J. Hughes

Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease

Body composition is poorly studied in inflammatory bowel disease (IBD). Sarcopenia describes a loss of muscle mass and strength.

Predicting fear of cancer recurrence in gynaecological cancer survivors

Background - Primary brain tumours are rare among adults, but patients often experience physical, cognitive, neurological and psychosocial morbidity. Research has documented high rates of unmet supportive care needs among subgroups, such as patients receiving specific treatments or those receiving palliative care, but the needs of patients in the period soon after diagnosis are not known. Aim - To describe the unmet supportive care needs of adults recently diagnosed with primary brain tumours and change in needs over the early diagnosis/treatment period. Methods - A representative population-based sample of 40 patients was recruited approximately three months after diagnosis through a state cancer registry in Queensland, Australia. Patients or carer proxies completed surveys of supportive care needs in six domains (physical/daily living, psychological, patient care and support, sexuality, health system and information needs, and brain tumour-specific needs) at baseline and three months later. Mean supportive care needs scores (scale 0-100, with higher scores indicating higher levels of need) were calculated and compared over time. Results - The highest mean supportive care needs score at each time point was for physical needs (baseline 47.9, SD 26.3), closely followed by psychological needs (baseline 45.8, SD 35.6). Mean scores for other domains ranged from 30.4 to 37.9. Mean scores in all domains except for sexuality significantly declined over time, with the greatest decline for the patient care and support needs domain (mean 15.9 point decrease). Conclusions - Adults with primary brain tumours experience high levels of unmet physical and psychological needs early in the disease trajectory. However, levels of needs, particularly for patient care, decline over time, perhaps with the completion of primary treatments. Further research is needed to confirm these findings in a larger sample and investigate reasons for the decline seen.Programme/Policy Process: Once a VHL develops its activities through a cooperative network of institutions which are users and producers of information, it was essential to structure such a network within the field of cancer control and develop a governance model that could allow its sustainable operation. The model is composed of Executive Secretary, Advisory Committee, Executive Committee and Responsibility Matrix. The institutions which are part of this collaborative network have been selected in order to represent the regional diversity present in Brazil and also the diverse profiles of institutions related to cancer control, such as research, academia, government, scientific societies and organizations representing patients.Background: Smoking rates in Aboriginal Australians are gradually reducing in some age groups, but not for people in the peak reproductive years.¹ Smoking cessation is vital for cancer prevention.² Many regional programs avoid the use of threat messages when targeting Australian Aboriginal smokers.³ Aim: To assess, for the first time, the responses of Aboriginal smokers, 18–45 years, to Risk Behaviour Diagnosis scales (RBD)⁴ and intentions to quit smoking, including gender differences. Methods: We interviewed 121 Aboriginal smokers, using a structured questionnaire including adapted RBD scales. The RBD measured perceived threat (susceptibility and severity of threat) and perceived efficacy (self-efficacy and response efficacy) on Likert scales. Intentions to quit were assessed. Scales were recoded into high-low responses. Face validity was assessed via an Aboriginal panel, and scales assessed for reliability. Chi-square tests investigated the associations between intention to quit, efficacy/threat and gender. Results: Among men, intention to quit was associated with perceived efficacy (X² = 15.23;df = 1; p < 0.0001), but not with perceived threat. For women, intention to quit was neither associated with efficacy nor threat. Both genders were more likely to have high intention to quit, with high efficacy and high threat (n = 54;45%:maleX² = 12.6;df = 1; p < 0.001:femaleX²= 5.6;df = 1; p < 0.05). There was no difference in intention to quit with low efficacy-high threat for either gender (n = 39;32%). In contrast, all of the men with low threat-high efficacy (n = 5;4%) intended to quit, whereas all of the women with low threat-low efficacy (n = 6;5%) intended to quit. Conclusions: High-perceived threat was associated with high intention to quit smoking only when perceived efficacy was high. Gender differences may be a consideration. The RBD scales could be used to tailor messages to the level of efficacy and threat in clinical consultations, and in regional programs. All Aboriginal Australian smokers may benefit from increased efficacy to quit smoking.Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australia

