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Introduction:\ud Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) practice has been shown to be variable and sub-optimal. This paper describes the development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). ReSPECT is a process which encourages shared understanding of a patient’s condition and what outcomes they value and fear, before recording clinical recommendations about cardiopulmonary-resuscitation (CPR) within a broader plan for emergency care and treatment.\ud \ud Methods:\ud ReSPECT was developed iteratively, with integral stakeholder engagement, informed by the Knowledge-to-Action cycle. Mixed methods included: synthesis of existing literature; a national online consultation exercise; cognitive interviews with users; a patient-public involvement (PPI) workshop and a usability pilot, to ensure acceptability by both patients and professionals.\ud \ud Results:\ud The majority (89%) of consultation respondents supported the concept of emergency care and treatment plans. Key features identified in the evaluation and incorporated into ReSPECT were: The importance of discussions between patient and clinician to inform realistic treatment preferences and clarity in the resulting recommendations recorded by the clinician on the form. The process is compliant with UK mental capacity laws. Documentation should be recognised across all health and care settings. There should be opportunity for timely review based on individual need.\ud \ud Conclusion:\ud ReSPECT is designed to facilitate discussions about a person’s preferences to inform emergency care and treatment plans (including CPR) for use across all health and care settings. It has been developed iteratively with a range of stakeholders. Further research will be needed to assess the influence of ReSPECT on patient-centred decisions, experience and health outcomes.

Purpose\ud Capture change in family members' experiences as they look after patients during chemotherapy, and understand variability in their needs for support.\ud \ud Method\ud Longitudinal digitally-recorded qualitative semi-structured interviews with family carers at the beginning, mid-point, and end of treatment. Twenty-five family members (17 women, 8 men), mean age 53, were interviewed. Fifteen participants were supporting a relative having chemotherapy with curative intent, and 10 a patient receiving palliative chemotherapy. They were recruited from two UK locations: a regional cancer centre in Southampton and a comprehensive cancer centre in London. Sixty-three interviews were conducted in total, and the data were analysed using Framework Analysis.\ud \ud Results\ud Three themes were generated from the data: Changing lives, Changing roles; Confidence in caring, and Managing uncertainty. These captured family carers' evolving needs and sense of confidence in caregiving during chemotherapy. Carers reported considerable anxiety at the outset of treatment which persisted throughout. Anxiety was underpinned by fears of disease recurrence or progression and concerns about treatment outcomes.\ud \ud Conclusions\ud This study presents original fine-grained work that captures the changes over time in family carers' experiences of chemotherapy and their adaptation to caregiving. It provides fundamental evidence of the challenges that cancer carers face during patients' treatment; evidence that can be used as a basis for carer assessment and to build much-needed carer interventions. Oncology nurses should assess carers': ability to care; needs for information and support to prepare them for this; wellbeing over time; and, any support they may require to prevent them from becoming overburdened.

Background People with dementia have poorer cancer outcomes than those without. Little information exists concerning implications of comorbid cancer-dementia for people having cancer treatment in an ambulatory care setting. The purpose of this focused ethnography is to characterise the environment, behaviour and processes that comprise the setting, and to explore what constitutes ‘good care’ in this context. Trial design The aim of this focused ethnography is to establish an empirically-based conceptual foundation to inform development of innovations to improve the way treatment and support is offered to people with dementia having cancer treatment. Objectives include: Understanding the physical fabric of the ambulatory care environment, and how this shapes patterns of behaviour and processes; Understanding the actions of those involved in the receipt or provision of care for people with dementia having cancer treatment, through exploration of interactions, perceptions, and language. Understanding the processes involved in care delivery, and how these shape treatment and support offered to patients. Identify characteristics that constitute ‘good care’ and gain an understanding of barriers and facilitators. Identify which aspects of the ambulatory care setting are amenable to modification to meet the needs of this complex population. This project will allow formation of a rich picture of the cultural context in which behaviour, environment and processes are situated, and identify ways in which the organisation of care might be structured to provide a person-centred service for people with dementia. Participants: Participation will be invited from people with dementia having cancer treatment (n ≤ 10), informal carers (n ≤ 10), and staff members (oncologists, nurses, radiographers, support workers, administrative staff, and allied health professionals) (n ≤ 30). Methods: Data will be collected via observations, interviews and document analysis. Data will be analysed using constant comparison, informed by the analytic tradition of grounded theory (Glaser & Strauss 1967), to allow the researchers to establish an empirically-based conceptual and theoretical foundation that is grounded in the original data. Legal entity responsible for the study Naomi Farrington. Funding National Institute for Health Research, United Kingdom. Disclosure All authors have declared no conflicts of interest.

