Poster Abstracts

Laura E Anderson^1,2, Katelyn Collins^1,3, Larry Myers^1,3, Michael J Ireland^3,4, Mariam Omar¹, Allanah Drummond³, Leah Zajdlewicz¹, Belinda Goodwin^1,4,5

¹Cancer Council Queensland, Fortitude Valley, Queensland, Australia

²National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia

³School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia

⁴Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia

⁵Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Queensland, Australia

Aims: Population-wide cancer screening programs save lives through early cancer detection; however, many people do not participate. We aimed to understand decision formation and prompts to action for screening behaviours to inform interventions to increase bowel, breast and cervical cancer screening uptake.

Methods: Cancer screeners (N = 962) were asked what made them decide to screen and what prompted them to act through an online survey. Content analysis was used to capture the frequency of common responses. Interrater reliability was high (κ = .96, %agree = 97%).

Results: For breast and cervical screening, decisions were commonly based on ‘screening being routine’ (32.58% – breast, 35.19% – cervical) or ‘receiving a reminder’ (20.53% – breast, 13.07% – cervical), and common prompts were ‘receiving a reminder’ (40.68% – breast, 29.13% – cervical), ‘screening being routine’ (22.05% breast, 18.65% cervical). Participants reported deciding to screen for bowel cancer due to ‘arrival of home screening test kit’ (40.50%) or the ‘experience of loved one's cancer’ (13.57%) and were prompted by ‘arrival of home test kit’ (23.58%), ‘convenience’ (15.72%) and the ‘desire to “get it over with”’ (10.22%). Importantly, approximately 25% of participants gave the same response to both the decision and prompt question.

Conclusions: Interventions should target reminders and messages that support screening as part of regular healthcare routine, particularly for breast and cervical cancer screening. For bowel cancer screening, messaging should encourage immediate use of bowel cancer screening kits upon arrival. The messaging inviting individuals to screening programs should be carefully considered, as it often coincides with both the decision to participate and prompts action.

Shalmoli Bhattacharyya¹, Sanchita Khurana¹, Reena Sharma², Bhavana Rai², Rashmi Bagga³

¹Biophysics, PGIMER, Chandigarh, India

²Radiotherapy, PGIMER, Chandigarh, India

³Obstetrics & Gynaecology, PGIMER, Chandigarh, India

Background: Cancer-associated mesenchymal stem cells (CA-MSCs) are MSCs present in the tumour microenvironment. Over the last decade, studies have demonstrated that CA-MSCs can, directly and indirectly, interact with the tumour microenvironment to promote or inhibit tumour growth. Therefore, understanding the interactions of CA-MSCs with tumour cells is critical to disease progression and response to therapy. Development of chemo-radio-resistance in cervical cancer is a major cause of mortality in developing countries like India, so in this study, we have focussed on the interaction of CA-MSCs with chemo-radio-resistant cervical cancer cells developed in our laboratory.

Methodology: CA-MSCs were isolated from biopsy samples of cervical cancer patients via explant method and characterised as per ISCT guidelines. Further, an in vitro chemo-radio-resistant cervical cancer cell line, HeLa (HeLa-CRR), was established by a fractionated treatment to cisplatin and megavoltage X-rays and was made resistant up to 2.5 μM cisplatin + 50 Gy. It was characterised via viability assay, clonogenic survival, cell cycle analysis, apoptosis assay and g-H2AX staining and compared to a sham-treated group (HeLa-NR). CA-MSCS were then co-cultured directly or indirectly (conditioned media) with HeLa cells to decipher the effect of CA-MSCs on cancer proliferation, migration, invasion, sphere formation abilities and response to chemo-radiotherapy.

Results: Isolated CA-MSCs were positive for CD105, CD73 and CD90 and negative for CD45, CD34 and HLA-DR and showed trilineage differentiation potential. Establishment of HeLa-CRR was confirmed by increased cell viability and clonogenic survival. HeLa-CRR also showed shortened G2/M phase, lower apoptosis and lesser number of g-H2AX foci compared to HeLa-NR. Co-culturing of CA-MSCs with HeLa-CRR/NR led to a significant increase in proliferation, migration, invasion and sphere formation ability of the cancer cells. Co-cultured cells also showed an altered response to chemo-radiotherapy.

Conclusion: This study revealed that CA-MSCs from cervical cancer patients showed pro-tumourigenic activity and affected therapeutic response in HeLa-NR and Hela-CRR cells.

Carina Chan, Grace Kim, Suzanne Kosmider, Azim Jalali, Catherine Oakman, Grace Gard

Western Health, St Albans, Victoria, Australia

Background: The recent approval of targeted therapies for mesenchymal epithelial transition exon 14 skipping mutations (METex14) has increased the treatments available for advanced lung squamous cell carcinoma (SCC). It is estimated that around 2% of SCC patients will harbour METex14. RNA testing is preferred for its sensitivity detecting the genomic aberrations which cause METex14. We aimed to identify patients with lung SCC harbouring METex14 who may benefit from targeted therapy.

Methods: We conducted a retrospective review of 336 patients discussed at Western Health lung multidisciplinary team meetings (MDM) between April 2022 and April 2023. Data extracted from electronic medical records included patient demographics, cancer stage and histological subtype, prior molecular testing and available tissue. Lung SCC patients who were alive as of May 2023 had tumour samples screened for METex14 via RNA testing.

Results: Thirty-seven alive lung SCC patients were identified, the median age was 71 years and 51% were male. Six (16%) had locally advanced disease and 13 (35%) had metastatic disease. Prior molecular testing had been completed for two patients; however, neither had been tested for METex14. Thirty-three patients (89%) had appropriate tumour samples for RNA testing to detect METex14, comprising of 61% small biopsy samples, 21% resection samples and 15% cytology samples. A METex14 result could not be obtained for one sample likely due to poor quality or low yield of RNA. No patients harboured METex14.

Conclusions: Real world prevalence of METex14 in lung SCC patients is low. However, sufficient tumour samples are available for testing in the majority of patients. Routine molecular testing should be considered for patients with lung SCC given the limited number of actionable targets and reimbursed therapies available.

Zoe Clarke¹, Yae Joo Jun², Catherine Osborne¹, Denise Andree-Evarts¹, Illiana Peters¹, Tamara Molloy², Matthew Fuller²

¹NSW Health – WNSWLHD, Dubbo, NSW, Australia

²NSW Health – WNSWLHD, Orange, NSW, Australia

Aims: Medical Imaging Simulated Radiation Therapy (MISRT) aims to reduce the financial and geographical burden of accessing palliative radiation therapy (RT) within WNSWLHD.

MISRT implementation for palliative cancer patients demonstrates extensive benefits to patients, health professionals and health resource management when quality peer reviewed research is translated into practice in a rural Radiation Oncology department. The use of MISRT enables more patients in WNSWLHD to access world-class RT and improves RT utilisation in rural and regional areas, through the elimination of RT simulation CT scanning.

Methods: Peer reviewed research has been translated to practice. One-on-one staff training sessions supported radiation therapists to develop knowledge and skills required for planning and treatment of patients on MISRT pathway. Training has also been provided to Medical Imaging staff within WNSWLHD to education on the requirements of MISRT. Upon completion of training, a staff survey using the Likert scale and open-ended questions to evaluate the benefits to department resource management, time efficiencies and clinical workflow processes was completed. Additionally, a retrospective analysis of patient demographic data has been analysed to evaluate transport emissions generated by patient travel to access RT and associated cost savings.

Results: A feasibility project completed in 2022 allowed for 16 patients to undergo palliative RT using the MISRT pathway. Environmental impact analysis of this study resulted in eliminating 15,400 km of patient travel and saving 2.23 tonnes of CO₂ emissions. Staff survey results support the expansion of MISRT in WNSWLHD Radiation Oncology. MISRT resulted in staff reported clinical workflow efficiencies and staff reported improvements in the human experience in delivering palliative RT to rural and remote populations.

Conclusion: The implementation of MISRT has demonstrated to be valuable to patients, specifically in decreasing time required for a patient to be present in the department. MISRT has also demonstrated an environmentally sustainable pathway to provide patients with world-class palliative RT treatment.

Merran Findlay^1,2,3,4,5,6, Georgina Kennedy^5,6,7, Angela Sita⁸, Tim Churches⁵, Nasreen Kaadan^7,9, Geoff P Delaney^5,6,9, Winston Liauw^10,11, Katherine Bell⁹, Joanna Fardell^5,6, Judith D Bauer¹², Meera Agar^5,6,13

¹Cancer Care Research Unit, Susak Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia

²Cancer Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia

³The Daffodil Centre, The University of Sydney – A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

⁴Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁵South Western Clinical School, University of NSW, Sydney, NSW, Australia

⁶Maridulu Budyari Gumal (SPHERE) Cancer Clinical Academic Group, University of NSW, Sydney, NSW, Australia

⁷Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

⁸Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia

⁹Liverpool & Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Liverpool, NSW, Australia

¹⁰School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia

¹¹Cancer Care Centre, St George Hospital, Sydney, NSW, Australia

¹²Department of Nutrition, Monash University, Melbourne, VIC, Australia

¹³Faculty of Health, University of Technology, Sydney, NSW, Australia

Aims: Healthcare dashboards visualise patient-level and aggregate data to guide decision-making, evaluate outcomes and reveal unwarranted variations in care. We have successfully demonstrated the technical feasibility of extracting and visualising near real-time evidence-based nutrition care data comprising nutritional status and involuntary weight loss in dynamic, automated dashboards. Next, we aimed to explore the interaction of nutrition care metrics with medical and supportive care within the context of outcome variation, including visualisation throughout the care trajectory.

Methods: The SPHERE Cancer Variation (CaVa) platform extracts and harmonises data from South Western Sydney Local Health District clinical information systems, including key named entities from free text clinical notes using Natural Language Processing (NLP). Novel harmonised clinical nutrition data were evaluated for quality, completeness, generalisability and alignment with patient outcomes and quality metrics against other prognostic factors including diagnostic and treatment episodes, dietetic resource utilisation and best-practice nutrition care in near real-time.

Results: Nutrition care dashboards comprising multiple data visualisations were deployed within the CaVa modular dashboard framework. Technical and functional feasibility at both aggregate and individual patient levels was demonstrated, in anticipation of supporting use cases covering daily clinical use, periodic clinical quality reviews and health service-level monitoring. This dashboard framework has now been successfully extended, with components reused across high nutrition-risk groups, confirming suitability for sustainable live deployment. Prototype dashboards created to assess utility of this framework for the nutrition care of patients with head and neck, lung or upper gastrointestinal cancers will be presented.

Conclusion: We have established a repeatable dashboard framework that can be co-designed and adapted for multiple contexts. This pilot has demonstrated timely visualisation of evidence-based nutrition care processes and prognostic nutrition outcomes is feasible. Adoption of automated nutrition care dashboards in routine care holds potential to inform decision-making and improve patient care and outcomes.

