baylock 1 , haryana M dhillon 1 , K Courneya 2 , C O'Callaghan 2 , A O'Brien 2 , A M Goddard 1 , J Turner 1, 3 , M Kabourakis 1 , H Rice 1 , S Begbie 4 , P Williams 4 , S Ackland 5 , C Fischer 5 , L Chantrill 6 , D Vandine 6 , R Ashgari 7 , M Hoque 7 , M Burge 8 , D Hickey 8 , S Della-Fiorentina 9 , S Ellul 9 , J L Vardy 1,3 1. Centre for Medical Psychology & Evidence- based Decision-making, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia 2. NCIC Clinical Trials Group, Sydney 3. Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW 4. North Coast Cancer Institute, Port Macquarie, NSW 5. Newcastle Private Hospital, Newcastle, NSW 6. Campbelltown Hospital, Campbelltown, NSW 7. Bankstown Lidcombe Hospital, Bankstown, NSW 8. Royal Brisbane & Women's Hospital, Brisbane, Qld 9. Southern Highlands Cancer Centre, Illawara, NSW Purpose:Observational studies indicate that physical activity (PA) is associated with colon-cancer specific survival. The NCIC CTG CO.21 (CHALLENGE) trial is designed to determine the effects of a structured PA intervention on disease-free survival in high-risk stage II or III colon cancer survivors who have completed adjuvant chemotherapy within the previous 2–6 months. Methods:Phase III randomized controlled trial. Target sample size of 962 patients is powered to detect a Hazard Ratio of 0.75 for disease-free survival (DFS). Trial participants are stratified by centre, disease stage, body mass index, and performance prior to randomization to a structured PA intervention or general health education materials. The PA intervention consists of a behavioural support program and supervised PA sessions delivered over a 3-year period, beginning with regular face-to-face sessions and tapering to less frequent faceto-face or telephone sessions. The goal of the PA program is to increase weekly PA by 10 MET hours/week. The PA program is delivered by physical activity consultants trained in exercise physiology and behavior change. Outcomes:The primary endpoint is DFS. Important secondary endpoints include multiple patient-reported outcomes (including those that address fatigue), objective physical functioning, biologic correlative markers (including assessment of the insulin pathway), and an economic analysis. Data is also being collected on motivational outcomes and behavior change that will inform program delivery. Current Enrollment:The study is open at 20 centers in Canada and 26 centers in Australia and will open in other countries in 2014. Accrual as of August 12, 2014 includes 357 registered and 310 randomized patients. Summary:Cancer survivors and cancer care professionals are interested in the potential role of PA to improve disease-free survival and quality of life, but a randomized controlled trial is needed to provide compelling evidence to justify changes in health care policies and practice.

447 THE COLON HEALTH AND LIFE-LONG EXERCISE CHANGE (CHALLENGE) TRIAL: PARTICIPANT ADHERENCE TO FITNESS ASSESSMENTS Brandi Baylock 1 , H M Dhillon 1 , E M Goddard 1 , J Turner 1 , H Rice 1 , M Kabourakis 1 , P Beale 2 , S Ackland 3 , J Seide 3 , L Horvath 4 , L Spencer 4 , S Begbie 5 , R Coppin 5 , M Burge 6 , A Hanley 6,7 , G Marx 8 , R Canavan 8 , T Ferguson 9 , L Campbell 9 , C Karapetis 10 , L Nolan 10 , R Ashgari 11 , R Liakos 11 , M Iddawela 12 , C Tenance 12 , S Della-Fiorentina 13 , R VanDerMeer 13 , T Price 14 , M Atkinson 15 , N Weng 16 , C Saliba 16 , L Chantrill 17 , L Skinner 17 , D Goldstein 18 , C Tsar 18 , E Walpole 7 , M Moore 19 , K Greenfield 20 , M George 21 , L Hill 21 , J L Vardy 1,2,22 1. Centre for Medical Psychology & Evidence- based Decision-making, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia 2. Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW 3. Newcastle Private Hospital, Newcastle, NSW 4. Royal Prince Alfred Hospital, Camperdown, NSW 5. North Coast Cancer Institute, Port Macquarie, NSW 6. Royal Brisbane & Women's Hospital, Brisbane, Qld 7. Princess Alexandra Hospital, Woolloongabba, Qld 8. Sydney Adventist Hospital, Sydney, NSW 9. Royal Perth Hospital, Perth, WA 10. Flinders Medical Institute, Adelaide, SA 11. Bankstown Lidcombe Hospital, Bankstown, NSW 12. Goulburn Valley Health, Traralgon, VIC 13. Southern Highlands Cancer Centre, Illawara, NSW 14. Queen Elizabeth Hospital, Brisbane, Qld 15. Queen Elizabeth Hospital, Brisbane, Qld 16. Liverpool Hospital, Liverpool, NSW 17. MacArthur Cancer Care Centre, Sydney, NSW 18. Prince of Wales Hospital, Sydney, NSW 19. St Vincent's Hospital, Fitzroy, VIC 20. St Vincent's Hospital, Fitzroy, VIC 21. Tamworth Base Hospital, Tamworth, NSW 22. Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW Background:Although there is compelling observational evidence that physical activity (PA) is strongly and inversely associated with colon cancer incidence, recurrence, and diseasespecific and overall survival, this has not been tested in a randomised, controlled setting and the mechanisms are unknown. CHALLENGE is a RCT examining the effects of a 3-year PA intervention on disease-free survival in people who have completed adjuvant chemotherapy for colon cancer. Aim:To assess the adherence rates to the fitness testing at 6, 12, 24 & 36 months post randomisation in Australian participants. Methods:Patients randomised to the intervention and control arms in Australia were included in this analysis. The PA testing results from 19 Australian sites were reviewed to evaluate fitness testing adherence at phase I-III (0–36 months) assessment time points. Descriptive data are presented. Results:A total of 60 participants from19 Australian sites were included in the analysis. There was an overall adherence rate of 73% to all protocol mandated fitness assessments. 51/60 (85%) participants completed the 6-month PA assessments, 33/42 (79%) 12-month, 15/24 (63%) 24-month, and 9/14 (64%) completed the 36-month PA assessments. Conclusions:The majority of CHALLENGE study participants are willing and able to complete the fitness assessments within the protocol-mandated time frames. While adherence to assessments appears to be decreasing over time, this is likely due to the small number of participants who have reached the 36-month assessment point to date. Strategies such as patient reminders, contact between assessments, and planning ahead are being used increase and maintain adherence rates over time.

448 THE SUPPORT NEEDS OF TERMINALLY ILL PEOPLE LIVING ALONE AT HOME: A NARRATIVE REVIEW Samar M Aoun 1 , Lauren J Breen 1 , Denise Howting 1 1. Curtin University, Perth, WA, Australia Publish consent withheld

449 WHY DO ONCOLOGY OUTPATIENTS WHO REPORT EMOTIONAL DISTRESS DECLINE HELP? Kerrie Clover 1,2,3 , Ben Britton 1,2 , Alex J Mitchell 4 , Sophia Wooldridge 1 , Gregory L Carter 1,2 1. Calvary Mater Newcastle , Hunter Region Mail Centre, NSW, Australia 2. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia 3. School of Psychology, University of Newcastle, Newcastle, NSW, Australia 4. Psycho-Oncology, Leicestershire Partnership Trust , Leicester, UK Aims:Many patients experiencing significant emotional distress do not seek help and little is known about the reasons for this. We explored the reasons for declining help among patients reporting distress. Methods:Oncology outpatients reporting significant distress during routine screening were asked if they would like help. Those who declined help were asked their reasons for declining. Available demographic and clinical variables were used to identify factors associated with reasons for declining help. Results:Of 311 patients with significant distress, 221 (71%) declined help and 215 of these gave a reason for declining professional help. The most common (n=99, 46%) reason was “I prefer to manage myself”. Two other common reasons were “already receiving help” (n=52, 24%) and not believing their distress was severe enough to require help (n=50, 23%). Stigma was rarely cited as a reason for declining help in our sample (n=1, <1%). Also uncommon were “I can't afford the money [for treatment]” (n=1, <1%) and “I didn't think anything could help” (n=12, 6%). Predictors for declining help were age and gender with younger patients and women more likely to decline help because they were more likely to already be in receipt of help. Distress score and PSYCH-6 scores were significantly lower among patients who rated their distress as not severe enough to require help. Nevertheless, there were patients who had maximal scores on distress and PSYCH in each group. Conclusions:Two common barriers to patient uptake of available clinical services to help with distress are a preference for self-help and a belief that distress is not sufficiently severe to warrant intervention. These beliefs were held by a proportion of individuals who reported very high levels of distress. Qualitative research and subsequent interventions for overcoming these barriers is required to obtain the most benefit from distress screening programs.