Background It is known that many individuals worry about their cancer recurring after colorectal cancer treatment but the significance and specific manifestations of this problem require exploration. Purpose This paper reports upon the research findings of a qualitative study to explain how fears of recurrence can affect individuals recovering from curative colorectal cancer surgery. Methods A longitudinal, grounded theory study was conducted. Sixteen participants who had received curative treatment for colorectal cancer were interviewed on up to four occasions during the 12 months following their surgery, 62 interviews were conducted in total. Results Many participants expressed anxiety about if and when their cancer might return, despite the knowledge that they had had successful treatment for early-stage colorectal cancer. This fear led some to adopt new behaviours in a desire to achieve a more dependable and controllable body. Heightened monitoring and management of the body characterised a state of ‘guarding’ – a concept developed from the data. By contrast, other participants did not perceive the risk of cancer recurrence to be as personally threatening or were able to assume strategies to manage any such concerns and find a sense of resolution to their recovery. Conclusion The nature of an individual’s response to fears of recurrence and consequent impact on their recovery warrants greater clinical consideration. Providing opportunities to openly discuss the possibility of cancer recurrence, assessing individual fears and offering suggestions on possible coping strategies to lessen the associated distress, are essential supportive activities enabling transition to life beyond cancer.

Context Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer. Usually managed as isolated symptoms, they often can occur simultaneously. Previous research often has addressed management of discrete symptoms rather than considering them as a cluster, which, in reality, is the situation faced by patients. Objectives This study aimed to examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue, compared with usual care. Methods A pretest/post-test, two-group, randomized, controlled trial was conducted. Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy (RT), and repeated three weeks after beginning RT. Symptom data were collected at four time points: prior to the intervention, three weeks, six weeks, and 12 weeks postintervention. Results One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong. Doubly multivariate analysis of variance revealed a significant difference (time×group interaction effect, P =0.003) over time between the PEI and usual care control group on the pattern of change of the symptom cluster. Significant effects on the patterns of changes in breathlessness ( P =0.002), fatigue ( P =0.011), anxiety ( P =0.001), and functional ability ( P =0.000) also were found. Conclusion PEI is a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms. More effort needs to be directed at studying impact of interventions on common symptom clusters.

Background This article presents the findings of a study about recovery following surgery for colorectal cancer. Most patients diagnosed with this cancer are treated with surgery. Few studies have employed a qualitative approach to examine their experiences and perceptions of recovering from this treatment. Objectives The purpose of this study was to discover the process of recovery for individuals following curative surgery for colorectal cancer. Design This qualitative study drew on grounded theory methods and used a prospective longitudinal design. Settings Ethical approval was granted by three Local Research Ethics Committees enabling patients to be recruited from three different hospitals in the South of England. Participants Purposive sampling was used to identify patients diagnosed with colorectal cancer who had had surgery with curative intent. Methods Each participant was interviewed up to four times following their surgery: at 6 weeks then at 3, 6 and 12 months. Sixty-two interviews were conducted. Emerging concepts from the analysis defined further data collection. Relevant literature was theoretically sampled and all data analysed using constant comparison. Theoretical saturation was achieved. Results Sixteen participants were recruited. Analysis of study data identified four conceptual stages representing the main phases individuals can experience during their recovery. They are: disembodiment, restoring embodiment, reclaiming control and managing embodied control. These occur in a stepwise progression, reflecting the emotional, physical and social processes involved in restoring perceived control over the body. They reflect the difficulty individuals can experience in understanding and self-managing their bodies. There is a desire to regain confidence and certainty over body function but this is threatened by fears about future health. Conclusions Achieving a sense of control of one's body, after surgery for colorectal cancer, proves to be a major challenge. Greater recognition of the consequences of cancer and its treatment upon the body and individualised management is required. Addressing how individuals can regain embodied control during their recovery needs to be integral within post-treatment support.