Subhash Gupta¹, Richa Tripathy², Vittal Huddar², Haresh KP¹, Goura K Rath¹, Tanuja Nesari², Shivam Singh¹, PRANAY TANWAR¹, Ashok Sharma¹, Omana Nair¹, Sandeep Mathur¹, Suman Bhasker¹, Ravi Mehrotra³

¹AIIMS New Delhi, New Delhi, India

²AIIA, Delhi, India

³ICMR, Delhi, India

Background: Many plants are known to have anticancer effects according to ancient Ayurvedic text. They are known to reduce the proliferation of cells and the size of tumour after treatment. Vardhamana Pippali Rasayana (VPR) is one the important time-tested ayurvedic medications that is also reliable in managing cancer as evidenced by the present Ayurveda practitioners with challenging results without any considerable adverse effects. However, its anti-cancer role in breast cancer is yet to be elucidated. The present study has explored the cytotoxic effects of Piper longum (pippali) aqueous extract on human breast cancer cell line (MCF7) using various in-vitro assays.

Methods: MCF7 cells were treated with different concentrations of aqueous extract of pippali (.25, .5, 1.0, 2.5, 3.75, 5.0, 7.5, 10, 12.5, 15, 20, 25, 30 and 50 μg/μL). The cytotoxic activity was analysed using MTT assay. DNA cell cycle analysis and apoptosis assay were performed in pippali aqueous extract treated and untreated MCF-7 cells.

Results: The effect of the pippali aqueous extract on MCF-7 proliferation was analysed after 24 h of pippali treatment using MTT assay which revealed the IC₅₀ value of the extract to be 3.125 μg/μL. Additionally, the same IC₅₀ concentration was also used to analyse the effect of pippali extract on apoptosis and DNA cell cycle of MCF7 cells. Induction of apoptosis and increased cell death were observed in pippali-treated cells compared with untreated cells. Moreover, G₀/G1 arrest was detected in pippali-treated cells compared to untreated cells.

Conclusion: The above-mentioned results indicate that VPR might have strong anti-cancerous potential. However, other functional assays are warranted to validate the drug's efficacy against breast cancer which will be done in our lab soon.

Morgan Leske¹, Bogda Koczwara^2,3, Elizabeth Eakin⁴, Camille Short⁵, Anthony Daly⁶, Jon Degner⁷, Lisa Beatty¹

¹College of Education, Psychology and Social Work, Finders University, Adelaide, SA, Australia

²Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA, Australia

³College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

⁴Faculty of Medicine, University of Queensland, Herston, QLD, Australia

⁵Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia

⁶Cancer Council SA, Adelaide, SA, Australia

⁷Cancer Voices, Adelaide, SA, Australia

Aim: Healthy Living after Cancer Online is a co-designed physical activity, nutrition and psychosocial web-delivered intervention for post-treatment cancer survivors. Previous research demonstrated low program uptake and usage, with feedback identifying a lack of accountability and information overload as factors. This study evaluated whether adding two 15-min telephone coaching calls to the intervention improved usage and outcomes.

Methods: Fifty-two Australian post-treatment cancer survivors were randomised to receive the program in a self-guided format (HLaC Online; n = 27) or with brief telephone support (HLaC Online + coaching; n = 25). Participants were asked to complete questionnaires at baseline, post-intervention (12 weeks later) and 1-month follow-up. Feasibility was measured via intervention uptake, usage, adherence, usability, satisfaction and attrition. Between-group effects were quantified using Cohen's d. Participants specified at baseline their intended module use; adherence was defined as the proportion of their completed nominated modules. Preliminary efficacy outcomes included quality of life, physical activity, nutrition, distress and cancer-related symptoms. Differences between groups and the clinical significance of change over time will be examined using repeated measures linear mixed model analyses and reliable change indices.

Results: Overall, 47 participants received their allocated intervention. Five (HLaC Online + coaching n = 4, and HLaC Online n = 1) dropped out due to personal reasons, cancer recurrence or technical difficulties. HLaC Online + coaching participants accessed more modules (M = 5.1, SD = 3.3 vs. M = 3.2, SD = 4.0, d = .5) and had higher adherence (M = 61.2%, SD = .4% vs. M = 34.4%, SD = .4%, d = .64). Those allocated to HLaC Online + coaching rated usability (M = 74.16, SD = 17.7 vs. M = 63.1, SD = 26.6, d = .49) and satisfaction (M = 26.5, SD = 3.38 vs. M = 22.0, SD = 5.94, d = .94) higher than HLaC Online participants. Analyses of preliminary efficacy outcomes are ongoing and complete results will be available at the time of the presentation.

Discussion: The initial findings support the implementation of telephone coaching calls to improve the feasibility of HLaC Online and highlight the importance of co-designing interventions.

Ashley Macleod^1,2, Linda Nolte^1,2

¹Austin Health, Heidelberg, VIC, Australia

²North Eastern Melbourne Integrated Cancer Services (NEMICS), Victorian Integrated Cancer Services, Melbourne, VIC, Australia

Aim: A systematic scoping review was conducted to understand the current state of cancer care for lesbian, gay, bisexual, trans, intersex, queer/questioning, asexual and other sexual and gender minority communities (LGBTIQA+) in Victoria.

Methods: The scoping review was conducted in three parts across 2022 and 2023. A rapid systematic review examined published systematic reviews, meta-analyses, qualitative meta-syntheses and integrated reviews specific to cancer care for LGBTIQA+ people with cancer. An environmental scan examined publicly available Australian cancer care policy resources relating to LGBTIQA+ cancer care for their level of recognition and inclusion of LGBTIQA+ specific cancer care. A dataset evaluation examined the presence of sexual orientation and gender identity (SOGI) data items within Victorian cancer related datasets and their data dictionaries.

Results: Most cancer care research does not include sub-group analyses examining the LGBTIQA+ population and experience. Where LGBTIQA+ focussed cancer research exists, studies often exclusively focus on cancers related to sex organs, or cancers known to be hormone dependent. Few Australian cancer care policy resources include LGBTIQA+ acknowledgement, inclusion or targeted actions. Most policy resources referred to the LGBTIQA+ community collectively, rather than as a collection of unique subgroups with diverse needs. Where differences in cancer care and/or service needs within the LGBTIQA+ community were acknowledged, documents frequently focussed on trans and gender-diverse people with cancer. In Victorian cancer datasets, only the National Cervical Screening Program dataset includes information about gender identity, and no datasets record information about a person's sexual orientation or preferred pronouns.

Conclusions: While cancer policies in Victoria may acknowledge the importance of recognising the unique needs of LGBTIQA+ people with cancer, dataset revision and the collection of SOGI data items is required to identify and understand this population. Victorian LGBTIQA+ specific cancer care and experience research is required.

Georgios Mavropalias^1,2, Kazunori Nosaka²

¹Murdoch University, Murdoch, WA, Australia

²Edith Cowan University, Joondalup, WA, Australia

Aims: Eccentric exercise (ECC) is a potentially effective exercise therapy modality during cancer, due to its effectiveness at improving muscle mass and architecture, body composition and metabolic markers which are often impaired during cancer disease and treatments, at lower efforts and cardiovascular demands compared to conventional exercises.^1–3 To examine the available evidence, we conducted a scoping literature review.

Methods: Medline and Scopus databases were searched for published studies included until August 2023. Search terms included keywords and various combinations related to ECC, cancer disease, symptoms and therapies. Peer-reviewed journal articles were included if they included humans or animals with cancer, examined the effects of different forms of ECC, were in English and were not reviews. Secondary searches involved reference lists of eligible articles as well as systematic reviews and meta-analyses assessing resistance exercise interventions during cancer.

Results: Animal (n = 3) and human (n = 4) studies were found. Animal studies (ApcMin/+ and Colon-26 mice models) concluded that ECC (through electrical stimulation) is an effective strategy to ameliorate muscle wasting during cancer cachexia.

Of the four human studies (108 people; 46 females), two included specific diseases (prostate or head-and-neck cancer) whereas two included multiple types (lymphoma, breast, prostate, lung and colorectal cancers). Cancer treatments were either local (surgery ± radiotherapy), systemic (chemo or hormone therapies) or a combination of the two. Forms of ECC included eccentric stepping (n = 3) and eccentric-overloaded squat exercises (n = 1).

ECC was safe and well tolerated (n = 4), significantly increased strength and function (n = 4), successfully increased muscle mass even during androgen-deprivation therapy or chemotherapy (n = 2) and caused clinical-relevant reductions in cancer-related fatigue (n = 2).

Geoffrey Yuet Mun Wong¹, Jun Li², Nazim Bhimani¹, Connie Diakos³, Mark P Molloy², Thomas J. Hugh¹

¹Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia

²Bowel Cancer and Biomarker Research Laboratory, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, St Leonards, New South Wales, Australia

³Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia

Introduction: The role of genomics in driving tumour biology and its influence on early recurrence in patients with colorectal liver metastases (CRLM) is inadequately understood. This study aims to profile and discover genomic biomarkers for early intrahepatic recurrence following curative-intent resection of CRLM.

Methods: Comprehensive genomic profiling of 24 fresh frozen CRLM samples from patients with early intrahepatic recurrence after resection of CRLM was performed using the TruSight Oncology 500 assay (Illumina, San Diego, CA). This assay assesses 523 genes implicated in a variety of solid tumour types. Functional annotation of somatic variants and filtering was performed using open-source genomic databases (ExAc, gnomAD) and software packages (ANNOVAR). Aggregated mutation information was summarised, analysed and visualised using the maftools package (version 2.16.0).¹ Function and interaction networks of genetic alterations were explored using GeneMANIA.² Estimation of the selective advantage conferred by somatic mutations was performed using cancereffectsizeR (version 2.7.0).³

Results: A total of 117 of 523 profiled genes were altered in samples from patients with early recurrence. TP53 (88%), APC (71%), KRAS (38%), SMAD4 (21%) and PIK3CA (17%) were the top five frequent cancer drivers. The identified gene alterations are implicated in diverse biological processes and complex molecular interactions, including cell population proliferation, signalling response to external stimulus, DNA repair, DNA methylation, RNA binding, cell adhesion, cell cycle control, chromatin remodelling and lineage-specific transcription factors. Among the cancer-related genes altered in early intrahepatic recurrence, BRAF mutation had the highest relative importance.

Navid Ahmadi, Alice Grant, Ahmed Goolam, George McClintock, Don Jeeves Perera, David Zalcberg, Henry Woo, Scott Leslie, Peter Ferguson, Nariman Ahmadi

Chris O'Brien Lifehouse, Stanmore, NSW, Australia

Introduction: Retroperitoneal lymph node dissection (RPLND) is the standard of care for patients with primary testicular cancer who have a residual mass following chemotherapy. The robotic (R-PLND) approach has gained momentum and favour over open surgery during the past decade due to its lower morbidity and faster recovery. Herein, we present our institution's experience in R-RPLND for treatment of a residual mass following primary chemotherapy for testicular cancer.