450 PSYCHIATRY REGISTRARS' VIEWS AND EDUCATIONAL NEEDS REGARDING THE CARE OF PATIENTS WITH LIFE-LIMITING ILLNESSES Benjamin Forster, Helen Proskurin 1 , Brian Kelly 2 , Melanie Lovell 1,3 , Ralf Ilchef 3,4 , Josephine Clayton 1, 3 1. Palliative & Supportive Care Service, HammondCare, Greenwich, NSW, Australia 2. Consultation Liaison Psychiatry Service, John Hunter Hospital, Newcastle, NSW, Australia 3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia 4. Consultation Liaison Psychiatry Service, Royal North Shore Hospital, St Leonards, NSW, Australia Introduction:Psychiatric concerns with unique features arise in the setting of life-limiting illness. There is currently however little formal teaching on these issues in psychiatry training. Aims:To explore psychiatry trainees' views and educational needs regarding the care of patients with life-limiting illnesses. The extent to which psychiatry trainees are given formal teaching on psychiatric issues at the end of life was explored, in addition to their level of confidence in the provision of psychiatric assessment and management of patients with lifelimiting illnesses. Methods:Semi-structured interviews were conducted with 17 psychiatry registrars with experience in consultation-liaison psychiatry. Participants were recruited through the psychiatry training networks in Northern Sydney and Hunter New England Local Health Districts. Registrars were asked about views on the role of psychiatrists looking after patients with lifelimiting illness, challenges faced within the role, and educational needs in providing care for these patients. Interviews were audio recorded and fully transcribed and then subjected to thematic analysis. Results:There were contrasting views on the role of psychiatry in life-limiting illness. Some registrars felt that a humanistic, supportive approach including elements of psychotherapy was helpful, even in the absence of a diagnosable mental disorder. Those who tended to report a more biological and clinical stance (with a reliance on pharmacotherapy), tended to have a nihilistic view of psychiatric intervention in this setting. Registrars generally felt ill-prepared to talk to dying patients and that there is an educational ‘famine’ in this area of psychiatry. They expressed a desire for more training and felt that increased mentorship and case based learning, with input from palliative care clinicians, would be most helpful. Conclusions:Psychiatry registrars feel ill-prepared to assess and manage patients with life-limiting illness and have contrasting views on the role of psychiatry in this setting. Targeted education is required.

451 INSOMNIA IN CANCER Mathew George 1 , A Elias 2 , M Chaman 3 1. Northwest Regional Cancer Centre, Tamworth, NSW, Australia 2. Rural Academic School, The University of Melbourne, Shepparton., VIC 3. Northwest Cancer Centre, Tamworth, NSW Insomnia in cancer: its associations and implications Aim:Insomnia is common in patients with cancer, occurring in 30–50% of cancer population. In spite of this high prevalence it is less studied. Existing data suggests that insomnia is related to depression in cancer patients. However, its relation to ongoing chemotherapy is not investigated. In this study we aimed to study the relationship between insomnia and chemotherapy after analysing confounding variables. Method:Consecutive patients who visited New England oncology clinic in Tamworth were recruited. Institutional review board approved the study. Insomnia was assessed by Bergen insomnia scale. Montgomery Asberg Depression rating scale was used for depression. In addition to this pain was assessed by brief pain inventory. Chronic medical conditions, type of cancer, side effects to chemotherapy, role of steroids and other drugs were studied as confounders. Results:56 patients participated the study. Age ranged from 33 years to 83 years (mean: 63.6, SD=10.97). There were 29 men and 27 women. 42 patients received at least one form of chemotherapy and 15 were receiving radiotherapy at the time of assessment. One or more chronic medical condition was present in 21 patients and 11 had a psychiatric illness. 37 patients were taking steroids and 13 were on sleeping medications. Mean insomnia score was significantly higher in those receiving chemotherapy than in those without chemotherapy (8.92 vs. 17.2, two tailed p=0.024, 95% CI=-1.09–15.24). There was no significant difference in insomnia score in terms of chronic medical condition, type of cancer, psychiatric history, use of steroids or adverse effects of chemotherapy. However, total insomnia score was correlated with depression rating score (Pearson correlation, r=0.33, p= 0.03). Conclusions:Insomnia in patients with cancer is found to be associated with concurrent chemotherapy and correlated with degree of depression. Identifying factors related to insomnia in cancer population has implications in its management and patient education.

452 PREDICTORS OF HIGH LEVELS OF DISTRESS AND UNMET NEEDS IN CARERS OF HIGH GRADE GLIOMA PATIENTS OVER TIME Georgia Halkett 1 , Elizabeth A Lobb 2,3 , Sonia Oliver 1 , Michelle M Rogers 1 , Anne P Long 4 , Anna K Nowak 4, 5 1. School of Nursing and Midwifery, Curtin University, Perth, WA, Australia 2. Calvary Health Care Sydney and Cunningham Centre for Palliative Care, Sydney, NSW, Australia 3. University of Notre Dame, Sydney, NSW, Australia 4. Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia 5. School of Medicine and Pharmacology, University of WA, Perth, WA, Australia Background:Caring for a person with HGG is unique because patients often experience functional and neurological deficits from diagnosis, as well as behavioural and personality changes, and cognitive decline. We aimed to determine carers' levels of distress over time, priortise their support needs and explore predictors of distress. Methods:Carers of people with HGG planned for chemoradiotherapy (CRT) completed questionnaires during CRT, 3 and 6 months later. Questionnaires: Distress Thermometer, General Health Questionnaire (GHQ), Partners and Carers Survey and Brain Tumour Specific Supportive Care Needs for Carers Survey (BTSSCNCS). Results:Participation was: Baseline n=119; 3 months n=95; 6 months n=71. At baseline, 61% of carers had moderate to high levels of distress, which persisted over the study period (57% at 3m; 58% at 6m). 39% reported a significant financial impact and 56% of those previously working full-time had taken leave or reduced working hours. Feeling unprepared to care, being the main carer, having difficulty understanding information, lacking confidence in caring ability, being male, and experiencing an employment decrease were associated with increased distress across time. Main carers and those who experienced difficulty understanding information had poorer GHQ scores from baseline to 3m. The most frequently reported PCS needs were: accessing carer relevant information, the impact of caring on usual life and understanding the experience of the person with cancer. The most frequently reported BTSSCNCS needs were: help accessing assistance they may be eligible for and adjusting to changes in the mental and thinking ability of the person with a brain tumour. Conclusion:The experience of caring for someone with HGG is highly distressing, and remains distressing. It reduces carers' ability to work and cope financially. Strategies are required to support carers to prepare for this new role. Future research should focus on testing interventions that aid in reducing carer distress.