Background Prostate cancer is prevalent worldwide. In England, men living with this malignancy often report unmet psychological, informational, urological and sexual needs. Their experience of care is correspondingly lower than that of other patient groups with cancer. To address this, prostate cancer clinical nurse specialist posts were established across England and Scotland. Their intent was to support men with this form of cancer, enhance symptom management and improve quality of service provision. Objectives The research sought to investigate prostate cancer clinical nurse specialists' roles, determine whom they targeted services at, and determine their work practices and perceived contribution. Design A mixed method multi-site exploratory-descriptive design was employed. Settings Data were collected across four acute NHS Trusts—one in the South of England, one in the Midlands, one in Northern England and one in Scotland, respectively. Participants Participants included 4 prostate cancer clinical nurse specialists, 19 of their clinical colleagues and 40 men they provided care to. Methods Data were collected through nurse specialists' completion of a Diary and Contact Sheets. Interviews were conducted concurrently with the nurses, stakeholders they worked alongside and patients on their caseload. Data were collected between November 2004 and January 2006. Results There was great variation in the qualifications and experience of nurse specialists and in the services they provided. Services ranged from generic support and information provided across the disease trajectory to provision of services to meet specific care needs, e.g. providing nurse-led clinics for erectile dysfunction. Patients and members of the multidisciplinary team welcomed the introduction of nurse specialists but were aware they could become over burdened through their rapidly growing caseloads. Conclusions Variability in services provided by the prostate cancer nurse specialists arose from differences in local demand for nursing services and the skills and experiences of those appointed. Such variability – whilst understandable – has implications for access and equity across patient groups. Further, it can compromise efforts to define clinical nurse specialists' contribution to care, can impede others' expectation of their role, and render their outcomes difficult to evaluate.

Objective Patients increasingly use the internet to source health information. Voluntary organisations offering information and support often provide such information on their websites. However, the internet is unregulated and information can be of poor quality. The aim of this study was to evaluate the quality of breast cancer information provided by 10 Great Britain (GB) voluntary organisations’ websites. Methods Quality of websites was evaluated using an investigator-designed appraisal tool based on European Commission (EC) quality criteria for health-related websites. Completeness and transparency of breast cancer information, and usability of websites, were appraised. Results Typically, breast cancer-specific organisations provided the highest quality information, particularly in terms of its completeness. However, great variability in quality was identified. Areas of weakness related to transparency of information, in particular disclosure of authorship, and its apparent currency. Conclusion Voluntary organisations providing web-based breast cancer information have progress to make to ensure information provided is complete and transparent, and websites are user-friendly. Unfortunately, informed decision-making will not be optimised if patients cannot access quality information. Practice implications Voluntary organisations should regularly review the quality of information on their websites. Grading of websites allows healthcare professionals to identify and signpost patients to trustworthy, up-to-date websites. Thus, ensuring patients receive high quality information.

Though cure from cancer is not guaranteed, children's chances of survival have increased significantly. As a result the paediatric oncology community is focused on providing appropriate follow-up care to an increasing number of young cancer survivors. How this care should be designed and delivered however remains the centre of ongoing discussion and was the focus of this review. The aims of the review were to (1) gain an understanding of current follow-up practices from studies involving health care professionals, (2) identify and evaluate studies presenting views of survivors, (3) examine commentaries on both the current and future design of long-term follow-up services and (4) evaluate existing follow-up guidelines. Empirical research, commentary papers and published guidelines were reviewed. Twenty-eight papers and five guidelines were analysed. Empirical papers were examined in relation to sample, design, findings and limitations. Commentary papers were assessed in relation to key issues about follow-up care. Guidelines were assessed on how far they were evidence-based, peer-reviewed and involved users in their development. Varying models of care were illustrated, and were dependent upon personnel and centre orientation. Variability in the level and degree to which long-term survivors were followed up was also reported. Inconsistencies in practice were noted. Nonetheless requirements for an effective service were highlighted in the majority of publications, these included communication and information. Although young people and professionals had a shared view on many aspects of follow-up care, these preferences were not consistently mirrored in service provision.

