those also reporting depression after surgery (p = 0.04).CONCLUSIONS: Current depression was frequent amonglong-term rectal cancer survivors and was highest amongthose with permanent ostomy. While current depressionand perceived nancial burden due to their illness/treatmentwere statistically associated, there were no differences bysurgery type. Psychosocial services for survivors shouldinclude concurrent discussion of depression and nancialburden. RESEARCH IMPLICATIONS: Research isneeded to identify factors inuencing high depressionand nancial pressures among long-term rectal cancer sur-vivors. CLINICAL IMPLICATIONS: Clinicians shouldbe aware that long-term survivors, particularly those withpermanent ostomy, can have depression and nancial bur-dens resulting from their illness or treatment. Encouragingpatients to receive psychosocial services may improvetheir well-being. FUNDING: National Cancer InstituteGrant No. R01-CA106912, HR-QOL in Colorectal CancerSurvivors with Stomas (Renewal), PI: Robert S. Krouse,MD, Co-PI: Lisa Herrinton, PhD.

P2-41Behavioral Intervention Targets for Exercise AmongHematopoietic Stem Cell Transplant SurvivorsShawna Ehlers, Eleshia Morrison, Christi Patten,Matthew Clark, Karen Grothe, Randi Hoffman,WilliamHogan,Tabetha Brockman, Chris Hughes, Dennis GastineauMayo Clinic College of Medicine, Rochester, MN, USA

PURPOSE: Physical activity interventions for hemato-poietic stem cell transplant (HSCT) patients demonstrateconsistent positive effects on distress, fatigue, and inde-pendent functioning. We utilized a prospective cohort ofHSCT patients to cross-sectionally document behavioraltheory constructs potentially associated with exercise thatmay be useful targets in the iterative process of behavioralintervention development and improvement. METHODS:HSCT survivors completed a survey of lifestyle behaviorsand associated constructs at 1-year post-HSCT. Theoryconstructs included exercise stage of change, exercise self-efcacy, and motivators and barriers to exercise among406 1 year survivors of HSCT; 391 analyzed whoresponded to query of intent to exercise. Survivors were pre-dominantly partnered (80.6%), Caucasian (92.4%), males(56.3%) who received autologous HSCT. The majority ofsurvivors had some college education (71.6%; 43.2%attained a 4 year degree or higher). RESULTS: Approxi-mately half of survivors reported regular exercise pre-HSCT(50.6%) and at 1-year follow-up (52.0%), with 39.9%reporting regular exercise in the past 6 months (612months post-HSCT). The majority of survivors reportedintent to exercise (84.0%) and intent to exercise more(75.0%) in the next 6 months. Self-efcacy for exercisewas >7 (010 Likert rating) for half of survivors (50.8%).Primary motivation factors for exercise were to improve

health (68.7%), relieve illness symptoms (29.8%), and re-spond to concerns by family, friends, or providers (32.5%).Primary barriers to exercise were fatigue (50.2%), stress(19.5%), and time (19.0%).CONCLUSIONS: In conclu-sion at least half of 1-year HSCT survivors endorse be-havior theory constructs of intent and self-efcacy atlevels associated with exercise adoption and maintenancein the exercise literature. Conversely near half may bene-t from behavioral interventions targeting these con-structs. Multiple risk interventions targeting exercise,fatigue, and stress with a focus on improving health andrelieving illness symptoms may increase patient receptiv-ity to intervention, especially if provided in a way thatminimizes time commitment. RESEARCH IMPLICA-TIONS: This research helps identify potential interven-tion targets to be tested in behavioral interventiondevelopment research and clinical trials of exercise inter-ventions. CLINICAL IMPLICATIONS: This researchhighlights factors important to survivors in their desire toincrease exercise and health. This information can helpclinicians start conversations about behavior change andpromote behavior change among individual survivors.FUNDING: KL2 RR 02415 (PI: Ehlers). This researchwas made possible by CTSA Grant Number UL1TR000135 from the National Center for Advancing Trans-lational Sciences (NCATS), a component of the NationalInstitutes of Health (NIH). Its contents are solely theresponsibility of the authors and do not necessarilyrepresent the ofcial view of NIH.

P2-42Perceived Stigma and Social Discrimination AmongCancer Survivors in Japan A Web-Based SurveyDaisuke Fujisawa1,2, Maiko Fujimori3,4, Ado Basaki-Tange3, Shino Umezawa3,5, Junko Ueda- Nouno3, AkikoAdachi2, Kazuho Hisamura6, Yuriko Suzuki4, MitsunoriMiyashita71Massachusetts General Hospital, Center for PsychiatricOncology and Behavioral Sciences, Boston, MA, USA,2Keio Uniersity School of Medicine, Palliative CareCenter, Tokyo, Japan, 3National Cancer Center East,Psycho-oncology Division, Kashiwa, Chiba, Japan,4National Center for Neurology and Psychiatry, Tokyo,Japan, 5Tokyo University of Medicine and Dentistry,Section of Liaison Psychiatry and Palliative Medicine,Tokyo, Japan, 6Komatsu Municipal Hospital, Komatsu,Ishikawa, Japan, 7Tohoku University, Department ofPalliative Care Nursing, Sendai, Miyagi, Japan

PURPOSE: Perceived stigma and social discriminationrelated to cancer have been associated with poor patientoutcomes, including poor quality life, negative affect(e.g. depression and low self-esteem), low uptake of med-ical services, social isolation, and poor physical outcomes.However, little is known about the prevalence and content