Method: We performed a retrospective review of our prospectively collected database from April 2018 until April 2023 at a major academic centre. All cases were performed by a single surgeon with experience in open and robotic RPLND. Perioperative and oncological outcomes were reported and 30-day complications were based on the Clavien–Dindo classification.

Results: Seventeen patients underwent R-RPLND. Median age was 33(22–68) years. Twelve (71%) patients had left sided cancer, three (18%) had right sided cancer and two had bilateral testicular cancer. Three (18%) had seminoma, 12(71%) NSGCT and two patients had teratoma only. Clinical staging: five (29%) IIA disease, five (29%) IIB and seven (41%) IIC. Histopathology was: eight (47%) teratoma, three (18%) residual cancer, one (6%) benign and five (29%) harbouring necrosis only. Median operative time was 300 (230–600) min with the median estimated blood loss (EBL) of 50 mL (IQR 30–300), and median node count of 39 (23–65). Median length of stay was 2 days (1–3) and three (18%) patients developed complications, of which two (12%) were chylous ascites requiring intervention and one (6%) developed small bowel obstruction which was managed conservatively. At median follow-up of 33 months, one (6%) patient developed in-field recurrence and one (6%) patient developed out of-field recurrence, both were subsequently salvaged with second line chemotherapy.

Conclusion: R-RPLND is safe and feasible in suitable patients, offering low morbidity and early recovery. Medium-term oncological outcomes are encouraging and comparable to open-RPLND series. Larger series and longer follow-up are required for validation of our outcomes.

Navid Ahmadi, Alice Grant, Ahmed Goolam, George McClintock, Don Jeeves Perera, David Zalcberg, Henry Woo, Scott Leslie, Peter Ferguson, Nariman Ahmadi

Chris O'Brien Lifehouse, Stanmore, NSW, Australia

Introduction: Primary retroperitoneal node dissection (RPLND) in recent years has gained momentum for treatment of stage IIA and IIB testicular cancers, showing high cure rates. Current trials for primary RPLND are predominantly performed via open surgery. Robotic RPLND (R-RPLND) has gained favour over open surgery due to its significantly lower morbidity; however, there is limited data available regarding the outcomes of primary R-RPLND for stage IIA&B disease. Herein, we report our initial experience of this cohort at our institution.

Method: We performed a retrospective review of our prospectively collected database from April 2018 to April 2023 at a major academic centre. All cases were performed by a single surgeon with experience in open and R-RPLND. Perioperative and oncological outcomes were reported, and 30-day complications were based on Clavien–Dindo classification.

Results: Eleven patients underwent primary R-RPLND. Median age was 33 (19–46) years, six (55%) patients had left sided cancer and five (45%) had right sided cancer. Clinical and pathological staging were: three (27%) IIA and eight (73%) IIB, while five (45%) had seminoma, five (55%) NSGCT and one (9%) pure teratoma. Median node size was 2.5 cm (1.2–4.5). Surgical template was unilateral in 2(18%), bilateral in 1(9%) and 8(73%) had modified template resection. Ten (91%) patients had nerve-sparing surgery. Median operating time was 300 min with median EBL of 50 (20–200) mL. Average length of stay was 2 days (1–2). One (9%) patient had a Clavien–Dindo III complication with chyle ascites requiring percutaneous drainage. With median follow-up of 14 (3–39) months, 1(9%) patient developed mediastinal recurrence at 13 months post op and underwent surgical excision with no recurrence to date.

Conclusion: Primary R-RPLND appears to be safe and feasible in selected patients with stage IIA and IIB testicular cancer. Larger series and longer follow-ups are required for validation of our findings.

Reem ALHulais, Stephen Ralph

School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, GoldCoast, QLD, Australia

A lack of investigation exists regarding the role and function of the cancer stem cell (CSC) populations in this thesis, methods were developed for selectively enriching CSC populations to allow for drug targeting studies. SW480 and CT26 parental wild-type (WT) colorectal cancer cells were transfected with a vector encoding the octamer-binding transcription factor 4 (OCT4) promoter site regulating the expression of enhanced green fluorescent protein (GFP). After repeated cell sorting (top ∼1%–5%), the highly positive OCT4-GFP populations were further enriched by using conditions of intermittent cycling between normoxia and anoxia. The resulting highly enriched OCT4-GFP CSC population produced markedly, more tumours of larger sizes compared to CT26 WT inoculated mice. Celecoxib treatment significantly decreased (∼50%) the number and volume of colorectal tumours of both WT and CSC cell type. Colorectal tumours produced significant red blood cell levels in the peritoneal cavities of untreated mice, but celecoxib treatment greatly inhibited peritoneal tumour angiogenesis. Studies using these model systems will help determine the role of CSC-enriched populations in tumour progression and therapeutic targeting. The evidence also supports the potential for repurposing and using celecoxib in chemosensitising colorectal cancer cells, rendering them more susceptible to standard chemotherapies, such as doxorubicin and 5-fluorouracil.

Sebastian Kang^1,2, Sally Allen¹, Amy Brown¹, Shivanshan Pathmanathan¹, Dinuka Ariyarathna¹, Sabe Sabesan^1,2, Corinne Ryan¹, Suresh Varma¹, Otty Zulfiquer^1,2, Abhishek Joshi^1,2

¹Townsville Cancer Centre, Douglas, Queensland, Australia

²James Cook University, Townsville, Queensland, Australia

Background: A nurse navigator (NN) role was implemented in Townsville Cancer Centre to meet the needs of elderly patients with cancer. The service includes a pre-assessment clinic for patients ≥75 years old referred to medical oncology to identify deficiencies and optimise health domains. Nurse navigation consults were provided for ongoing monitoring and multi-disciplinary co-ordination during treatment. The safety outcomes and patterns of oncology management since the implementation of this service were examined.

Materials and methods: A retrospective audit was performed of patients ≥75 years who were referred to receive systemic therapy between January 2019 and November 2022. Patients receiving intra-vesicular or hormonal treatment were excluded. Data collection included rates of de-escalation of treatment plans from standard of care, and safety outcomes including unplanned hospitalisations and discontinuation rates of systemic therapy due to toxicity. Comparison was made between a historical group (January 2019 to March 2020) to post-NN implementation (April 2020 to November 2022).

Results: Forty-four patients in the NN cohort and 47 patients in the historical cohort received systemic therapy. The rates of de-escalated therapy were similar between both cohorts (31.8% vs. 34%, p = 0.82). Twenty-five (56.8%) patients in the NN cohort received nurse navigation during systemic therapy with the remainder either declining the service (18.2%), were followed up by other services, for example, cancer care coordinators (9.1%) or deemed appropriate to not require follow-up through the pre-assessment clinic (11.4%). Safety outcomes were improved since the implementation of the NN service, with a significant reduction in the number of unplanned hospitalisations (mean 0.75 vs. 1.38, p = 0.005), length of hospital stay (mean 3.64 vs. 7.55 days p = 0.03) and treatment discontinuations due to systemic therapy related toxicity (15.9% vs. 21.3%, p = 0.04).

Conclusions: Our 2-year experience with the geriatric oncology NN service suggests that navigation through systemic therapy improves safety outcomes despite no significant changes in de-escalated systemic therapy rates.

Matthew A Powell¹, Sakari Hietanen², Robert L Coleman³, Bradley J Monk⁴, Oleksandr Zub⁵, David M O'Malley⁶, Lucy Gilbert⁷, Iwona Podzielinski⁸, Roberto Angioli⁹, Dana Chase¹⁰, Ashish Banerjee¹¹, Dirk Bauerschlag¹², Destin Black¹³, Annemarie Thijs¹⁴, Sudarshan Sharma¹⁵, Michael A Gold¹⁶, Kari L Ring¹⁷, Zangdong He¹⁸, Shadi Stevens¹⁹, Brian Slomovitz²⁰, Mansoor R Mirza²¹

¹National Cancer Institute-sponsored NRG Oncology; Washington University School of Medicine, St. Louis, Missouri, USA

²Turku University Hospital and FICAN West, Turku, Finland

³US Oncology Research, The Woodlands, Texas, USA

⁴HonorHealth Research Institute, University of Arizona College of Medicine, Phoenix; Creighton University School of Medicine, Phoenix, Arizona, USA

⁵Chernihiv Regional Oncology Hospital, Chernihiv, Ukraine

⁶Ohio State University; James Comprehensive Cancer Center, Columbus, Ohio, USA

⁷McGill University Health Centre, Montreal, Quebec, Canada

⁸Parkview Health, Fort Wayne, Indiana, USA

⁹University di Roma – Campus Biomedico, Rome, Italy

¹⁰David Geffen School of Medicine at UCLA, Los Angeles, California, USA

¹¹GSK, Point Cook, Victoria, Australia

¹²University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

¹³LSU Health Shreveport, and Willis-Knighton Physician Network, Shreveport, Louisiana, USA

¹⁴Catharina Hospital, Eindhoven, the Netherlands

¹⁵AMITA Adventist Hinsdale Hospital, Hinsdale, Illinois, USA

¹⁶Oklahoma Cancer Specialists and Research Institute, Tulsa, Oklahoma, USA

¹⁷University of Virginia Health System; Emily Couric Clinical Cancer Center, Charlottesville, Virginia, USA

¹⁸GSK, Collegeville, Pennsylvania, USA

¹⁹GSK, London, UK

²⁰Mount Sinai Medical Center; Florida International University, Miami Beach, Florida, USA

²¹Copenhagen University Hospital; Nordic Society of Gynaecologic Oncology-Clinical Trial Unit, Copenhagen, Denmark

Aims: The RUBY trial evaluated the efficacy and safety of dostarlimab + standard of care (SOC) carboplatin paclitaxel (CP) versus CP alone in A/R EC. The primary endpoint of PFS by investigator assessment (INV; RECIST v1.1) was significantly longer with dostarlimab + CP than placebo + CP in the mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations. Here, we present the secondary efficacy endpoints by BICR.

Methods: RUBY is a phase 3, global, randomised, double-blind, multicentre, placebo-controlled study (Funded by Tesaro: NCT03981796, GSK: 213361). Patients with primary advanced stage III or IV or first recurrent EC were randomised (1:1) to receive dostarlimab 500 mg or placebo, plus carboplatin AUC 5 and paclitaxel 175 mg/m² Q3W (six cycles), followed by dostarlimab 1000 mg or placebo, monotherapy Q6W for up to 3 years. Secondary endpoints by BICR assessment (RECIST v1.1) were PFS, ORR, DOR and DCR in the dMMR/MSI-H and overall populations.

Results: Of the 494 patients randomised (dostarlimab + CP: 245; placebo + CP: 249), 47.8% had recurrent disease, 18.6% and 33.6% had primary stage III and IV disease, respectively. PFS by BICR was longer with dostarlimab + CP than placebo + CP in the dMMR/MSI-H (HR: .29; 95% CI: .158–.543) and overall populations (HR: .66; 95% CI: .517–.853). ORR and DCR by BICR were similar between the two arms in the two populations. Mdor by BICR was NE (95% CI: 13.1–NE) with dostarlimab + CP and 6.9 (5.5–10.1) months with placebo + CP in the Dmmr/MSI-H population; 12.9 (8.2–NE) with dostarlimab + CP and 6.7 (5.7–8.3) months with placebo + CP in the overall population. Safety was previously reported.

