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Background: Many cancer survivors face difficulties affecting their quality of life, of which anxiety, depression, and fatigue are prominent issues. Therefore, the web-based computer-tailored 'Kanker Nazorg Wijzer' intervention (KNW; Cancer Aftercare Guide) was developed, a self-management tool aimed at increasing survivors' psychosocial well-being. Methods: As part of a randomized controlled trial comparing a waiting list control group (n=231) with an intervention group (n=231), the effectiveness of the KNW on quality of life (EORTC QLQ-C30), anxiety and depression (HADS), and fatigue (CIS) was assessed at 6 and 12 months from baseline using multilevel linear regression analyses. Theoretically hypothesized mediators, measured at 3 months from baseline, were problem solving skills (SPSI-R) and personal control (IPQ-R). Mediation analyses were conducted with Hayes' PROCESS macro. Results: At 6 months from baseline, the KNW was effective in reducing depression and fatigue. In addition, effects were found for emotional and social functioning, although these effects were less strong. At 12 months from baseline, the effects were not statistically significant. Mediation analyses, with depression and fatigue at 6 months from baseline as outcomes, showed that personal control mediated the effects of depression and fatigue. There was no evidence for problem solving skills as mediator. Conclusions: The KNW can be considered as an effective intervention (at short-term), low-intensive, and easy accessible intervention that expedites cancer recovery, partly through changing personal control. Therefore, it might serve as a first step in stepped care for initial psychosocial support after cancer treatment.

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Objective To explore cancer survivors' unmet needs in the first year after primary treatment, and to investigate the relationship between demographic, disease-related, and psychosocial characteristics and the number of unmet needs in different domains. MethodsCancer survivors were recruited through eight Dutch hospitals (November 2012-January 2013). In a cross-sectional survey, 255 survivors were asked about unmet needs across several domains (CaSUN) and demographic, disease-related, and psychosocial characteristics, comprising quality of life (EORTC QLQ-C30), psychological distress (HADS), mental adjustment (MAC), and problem solving (SPSI-R:S). ResultsSixty-three percent of survivors reported one or more unmet needs (M=5.13, SD=6.98, range=0-34). Common unmet needs concerned emotional support (31.3%), smoking cessation (26.7% of smokers), managing side effects/complications (25.9%), fear of recurrence (23.0%), cancer care (22.0%), social support (22.0%), up-to-date information (19.8%), and carrying out work (19.6%). Regression analysis showed that age, higher education, participation in support programs, anxiety, depression, and negative adjustment style correlated positively, while being female, time since last treatment, and quality of life correlated negatively with the number of unmet needs. Lower number of unmet needs also accounted for other types of cancer (except colon cancer) than breast cancer. These relationships differed per need domain. ConclusionsThe heterogeneity in unmet needs complicates the provision of adequate support for survivors.

Background: While a healthy lifestyle is beneficial for cancer survivors, adherence to recommendations is low. We assessed the contribution of distal (socio-demographic, cancer-related, psychological), and proximal factors (attitude, social support, self-efficacy), and intention in explaining smoking, physical activity, alcohol, fruit, and vegetable consumption. Methods: Cancer survivors (N = 255; 70.7% females; mean age 60.6 years) participated in this cross-sectional survey. Findings: Higher fruit consumption was only correlated with a stronger intention (B=56; R2 = .574). Higher vegetable consumption was correlated with a stronger intention (B=37.22) and longer period after cancer treatment (B=1.06; R2 = .440). Adherence to fruit (54.8%) and vegetable (27.4%) recommendations was lowest of all behaviors and mutual correlation was weak (rs= .24, p < .001). Strongest correlates of other lifestyle behaviors were self-efficacy and attitude. Unhealthy behaviors were correlated with lower adherence to the fruit recommendation. Discussion: Vegetable and fruit consumption are most urgent to change and should be considered as different behaviors. The proximal factors most strongly contributed to explain lifestyle behaviors among cancer survivors.

Background: Online interventions have been proven effective in changing lifestyle behaviors and therefore can be beneficial for cancer survivors. We assessed the effectiveness of the online ‘Kanker Nazorg Wijzer (KNW)’ (Cancer Aftercare Guide) on diet, physical activity, and smoking outcomes.Methods: Survivors participated in a RCT (intervention [IC]: n = 232, 79.3% females, mean age 55.6 years; usual-care control [UC]: n = 231, 80.5% females; mean age 56.1 years). Data was obtained from online questionnaires and analyzed at baseline and after 6 months (n=325; 70.2%) using multilevel analysis.Preliminary findings: IC reported significantly higher vegetable (B = 14.08, p = .003) and whole wheat bread (B = 0.43, p = .05) consumption and a nearly significant increase in days per week activity (IC = .34 days, UC = .20 days; B = .29, p = .09). A higher proportion of smokers (11.1%) quit smoking in IC (UC = 3.1%). Comparative tests for smoking behavior were impossible due to the small numbers.Discussion: Preliminary results indicate the KNW to be effective in changing dietary behavior. Trend effects on physical activity might consolidate over time, simultaneously with a decrease of possible medical complaints.

Rotterdam, De Doelen; 4e Ronde 14.15 – 15.30; Syposium: Bevorderen van de gezondheid met online computer-tailoring – D.A. Peels

Background: Since eHealth can be a valuable tool for addressing frequently occurring psychosocial problemsin the population of cancer survivors, we developed the ‘Kanker Nazorg Wijzer’ (KNW; CancerAftercare Guide). This is an online tailored intervention aimed at increasing survivors’ quality of life bytackling frequently experienced problems. Methods: As part of a RCT, quality of life (EORTC QLQ-C30), psychological distress (HADS), and fatigue (CIS)at 6 months were compared between the intervention (n = 186) and control (n = 149) group,controlling for baseline values. MANCOVAs tested overall effects, ANCOVAs subscale effects. Findings: MANCOVAs only revealed an effect for psychological distress. Results of the ANCOVAs showedthat the intervention group reported higher emotional functioning (QLQ-C30; p = .03, ƞ2 = .009), loweranxiety (HADS; p = .03, ƞ2 = .007) and depression (HADS; p = .01, ƞ2 = .011), less subjective fatigue(CIS; p = .03, ƞ2 = .007) and higher motivation for undertaking activities (CIS; p = .03, ƞ2 = .008). Discussion: The first results of the intervention-effectiveness are promising. The KNW seems to successfullyaddress important patients’ needs. Further research will explore relevant moderators or mediators.