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2014 The Authors. Psycho-Oncology 2014 John Wiley & Sons, Ltd. Psycho-Oncology 23: (Suppl. 1): 1144 (2014)DOI: 10.1002/pon

of stigma and social discrimination among cancer survi-vors, especially in Asian culture. Therefore, this studyaimed to examine the prevalence and content of perceivedstigma and social discrimination among cancer survivors.METHODS: An anonymous web-based survey wasconducted over a month in December 2012. 628 Japanesesurvivors of various types of cancer who has been diagnosedas cancer within ten years were enrolled. The participantswere recruited through a nation-wide commercial-basedwebsite-monitoring system. Participants were asked to reportthe frequency of perceived stigma and social discrimination(PSSD) related to cancer, using a single self-rated four-pointscale. Those participants who endorsed any PSSD wereasked to describe their experiences of PSSD using free-textelds. Qualitative methods were used to extract PSSDthemes, using the following process: 1) systematic codingand categorization of the codes by two independent re-searchers, 2) integration of categories through discussionuntil reached agreement, and 3) axial coding to characterizethe nature of the themes, reviewed by a multidisciplinaryteam consisting of a cancer survivor, oncologist, nurse,social worker, clinical psychologist, psychiatrist, social psy-chologist and social-psychiatry researcher. RESULTS:61.6% of the cancer survivors reported some degree of per-ceived stigma and social discrimination. 78 categories wereextracted from 492 codes, and were integrated into eightthemes under three major axes. Axis-1: Self-stigma in-cluded i) Negative attitude toward self and ii) Negative bodyimage. Axis-2: Interpersonal discrimination included i)Discrimination at work (personal attitude from colleagues/partners), which comprised the largest proportion of theresponse, ii) Change in social role, and iii) Undesirable per-sonal attitude from other people. Axis-3: Social discrimina-tion included i) Insufcient formal support in job-relatedissues, ii) insufcient formal support in areas other thanjob-related issues, and iii) negative attitude by medicalprofessionals. CONCLUSIONS: This study illustratespreliminary conceptualization of perceived stigma andself-discrimination of cancer survivors, which allows deeperunderstanding of suffering that may be experienced by cancersurvivors. RESEARCH IMPLICATIONS: Our prelimi-nary conceptualization of perceived stigma and social dis-crimination warrants further verication through quantitiveresearch. Subsequent research also should be conducted toevaluate social, institutional, family and personal risk factorsfor perceived stigma and discrimination among survivors, inorder to identify targets for intervention. CLINICALIMPLICATIONS: This study demonstrates that almosttwo-thirds of patients may continue to experience perceivedstigma and social discrimination related to cancer, up toseveral years after cancer diagnosis. Clinicians should con-sider evaluating sources of both self-stigma (e.g., negativeattitudes toward self) and social stigma and discrimination(e.g., negative attitudes and actions of other) among survi-vors, and their potential implications on outcomes such as

self-esteem, social relationships, and employment stability.FUNDING: This study was supported by a grand-in-aidfrom Japan Ministry of Health Labor and Welfare.

P2-43Survivor Net: Developing a Breast Cancer SurvivorshipCare Plan Template for a Safety Net HospitalSoa Garcia1,2, Elizabeth Hahn1,2, Crystal Johnson1,Mallory Snyder1, Pam Khosla31Department of Medical Social Sciences, NorthwesternUniversity, Chicago, IL, USA, 2Robert H. LurieComprehensive Cancer Center of Northwestern University,Chicago, IL, USA, 3Sinai Health System, Chicago, IL, USA

PURPOSE: Leading oncology professional societies andaccrediting agencies recommend providing survivorshipcare plans (SCPs) at the end of primary cancer treatmentto improve continuity of care and address survivorsneeds. However, SCPs have yet to be broadly adopted.Despite the existence of SCP templates, the primaryimplementation barrier is the time spent by providers com-pleting them. We are attempting to reduce that burden andmaximize usefulness to patients by designing an SCP tem-plate that is tailored to a safety net hospital that providescare to vulnerable populations.METHODS: We conductedin-depth (3060 minute) individual interviews with physi-cians and nurses who treat breast cancer survivors in a safetynet hospital. We conducted two focus groups with womenwithin 4 months to 2 years of completing primary breastcancer treatment. The interviews and focus groups inquiredabout common post-treatment survivorship concerns andopinions about SCPs (including specic templates, timingand delivery). We conducted a review of existing SCP tem-plates and recommendations, gathering over 200 clinicaldata elds from which we selected those that best met clinicneeds. We drafted our SCP template from the chosen elds,formatting them such that a majority (>70%) include drop-down options for easier completion. RESULTS: Clinicians(n=8) were largely in favor of SCPs but unfamiliar withthem and concerned about the time and training involved.Breast cancer survivors (n=12) reported unmet needs aftercompleting treatment, had favorable views of SCPs and themajority preferred more comprehensive templates. In re-sponse to stakeholder input, we drafted 1) an SCP templatewith the comprehensive introduction and follow-up care rec-ommendations preferred by survivors, and the brief treat-ment summary and drop-down options preferred byclinicians; and 2) a manual to standardize SCP completionand delivery. CONCLUSIONS: Breast cancer survivorsand clinicians provided complementary perspectivesthat we used to inform development of an SCP interven-tion. An SCP intervention (template and implementa-tion manual) were tailored for use in a new safety nethospital survivorship clinic. The SCP intervention willbe piloted in a feasibility study with breast cancer

127Poster Abstracts of the APOS 11th Annual Conference

2014 The Authors. Psycho-Oncology 2014 John Wiley & Sons, Ltd. Psycho-Oncology 23: (Suppl. 1): 1144 (2014)DOI: 10.1002/pon