P190 Low muscle mass in inflammatory bowel disease (IBD): common and predictive of functional sarcopenia and osteopenia

polymorphous angiocentric and angiodestructive infiltrate. LYG affects the lungs predominantly. The digestive tract is rarely involved. Patients with a primary or secondary immunodeficiency are at increased risk for LYG. We report a case of LYG in a patient with Crohn’s disease (CD). This description also identifies an EBV-driven B-cell lymphoma in a patient following methotrexate (MTX) immunosuppression for inflammatory bowel disease (IBD). We have proceeded to an extensive review of the literature and to the best of our knowledge no other cases of Lung-free LYG have been described in patient CD. Methods: 40 years old female. Diagnosed with Crohn disease when she was 20 years old, she was an estenotic colonic she needed right hemicolectomy and then she also needed transverse colectomy because of a new stenosis. Since then, she followed MTX treatment. She came for consult in July 2012 with malaise, weight loss, severe malnutrition, abdominal pain, inflammation in midline abdomen. A CT scan was performed: a subcutaneous collection was seen, and ileosigmoidy stenosis and bowel stenosis. Surgery was performed, ileosigmoid resection and protective ileostomy. There were no immediate complications after the procedure. She was admitted to the hospital again because of malaise, evening fever, pain in left hypochondrium, and dehydration. Pathology examination results were obtained, with the diagnosis of lymphomatoid granulomatosis. The Hematology Department was consulted and Rituximab treatment was initiated (4 cycles). A new colon biopsy was obtained by colonoscopy and refractoriness was shown. Treatment with R-CHOPx6 was prescribed, obtaining parcial remission. Salvage therapy (R-ESHAPx2) was administrated, following autologous bone marrow transplantation. Results: Management of the disease was extremely challenging because of the overlapping of symptoms between Crohn’s disease and Lymphomatoid Granulomatosis. Because it is a very rare condition, we needed to consult a renowned center in pathology. No lung affection has been shown during the development of the disease. Conclusions: Immunosuppression produced by Crohn’s disease treatment creates risks that must be assumed by patients and doctors that treat them. Complex clinical characteristics and with no response to conventional treatments must make us think about associated entities. Biologic treatments and more specific drugs could reduce the incidence of these serious diseases.

P409 More targeted evaluation of nutrition in inflammatory bowel disease (IBD) reveals opportunities to optimise care: body mass index, body composition and iron deficiency

(42%), and 5 indeterminate colitis (11%); 67% of pts (30/45) were previously evaluated by a gastroenterologist while the remaining 33% (15/45) only by their general practitioner (GP). At final analysis only 60% of pts (27/45) reported a good overall satisfaction from their previous medical experiences. A complete dissatisfaction was observed in 11/30 pts (37%) previously evaluated by a gastroenterologist and in 7/15 pts (47%) evaluated only by their GP. Overall satisfaction rate before MI was significantly lower in pts affected by indeterminate colitis (p = 0.004) and in pts <40 years old (p = 0.02). Physicians’ communication skills were reported quite satisfactory by female (p = 0.01) while poorly satisfactory in pts with family history of IBD (p < 0.001), in pts <40 years old (p < 0.001), and in pts affected by indeterminate colitis (p = 0.05). Concerning physician empathy perceived by pts it was strongly in female pts (p < 0.001) and lack in those with family history of IBD (p < 0.001). At multivariable analysis only good physician empathy perceived by female resulted significant (p = 0.002). After MI counselling all pts (100%) reported a good overall satisfaction without lack of empathy (71% marked “excellent empathy”) due to the fact that they felt they had complete answers to their questions. All pts appreciated the use of explanatory pictures. The mean duration of the visit was 41.5±8.7 minutes. Conclusions: MI is very well appreciated by IBD pts. It is a quite time-consuming technique but considerably useful at the first visit and in younger pts. Explanatory pictures help pts to better understand their clinical condition. MI can help physicians, especially gastroenterologists, to move from “cure” to “care” with their IBD patients.