453 PATIENT, CAREGIVER AND HEALTHCARE PROFESSIONAL'S EXPERIENCES AND PERCEPTIONS OF ADVANCE CARE PLANNING IN CANCER PATIENTS: A SYSTEMATIC REVIEW Stephanie Johnson 1 , Phyllis Butow 2 , Ian Kerridge 3 , Martin Tattersall 1 1. Cancer Medicine, The Univeristy of Sydney, Sydney, NSW, Australia 2. The Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The Univeristy of Sydney, Sydney, NSW, Australia 3. The Centre for Values, Ethics and Law in Medicine (VELIM), The Univeristy of Sydney, Sydney, NSW, Australia Aims:To systematically identify and review quantitative and qualitative studies which explore patient, caregiver and healthcare professionals experiences and perceptions of advance care planning (ACP) in cancer patients. Methods:Data sources included Medline, EMBASE, PsychINFO, and Cochrane Central Register of Controlled Trials (1950 to October 2013), plus citation and author searches. All studies that described original data on perceptions or experiences of adults with cancer, family, friends or professionals caring for this group regarding ACP were included. A narrative synthesis was conducted following The Economic and Social Research Council's (ESRC) Methods Programme “Guidance on the Conduct of Narrative Synthesis in Systematic Reviews”. Results:Of the 2015 titles identified, 37 studies were included (18 quantitative, 14 qualitative, 5 mixed methods). Five conceptual themes were identified: advance care planning is relational (family as a motivator or barrier, the therapeutic relationship); ACP provokes fear and distress (timing, information giving, initiation, setting); stakeholder views regarding ACP vary (physicians as gatekeepers, patient, carer and health professional's views); institutional culture is influential in ACP; knowledge and understanding of ACP is a motivator or barrier. Conclusion:The complex social, intersubjective and institutional nature of ACP requires analysis of how all stakeholders approach ACP. We suggest that future research should include in-depth analysis of the social and cultural systems within which ACP is embedded. Examination of the philosophical foundations of ACP and the organisational influence of the healthcare setting on the implementation and efficacy of ACP may improve the understanding and utility of this complex process.

454 SUITABILITY OF CANCER REGISTRIES FOR RECRUITING PATIENTS WITH LOW-INCIDENCE CANCERS FOR SUPPORTIVE CARE STUDIES Danette H Langbecker 1 , Kate Hunt 1 , Patsy Yates 1 1. Queensland University of Technology, Kelvin Grove, Qld, Australia Aims:In Australia, state-based cancer registries offer a mechanism for recruiting population-based samples of cancer patients for research; however, the suitability of this method for the recruitment of patients with low-incidence cancers for supportive care studies is unclear. This report describes the process of recruitment of primary brain tumour patients, response rates and sample representativeness. Methods:We aimed to recruit a population-based sample of 40 newly diagnosed brain tumour patients through the Queensland Cancer Registry for a pilot longitudinal study of needs, distress and service utilisation. For eligible patients identified via the registry, consent to contact was sought from patients' treating doctors, and once obtained, patients were invited to participate and consented. The CONSORT flowchart and descriptive statistics were used to describe participant flow through the recruitment process. Results:Of 212 adults identified as eligible via the registry, consent to contact was attempted for 203 patients via treating doctors, and obtained for 97 patients (45.8%). Reasons for non-consent to contact (from clinicians) included no response (for 74 patients), refusal (20) and return-to-sender (12). Almost half (40; 18.9% of all potentially eligible patients) invited to participate consented and completed baseline data collection. Reasons for patient non-consent included no response (48 patients), refusal (5), death (3) and return-to-sender (1). Comparison of participants and non-participants (based on registry data) showed no significant differences in age at diagnosis, gender, area of residence or tumour characteristics (side, location, lobe, histology or grade). Conclusions:Patient recruitment was limited primarily by non-response from clinicians, suggesting earlier clinician involvement is needed. Although the final response rate was low, the sample was representative of the target population's demographic and disease characteristics, suggesting this method may be feasible for patient recruitment for future supportive care studies where generalisability is desired.

455 CHEMOTHERAPY IN THE LAST TWO AND FOUR WEEKS OF LIFE AND CORRELATION WITH PALLIATIVE CARE OUTCOMES Sylvia Lee 1 , Jasotha Sanmugarajah 2 , Suzanne Allan 2 , Rohan Vora 1 1. Gold Coast Hospital Health Service, Robina, QLD, Australia 2. Cancer and Blood Disorders, Gold Coast Hospital Health Service, Southport, QLD, Australia Background:There have now been several published studies and audits both in Australia and in other countries, looking at the rate of chemotherapy use in the last few weeks of life, the factors that influence this, and how this can be improved. 1–7 Those that continue until near the end of life have an undeniably adverse effect on the quality of life of many patients. According to an analysis carried out at the NHMRC Clinical Trials Centre, the PBS cost of chemotherapy drugs alone has increased from $65 million in 1999–2000 to $466 million in 2011–2012, which equates to an average annual increase of 19%. 8 To date, there have not been any publications looking at the correlation between use of chemotherapy towards the end of life and PCOC scores. The Palliative Care Outcomes Collaboration is a national approach towards the routine assessment in palliative care practice using standardised assessment tools for functional status and symptoms. 9 Aims:To assess the rate of use of chemotherapy in the last two and four weeks of life in the Gold Coast Area Health District; to identify factors that play a role in the trend towards aggressive cancer treatment towards the end of life; to assess the trends of referrals to palliative care; and to assess the impact of this on patients' quality of life by correlation with PCOC scores or other surrogate indicators. Methods:Mortality data available for the District from 2011 to 2013 will be analysed. A retrospective chart review on the deceased patients (with solid tumours only) will be performed by analysing the medical and chemotherapy records. Analysed variables: gender, date of birth, date of diagnosis, date of last chemotherapy, date of death, tumour origin/histology, treatment regimen, when referred to palliative care, reason for ceasing treatment, and PCOC information pre- and post treatment. 1. Earle CC, Neville BA, Landrum MB, etal: Trends in the Aggressiveness of Cancer Care Near the End of Life. J Clin Oncol 22:315–321, 2004 2. Earle CC, Landrum MB, Souza JM, etal: Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue? J Clin Oncol 26:3860–3866, 2008 3. Kao S, Shafiq J, Vardy J, etal: Use of chemotherapy at end of life in oncology patients. Ann Oncol 20:1555–1559, 2009 4. Nappa U, Lindqvist O, Rasmussen BH, etal: Palliative chemotherapy during the last month of life. Ann Oncol 22:2375–2380, 2011 5. Saito AM, Landrum MB, Neville BA, etal: The effect on survival of continuing chemotherapy to near death. BMC Palliative Care 10:1–11, 2011 6. Yoong J, Seah J, Hamilton K, etal: Mortality within 30 days of receiving systemic anti-cancer therapy at a regional oncology unit: What have we learned? Asia-Pac J Clin Oncol 8:325–329, 2012 7. Zdenkowski N, Cavenagh J, Ku YC, etal: Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy. Internal Med J 43:1191–1198, 2013 8. Karikios DJ, Schofield D, Salkeld G, etal: Rising cost of anticancer drugs in Australia. Internal Med J 44:458–463, 2014 9. University of Wollongong: Palliative Care Outcomes Collaboration. http://www.pcoc.org.au

456 SUPPORTING SOMEONE WITH CANCER: THE DEVELOPMENT AND IMPLEMENTATION OF A CARER SUPPORT PROGRAM AT THE OLIVIA NEWTON-JOHN CANCER & WELLNESS CENTRE (ONJCWC) Dianne Legge 1 , Tamara Boatman 1 , Silvana Petrevski 1 , Robin Curwen-Walker 1 1. Austin Health Cancer Services, Heidelberg, VIC, Australia Background:With the focus of treatment centres primarily directed towards patients, the supportive care needs of carers and family members are often left inadequately addressed. Recent literature points to a range of unmet needs for carer populations such as information, uncertainty, loss and role changes. A review of the brain tumour support group was the impetus for the development of a carer support program at Austin Health in 2010. A pilot group exclusively for carers, to be held in the evening was recommended. Methods:“Supporting Someone with Cancer” (SSWC) programs are open groups, operating from 5.30–8pm, including refreshments. The sessions provide information and facilitated discussions based on themes identified by carer feedback. Two staff facilitate each program. Initially bi-monthly, the program is now offered monthly due to carer demand. Sessions alternate between themed guest speakers and general discussion over a meal; “kitchen table wisdom”. Sessions are evaluated via survey following each session. Results:Since early 2011, 14 SSWC programs have been run. 197 carers has participated, with a wide spread of ages and mix of gender. The brain tumour population is highly represented (>65%) due to the engagement of a care coordinator and high carer burden associated with this illness. Overwhelmingly, the most valuable aspect for participants was the opportunity to meet and talk with others in a similar situation, even if that wasn't their stated aim for attendance. Specifically targeted session such as “Demystifying Palliative Care” gives participants the chance to enquire in a safe and nurturing environment. Conclusion:“Supporting Someone with Cancer” is now an integral part of the Wellness and Supportive Care program at ONJCWC, with continued strong attendance. Further research is planned, focusing more directly on the impacts and meaning of this group, and the role it plays in supporting carers.