Despite growing research in the UK suggesting that patients from black and ethnic minority groups feel that they do not always receive the best treatment and care, little is known about how care professionals themselves respond to working with this group. The study, involving focus groups with health and social care staff, was undertaken to learn about their views and experiences. The principal finding was the extent to which staff experience difficulties in caring for patients from black and ethnic minority groups. Entailing serious challenges to their own professional practice, these were found to arise at all stages of patients' experience of cancer, including at diagnosis, during treatment and at the palliative phase. Staff were concerned that their inability to communicate with some patients meant that they were not able to provide them a good service, as they could not develop an easy relationship and talk around issues. Yet it could be difficult to work with interpreters, as well as family members, both of who could be reluctant to translate important information. They were also conscious of not being fully sensitive to patients' differing cultures, while noting the importance of not making assumptions about particular beliefs or behaviour. Staff would welcome training to help them to explore their attitudes and assumptions in working with black and ethnic minority patients, but did not seek induction into the detailed practices of different cultures. Some staff felt they would benefit from training in working with interpreters.

Objectives: To develop and evaluate a pilot multi disciplinary education and support group programme for patients with fatigue post cancer treatment. Design: Mixed method feasibility study. Intervention: Programme comprised face-to-face nursing assessment followed by 3 support and information giving workshops. Workshops delivered large group support and small group discussion with therapists of participants' choice. Therapists included a clinical psychologist, nurse, dietician, physiotherapist and occupational therapist. Participants: Six subjects with breast cancer. Main outcome measures: The Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, and the European Organisation for Research and Treatment of Cancer QLQ C30. Participants completed these prior to, immediately after, and six weeks following, the programme. They also completed a programme evaluation by telephone. Results: Preliminary results indicate the programme provided information, support and management strategies for fatigue specifically, and living with cancer generally. Patients appreciated the opportunity to share their experiences whilst at the same time gaining particular help and advice for their own specific problems and concerns. Whilst not reducing the level of fatigue there was some evidence that impact on function was lessened. Conclusions: Whilst the number of participants was small, findings from this study are sufficiently encouraging to warrant continuing this service development and its evaluation. © 2006 Elsevier Ltd. All rights reserved.

Summary Background The paediatric oncology community is focused on providing appropriate care to survivors of childhood cancer, given that despite increases in survival rates it is estimated that 60% will have one or more problems related to their disease or treatment. Agreement and consistency in how follow-up for this group of young people should be designed and delivered has not yet been reached and rarely have young people been asked to contribute to this discussion. Methodology The study aimed to find out what young people who are receiving long-term follow-up for childhood cancer would like from their follow-up service. It aimed to illuminate the dimensions of care valued by young people as well as make explicit to professionals health care needs that must be met to provide optimum care into their adult life. The emphasis was on qualitative, participatory methods using reflexive and responsive approaches to give primacy to the voice of participants. Data were generated through a series of workshops, interviews and questionnaires. Findings Forty young people (12 male: 30% and 28 female: 70%), participated in the study. Preliminary analysis yielded a descriptive typology that could serve as a basis for classifying and clarifying health care needs: defined as what the young people in this study wanted from a follow-up service. Five categories of health care need were identified: (i) need for a positive relationship with health care professionals; (ii) need for information; (iii) need for communication; (iv) need for parents to be supported; (v) need for health care professionals to have appropriate knowledge. Conclusions and relevance to practice Young people in this study were clear about the structure and process of a service that would meet their needs. Assembling data into a typology of health care need presents those delivering and commissioning services a tangible indicator of outcome that can be confidently described as what young people want from any current or future model of follow-up service.