Conclusions: Dostarlimab + CP showed clinically meaningful improvement in BICR-assessed PFS versus CP alone, in the two populations. HRs for BICR- and INV-assessed PFS were consistent; benefits seen in all BICR-assessed endpoints were consistent with INV. Dostarlimab + CP represents a new SOC for patients with primary A/R EC.

Originally presented at 2023 ASCO Annual Meeting (10.1200/JCO.2023.41.16_suppl.5503). Permission granted by Wolters Kluwer.

Greta K Beale¹, Alice Connor^1,2, Alexander Yuile¹, Andrew Kneebone³, George Hruby³, Thomas Eade³, Edward Hsiao⁴, Geoff Schembri⁴, Madeleine Tilley¹, Adrian Lee^1,2, Alex Guminski^1,2, David Chan^1,2

¹Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia

²The University of Sydney, Sydney, NSW, Australia

³Radiation Oncology, Royal North Shore Hospital, St Leondard, NSW, Australia

⁴Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia

Background: Prostate specific membrane antigen (PSMA) PET/CT imaging is increasingly used to stage metastatic prostate cancer (Mpc). Increased PSMA avidity is correlated with higher-grade disease and poorer prognosis. The role of PSMA avid tumour burden in predicting survival outcomes remains unclear to date. We aimed to investigate PSMA avid tumour burden as a potential prognostic biomarker in Mpc.

Methods: Following HREC approval, Mpc patients receiving androgen deprivation therapy (ADT) who underwent [68Ga]Ga-PSMA-11 PET/CT within 3 months of treatment initiation were identified at Royal North Shore Hospital, Australia (2014–2019). Patients were collected as two cohorts; cohort 1 received ADT + further systemic therapy (docetaxel, enzalutamide or abiraterone); cohort 2 received ADT alone.

Images were analysed using MIM software (version 6.8.3) and lesions above a flat SUV threshold of 4 were validated by nuclear medicine physician review and were included for analysis. Relevant clinicopathologic variables, clinical outcomes (progression-free and overall survival) and PSMA avid tumour burden (total, primary and metastatic) were collected. Each cohort was dichotomised by the median tumour burden, with groups compared using the log-rank test.

Results: Ninety-eight patients were identified (cohort 1: 15, cohort 2: 83). For cohort 1, median age at diagnosis was 71 years, and the median Gleason score was 7. Ten (67%) were treated with ADT and docetaxel with the others treated with ADT and novel anti-androgenics. The median total PSMA-avid tumour burden was 119.2 Ml (IQR 12.3–252.2). Appreciating the small number of patients in cohort 1, there was no significant difference in PFS between those above and below the median total PSMA avid tumour burden (p = 0.3).

Conclusion: Here, we describe the relationship between clinical outcomes and PSMA PET scan findings in patients with newly diagnosed Mpc. Further data concerning overall survival analysis and cohort 2 will be presented at the meeting.

Cassie Beaven¹, Benedicta Emechete², Edward Sia², Bahram Forouzesh¹

¹Medical Oncology, Rockhampton Base Hospital Queensland Health, Rockhampton, Queensland, Australia

²Radiation Oncology, Genesis Care, Rockhampton, Allenstown, Australia

Background: Prior to the introduction of immunotherapy, geriatric patients were often considered unsuitable for systemic anti-cancer therapies based on evaluations using traditional assessment tools including the Eastern Cooperative Oncology Group (ECOG) score, Charlson Comorbidity Index (CCI) and the Cancer and Aging Research Group (CARG) score. The advent of immunotherapy has transformed the landscape of medical oncology, where for some malignancies it offers equal or superior efficacy and improved tolerability compared to traditional chemotherapy regimens. Furthermore, it has allowed for the option of systemic therapy in the setting of metastatic melanoma and non-melanoma skin cancers. Considering the geriatric population's significant representation among those with advanced skin cancers, the tolerability of immunotherapy is of particular interest within this groups.

Aim: Assess the tolerance of immunotherapy in two geriatric patients who, based on traditional assessment tools, would have been considered unsuitable for systemic therapy.

Methods: This study presents a case series of two octogenarian patients, aged between 80 and 89 years old, who received cemiplimab immunotherapy to manage metastatic cutaneous squamous cell carcinoma. Demographics, comorbidities, baseline geriatric assessments, experienced toxicities and oncological outcomes were accessed through the cancer care health information system MOSAIQ.

Results: The first patient, an 85-year-old male with an ECOG score of 2, CCI score of 14 points and CARG score of 12 points, completed 35 cycles of cemiplimab with the most severe toxicity being grade 2 fatigue. The second patient, an 89-year-old male with an ECOG score of 1, CCI score of 14 points and CARG score of 6 points, completed 24 cycles of cemiplimab and experienced only grade 1 toxicities. Both patients achieved an excellent oncological response to immunotherapy.

Conclusion: This case series of two octogenarian patients demonstrates that immunotherapy was well tolerated. It suggests that traditional assessment tools may not adequately assess the suitability of immunotherapy for this population.

Cassie Beaven, Harshil Trivedi, Sudhakar Vemula

Medical Oncology, Rockhampton Base Hospital Queensland Health, Rockhampton, Queensland, Australia

Background: Adjuvant chemotherapy is the standard of care for management of high-risk early breast cancer. The impact on disease-free and overall survival is most significant when started within 4 weeks of surgery, and is reduced for every 4 weeks that chemotherapy is delayed. The greatest benefit is in those with triple negative breast cancer (TNBC).

Aim: To identify delays in starting adjuvant chemotherapy for high-risk early breast cancer patients in Central Queensland.

Methods: Clinical data for patients with invasive breast cancer that underwent surgery followed by adjuvant chemotherapy at Rockhampton and Gladstone hospitals between August 2017 and August 2022 was analysed. Time from last surgical procedure to commencement of adjuvant chemotherapy was grouped; <4 weeks, 4–8 weeks, 8–12 weeks, 12–16 weeks and >16 weeks.

Results: Overall 98 patients were assessed; 98.9% were female, 14 (14.2%) had TNBC and 84 (85.7%) had non-TNBC. Mean age at diagnosis was 52.6 years, 48 (49%) required a second surgery and average distance to treatment centre was 104.4 km. The average time from final surgery to commencement of adjuvant chemotherapy was 46.9 days (range: 16–118 days) for all patients and 45 days (range: 20–95 days) for the TNBC group. Overall, 10.2% of all patients and 14.3% of TNBC patients received adjuvant chemotherapy in less than 4 weeks from surgery, 71.4% within 4–8 weeks, 13.3% within 8–12 weeks, 4.1% within 12–16 weeks and 1.0% in more than 16 weeks. On average it took 13.9 days (range: 2–86 days) to refer to medical oncology from last surgery, 20 days (range: 1–64 days) for a medical oncology appointment and 17.3 days (range: 3–63 days) from appointment to commencement of chemotherapy.

Conclusion: This audit demonstrates that only a minority of high-risk early breast cancer patients commence adjuvant chemotherapy within the recommended period of less than 4 weeks following surgery, warranting further investigation into the causes for delays.

Maria Bechelli¹, Kris Ivanova¹, Suan Siang Tan², Beena Kumar², Dayna Swiatek³, Surein Arulananda², Sue Evans¹

¹Cancer Council Victoria, Melbourne, Victoria, Australia

²Monash Health, Melbourne, Victoria, Australia

³Department of Health, Victorian Cancer Agency, Melbourne, Victoria, Australia

Aims: The Victorian Cancer Registry (VCR) conducted a project to assess the efficacy of using artificial intelligence (AI) applied to pathology reports to identify potential cancer cases for clinical trials. This initiative aimed to enhance clinical trial accessibility in Victoria, Australia.

Methods: VCR used the Rapid Case Ascertainment (RCA) module in the document processing system (E-Path Plus – an Inspirata© product). The RCA module targeted cases reported by Monash Pathology fulfilling the selection criteria for three phase three randomised controlled clinical trials at Monash Health (MH), which employed genetic markers as eligibility criteria. The AI engine extracted terms pertaining to topography and specific genetic tests from pathology reports. The identified cases were forwarded by VCR to MH for eligibility screening. The RCA's performance was evaluated against manually reviewed cases.

Results: Between June 2022 and May 2023, 302 cases across the three studies were identified and forwarded to MH for screening. Of these, seven were eligible to approach (0/48 in study 1, 6/19 in study 2 and 1/235 in study 3). The main reasons for ineligibility after screening were lack of tumour staging (174/295 = 59%) and normal genetic test results (96/295 = 33%). The RCA tool contributed five eligible cases to MH's selection. The RCA module accurately determined eligibility in 93% of pathology reports, achieving an F1 score of .93. The false positive rate was 4% and the false negative rate was 3%.

Conclusions: The RCA tool exhibits strong predictive capabilities for pathology selection to the three selected clinical trials. However, work is required to capture more granular data with confidence so as to reduce the burden of manual screening by minimising false negatives rates. This study was conducted in only one site. It may be that the tool would be more effective when applied in medical environments without extensive clinical trials infrastructure.

Anish Bhattacharya, Rajender Kumar, Avanthiga Subrhamanian, Bhagwant Rai Mittal

PGIMER, Chandigarh, India

Aim: Paediatric sarcomas are heterogeneous musculoskeletal malignancies arising from mesenchymal cells and account for less than 10% of childhood malignancies. There is limited literature on the role of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in the initial evaluation of paediatric sarcomas. In this retrospective analysis, we aimed to evaluate the role of ¹⁸F-FDG PET/CT for initial staging and treatment planning of sarcomas in the paediatric population.

Methods: We retrospectively analysed patient data from the PET/CT registry at our tertiary care hospital from 2010 to 2022. A total of 107 biopsy-proven paediatric sarcoma patients underwent ¹⁸F-FDG PET/CT for initial workup. All patients fasted for 4 h before radiotracer injection. Whole-body PET/CT was done 60 min after intravenous injection of ¹⁸F-FDG. Scan findings were reviewed qualitatively and semi-quantitatively by an experienced nuclear medicine physician. Lesions with ¹⁸F-FDG avidity and corresponding changes on CT images were designated PET-positive. The final diagnosis and change in treatment plan were evaluated based on PET/CT images.

Results: A total of 107 children (34 female) aged 13.2 ± 4.6 (range 1.2–19) years underwent ¹⁸F-FDG PET/CT for initial staging of sarcomas. Of these, 21/107 (19.6%) were extraosseous and 86/107 (80.4%) were of osseous origin, mainly comprising Ewing's sarcoma, osteosarcoma, rhabdomyosarcoma and chondrosarcoma. The maximum standardised uptake value (SUVmax) of the primary lesions was 8.1 ± 4.9 (range 1–32). Sixty-two (62/107; 57.9%) children had metastatic lesions at the initial staging workup. While 27 patients had only regional lymph node metastasis, the remaining 35 had distant metastases in either lymph nodes (17), lungs (22) or skeletal or marrow lesions (18). ¹⁸F-FDG PET/CT changed the treatment plan in 35 children who had distant metastatic lesions.