457 HAVIN' A YARN: A PROJECT TO SUPPORT ABORIGINAL PEOPLE AFFECTED BY CANCER Sue M Merritt 1 , Craig Holloway 2 , Anna Boltong 1 1. Cancer Information and Support Services, Cancer Council Victoria, Melbourne, VIC, Australia 2. Health Programs, Victorian Aboriginal Community Controlled Health Organisation, Melbourne, VIC, Australia Background:There were 457 cancer diagnoses reported for Aboriginal Victorians during 2008–2012 with significantly higher mortality than other Victorians(1). The Havin' a Yarn project was a partnership between Cancer Council Victoria (CCV) and the Victorian Aboriginal Community Controlled Health Organisation to facilitate discussions among Aboriginal Victorians about cancer in a safe, culturally appropriate space, explore supportive care needs and increase access to cancer information. Method:Engagement of the Aboriginal community was accomplished through sharing of experiences in ‘yarning circles.’ Methods of educating key cancer staff in knowledge and awareness of Aboriginal health and cancer issues were determined through consultation with key stakeholders. A consumer-led evaluation framework was utilised to allow greater relevance and dissemination of project findings within the Aboriginal community. Results:Seventy-one people attended three yarning circles and an additional 40 community meetings were held to help determine strategies for meeting information and support needs. These were: 1) The development of Aboriginal cancer support groups (ACSG); and 2) Culturally relevant resources and training. Appropriate artwork and Aboriginal involvement were important identifiers in what was culturally relevant. Tailored guidelines for starting an ACSG group were developed, two ACSGs were formed, and 8 aboriginal people attended ACSG leader training. A supportive care information pack was developed and distributed to over 550 Aboriginal people affected by cancer. Forty-two CCV staff attended Cultural Safety training and cancer education was delivered to four forums of Aboriginal Health Workers. A DVD developed as part of the project depicts Aboriginal people sharing their cancer experiences, reflections on the project, partnership formations and key learnings. Conclusions:The Havin' a Yarn project has allowed Aboriginal Victorian's voices to inform the content of CCV's supportive care programs, including the development of the first two Victorian ACSGs, the first Aboriginal-specific leader training and the first Aboriginal-specific supportive care information pack. 1. Cancer in Victoria: Statistics and trends 2012. Cancer Council Victoria, 2013.

458 THE NURSES' ROLE IN MONITORING PATIENTS WITH ADVANCED MELANOMA RECEIVING IPILIMUMAB IN AN AMBULATORY SETTING AT PETER MACCALLUM CANCER CENTRE, AUSTRALIA Donna Milne 1 , Hannah Burrell 1 , Mei Krishnasamy 1,2 , Karla Gough 1 1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia 2. Department of Nursing, School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia Background:Ipilimumab is an anti-CTLA-4 monoconal antibody that improves survival of patients with metastatic melanoma. It can result in mild to severe, even life threatening autoimmune adverse effects affecting the gastrointestinal tract, liver, skin and endocrine system. Ipilimumab became accessible to patients off trial in 2013 and thus available outside specialist cancer centers. As nurses are often the first point of contact for patients they need to be aware of signs of serious adverse effects and of appropriate interventions to respond to them. Aim:To describe the nature and frequency of problems and side effects (SE) experienced by patients and the nursing interventions initiated to manage these issues. Sample:31 patients commencing Ipilimumab between August 1st and December 31st 2013. Method:SE and nursing intervention data were recorded on a standardised template by a specialist melanoma nurse at each contact initiated by a patient or at a specific follow up time point by the nurse. Outcome data from prescribed interventions were also recorded. Data have been analysed descriptively. Results:31 patients receiving a total of 77 doses of Ipilimumab are included in the analysis (range 1–4). Mean number of contacts 4.2 (range 1–8). Total number of SE reported was 389 and included fatigue (n=84, 22%), general weakness (n=47, 12%), skin changes (n=30, 8%) and decreased appetite (n=31, 8%). Autoimmune events occurred in 5 patients, 2 stopped treatment prematurely. Nursing interventions included arranging mobility aids, commencing topical emollients and antihistamines, advising on eating practices and arranging medical assessments. The greatest risk to patients is the nurses' inability to recognize such common SE may be related to Ipilimumab. Conclusions:Nurses with appropriate knowledge and expertise play a vital role in identification and timely initiation of interventions for Ipilimumab-related SE that may otherwise be life-threatening.

459 THE PRIMACY OF QUALITY OF LIFE CONSIDERATIONS: MEETING THE CLIENT'S NEEDS. APPLYING FLEXIBILITY IN THE MANAGEMENT OF SECONDARY LYMPHOEDEMA IN A PALLIATIVE CONTEXT Gillian Buckley 1 , Ronna Moore 2 1. Gillian Buckley Physiotherapy Pty Ltd, Middle Park, VIC, Australia 2. Ronna Moore Remedial Massage Therapist, Malvern, VIC, Australia Background:The presentation of complex lymphoedema in the palliative context requires an approach which is first and foremost responsive to the immediate and prioritized needs of the client. This approach may require modifications of the guidelines for lymphoedema management, as well as flexibility in the provision of treatment. Case presentation:Our case describes a 55 year old woman with lung cancer who presents with complications of her advanced disease, including extensive oedema of her right upper limb. Treatment:It was necessary to modify treatment in response to changing circumstances in the face of the client's general deteriorating condition. Despite some potential contraindications to treatment, lymphoedema management was successfully undertaken. Outcome:There was a dramatic reduction in the oedema of the client's arm, which was then maintained with adjustable compression. There was a concurrent significant reduction in the levels of pain and the emotional distress associated with the oedematous limb. Conclusion:This case outlines the challenges of supporting a client with refractory disease. Guided by the principles of palliative care, the lymphoedema therapist can contribute to the quality of life of the palliative client where oedema is a significant issue for the client. Responsiveness and sensitivity to the physical, emotional and psychosocial needs of the client and carers are required in tandem with flexibility with respect to the management of the oedema itself.

460 THE IMPACT OF AN INPATIENT HOSPITAL ADMISSION ON PATIENT'S PHYSICAL FUNCTIONING AND QUALITY OF LIFE RATE IN THE ONCOLOGY SETTING Andrew Murnane 1 , Justin Keogh 2 , Fiona Magat 2 , Sonya Imbesi 2 , Marie Coulombe 1 , Sharni Patchell 1 , Alan Abbott 2 1. Peter MacCallum Cancer Centre, Melbourne, Vic, Australia 2. Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia Introduction:Prolonged bed rest is often associated with acute inpatient hospital admissions, has been shown to significantly decrease patient's physical function and health related quality of life (HRQoL). The aim of this study was to investigate the effects of hospitalisation and to describe the pattern and prevalence of functional decline in oncology patients over the course of their inpatient admission. Methods:This was a prospective observational study of 55 consenting inpatients recruited over a 10 week period. Assessment measures were undertaken bi-weekly until discharge from hospital or they became too unwell to continue. Functional status and HRQoL data were collected using the, timed up and go test (TUG), 30-second chair sit to stand (STS), 30second arm curl, isometric muscle strength testing, EORTC-C30 and SF-8. Results:55 patients (28 male), median age 64 years (±SD 10.8) with an average length of stay of 18 days participated in the study. Reason for hospital admission included; symptom management (36%) or delivery of cancer treatment (35%). A number of subscales on the EORTC-C30 including physical functioning and functional assessments (TUG, STS and knee extension) showed a trend of weekly decline in performance but were not statistically significant. Compared to the general population 87% and 82% of the cohort scored below the norm in physical functioning and mental health respectively; 43% recorded TUG indicative of falls risks; 76% were below age matched norms for STS and 20% were below in upper limb strength. Conclusion:Despite non-significant declines in physical functioning and HRQoL during their hospital admission, participants demonstrated substantially reduced HRQoL and physical functioning at time of hospital admission and at discharge compared to healthy age-matched normative data. Despite this low level of function very few received rehabilitation followup. Screening programs using simple functional assessment measures (STS, TUG) could be useful in identifying patients at risk of deconditioning and those who require specialised input on discharge to prevent further declines in function and hospital re-admissions.