Summary Receiving the 2003 Distinguished Merit Award from the European Oncology Nursing Society is a great moment in my professional career. It is also a time for reflection. We can easily become immersed in the specifics of our work and forget the larger picture. An opportunity such as this allows me to step back, reflect and review what I have accomplished. It also challenges me to think about the totality of cancer nursing and cancer care, look at where we have been and about where we should be going. At the heart of this lies the concept of supportive care. I would like to consider three pertinent areas. First, I will define what I consider the domain of supportive care in cancer to be. Second, I will look at what is needed to further supportive care for people with cancer. This involves building the discipline of more rigorous symptom assessment and documentation; better management of the symptoms and concerns that confront people with cancer; moving beyond the traditional framework of treatment and care, embracing a more integrated approach; addressing quality whilst at the same expediting the delivery of supportive care services. Third, I would like to consider the challenges to reform that this presents for cancer nursing and cancer nurses. A road map for change will be presented which highlights both the necessity to promote a supportive care culture whilst simultaneously building a dedicated infrastructure of staff and services. Nurses must play a key role in supportive care. Because of our unique clinical and research base, we are primed to assume leadership roles in both these spheres. Mutual valuing, partnership and shared working are the only means of delivering enhanced cancer care. We should grasp opportunities, confident that together we have the skills and knowledge to move forward. Today is yesterday's tomorrow. We cannot do anything about yesterday, but we can do something about today to ensure tomorrow is how we want it to be. We can become what we dream, let us live that dream outside and really drive forward the care we provide for people with cancer and their families.

Hold on to your stethoscopes, button down your white coats d the National Institute for Clinical Excellence (NICE) guidance on supportive and palliative care [1] has landed and will probably have significant ramifications for the daily working practices of oncologists. If we think we can sit back, relax and read this over a cup of hot cocoa, then place it on the top shelf to collect dust, we have got another thing coming d the recommendations are both radical and comprehensive and compliance will be monitored with vigour. At first glance, the 204 pages seem an onerous addition to the torrent of reading material confronting the busy oncology team. Its recommendations are, however, generally sensible, based entirely on published evidence and clearly laid out in the well-written genre of NICE documents. Its fundamental aims are to improve the well-being of both patients and staff alike, but in the short-term this might have some uncomfortable workload implications for our practice. So before implementation activity gets into full swing it is well worth a read d after all forewarned is forearmed.

Although fatigue has been a focus for research in adult cancer care for some time, the same cannot be said for adolescent oncology practice. This paper summarises the literature concerning fatigue in adolescents with, and following, cancer diagnoses, drawing on data from four empirical studies. Fatigue is multidimensional, multifactorial and highly subjective, but can be managed to enhance self-caring and coping strategies. All of the studies reviewed within indicate that fatigue is a troublesome symptom, which impacts on quality of life. From this review, we set up a research study. This paper provides a brief report of preliminary data from this study drawn from a group of adolescents in late remission from childhood cancer. These data are used to evaluate the utility of focus groups as a method of data collection in exploring the concept of fatigue in adolescents. Concurring with the studies we reviewed, findings from the preliminary data suggest that fatigue is a highly subjective and ‘abnormal’ phenomenon that holds a variety of implied meanings and associated metaphors connected with past experiences of childhood cancer. The focus group proved to be a viable research method to facilitate mutual disclosure and provoke discussion. Recognition of the research challenges with adolescents, where there is the potential for a range of meanings for the experience of fatigue, is an important finding for future studies.

This paper gives an account of the process of refining the content validity of an audit tool, which defines and measures best practice in colorectal cancer nursing and identifies areas for development. The European Oncology Nursing Society (EONS) and AstraZeneca collaborated to develop the Nursing in Colorectal Cancer Initiative (NICCI). The initiative was funded through educational grants from AstraZeneca and led by EONS. It is a project with two components, education and audit. The education component culminated in a manual that provides a core set of materials concerning fundamental aspects of colorectal cancer, to foster a common understanding amongst nurses at national and international levels. An audit tool was developed to measure standards of nursing care in relation to the delivery of cytotoxic chemotherapy to patients with advanced colorectal cancer. The content validity of the audit tool was established in three stages by expert panel review with revisions made to the content and organisation of the audit measures at each stage. The standards set by the NICCI Audit Project have key implications for multi-professional practice in colorectal cancer care.