Conclusion: ¹⁸F-FDG PET/CT is a good imaging modality for accurately staging sarcomas in children and to detect distant metastases at the initial workup.

Jaimee Cacic¹, Ashley Bigaran², David Liu², Kate Crombie², Darren Wong², Kat Hall², Linda Watson², Ronald Ma², Carlene Wilson², Amanda Dalyell², Ahmad Aly², Steven Kunz², Marissa Ferguson², Laurence Weinberg², Danny Brazzale², Claire O'Donnell², Grace Williams², Karalyn McDonald², Celia Lanteri², Brooke Chapman¹

¹Nutrition & Dietetics, Austin Health, Heidelberg, Victoria, Australia

²Austin Health, Heidelberg, Victoria, Australia

Aims: Malnutrition is highly prevalent in patients with oesophago-gastric cancer and contributes to adverse peri- and postoperative outcomes. Prehabilitation including early, tailored nutrition interventions may improve clinical outcomes. We aim to describe changes in nutritional and muscle parameters in patients undergoing a multidisciplinary prehabilitation program prior to oesophago-gastric surgery.

Methods: Patients were provided with a comprehensive program encompassing nutrition, physical and psychological optimisation and followed prospectively until surgery. Nutrition and muscle parameters were assessed via Patient Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), triceps skinfold (TSF) and calf circumference (CC). Targeted nutrition interventions aimed to meet patient's measured resting metabolic rate as measured by indirect calorimetry.

Results: Ten patients have completed prehabilitation (90% male, mean age 63.8 ± 6.7 years). Nutritional status improved significantly from 40% malnourished at baseline to 10% malnourished at surgery (p = 0.03), with a non-significant trend (p = 0.08) towards improved nutrition impact scoring on PG-SGA during the period of prehabilitation (mean 8.2 ± 5.7 at baseline vs. 3.3 ± 2.5 at surgery), with a large effect found (d = 1.1 95% CI: [1.67–3.52]). Dietary energy and protein intake improved significantly following dietetic intervention, from 6.5 ± 2.2 MJ and 63.1± 24 g protein to 9.2 ± 1.4 and 93.1 ± 19 g protein (both p < 0.005); equivalent to 94% of individual's measured metabolic rate and 100% of estimated protein requirements. Anthropometric improvements were seen in TSF (9.9 ± 6.1 to 11.4 ± 6.4 mm p = 0.04) and CC (36.2 ± 2.5 to 38.0 ± 3.1 cm p = 0.001). Non-significant improvements in HGS were seen (31.5 ± 6.12 to 34.3 ± 8.6 p = 0.27) with a small to medium effect size found (d = .37 95% CI: [3.8–5.6]).

Conclusions: Preliminary data shows that prehabilitation improves dietary intake, nutritional status and anthropometric parameters in patients undergoing oesophago-gastric cancer surgery. Future research will focus on replicating these results in a larger sample and observing the impact on postoperative patient and clinical outcomes.

Cian Casey, Bernard Hanekon, Rupert Hodder, Andrew Coveney, Daniel Wong, Chloe Price

Sir Charles Gairdener Hospital, Subiaco, WA, Australia

Retroperitoneal sarcomas are a rare family of soft tissue cancers, many subtypes behave very aggressively with high mortality rates. Management of retroperitoneal sarcomas requires complex surgery with a high degree of morbidity, accurate pre-operative tissue diagnosis greatly aids management.

Western Australia's State Sarcoma Unit is located at Sir Charles Gairdener Hospital, it is the single institution within the state for managing soft tissue sarcomas. Increasingly, utilisation of PET/CT has been employed to guide percutaneous biopsies, assisting in operative planning. The use of PET/CT with respect to retroperitoneal sarcomas has not been fully elucidated. There is a moderate body of evidence to suggest that increasing SUVmax correlates with more aggressive subtypes. PET/CT guided biopsies may prove most useful in Leiomyosarcomas which often have both well differentiated and dedifferentiated components. Use of PET/CT allows targeting of ‘hot areas’ which are more likely to reflect dedifferentiated components.^1–3 There is limited research to suggest that PET/CT guided biopsy may offer improved diagnostic yield when compared to conventional CT or ultrasound guided biopsy.⁴

Hollie Bailey¹, Cameron Forshaw¹, Felicity Casey², Rachel S Newson², Helen Burlison¹, Tom Brown¹, Dusha Jeyakumaran²

¹Adelphi Real World, Bollington, UK

²Eli Lilly and company, Sydney, NSW, Australia

Aims: Investigate characteristics, testing patterns and first-line treatment (1L) in patients with RET fusion-positive (RET+) advanced non-small cell lung cancer (Ansclc) in Australia.

Methods: Real-world data were collected from the Adelphi NSCLC Disease Specific Programme, a cross-sectional survey of 30 oncologists/pulmonologists and their patients with Ansclc, conducted during December 2022–June 2023. Physicians provided information on their next eight consulting Ansclc patients; six at random and two specifically RET+ [oversample].

Results: Data on 240 patients were collected; 193 random sample patients and 47 oversample patients. Within the random sample, 37% (n = 71) had their RET fusion status known at advanced diagnosis (Adx), and n = 1 identified as RET+. Of all RET+ patients at Adx (n = 47), mean (SD) age was 59.0 (12.9), 49% were males and 81% had an ECOG score of 0–1 at initiation of 1L treatment. Almost all RET+ patients (96%) had adenocarcinoma histology. RET – patients at Adx were mostly males (54%), 69% had an ECOG score of 0–1 and 81% had adenocarcinoma.

RET fusion status was primarily determined via Next-Generation Sequencing (NGS) (76%), with most samples collected by core needle biopsy (85%). RET results were received prior to 1L treatment for 85% of RET+ patients. Of all RET+ patients who were tested for PD-L1 (n = 46), 57% had 1%–49% expression and 17% had ≥50% expression.

The most common 1L regimen in the full Ansclc sample was carboplatin + pemetrexed + pembrolizumab (23%) followed by pembrolizumab monotherapy (18%), whilst in the RET+ cohort selpercatinib was an equally prescribed 1L treatment to carboplatin + pemetrexed + pembrolizumab (both 26%).

Conclusion: This real-world study documented that RET testing at Adx is still not commonplace for patients. Where testing occurs, it is primarily through NGS and chemoimmunotherapy is predominantly used as 1L treatment. This highlights the need for increased RET testing at Adx and availability of RET selected therapies to improve patient outcomes.

David Chen^1,2,3

¹Surgical Outcomes Research Centre (SouRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia

²Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

³School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Introduction: Currently in Australia, all hepatobiliary malignancies have a relative post-diagnosis 1-year survival below 50%. Consequently, 1 month represents a significant proportion of the relative survival. Days Alive and At Home within 30 Days post-surgery (DAH₃₀) is a novel composite outcome metric which accurately maps the perioperative period, where a lower score represents less time at home. This study aims to analyse perioperative factors relative to DAH₃₀ in hepatobiliary cancer patients.

Methods: This was a retrospective, population-based cohort study. A sample of 498 consecutive adult patients undergoing hepatobiliary oncology surgery at Royal Prince Alfred Hospital and Chris O'Brien Lifehouse between 2016 and 2022 were included. Predictors were identified from literature and expert opinion, including patient characteristics and surgical outcomes. Following calculation of DAH₃₀ score, zero-augmented regression was utilised to identify significant (p < 0.05) predictors of DAH₃₀.

Results: The median (IQR) age was 61 (52–70), and 317 (63.7%) of patients were men; median DAH₃₀ was 22 (13–24). Univariate analysis identified 19 predictors significantly associated with DAH₃₀. Subsequently, multivariable modelling identified that surgical approach, number of ICU admissions, sepsis influenced all DAH_30[0–30] scores. BMI, Charlson comorbidity index and ‘other’ complications influenced DAH_30[0] scores of 0, while operation time, presence of any complication, especially wound, gastrointestinal and cardiovascular complications, and Clavien–Dindo classification influenced non-zero DAH_30[1–30] scores. Wound complications had the largest negative impact on DAH_30[1–30] (IRR = .77, 95%CI: [.66, .89]), and number of ICU admissions had the largest impact on DAH_30[0] (OR = 7.96, 95%CI: [1.90, 33.34]).

Conclusion: This study identified 12 perioperative predictors significantly associated with DAH₃₀, which can be used to improve patient-centred care. Anthropometric factors can be optimised with prehabilitation; increased and early postoperative monitoring for complications can likely reduce complication development and severity. While some predictors are non-modifiable, they can still be considered when evaluating the utility of clinical guidelines or biomedical developments.

Kar Ven Cavan Chow^1,2, Ciara Conduit^3,4, Anna Kuchel^1,2, Shirley Wong⁵, Peter Grimison⁶, Andrew Weickhardt⁷, Ganes Pranavan⁸, James Lynam⁹, Patricia Bastick¹⁰, Jeffrey Goh², Shomik Sengupta¹¹, Annabel Smith¹², Elizabeth Liow¹³, David Campbell¹⁴, Ming Wong¹⁵, Kristina Zlatic⁴, Sophie O'Haire⁴, Peter Gibbs⁴, Ben Tran^3,4, Chun Loo Gan³

¹School of Medicine, The University of Queensland, Brisbane, Queensland, Australia

²Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

³Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁴Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia

⁵Western Health, Albans, Victoria, Australia

⁶Chris O'Brien Lifehouse, Camperdown, NSW, Australia

⁷Olivia Newton-John Cancer Wellness & Research Centre, Heidelberg, Victoria, Australia

⁸Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia

⁹Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia

¹⁰Southside Cancer Care, Miranda, NSW, Australia

¹¹Eastern Health and Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia

¹²Ashford Cancer Centre (ICON), Kurralta Park, South Australia, Australia

¹³Monash Health, Clayton, Victoria, Australia

¹⁴Barwon Health, Geelong, Victoria, Australia

¹⁵St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia

Aim: To evaluate the real-world treatment patterns and outcomes for patients with extra-cranial, extra-gonadal germ cell tumours (EGCT).

Methods: This retrospective audit included patients with EGCT within the iTestis database since its conception in 2018. Demographics, clinicopathologic features, treatment characteristics and outcomes were recorded. Data was analysed using descriptive statistics and Kaplan–Meier method for overall survival (OS).

Results: Thirty-three patients were included, comprising 3% of the iTestis registry (n = 1256). Primary sites of disease included mediastinal (n = 18/33, 55%), retroperitoneal (n = 14/33, 42%) and other (n = 1/33, 3%). Histological classification was non-seminoma in 21 patients (64%) and pure seminoma in 12 patients (36%). Based on the IGCCCG risk classification, 14 (42%), 4 (12%) and 15 patients (46%) had good, intermediate and poor risk disease, respectively. Median age was 31 years (range 18–64) and 26/33 patients (78.8%) had an ECOG of 0–1.