461 IMPLEMENTING A LEISURE ACTIVITY MAINTENANCE PROGRAM INTO AN INPATIENT CANCER SETTING Jodie Nixon 1 , Lyndal Gray, Kate Brennan, Megan Trevethan, Sally Bennett, Mary Whitehead 1. princess Alexandra Hospital, Woollongabba, QLD, Australia Aims:A formalised Leisure Activity Maintenance Program (LAMP) was commenced in March 2013 on an acute oncology ward to assist with the management of cancer related fatigue of cancer patients during their inpatient stay. The aim of this program was to provide patients with a structured, supported program that allowed them to stay active whilst undergoing medical interventions. Methods:A review of the research literature regarding fatigue management in oncology in patient settings was conducted. In line with the NCCN Guidelines (version 1.2012) for Cancer-Related Fatigue, a program, LAMP, was developed to enable inpatients the access for general strategies for management of fatigue during the inpatient stay. Results:Part A of the project was the implementation of the program, which looked at the feasibility of carrying out the program. During the 12 months since instigation of the programthere were 265 occasions of services provided, with a range of between five to sixteen patients referred each month. Program sessions ranged from cognitive stimulation, distraction through socialisation, off ward visits to cafes, and encouragement to stay active through participation in domestic chores. Part B is a pilot of 10 participants, looking at the satisfaction of patients with the program, and reviewing the perceived levels of activity and leisure participation during the inpatient stay. These results are undergoing analysis. Conclusions:This innovative program of using a therapy assistantto increase patient's activity levels during an inpatient oncology stay is the first step in incorporating published guidelines to assist with the management of cancer related fatigue.

462 SCORED PATIENT-GENERATED SUBJECTIVE GLOBAL ASSESSMENT AND SERUM ALBUMIN FOR NUTRITIONAL ASSESSMENT OF GYNECOLOGICAL CANCER PATIENTS IN PALLIATIVE CARE Camila S Rodrigues, Marina S Lacerda, Gabriela V Chaves Instituto Nacional do Câncer – INCA – Rio de Janeiro/Brazil Background:Compromised nutritional status is common among cancer patients and is associated with hindered treatment response, greater need for hospitalization, lower quality of life, and less chance of survival. Aims:To identify the nutritional status of women with gynecological cancer in palliative care using the Patient-Generated Subjective Global Assessment (PG-SGA) and the association of serum albumin to the nutritional status rating using PG-SGA as determinants of lenght of hospital stay and mortality. Methods:49 women with gynecological tumors, in palliative care, and hospitalized during the month of November 2012 at the foremost centers for the prevention and treatment of cancer in Rio de Janeiro were assessed during the first 24 hours of hospitalization. Data were collected on PG-SGA, albumin, and mortality. Statistical significance was reported at the conventional p<0.05 level. Results:10,2% of the patients were classified as being well nourished (PG-SGA A), 52,9% as at nutritional risk or moderately malnourished (PG-SGA B), and 30,6% as being severely malnourished (PG-SGA C). Most of the women (83,7%) reported eating less than they normally would and 77,6% reported losing weight. The most prevalent gastrointestinal symptom were xerostomia (55,1%) and early satiety (44,9%). 91.8% had limitations in functional capacity, and 44.9% reported spending most of their time sitting or lying down. The median serum albumin was significantly higher (p<0,001) in the group of well-nourished patients (PG-SGA A), when compared to malnourished (PG-SGA B and C). There was a positive association between serum albumin and survival (r=0,558; p=0,001), and a negative correlation between serum albumin and PG-SGA score (r=-370; p=0,012). The median of survival was 57 days, being higher in well nourished patients (137 days). Conclusion:PG-SGA is a useful and viable method of nutritional assessment for patients with gynecological tumors in palliative care, related to serum albumin levels and mortality.

463 EVALUATING THE UTILITY OF THE QUAL-EC IN THE CLINICAL CARE OF PATIENTS WITH ADVANCED CANCER Susan Slatyer 1,2 , Anna Nowak 3 , Catherine Pienaar 4 , Anne Wilkinson 4 , Anil Tandon 5 , Mark Wallace 4 1. School of Nursing and Midwifery, Curtin University, BENTLEY, WA, Australia 2. Centre for Nursing Research, Sir Charles Gairdner Hospital, NEDLANDS, WA, Australia 3. The University of Western Australia, CRAWLEY, WA, Australia 4. School of Nursing and Midwifery, Edith Cowan University, JOONDALUP, WA, Australia 5. Palliative Care Service, Sir Charles Gairdner Hospital, NEDLANDS, WA, Australia Improvement of quality of life (QoL) is a fundamental goal of care for people with advanced cancer. The Quality of Life at the End of Life (QUAL-E) instrument was developed to measure four domains: Symptom control; Relationship with healthcare provider; Preparation for end of life (concerns about loved ones); and Life completion 1 . Piloting the QUAL-E with Australian palliative inpatients (n=52) demonstrated acceptability and face validity 2 . A reduced 17-item instrument, the QUAL-E-Cancer (QUAL-EC), validated with Canadian patients (n=464) was recommended to assess QoL in people with advanced cancer 3 . Aims:This study evaluated the utility and feasibility of the QUAL-EC by: Exploring associations between QUAL-EC domain scores and distress. Exploring in-depth responses to the QUAL-EC when administered as an interview. Methods:A cross-sectional, mixed methods design was used. Convenience sampling recruited patients with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the QUAL-EC and the Distress Thermometer Screening Tool 4 (DT). Qualitative data collection involved digital recordings of QUAL-EC interviews. Results:The accrual target of 25 inpatients (78% response) and 25 outpatients (96% response) was reached. The mean age was 59.9 years. The most common diagnoses were mesothelioma (26%), and cancers of the lung (22%) and brain (10%). Patients' DT scores indicated that 39.6% were experiencing severe distress (score ≥7) while 40% reported moderate distress (score 4-6). Levels of distress significantly correlated with two QUAL-EC domains: Symptom control ( r =0.52, p < 0.001 ) and Preparation for end of Life ( r =0.32, p < 0.05 ). Qualitative analysis described the influence of pervasive emotional stress, bothersome symptoms, and psychosocial factors on QUAL-EC responses. Conclusions:Distress was associated with either symptom burden, or concerns about loved ones. When distress is identified on screening, the QUAL-EC offers potential as an instrument capable of nuanced assessment to direct intervention towards psychosocial or physical and symptom-related concerns. 1. Steinhauser K, Bosworth H, Clipp E, McNeilly M, Christakis N, Parker J, etal. Initial assessment of a new instrument to measure quality of life at the end of life. Journal of Palliative Medicine. 2002;5:829–841. 2. Wilkinson A, Slatyer S, McCullough K, Williams A. Exploring the Quality of Life at the End of Life (QUAL-E) instrument with Australian palliative care hospital patients. Journal of Palliative Care. 2014;30:16–23. 3. Lo C, Burman D, Swami N, Gagliese L, Rodin G, Zimmermann C. Validation of the QUAL-EC for assessing quality of life in patients with advanced cancer. European Journal of Cancer. 2011;47:554–560. 4.Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management (V.2.2013). © 2013 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed December 13, 2013. To view the most recent and complete version of the NCCN Guidelines®, go on-line to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

464 WHAT DO PATIENTS UNDERSTAND ABOUT THE INFORMATION THEY RECEIVE DURING RADIOTHERAPY? Haryana Dhillon 1 , Sian K Smith 2 , Django Nathan 3 , Jennifer Taylor 3 , Eleni Van Gelder 4 , Georgia Halkett 5 , Ann Dixon 1 , Chris Milross 6 1. Centre for Medical Psychology, Sydney Medical School, , University of Sydney, Sydney, NSW, Australia 2. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia 3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia 4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia 5. School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Sydney, NSW, Australia 6. Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia Background:Patients receiving radiotherapy require relevant and accurate information so they can be involved in decisions about their treatment and effectively manage their treatment-related side effects. There is a lack of research exploring how patients describe and make sense of the information received at different stages of their treatment journey, from initial treatment decisions through to follow-up care. Aim:To explore how patients understand and interpret information as they proceed through radiotherapy. Methods:Semi-structured interviews were conducted with 21 radiotherapy patients with a range of cancer types. Data were analysed using Framework approach to compare and contrast how patient experiences differ. Results:Key themes included: (1) perceived role and responsibilities in the treatment decision-making process, (2) understanding of radiotherapy and what happens beyond treatment, (3) preparedness for side-effects and their management, (4) overall experience of care and support, and (5) strategies to improve communication and the patient experience. Most patients perceived the initial decision to undergo radiotherapy as a recommendation presented by the medical team not a choice, but were happy to follow their advice due to high levels of trust and confidence in their expertise. While most patients had a good understanding about the intent of radiotherapy and recall of the associated sideeffects, some did not appear to be aware of their medical future following radiotherapy (e.g. recurrence risk, side effects, follow-up appointments). Participants suggested ways to enhance the patient experience, including: making information more accessible outside the hospital, incorporating patient mentoring, treatment centre tours, and consistent staff contact. Conclusion:Information about radiotherapy is understood to varying degrees by patients receiving this treatment. Improvement in information accessibility, familiarity with the treatment centre, and continuity of staff involved in care may facilitate patient knowledge about treatment and its side-effects. Future research could focus on lower education and literacy populations.