This paper describes the structure of an audit study together with the two-phase development of an audit tool and methodology. The purpose of the study was to develop a tool that defines and measures best practice in colorectal cancer nursing, and identifies areas for development. The European Oncology Nursing Society (EONS) and AstraZeneca collaborated to develop the Nursing in Colorectal Cancer Initiative (NICCI). The initiative was funded through educational grants from AstraZeneca and led by EONS. It is a project with two components, education and audit. The purpose of the project is to provide a sound educational basis for nurses in the elements of colorectal cancer care, together with the tools to evaluate and develop practice. The education phase culminated in an educational manual that provides a core set of materials concerning the fundamental aspects of colorectal cancer, to foster a common understanding amongst nurses nationally and internationally. The education manual provided the referenced rationale for the definition of a set of hallmarks and standards of clinical practice. The audit tool was developed from the hallmarks and standards and is focused on the care of patients receiving cytotoxic chemotherapy for colorectal cancer. The audit methodology is based on the structure, process outcome triad, together with the TELER™ system of audit. © 2001 Harcourt Publishers Ltd.

OBJECTIVES: To investigate cancer patients' experience of fatigue and their perceptions about the causes, management and impact of this symptom. DESIGN: Cross-sectional, questionnaire-based survey. SETTINGS: Three regional cancer centres; Glasgow, Birmingham and Southampton. PARTICIPANTS: One thousand three hundred seven outpatients with cancer attending the three units over a 30-day period. MAIN OUTCOME MEASURES: Investigator designed questionnaire and the fatigue sub-scale of the Functional Assessment of Cancer Therapy Fatigue (FACT-F) questionnaire. RESULTS: The response rate was 576 of 1307 (44%). Fatigue was reported to affect 58% of patients 'somewhat or very much'. The comparable figures for pain and nausea/vomiting were 22% and 18%, respectively. Fatigue had never been reported to the hospital doctor by 52% (281 of 538) of patients with this symptom. Only 75 patients (14%) had received treatment or advice about the management of their fatigue. Fatigue was reported to be not well-managed by 33% (180 of 538) of patients with this symptom. The comparable figures for pain and nausea/vomiting were 9% (46 of 538) and 7% (37 of 538), respectively. The median FACT-F score was 18 (range 0-52). On multivariate analysis 54% of the variation in FACT-F scores could be explained by the combination of quality of life, depression, dyspnoea, weight loss/anorexia and use of analgesics in the previous month. CONCLUSIONS: Fatigue has been identified as an important problem by patients with cancer. It affects more patients for more of the time than any other symptom and is regarded by patients as being more important than either pain or nausea/vomiting. Research into the aetiology and management of this symptom should be regarded as a priority.

Hazel Robertshaw BSc(Hons), RGN, Lecturer Practitioner in Cancer Care, Imperial Cancer Research Fund and Oxford Brookes University. ICRF Medical Oncology Unit, Churchill Hospital, Headington,Oxford OX3 7LJUK Alison Richardson BN(Hons) MSc PhD, RGN, PGDE, RNT, Professor of Cancer and Palliative Nursing Care, Florence Nightingale School of Nursing and Midwifery, Kings College London. James Clerk Maxwell Building,Waterloo Road, London SE18WA,UK. Correspondence and oiprints requests to: Hazel Robertshaw

Six hundred and thirty four interviews of injecting drug users were performed between 1992 and 1994 as part of a study of injecting drug use and HIV prevalence in Edinburgh, Scotland. Amphetamine was injected by more subjects (44%) than any other drug. Preference for injection as the route of administration of amphetamine increased over the period despite no change in the popularity of the drug generally. Simultaneously, heroin use and injection declined. Analyses indicated that amphetamine injectors comprised two distinct sub-groups. The majority were polydrug injectors who injected frequently, had a longer injecting history and were more likely to share injection equipment. About one-fifth were stimulant-only injectors who injected infrequently, were relatively recent initiates to injecting and whose numbers increased over the 3 years. Drug treatment and prevention services may need to explore alternative methods to respond effectively to these emerging trends.