Initial treatment was chemotherapy in 27 patients (82%), surgery in two patients (6%) and unknown in four patients (12%). Of those receiving chemotherapy, the most common was BEP (n = 20/27, 74%), followed by VIP (n = 5/27, 19%) and EP (n = 2/27, 7%). Following chemotherapy, residual mass was present in 19/27 patients (70%) and surgery was conducted in 16 patients. 9/27 patients received second-line chemotherapy, most commonly TIP (n = 4/9, 44%), followed by one patient each for BEP, EP, VIP, high-dose chemotherapy and other.

Mediastinal tumours had a numerically lower 12-month OS (79.8%), with the poorest outcomes observed for non-seminomas (70.7%) compared to seminomas (100%). Twelve-month OS for retroperitoneal tumours was 100% regardless of histology. Twelve-month OS for IGCCCG good, intermediate and poor risk were 100%, 100% and 79%, respectively.

Conclusion: Consistent with published literature, non-seminoma mediastinal primaries have poorer outcomes compared to retroperitoneal primaries or mediastinal seminomas. Complying with and identifying optimal treatment strategies and access to clinical trials are required to improve outcomes.

Udari Colombage^1,2, Sze-Ee Soh¹, Kuan-Yin Lin³, Jennifer Kruger⁴, Helena C. Frawley²

¹Physiotherapy, Monash University, Frankston, Victoria, Australia

²Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia

³Physical Therapy, National Taiwan University, Taiwan

⁴Auckland Bioengineering Institute, The University of Auckland, Auckland

Aim: This pre–post single cohort feasibility trial aimed to investigate the feasibility of recruiting into a pelvic floor muscle training (PFMT) program delivered via telehealth to treat urinary incontinence (UI) in women with breast cancer on aromatase inhibitors.

Methods: Fifty-four women with breast cancer underwent a 12-week PFMT program using an intra-vaginal pressure biofeedback device: femfit. The primary feasibility outcome was consent rate. Secondary outcomes included prevalence and burden of UI, as well as pelvic floor muscle (PFM) strength measured as intravaginal squeeze pressure. Differences in secondary outcomes pre- and post-intervention were compared using McNemar's and paired t-tests.

Results: The mean age of participants was 50 years (SD ± 7.3). This study had a consent rate of 100% (n = 55/55) and retention rate of 87% (n = 48/55). The mean attendance rate of supervised sessions with the physiotherapist was 96% (SD ± 3) and the mean adherence rate to the home exercise program was 76% (SD ± 11). All participants reported that they felt the program was beneficial and tailored to their needs. A significant increase in PFM strength was observed post-intervention (mean intravaginal squeeze pressure change 4.8 mmHg, 95% CI: 3.9, 5.5).

Conclusion: This study demonstrated that PFMT delivered via telehealth may be feasible and acceptable in women with breast cancer on aromatase inhibitors who experience UI. Further studies that are powered to detect differences in PF symptoms and PF muscle strength are required to confirm these results.

Sophia Frentzas^1,2, Tarek Meniawy³, Steven Kao⁴, Jermaine Coward⁵, Timothy Clay⁶, Nimit Singhal⁷, Allison Black⁸, Wen Xu⁹, Rajiv Kumar¹⁰, Young Joo Lee¹¹, Gyeong-Won Lee¹², Wangjun Liao¹³, Diansheng Zhong¹⁴, Her-Shyong Shiah¹⁵, Yuh-Min Chen¹⁶, Rang Gao¹⁷, Ruihua Wang¹⁸, Hao Zheng¹⁹, Wei Tan²⁰, EunKyung Cho²¹

¹Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia

²Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia

³Department of Medical Oncology, Linear Clinical Research and School of Medicine, University of Western Australia, Nedlands, WA, Australia

⁴Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁵Clinical Trials Unit, Icon Cancer Centre, Brisbane, QLD, Australia

⁶Department of Medical Oncology, St John of God Subiaco Hospital, Perth, WA, Australia

⁷Department of Medical Oncology, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia

⁸Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia

⁹Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia

¹⁰Department of Oncology, New Zealand Clinical Research, Christchurch, New Zealand

¹¹Division of Hemato-Oncology, National Cancer Center, Gyeonggi-do, South Korea

¹²Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea

¹³Department of Oncology, Nanfang Hospital of Southern Medical University, Guangzhou, China

¹⁴Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China

¹⁵Division of Hematology and Oncology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

¹⁶Department of Chest Medicine, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan

¹⁷Medical Oncology, BeiGene (Shanghai) Co., Ltd., Shanghai, China

¹⁸Clinical Development, BeiGene (Shanghai) Co., Ltd., Shanghai, China

¹⁹Biostatistics, BeiGene (USA) Co., Ltd., San Mateo, California, USA

²⁰Clinical Biomarkers, BeiGene (Shanghai) Co., Ltd., Shanghai, China

²¹Division of Oncology, Department of Internal Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea

Aims: T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domains (TIGIT) inhibitor with an anti-programmed cell death protein 1 (PD-1) antibody has shown promising antitumour activity in solid tumours. Phase 1/1b open-label study AdvanTIG-105 (NCT04047862) assessed safety and preliminary antitumour activity of anti-TIGIT monoclonal antibody (mAb) ociperlimab + anti-PD-1 mAb tislelizumab in patients with advanced solid tumours. During dose-escalation, ociperlimab + tislelizumab was well tolerated, showing antitumour activity, establishing the recommended phase 2 dose (RP2D) of ociperlimab 900 mg IV Q3W + tislelizumab 200 mg IV Q3W. Here, we report cohort 5 dose-expansion results.

Methods: Eligible adults had histologically/cytologically confirmed locally advanced or metastatic CPI-experienced NSCLC for which they received ≤2 prior therapies, including anti-PD-(L)1 in the most recent line, and progressed after complete or partial response or stable disease. Patients received RP2D ociperlimab + tislelizumab until disease progression, intolerable toxicity or withdrawal of consent. Primary endpoint was investigator-assessed objective response rate (ORR) per RECIST v1.1. Secondary endpoints included disease control rate (DCR), duration of response (DOR) and safety.

Results: As of 20 June 2022, 26 patients were enrolled; 25 were efficacy-evaluable. Median study follow-up was 46.1 weeks (range, 25.4–59.0). Confirmed ORR was 8.0% (95% CI: 1.0–26.0), with two patients experiencing partial response. Confirmed DCR was 56.0% (95% CI: 34.9–75.6); median DOR was not reached. Overall, 23 patients (88.5%) experienced ≥1 treatment-emergent adverse event (TEAE), 11 patients (42.3%) experienced Grade ≥ 3 TEAEs and nine patients (34.6%) experienced serious TEAEs. The most common TEAEs were fatigue (30.8%) and cough (26.9%). TEAEs leading to treatment discontinuation occurred in four patients (15.4%), of which two were related to treatment; no TEAEs led to death.

Conclusions: Ociperlimab 900 mg + tislelizumab 200 mg was generally well-tolerated and showed preliminary antitumour activity in patients with locally advanced/metastatic CPI-experienced NSCLC.

Kate Crombie^1,2, Stephen Kunz³, Liam Johnson^1,4, Jamiee Caic⁵, Brooke Chapman⁵, Ronald Ma⁶, Carlene Wilson², Grace Williams², Laurence Weinberg⁷, Marissa Ferguson⁷, Celia Lanteri⁸, Danny Brazzale⁸, Amanda Dalyell³, Kat Hall^7,9, Linda Watson³, Ahmad Aly³, Darren Wong¹⁰, David Liu^7,9,11, Ashley Bigaran^2,9

¹School of Behavioural Sciences, Australian Catholic University, Melbourne, Victoria, Australia

²Wellness and Supportive Care, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia

³Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria, Australia

⁴School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

⁵Department of Nutrition and Dietetics, Austin Health, Melbourne, Victoria, Australia

⁶Health Information Systems, Austin Health, Melbourne, Victoria, Australia

⁷Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria, Australia

⁸Department of Respiratory Medicine, Austin Health, Melbourne, Victoria, Australia

⁹Department of Surgery, Austin Precinct, The University of Melbourne, Melbourne, Victoria, Australia

¹⁰Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia

¹¹Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: Complications following oesophago-gastric cancer surgery are a frequent occurrence. Baseline comorbidities and reduced cardiorespiratory fitness and physical function increase rates of postoperative complications. Oesophago-gastric cancer patients undergoing prehabilitation, including exercise training (EXT), experience improved cardiorespiratory fitness and physical functioning; however, whether EXT reduces complication rates is unknown. We investigated the effect of EXT on postoperative complication rates and other surgical and physical outcomes in adults preparing for oesophago-gastric cancer surgery.

Methods: A single-centre comparative retrospective and prospective study recruited patients with oesophago-gastric cancer with or without neoadjuvant chemotherapy/radiotherapy into an EXT program. Participants were compared against their baseline data and to a set of historical controls who did not undergo prehabilitation from 2016 to 2021 (HC, n = 287). EXT was performed twice weekly for 3 months at moderate to vigorous exercise intensities. Postoperative surgical outcomes included respiratory and cardiac complication rates, days in ICU, textbook outcomes, postoperative length of stay, complication grade and 30-day hospital stay. Physical outcomes assessed at baseline and prior to surgery included cardiorespiratory fitness (peak oxygen uptake, 6-min walk test) and physical function measures (sit-to-stand, grip strength).

Results: Twenty-one participants completed prehabilitation (81% male, age 66.5 + 10.2 years). EXT reduced cardiac complication rates (HC 29% vs. EXT 5%, p = 0.01), days in ICU (3.5 + 4.0 vs. 1.9 + 2.4 days, p < 0.001) and improved textbook outcomes (19% vs. 43%, p = 0.02), compared with HC. No differences in other surgical outcomes (all, p > 0.05) were detected between EXT and HC. Compared with baseline, no differences were detected in physical outcomes; however, trivial to medium effects (Cohen's d = .02—.58) were observed in favour of the EXT.

Conclusion: Preliminary data suggests that EXT reduces postoperative complications following oesophago-gastric cancer surgery compared to HC. However, further research is needed to explore the impact of prehabilitation on postoperative outcomes in larger sample sizes to confirm these initial findings.

Ieta D ’ Costa¹, Mandy Truong², Lynette Russell³, Karen Adams¹

¹Faculty of Medicine, Nursing and Allied Health, Monash University, Melbourne, Victoria, Australia

²Monash University, Clayton, Melbourne, Victoria, Australia

³Indigenous Studies, History, Monash University, Melbourne, Victoria, Australia

Background: Racism contributes to inequities faced by people of colour and minority groups.^1,2 While there is widespread recognition of this, programmes to combat it have not made much impact.^2,3 Research in racism in healthcare has concentrated on personal experiences of healthcare workers and patients,^3,4 assuming that racism and the concept of race are similarly understood by all. However, ethnicity and race are often conflated and racism seen as primarily interpersonal and ahistorical.