465 IMPROVING MALNUTRITION SCREENING IN THE RADIOTHERAPY SETTING Belinda Steer 1 , Erin Kennedy 1 , Kirsty Rowan 1 , Nicole Kiss 1 1. Peter MacCallum Cancer Centre, East Melbourne, Vic, Australia Aims:To pilot and evaluate the effectiveness of a new malnutrition screening, referral, assessment and treatment strategy for Peter Mac ambulatory radiotherapy patients in order to address the issue of cancer malnutrition, enhance nutrition services and improve patient care Methods:A retrospective comparison of 318 new radiotherapy patients pre-and 324 patients post-implementation of the strategy across three Peter Mac radiotherapy sites. Data was collected on nutrition screening, weighing and referral practices at initial nursing assessment, and dietitian's nutrition assessment and treatment practices. Implementation of the strategy involved development of a triage system for dietetic referral post screening based on Malnutrition Screening Tool (MST) score, establishing weighing stations, and training for nursing staff on the MST, weighing practices and new referral processes. Dietitians were trained on the new assessment and treatment processes. Pre-and post-implementation data were compared using descriptive statistics. Results:Post implementation there was an improvement in malnutrition screening and the proportion of patients being weighed at initial assessment (18% vs. 53%; 31% vs. 61%, respectively). There was a small increase in the number of referrals made from 13% at baseline to 17% post-implementation, with an increase in the percentage of referrals from medical and allied health staff (7% vs. 20%; 0% vs. 8%, respectively). Appropriate timing of nutrition assessment remained relatively constant (78% vs. 72%) whilst the proportion of patients being assessed in their final week of treatment remained high (93% vs. 98%). Conclusions:The strategy improved malnutrition screening rates and weighing practices of ambulatory radiotherapy patients and potentially increased awareness of malnutrition risk with healthcare professionals in this patient group. Nutrition assessment and management throughout treatment remained timely and appropriate. Further work is underway to establish strategies to promote sustainable practice and ongoing evaluation of the strategy.

466 DID THE IMPLEMENTATION OF A PROSTATE CANCER SPECIALIST NURSING SERVICE REDUCE UNMET SUPPORTIVE CARE NEEDS AMONGST CARERS? Julie Sykes 1 , Leanne Monterosso 2 , Sanchia Aranda 3 , Ian Roos 4 , Wei Hong Liu 5 , Danette Langbecker 5 , Lynda Carnew 5 , Patsy Yates 5 1. Prostate Cancer Foundation of Australia, ST LEONARDS, NSW, Australia 2. The University of Notre Dame Australia, Murdoch, WA, Australia 3. Cancer Institute NSW, Sydney, NSW, Australia 4. Cancer Voices Australia, Melbourne, VIC, Australia 5. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia Aims:In 2012, a prostate cancer specialist nursing service was introduced to provide direct patient care in 12 health centres across Australia. This specialist role was evaluated to measure its impact on patients, their carers, and the health care system. As part of the evaluation, this study aimed to describe the changes in supportive care needs of carers of men with prostate cancer. Methods:In this uncontrolled, two-cohort, comparative study, 129 carers in the six months before (Cohort 1) and 105 carers 18 months after (Cohort 2) the introduction of the service completed a questionnaire assessing their unmet supportive care needs (45 items) in relation to health care service, psychological and emotional, work and social, information and non-specific needs. Results:The ten most frequently reported unmet needs were identified for each cohort. Seven unmet needs were the same for both cohorts: two related to health care service need (addressing fears about the person with cancer's physical/mental deterioration; finding more accessible hospital parking), four related to psychological and emotional need (addressing problems with sex life; getting emotional support; coping with the person with cancer's recovery not turning out as expected; making decisions about life in the context of uncertainty), and one related to work and social need (the impact on carer's working/usual activities). The proportion of carers who reported that their needs were satisfied was higher among Cohort 2 than Cohort 1 for six of these seven items, although this only reached statistical significance for one item. Overall, Cohort 2 carers reported more satisfaction than Cohort 1 carers for 31 of 45 items Conclusions:Although the implementation of the prostate cancer specialist nursing service did not substantially reduce unmet supportive care needs amongst carers, there was a trend for those using this service to report more satisfaction with their care.

467 MUSCULOSKELETAL EFFECTS OF EXERCISE IN MEN WITH PROSTATE CANCER INITIATING ANDROGEN DEPRIVATION THERAPY Robert U Newton 1 , Daniel A Galvão 1 , Nigel Spry 2 , Prue Cormie 1 , Suzanne K Chambers 3 , Robert A Gardiner 4 , David H Shum 3 , David Joseph 2 , Dennis R Taaffe 5 1. Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, WA, Australia 2. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia 3. Griffith Health Institute, Griffith University, Brisbane, QLD, Australia 4. Centre for Clinical Research at Royal Brisbane Hospital, The University of Queensland, Brisbane, QLD, Australia 5. School of Medicine, University of Wollongong, Wollongong, NSW, Australia Aims:Androgen deprivation therapy (ADT) for the management of prostate cancer is associated with a range of musculoskeletal toxicities. Although exercise with rehabilitative intent is effective in reversing a number of these adverse effects, it is unknown if exercise simultaneously initiated with ADT can prevent toxicities from occurring. The purpose of this study was to determine if exercise can mitigate these adverse effects in men during the initial phase of testosterone deprivation. Methods. Fifty-one men initiating ADT for prostate cancer were randomized to exercise (EX, n=26) or usual care (CON, n=25) for 6 months. Exercise consisted of progressive resistance, aerobic, and impact-loading exercise 3 times per week at moderate-to-high intensity under supervision. Whole body lean mass and bone mineral content (BMC), and total hip and lumbar spine bone mineral density (BMD) were assessed by DXA. Neuromuscular strength for chest press, seated row and leg press exercises were assessed using the 1RM method. Results. There was a significant difference between groups following 6 months for whole body lean mass (p=0.023) being preserved in EX and decreasing in CON by 1.15kg. Similarly, there were significant between group differences for all strength measures (p<0.01) with chest press strength preserved and leg press (33.3%) and seated row strength (7.8%) increased in EX, while chest press decreased (-7.5%) and leg press strength increased (9.6%) in CON. There was no significant change in EX or CON for whole body BMC or spine BMD with hip BMD decreasing in CON by −1.2% (p=0.019). Conclusions. Lean mass and bone mass can be preserved and strength improved in men who simultaneously initiate exercise and ADT. Consequently, men initiating ADT should be encouraged to undertake specific exercise as an adjunct treatment to preserve their musculoskeletal health.