Fatigue is frequently experienced by patients with chronic illnesses, and especially by patients with cancer and chronic obstructive airways disease. However, there is a paucity of qualitative research into the experiences of fatigued individuals and, consequently, definitions of fatigue have, to date, been based solely on observation and conjecture. The purpose of this study was to capture a detailed description of the fatigue experienced by individuals with cancer and chronic obstructive airways disease. A phenomenological research design was adopted. The findings presented in this paper depict fatigue as a complex phenomenon. The paper describes the physical and mental sensations embodied in fatigue, the impact of fatigue on everyday functioning, the emotional feelings evoked by fatigue and the impact of fatigue on perceived control. These findings have relevance for clinical nursing and future research.

Introduction: Following a successful pilot study of patients treated surgically, we are conducting an innovative project to test the feasibility of establishing a cohort of patients treated with curative intent radiotherapy. We are assessing patient reported outcomes (PROMS) to understand recovery of health and wellbeing and a range of factors associated with this. We have little information about the needs and wellbeing of patients who undergo curative treatment and there is insufficient evidence to guide the development of services to support patients after treatment and to identify those at risk of protracted recovery. Methods: A prospective, longitudinal cohort study design is employed. Eligible patients due to undergo radiotherapy with curative intent between October 2015 and April 2016 at six sites across the UK are eligible to participate. Participants complete questionnaires before treatment and three months later. Questionnaires include validated PROMs, across a number of domains, including quality of life, recovery, wellbeing and socio-demographic details. Participants’ clinical details are also collected. Study procedures will be evaluated using semi-structured interviews with patient participants and local site staff. Results: We will assess the feasibility of recruiting a consecutive sample of eligible patients and retaining these patients for the duration of the study. Feasibility assessment will also be informed by interview data gathered on the acceptability of the study procedures, the questionnaires and the methods for gathering medical details. Conclusion: This study will test the feasibility of a cohort of patients to asses wellbeing and understand patterns of recovery, this will inform a large (n=1000) UK wide cohort study of patients undergoing treatment with curative intent (radiotherapy and surgery) we plan to follow patients for a number of years. This novel approach to understanding lung cancer survival will enhance our ability to offer patients appropriate and timely support and identify who is most at risk of protracted recovery.