Purpose: To explore healthcare workers perceptions of racism, its impact and reduction to aid development of anti-racist strategies.

Methods: Forty-nine staff within one Australian hospital participated in individual qualitative interviews regarding the definition, impact and ways of reducing racism. Interviews were analysed with a reflexive thematic analytic approach using a Postcolonial framework.

Results: There was unanimous agreement that racism was experienced by minority groups, people of colour and Aboriginal peoples in Australia with a detrimental effect on health and wellbeing. There was uncertainty for some as to what constituted ‘actual racism’ – it was commonly thought of as individual prejudice though structural racism was also noted. Participants commonly defined race as involving physical or cultural differences, suggesting that discredited historical and colonial concepts of race continue in Australian society.

Racism was not described as an ideology created to justify colonial distribution of power and resources. While many felt that education was the best way to reduce racism and its impact, it was noted that being educated did not necessarily change racist behaviour.

Bianka D ’ souza¹, John R Zalcberg¹, Ahmad Aga², Sumitra Ananda^3,4, Khashayar Asadi⁵, Peter Bairstow¹, Robert Blum⁶, Alex Boussioutas⁷, Stephen Brown⁸, Wendy Brown⁷, Richard Chen⁹, Cuong Duong⁴, Stephen Fox⁴, Marnie Graco⁵, Hugh Greene¹, Chris Hair¹⁰, Sayed Hassen¹¹, Andrew Haydon⁷, Michael Hii¹², Harpreet Kaur¹, Lara Lipton⁹, Sim Yee Ong¹¹, Cameron Snell⁴, Peter Tagkalidis^7,13,14, Bassam Tawfik¹⁵, Stefan Uzelac¹, Sharon Wallace¹⁶, Rachel Wong¹¹, Liane Ioannou¹

¹Monash University, Melbourne, Victoria, Australia

²Melbourne Pathology, Melbourne, Victoria, Australia

³Epworth HealthCare, Melbourne, Victoria, Australia

⁴Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁵Austin Health, Melbourne, Victoria, Australia

⁶Bendigo Health, Bendigo, Victoria, Australia

⁷Alfred Health, Melbourne, Victoria, Australia

⁸Grampians Health, Ballarat, Victoria, Australia

⁹Cabrini Health, Melbourne, Victoria, Australia

¹⁰Epworth HealthCare, Geelong, Victoria, Australia

¹¹Eastern Health, Melbourne, Victoria, Australia

¹²St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia

¹³Melbourne Health, Melbourne, Victoria, Australia

¹⁴Western Health, Melbourne, Victoria, Australia

¹⁵Melbourne Pathology, Geelong, Victoria, Australia

¹⁶Dorevitch Pathology, Ballarat, Victoria, Australia

Despite evidence-based guidelines stating that testing for HER2 status should be performed in all patients with advanced or recurrent gastric cancer, and that such testing should be in accordance with standardised diagnostic and pathological testing algorithms, there is a need to better understand this in practice to enable equity in patient outcomes.

The HER2 Project aims to determine the extent to which tumours from patients with advanced or recurrent gastric cancer across major centres in Victoria are being adequately assessed for overexpression and/or amplification of HER2; and to determine the extent that standardised testing algorithms are being used to test for HER2 status.

This is a retrospective cohort study that will be split into three phases: Phase I – Data Extraction, Phase II – Pathology Review and Phase III – Qualitative Sub-study. For Phase I and II, this project plans to leverage data collected for the Upper Gastrointestinal Cancer Registry (UGICR) to understand current practices of testing for HER2 status in patients with advanced gastric cancer across twelve hospitals in Victoria. For Phase III, stakeholders involved the various stages of HER2 testing will be invited to participate in structured interviews, to better understand current practice in Australia.

This mixed methods approach incorporating clinical quality registry data may provide us with insight into current HER2 testing practices in Australia, as well as suggestions for how to improve future testing standards. The implication of any failure to correctly diagnose HER2 positive tumours is that these patients may miss the opportunity to receive targeted drug therapy, which is known to improve response to treatment as well as prolong overall survival.

Daphne Day¹, Arlene Chan², Phuong Dinh³, Michael Slancar⁴, Vinod Ganju⁵, Nicole McCarthy⁶, Janine Lombard⁷, Demiana Faltaos⁸, Mark Shilkrut⁹, Rosalind Wilson¹⁰, Caitlin Murphy¹¹

¹Monash Health, Monash University, Clayton, VIC, Australia

²Breast Cancer Research Centre, Curtin University, Breast Clinical Trials Unit, Hollywood Private Hospital, Nedlands, WA, Australia

³Crown Princess Mary Cancer Care Centre, Westmead, NSW, Australia

⁴ICON Cancer Centre, Southport, QLD, Australia

⁵Pininsula & South Eastern Haematology and Oncology Group, Frankston, VIC, Australia

⁶ICON Cancer Centre Wesley, Auchenflower, QLD, Australia

⁷Calvary Mater Newcastle, Waratah, NSW, Australia

⁸Clinical Pharmacology, Olema Oncology, San Francisco, California, USA

⁹Clinical Development, Olema Oncology, San Francisco, California, USA

¹⁰Clinical Science, Olema Oncology, San Francisco, California, USA

¹¹Cancer Services Trial Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia

Background: OP-1250 is small molecule CERAN/SERD that binds to and completely blocks transcriptional activity of wild-type and mutant ER. OP-1250 was well tolerated in a phase ½ monotherapy study (OP-1250-001), and the recommended phase 2 dose is 120 mg once a day (qd). OP-1250 with palbociclib showed synergistic activity in preclinical models. Here, we report updates of pharmacokinetics (PK), drug–drug interactions (DDI), safety and efficacy from a study of OP-1250 with palbociclib (OP-1250-002).

Methods: Pts with advanced or MBC with progression on or after ≤1 line of endocrine therapy (prior CDK4/6 inhibitors and chemotherapy were allowed) were enrolled into sequential cohorts to receive escalating doses of OP-1250 PO qd with palbociclib 125 mg PO qd for 21 of 28 days, using a 3 + 3 design, followed by dose expansion.

Results: As of 23 January 2023, 20 pts have been treated with palbociclib and OP-1250 doses of 30/60/90/120 mg (n = 3/3/3/11). Fourteen received prior CDK4/6 inhibitor; 11 received prior palbociclib. No DLTs occurred. The most common (≥4 pts) treatment emergent adverse events (Aes) were neutropenia, nausea, vomiting, anaemia, gastroesophageal reflux, constipation and thrombocytopenia (all were Grade 1–2, except neutropenia). Grade 3 neutropenia occurred in 11 pts (55%). No Grade 4 Aes occurred. The exposure of OP-1250 (n = 18) was consistent with the monotherapy study. Palbociclib exposure at steady state was comparable to published monotherapy data when combined with OP-1250 at all dose levels tested. Anti-tumour activity has been observed including partial responses.

Conclusions: OP-1250 did not affect palbociclib PK and no DDIs have been observed with this combination. OP-1250 and palbociclib combination was well tolerated, safety was consistent with individual profiles of each drug as a monotherapy. Tumour responses were observed in this heavily pretreated population. Expanding on our previous report (SABCS 2022), these data provide rationale to continue exploring OP-1250 with the approved dose of palbociclib (NCT0526610).

Jayesh Desai¹, Diwakar Davar², Sanjeev Deva³, Bo Gao⁴, Tianshu Liu⁵, Marco Matos^6,7,8,9, Tarek Meniawy¹⁰, Ken J O'Byrne¹¹, Meili Sun¹², Mark Voskoboynik¹³, Kunyu Yang¹⁴, Xinmin Yu¹⁵, Xin Chen¹⁶, Yan Dong¹⁷, Hugh Giovinazzo¹⁸, Shiangjiin Leaw¹⁹, Deepa Patel¹⁶, Tahmina Rahman¹⁸, Yanjie Wu¹⁹, Daphne Day^20,21

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA

³Auckland Cancer Trials Centre, Auckland City Hospital/University of Auckland, Auckland, New Zealand

⁴Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia

⁵Affiliated Zhongshan Hospital of Fudan University, Shanghai, China

⁶Pindara Private Hospital, Benowa, QLD, Australia

⁷Medical Oncology Group of Australia, Sydney, NSW, Australia

⁸Australian Medical Council, Canberra, ACT, Australia

⁹Medical Board of Queensland, Brisbane, QLD, Australia

¹⁰Linear Cancer Research and University of Western Australia, Nedlands, WA, Australia

¹¹Princess Alexandra Hospital and Queensland University of Technology, Brisbane, QLD, Australia

¹²Jinan Central Hospital, Shandong University, Central Hospital Affiliated to Shandong First Medical University, Shandong, China

¹³Nucleus Network and Monash University, Melbourne, VIC, Australia

¹⁴Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

¹⁵Zhejiang Cancer Hospital, Hangzhou, China

¹⁶BeiGene USA, Inc., Ridgefield Park, New Jersey, USA

¹⁷BeiGene USA, Inc., Cambridge, Massachusetts, USA

¹⁸BeiGene USA, Inc., San Mateo, California, USA

¹⁹BeiGene (Shanghai) Co., Ltd., Shanghai, China

²⁰Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia

²¹Faculty of Medicine, Monash University, Melbourne, VIC, Australia

Background: OX40 is an immune costimulatory receptor, expressed on activated CD4⁺/CD8⁺ T cells, which promotes T-cell proliferation/survival in the tumour microenvironment. BGB-A445, a novel mAb OX40 agonist, does not compete with endogenous OX40 ligand-binding. In preclinical studies, BGB-A445 demonstrated antitumour activity as monotherapy ± anti-PD-1 mAb. We report data from the ongoing dose-escalation part of a multicentre, ph1 dose-escalation/expansion study (NCT04215978) of BGB-A445 ± tislelizumab in patients with advanced solid tumours.

Methods: Eligible patients were enrolled into seven dose-escalation cohorts of BGB-A445 IV as monotherapy (Part A) or five dose levels of BGB-A445 IV + tislelizumab 200 mg IV (Part B) on Day 1 of 21-day cycles. Dose-escalation was guided by a Bayesian (Mtpi-2) approach. Endpoints: safety/tolerability, pharmacokinetics (PK) and preliminary antitumour activity (RECIST v1.1).

Results: As of 31 August 2022, 59 patients enrolled in Part A and 32 in Part B. In Parts A and B, Grade ≥3 treatment-emergent Aes (TEAEs) were reported in 24 (41%) and 17 (53%) patients, respectively; the most reported (≥3 reported) were diarrhoea, nausea and abdominal pain. Serious TEAEs were reported in 23 (39%) patients in Part A and 16 (50%) in Part B. Treatment-related Aes leading to treatment discontinuation occurred in one patient (Part A). No patients reported Grade ≥3 imAEs in Part A versus one patient in Part B. No DLTs were observed. In the efficacy-evaluable population (Part A, n = 50; Part B, n = 30), PR was observed in two (4%) patients (unconfirmed) and seven (23%) patients (confirmed), SD in 18 (36%) and 13 (43%) patients (confirmed), and PD in 26 (52%) and 8 (27%) patients, respectively.