468 SUPPORTING ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE DIAGNOSED WITH CANCER TO NAVIGATE THE HEALTHCARE SYSTEM Laura Tam 1 , Judith Meiklejohn 2 , Gail Garvey 2 , Jennifer Martin 3,4 , Jon Adams 5 , Euan Walpole 6 , Mike Fay 3,7 , Patricia Valery 2 1. Mphil Student, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia 2. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia 3. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia 4. School of Medicine, University of Newcastle, Newcastle, New South Wales, Australia 5. Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia 6. Princess Alexandra Hospital, Brisbane, Queensland, Australia 7. Genesis Cancer Care, Newcastle, New South Wales, Australia The barriers that Aboriginal and Torres Strait Islander people diagnosed with cancer face in accessing cancer care are well documented. However, factors facilitating this cohort of patients to successfully navigate the health system such as, culturally-aware clinicians, engagement of Indigenous support workers and financial support, have been largely anecdotal. Aim:This study aimed to examine the factors that enable Indigenous patients to have a positive cancer journey. Method:Semi-structured interviews were conducted with consenting adult Indigenous cancer patients – recruited from a major tertiary hospital in Queensland. Participant inclusion criteria were: age >18 years, able to provide consent, have an established diagnosis of any type of cancer, and either actively receiving treatment or recently completed treatment (no more than 30 days of study enrolment). Twelve Indigenous cancer patients were interviewed and transcribed verbatim. Transcripts were then independently analysed by researchers through the comparison and contrast of experiences to elicit common themes until no new concepts were identified. Results:The factors that assisted Indigenous cancer patients to navigate the health care system were associated with resilience – either innate or adaptive; the level of support received from family and friends was crucial to the patient's perception of their cancer journey; and spirituality was also highlighted as a source of strength for some. A strong therapeutic alliance was critical to the patient's positive experience as was support from the health system. Conclusion:Despite the often cited barriers to accessing cancer care, some Indigenous patients have reported successful navigation through the system. The determinants of a positive cancer journey appear to be multifactorial – personal, environmental and health-professional associated factors. These factors may provide some guidance to other Indigenous cancer patients in helping them to more positively navigate their cancer journey through the health system.

469 GASTROINTESTINAL MUCOSITIS IS ASSOCIATED WITH MUC 2 AND 4 EXPRESSION, AND EXOCYTOSIS OF MUCIN STORES Daniel Thorpe 1 , Andrea Stringer 2 , Ross Butler 1 1. School of Pharmacy & Medical Sciences , The University of South Australia, Adelaide, SA, Australia 2. School of Pharmacy & Medical Sciences , The University of South Australia, Adelaide, SA, Australia Background:Mucositis is a severe does limiting toxic side effect of chemotherapy. Irinotecan, used to treat solid tumours, is associated with severe mucositis and diarrhoea. Mucus secretion may be associated with incidence and severity of diarrhoea. The aim of this study was to determine the changes to mucins in the gastrointestinal tract during mucositis. Methods:Dark Agouti (DA) rats were administered a single dose of 175mg/kg of irinotecan intraperitoneally (ip) and 0.01mg/kg atropine subcutaneously (sc). Experimental and untreated control rats were killed at times 6, 24, 48, 72, 96 and 120h after treatment. Jejunum and colon samples were formalin fixed. Haematoxylin and eosin (H&E) staining, Alcian Blue-PAS staining, High iIron dDiamine and immunohistochemistry with Muc2 and Muc4 antibodies were carried out. Goblet cells (intact and cavitated) and positively stained cells were counted. Statistical analyses were carried out using a Kruskal-Wallis test with Dunns post test. Results:Cavitated goblet cells (cells which have undergone recent exocytosis of mucin stores) as a percentage of the total cells increased significantly (p>0.05) at 72h compared with controls in the colon. Muc2 positively stained goblet cells in the crypts in the jejunum significantly decreased (p>0.05) at 96h, and in the colon at 72h compared to controls. Muc4 positively stained cells in the colon decreased significantly at 72h, 96h and 120h (p>0.05) compared to controls. Conclusions:Exocytosis of mucin stores increases following administration of irinotecan. Muc2 and Muc4 expression is also increased at similar time points. This indicates that Muc 2 and Muc 4 expression are associated with the exocytosis of mucins, which is likely to contribute to the pathophysiology of mucositis and associated diarrhoea.

470 AN ALTERNATIVE MEDICAL SERVICES ADVISORY COMMITTEE (MSAC) ASSESSMENT MODEL: INHERITED CANCER AS AN EXEMPLAR Vanessa Tyrrell 1 , Melody Caramins 2, 3 1. Royal College of Pathologists of Australasia (RCPA), Surry Hills, NSW, Australia 2. Faculty of Medicine, School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia 3. SDS Pathology, North Ryde, NSW, Australia The process for assessment of applications for inclusion on the Medicare Benefits Schedule is rigorous and can involve a large investment by both applicants and government to prepare items for assessment by MSAC. For genetic testing MSAC has routinely been asked to assess applications on a gene by gene approach. The Department of Health (DOH) has commissioned a project to be led by the Royal College of Pathologists of Australasia (RCPA) to develop and pilot an alternative to the assessment of genetic tests by using a disease-based approach. The disease-based approach is being piloted with an application for heritable mutations predisposing to cancer. This disease group is defined as and limited to known genes which have a well-established protocol for clinically actionable outcomes. The pilot is intended to be technology and platform agnostic, and will address the advances in genetic testing in the clinical environment. The desired outcome is to demonstrate that a disease based approach is a feasible alternative to the assessment of genetics by MSAC for public funding via the MBS. It is also envisaged that this could result in the development of genetic test application guidelines to be used to process future applications. This would also contribute to the integration of advancing genetic testing capabilities in the healthcare system to improve patient management and health outcomes.

471 FACTORS ASSOCIATED WITH PREFERENCE OF COMMUNICATION ABOUT LIFE EXPECTANCY WITH PHYSICIANS AMONG CANCER PATIENTS UNDER RADIATION THERAPY Megumi Uchida 1 , Chikao Sugie 2 , Michio Yoshimura 3 , Eiji Suzuki 4 , Yuuta Shibamoto 2 , Masahiro Hiraoka 3 , Tatsuo Akechi 5, 1 1. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan 2. Department of radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, JAPAN 3. Department of radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine , Kyoto, JAPAN 4. Department of Breast Surgery, Kyoto University Graduate school of medicine, Kyoto, JAPAN 5. Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Aichi, Japan Aim:The aim of this study is to investigate factors associated with preference of communication about life expectancy with physicians (whether want to share information about life expectancy with physicians or not) among cancer patients under radiation therapy. Methods:Cancer patients aged twenty years or older were consecutively sampled when they started radiation therapy at two university hospitals. The patients were asked to complete self-administered questionnaires assessing both patient's and medical staff's factors. Patient's factors contained their preference whether to share information about life expectancy with doctors or not, their preference in treatment decision making (leave it to doctors or not), psychological distress (Hospital Anxiety and Depression Scale: HADS), physical distress (M.D. Anderson Symptom Inventory: MDASI), quality of life (EuroQol five-dimensional: EQ-5D) and sociodemographic and medical factors. Medical staff's factors involved actual level of cancer care received (e.g., communication style of physicians, symptom management). Results:Two hundred and twenty-six patients answered about their preference of communication about life expectancy. (Response rate: 58%) 45% of the participant wished to share information about their life expectancy with physicians. Eighty-five percent of the participants recognized their aim of radiation therapy as cure. Univariate analysis indicated that employment status (full or part time) and patient's preference of treatment decision making (leave it to doctors) were associated with communication about life expectancy. A multiple regression analysis revealed that only employment status (full or part time) was significantly associated with preference of communication about life expectancy. Conclusions:There was a significant association between employment status and patient's preference of communication about life expectancy with physicians. This indicates that it is better for physicians to discuss life expectancy with cancer patients if they continue to work after their cancer diagnosis.