Abstract 767 Background: Tosedostat is a novel oral inhibitor of the M1/17 family of aminopeptidases which induces an amino acid deprivation response that is selectively toxic for myeloid blasts (Leuk Res. 2011: 5:677-81) and has shown promising activity in elderly relapsed/refractory AML patients (J Clin Oncol 2010:28:4333-8). Aims: The OPAL study was undertaken to compare the activity of tosedostat at a once-daily dose of 120 mg for 24 weeks compared to 240 mg once daily for 8 weeks followed by 120 mg once daily for a further 16 weeks., as measured by bone marrow and hematology responses at 24 weeks. Methods: This was a phase II randomized (1:1) multi-center study. Patients were eligible if aged 60 years or older with previous CR lasting Results: Seventy-three patients were randomized and received tosedostat, 38 at 120 mg and 35 at 240 mg. Median age was 72 (range, 64 to 86), and 59% were male. Twenty-six patients (36%) had secondary or therapy-related AML, of which 19 (26%) had prior MDS. Median time since AML diagnosis was 211 days and 38% had received primary therapy with cytarabine/anthracyclines; 36% with a hypomethylating agent (HMA) and 23% with other cytarabine regimes. Fifty-two percent had been refractory to primary therapy, 19% had previously had a remission of up to 6 months and 29% a 6–12 month remission (mean 97 days including refractory). Twenty-three patients (32%) had no post-treatment bone marrow sample taken, predominantly due to early progression: 34% completed 12 weeks on study and 14% completed 24 weeks and were eligible to enter an extension study which is ongoing. The overall response rate was 22%; (CR/CRp/MLFS 12%; PR 10%) and an additional 29% had a best response of stable disease. The most common adverse events which occurred (total; grade 3 or worse) were diarrhea (58%; 4.1%), peripheral edema (55%; 0%), fatigue (49%; 21%), dyspnea (41%; 16%), nausea (38%; 0%), decreased appetite (37%; 3%), febrile neutropenia (36%; 29%) and hypotension (36%, 10%). Median overall survival (OS) (at 15 July 2011) was 126 days. Median OS in patients with CR/CRp/MLFS, PR and SD were 280, 195 and 162 days respectively, and 261.5 days for patients with a response of PR or better. Median OS for patients with progression of disease or who were unevaluable was 61 days. Similar responses were seen in the two dose groups. Additional non protocol-specified analyses showed that the following types of patient appeared to respond well: AML NOC vs other AML types 16% vs 29% response, median OS 75 vs 168 days; patients with poor risk cytogenetics compared to intermediate/better, median OS 159 vs 107 days; those who received prior HMA compared to others, 38% vs 13% response, median OS 171 vs 104 days; and absence of prior CR 29% vs 14% response and median OS 169 vs 103 days. Conclusions: These results provide further encouraging evidence of efficacy and a favorable toxicity profile in a difficult to treat patient population. A phase III program of pivotal studies with tosedostat in AML and MDS will start in the near future. Response Category (n=73) Number (%) Overall Survival (median days) All Patients n/a 126 (4–452) Overall Responder (PR or better) 16 (22%) 261.5 (71–445) CR/CRp/MLFS 9 (12%) 280 (181–422) Partial Remission 7 (10%) 195 (71–445) Stable Disease 21 (29%) 162 (43–284) Progressive Disease/unevaluable 36 (49%) 61 (4–452) Disclosures: Cortes: Chroma Therapeutics Ltd.: Consultancy, Research Funding. Feldman: Chroma Therapeutics Ltd.: Consultancy, Research Funding. Yee: Chroma Therapeutics Ltd.: Consultancy, Research Funding. Rizzieri: Chroma Therapeutics Ltd.: Consultancy, Research Funding. Advani: Chroma Therapeutics Ltd.: Consultancy, Research Funding. Charman: Chroma Therapeutics Ltd.: Employment, Equity Ownership. Toal: Chroma Therapeutics Ltd.: Employment, Equity Ownership. Kantarjian: Chroma Therapeutics Ltd.: Consultancy, Research Funding.

Background: Despite evidence that cancer survivors experience a range of unmet needs services remain poorly developed. Many questions remain about what form services should take, and who, where and how they should be delivered. This study sought to gain insight into, and understanding of, patients’ and care managers’ views of a newly established programme designed to respond to supportive care needs of patients who have recently completed treatment. The programme, entitled ‘Surviving Cancer, Living Life’ consists of telephone care management and at this stage of development involves patients with breast and prostate cancer. The programme has been developed and implemented through a partnership between Guy’s and St Thomas’ NHS Foundation Trust and Pfizer Health Solutions. Material and Methods: This study utilised a qualitative approach. A purposeful sample of 22 patients and 3 care managers involved in delivery were interviewed. Interviews explored reactions to the programme, nature of relationships developed with care manager, and perceived impact and outcomes of telephone support. Interviews were recorded, transcribed verbatim and subject to Framework Analysis. Results: Perceptions of the programme were unequivocally positive – it appeared to answer a deep felt need for support at a period when patients felt vulnerable. It represented a new and strikingly positive experience of healthcare in contrast to many of the inadequacies felt to be present in the traditional, routine approach to cancer care follow up. The programme met a need for emotional, practical and informational support and provided relational continuity and a point of access. It helped patients reframe their life and adjust to life after treatment. The form of delivery – based solely on telephone contact – was considered advantageous compared to face to face contact, particularly in terms of convenience, confidentiality and continuity. Conclusions: The medium of the telephone appears to hold significant promise when designing services to meet the supportive care needs of patients as they adapt to life after finishing treatment.