472 PREVALENCE OF FATIGUE AMONG CANCER PATIENTS UNDER RADIATION THERAPY AND ITS ASSOCIATED FACTORS Megumi Uchida 1 , Toru Okuyama 1,2 , Chikao Sugie 3 , Michio Yoshimura 4 , Eiji Suzuki 5 , Yuuta Shibamoto 3 , Masahiro Hiraoka 4 , Tatsuo Akechi 1,2 1. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan 2. Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan 3. Department of radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, JAPAN 4. Department of radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine , Kyoto, JAPAN 5. Department of Breast Surgery, Kyoto University Graduate school of medicine, Kyoto, JAPAN Aim:The aim of this study is to investigate the prevalence of fatigue among cancer patients under radiation therapy and its associated factors. Methods:Cancer patients aged twenty years or older were consecutively sampled when they started radiation therapy at two university hospitals. The patients were asked to complete self-administered questionnaires assessing fatigue (Cancer Fatigue Scale: CFS, composed of three subscale: physical, affective and cognitive), psychological distress (Hospital Anxiety and Depression Scale: HADS), subjective symptoms (M.D. Anderson Symptom Inventory: MDASI) and sociodemographic & clinical factors. Results:Two hundred and fifty-nine patients returned their questionnaire. (Response rate: 67%) The mean (+-SD) and median age of the study population was 63.6(+-12) and 66 years, respectively. 37% of the participants had clinical fatigue (CFS total score >18). Univariate analysis indicated that 1.Period from diagnosis, ECOG-PS, pain, nausea, sleep disturbance, shortness of breath, lack of appetite, dry mouth, sad, vomiting, numbness, psychological distress and history of anti cancer therapy (chemotherapy & molecular target therapy) were associated with physical fatigue, 2. Education, nausea, sleep disturbance, shortness of breath, lack of appetite, dry mouth, sad, vomiting, psychological distress were associated with affective fatigue, 3. Age, period from diagnosis, pain, sleep disturbance, shortness of breath, lack of appetite, dry mouth, sad, vomiting, numbness, psychological distress, employment were associated with cognitive fatigue. A multiple regression analysis revealed that 1. Nausea, lack of appetite, dry mouth, numbness and psychological distress were associated with physical fatigue, 2. Psychological distress was associated with affective fatigue, 3. Period from diagnosis, dry month and psychological distress were associated with cognitive fatigue. Conclusions:Multi-dimensional factors were associated with fatigue among cancer patients under radiation therapy. Especially, psychological distress was associated with all subscale of fatigue. Intervention to psychological distress may relieve cancer patients' fatigue under radiation therapy.

473 IS CROFELEMER AN EFFECTIVE INTERVENTION FOR DACOMITINIB-INDUCED GASTROINTESTINAL TOXICITY? Ysabella Van Sebille 1,2 , Rachel Gibson 2 , Joanne Bowen 1 1. Discipline of Physiology, School of Medical Sciences , The University of Adelaide, Adelaide, S.A, Australia 2. Discipline of Anatomy and Pathology, School of Medical Sciences, University of Adelaide, Adelaide, S.A, Australia Background:Dacomitinib is a new irreversible pan-HER tyrosine kinase inhibitor currently in clinical trials for the treatment of advanced cancers. Patient oncology results have been promising, however dacomitinib use has been hindered by significant diarrhoea. The underlying mechanism(s) of dacomitinib-induced diarrhoea are unknown, but have been hypothesized to be due to secretory mechanisms within the gut. Crofelemer is a natural compound extracted from the stem bark latex croton lechleri tree. It is known to have antisecretory activity due to its dual inhibitory action on CFTR and CaCC and is currently used clinically to treat diarrhoea associated with AIDS antiretroviral medication. Aim:To determine if crofelemer is an effective inhibitor of dacomitinib-induced diarrhoea Methods:Male Wistar rats (n=36) received 7.5mg/kg dacomitinib and either 10mg/kg, 25mg/kg or 50mg/kg crofelemer via daily oral gavage for 21 days. Diarrhoea was graded 2xdaily using a validated diarrhoeal grading system. Rats were killed after 21 days and the entire gastrointestinal tract removed. Samples of distal colon were mounted in ussing chambers to measure Isc as an indicator of chloride secretion and routine histopathological analysis was conducted along the gastrointestinal tract. Results:In the current administrative schedule, crofelemer is unable to reduce dacomitinib-induced diarrhoea, or maintain body weights. Ussing chamber data indicate that crofelemer is effectively inhibiting chloride secretion, yet this becomes redundant when co-treated with dacomitinib. Histopathological results are expected to reveal minimal damage (as hypothesized to be secretory diarrhoea). Conclusion:Based on preliminary results it is hypothesized that crofelemer interacts with dacomitinib and is therefore not only ineffective at inhibiting associated diarrhoea, but in-fact exacerbates associated side effects. Results from this study may demonstrate that dacomitinib has a different mechanism of diarrhoea that traditional chemotherapy-induced diarrhoea indicated by chloride secretion experiments in ussing chambers and histological analysis.

474 “UNDRESSING” DISTRESS AMONG CANCER PATIENTS AND CARERS IN REGIONAL WESTERN AUSTRALIA Kaaren J Watts 1 , Louise H Good 1 , Sandy McKiernan 1 , Deborah Kruger 1 , Zahra Alamin 1 , Emma Croager 1 1. Cancer Council Western Australia, Shenton Park, WA, Australia Background and Aim:Distress is prevalent among people affected by cancer, particularly in regional Australia where the tyranny of distance creates inequities in access to cancer support services. Cancer Council Western Australia's (CCWA) Regional Cancer Support Coordinators (CSCs) provide cancer patients and carers with supportive care in six regions: Great Southern, Hills, Midwest, Peel/Rockingham, South West, and Wheatbelt. In March 2013, CSCs were trained in distress management using the Distress Thermometer and Problem List (DT-PL). They started screening regional clients thereafter. The aim of this observational, cross-sectional study is to describe the characteristics of distress among cancer patients and carers in regional Western Australia. Methods:All new clients (patients and carers) referred to CCWA CSCs, and clients interested in attending a cancer support group, were eligible for screening. Cancer Support Coordinators screened clients using the DT-PL, either face-to-face or by telephone, in conjunction with an in-depth assessment using a client assessment form. Preliminary distress screening data for 258 patients and 54 carers from 3 regions (Midwest, South West and Wheatbelt) have been analysed and are reported here for the 12 months from April 2013 to March 2014. The target screening data to be collated is for all six regions, representing almost 700 clients. Results:We report results for the three regions collectively. The mean distress score was 5.4 ( SD =2.7), with 72% of clients scoring 4 or more on the DT-PL. A large proportion of clients reported emotional problems (86%) and physical problems (89%). The six most common problems reported were worry (67.6%), fatigue (64.7%), sadness (56.1%), fears (48.4%), sleep (47.8%), and memory/concentration (40.7%). Conclusions:Priority areas of need among clients in regional Western Australia are within the emotional and physical domains. These data will assist cancer organisations to plan and to target future supportive care services to meet these priority needs.

475 ITEM GENERATION AND CONTENT VALIDITY TESTING OF THE HEALTH LITERACY OF CAREGIVERS SCALE-CANCER (HELICAS-C) Eva YN Yuen 1 , Tess Knight 1 , Sarity Dodson 1 , Lina Ricciardelli 1 , Sue Burney 2 , Trish M Livingston 1 1. Deakin University, Burwood, VIC, Australia 2. School of Psychological Sciences, Monash University, Clayton, VIC, Australia Aims:Caregivers provide extensive and multifaceted support for people with cancer. While it is important they have sufficient knowledge and skills to provide optimal care, few measures are currently available to assess a caregiver's capacity to find, understand and use health information for optimal care provision. The aim of this study is to describe the development and pre-testing of an instrument designed to measure cancer caregiver health literacy. Methods:Domains for the measure were identified using a conceptual framework of caregiver health literacy. Items for the measure were developed from statements provided by participants of concept mapping workshops (people with cancer [ n =13], caregivers [ n =13], healthcare providers or policymakers [ n =11]). Content validity of items was assessed through expert ratings ( n =8) cognitive interviews with caregivers recruited through Carers Victoria ( n =16). Results:Eighty-two items were initially generated across 10 domains, each corresponding to one of two response options: ‘agree/disagree’; or ‘difficulty in undertaking tasks’. An item writing criterion was used to ensure items were comprehensible to caregivers with a range of literacy capacities and were relevant to them across the disease continuum. Expert review suggested that the majority of items were relevant and clear (Content Validity Index [CVI]>0.75). Cognitive interviews with caregivers revealed that most items were well understood. Minor revisions were made to improve item clarity and ensure domains were adequately covered: three items were deleted, 19 items were modified, and 9 items were added. Conclusions:The final measure of caregiver health literacy contains 88 items. The new measure could be used to identify the health literacy needs and strengths of caregivers, and support the evaluation of interventions, information resources and healthcare services.

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