Conclusions: BGB-A445 ± tislelizumab was well-tolerated across all doses in patients with advanced solid tumours and demonstrated preliminary antitumour activity. The dose-expansion part is ongoing in patients with NSCLC and HNSCC.

Georgia De ’ Ambrosis¹, Brian De'Ambrosis², Angus Collins³

¹Queensland Health – Gold Coast University Hospital, Southport, QLD, Australia

²South East Dermatology, Brisbane, QLD, Australia

³Sullivan Nicolaides, Brisbane, QLD, Australia

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is a relatively uncommon type of malignant tumour which falls under the category of extranodal B-cell non-Hodgkin lymphoma. Lesions typically occur on the trunk and upper extremities, and most commonly affect Black individuals. On histology, PCMZL characteristically presents as a dermal lymphoid infiltration, which either has a diffuse or nodular pattern.

We present a case of a 38-year-old male who presented with a nodule on his medial left cheek. The nodule grew rapidly over a period of 2 weeks, after which it ceased growing and remained asymptomatic until he presented to the dermatologist roughly 6 months later. The dermatologist performed a shave biopsy measuring 8 × 6 × 3 mm. Histology showed a diffuse lymphocytic infiltrate within the dermis, which also contained a large number of plasma cells and scattered histocytes as well as follicular plugging. Immunoperoxidase studies were subsequently performed to elucidate the nature of the infiltrate, which were consistent with a marginal zone lymphoma with plasmocytic differentiation and colonisation of follicles.

Upon diagnosis, the dermatologist referred the patient to a medical oncologist. PET-CT showed no evidence of distant disease, and the patient returned to the dermatologist 2 months later for excision of the lesion. The lesion was considered excised on histology, however there was evidence of cells approaching the 12 and 6 o'clock margins. One month later, there were no signs of recurrence, and the defect was healing well. However, 4 months later a recurrent plaque developed over the same location. Repeat PET-CT was performed through oncology, which demonstrated localised disease with no evidence of distant spread. The patient was subsequently referred to a radiation oncologist for radiotherapy for treatment of the recurrent disease. This case will discuss the pathology findings of PCMZL, and the management and surveillance of the condition.

Christine Dijkstra¹, Tharani Sivakumaran^1,2, Krista Fisher³, Huiling Xu^4,5, Trista Koproski³, Matthew White¹, Eveline Niedermayr³, Wendy Ip^4,6, Hui Li Wong^1,2, Andrew Fellowes⁵, Penny Schofield⁷, Richard Rebello^4,6, David Bowtell⁸, Richard Tothill^1,4,6, Linda Mileshkin^1,2

¹Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia

³Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Department of Clinical Pathology, The University of Melbourne, Melbourne, VIC, Australia

⁵Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁶University of Melbourne Centre for Cancer Research, The University of Melbourne, Melbourne, VIC, Australia

⁷Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia

⁸Cancer Genetics & Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aims: Cancer of unknown primary (CUP) describes a heterogenous collection of metastatic malignancies without an identifiable primary site despite standardised clinical investigation. Evidence to guide diagnosis, molecular therapeutics and treatment, and supportive care for CUP patients is lacking. SUPER is a national prospective cohort study initiated to address these information gaps by (1) describing the clinical, quality of life and psychosocial characteristics of a CUP cohort, and (2) establishing a biobank/databank resource of CUP.

Methods: CUP patients were recruited to SUPER from 12 participating sites across Australia (2013–2021) over three phases. Project management was co-ordinated between Peter MacCallum Cancer Centre and the University of Melbourne and testing was also done by two independent labs at these centres. Clinical and patient reported outcome data was collected over 12 months. Patient samples underwent mutational profiling and tissue-of-origin prediction by molecular profiling. Results were discussed in a molecular tumour board (MTB). Clinical management questionnaires were completed before and after receiving molecular results.

Conclusions: Over three phases, data collection and management became digitised enabling greater flexibility and streamlined tracking of samples. The testing success rate increased, and more comprehensive molecular profiling was done. More information was returned to treating clinicians with a reduced turn-around-time.

Hayley T Dillon^1,2, Nicholas J Saner², Tegan Ilsley^2,3, David Kliman⁴, Andrew Spencer⁴, Sharon Avery⁴, David W Dunstan^1,2, Robin M Daly¹, Steve F Fraser¹, Neville Owen^2,5, Brigid M Lynch^2,6,7, Bronwyn A Kingwell^2,8, André La Gerche²

¹Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia

²Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

³Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia

⁴Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Australia

⁵Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia

⁶Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

⁷Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

⁸CSL, Melbourne, VIC, Australia

Background: Allogeneic stem cell transplantation (allo-SCT) provides a potential cure for high-risk, recurrent, and refractory haematological cancers (HC). However, allo-SCT survivors experience significant treatment-induced exercise intolerance and associated cardiovascular mortality.

Purpose: We conducted a randomised controlled trial in HC patients scheduled for allo-SCT to determine if a 4-month multifaceted activity program could preserve peak oxygen uptake (V̇O_2peak) and its determinants.

Methods: Sixty-two HC patients scheduled for allo-SCT were randomised to usual care (UC; n = 32, 55 ± 15 years, 63% male) or the multifaceted activity program (Activity; n = 30, 50 ± 16 years, 60% male). Patients assigned to Activity completed thrice weekly aerobic and resistance exercise for 4-month and concurrently aimed to reduce sedentary time by 30-min/day via replacement with short (3-min), frequent (hourly), light-intensity activity. Cardiopulmonary exercise testing (CPET) was conducted prior to allo-SCT admission, and 12-weeks following discharge to assess V̇O_2peak, as well as peak power output (PPO), respiratory exchange ratio (RER) and heart rate (HR). Peak lactate was also assessed via finger prick capillary sample.

Results: Fifty patients completed follow-up (23 Activity; 27 UC), 96% of whom satisfied peak CPET criteria (22 Activity; 26 UC). Compared to UC, there was a significant treatment benefit for Activity on V̇O_2peak (net difference: 2.5 mL/kg/min [95% CI: .3, 4.8], p = 0.03) due to a 15% reduction in UC (−3.4 mL/kg/min [95% CI: −4.9, −1.8], p < 0.001) and no significant change in Activity (−.9 Ml/kg/min [95% CI: −2.5, .8], p = 0.31). Similarly, PPO declined less in Activity than UC (−11% vs. −24%; interaction, p = 0.03), while peak HR and lactate reduced similarly in Activity and UC (−9 vs. −7 beats/min, p = 0.75; −1.3 vs. −2.2 mmol/L; p = 0.22). Peak RER was unchanged in both groups.

Conclusion: A multifaceted activity program targeting exercise and sedentary behaviour is effective in attenuating allo-SCT-induced declines in V̇O_2peak. Whether these benefits on VO_2peak translate to reduced cardiovascular morbidity and greater longevity warrants investigation.

Pei Ding^1,2,3, Kevin Jasas⁴, Victoria Bray⁵, Abhijit Pal^6,7, Rebecca Moor^8,9

¹Westmead Hospital, Sydney, NSW, Australia

²Nepean Hospital, Sydney, NSW, Australia

³University of Sydney, Sydney, NSW, Australia

⁴Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia

⁵Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia

⁶Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia

⁷Ingham Institute of Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia

⁸University of Queensland, Brisbane, QLD, Australia

⁹Mater Cancer Care Centre, Mater Private Hospital Springfield, Brisbane, QLD, Australia

Aim: The Australian subset of the THASSOS-INTL (NCT04808050) study describes the demographics, clinical characteristics, treatment patterns and survival outcomes in patients with resected, early stage NSCLC.

Methods: This multicentre, retrospective study enrolled patients with clinical stage (CS) IA–IIIB resected NSCLC (AJCC 7th edition) diagnosed between 1 January 2013 and 31 December 2017 and followed for survival or disease recurrence/progression until death, last medical record or 31 December 2020 (data cut-off). Survival estimates were evaluated using Kaplan–Meier curves.

Results: Of 199 patients recruited (median [range] age, 67 [35–88] years), 107 (53.8%) were male and 174 (87.4%) were current/former smokers; 84 (42.2%) patients had CS-I, 56 (28.1%) CS-II and 59 (29.6%) CS-III. Predominant histological subtypes were adenocarcinoma (113 [56.7%]) and squamous cell carcinoma (64 [32.1%]); 111 (55.8%) had right lung involvement and 123 were (61.8%) Pn0. At index diagnosis, 9 (12%) had EGFR mutation out of 75 (37.7%) tested. PD-L1 expression was seen in 11 (57.8%) out of 19 (9.5%) tested. Overall, 105 (52.8%) patients had surgery only. A total of nine (4.5%) patients received neoadjuvant therapy (chemotherapy, 5 [2.5%], chemoradiotherapy, 4 [2.0%]) and 70 (35.2%) received adjuvant therapy (chemotherapy, 46 [23.1%], radiotherapy, 3 [1.5%] and chemoradiotherapy, 21 [10.6%]); 6 (3%) received both. Approximately 69.9% of patients survived ≥3 years across all stages with a median overall survival of 4.3 (.10–7.96) years: CS-I (4.7 [.29–7.96] years), CS-II (4.1 [.1–7.24] years) and CS-III (3.4 [.3–7.8] years). Disease recurrence/progression was seen in 89/191 (44.7%) (local: 23.6% [21/89], extra-thoracic: 43.8% [39/89]; CNS metastasis: 7.9% [14/89]) patients.

Conclusion: Our study showed that >50% of patients received only curative surgery thus mandating multidisciplinary management in accordance with the recent guidelines for neoadjuvant and adjuvant regimens. Although EGFR mutation rate of 12% is in line with previous studies, the low PDL-1 testing rate calls for improved biomarker work-up at diagnosis.

Study and medical writing sponsorship: AstraZeneca International

Legal entity responsible for the study: AstraZeneca International

Vicky Makker¹, Nicoletta Colombo², Antonio Casado Herraez³, Bradley J Monk⁴, Helen Mackay⁵, Alessandro D Santin⁶, David S Miller⁷, Richard Moore⁸, Sally Baron-Hay⁹, Isabelle Ray-Coquard¹⁰, Ronnie Shapira-Frommer¹¹, Kimio Ushijima¹², Kan Yonemori¹³, Yong Man Kim¹⁴, Eva M Guerra Alia¹⁵, Ulus A Sanli¹⁶, Jie Huang¹⁷, Jodi McKenzie¹⁷, Robert Orlowski¹⁸, Bas Ebaid¹⁹, Domenica Lorusso²⁰

¹Memorial Sloan-Kettering Cancer Center, New York, New York, USA

²University of Milan-Bicocca, European Institute of Oncology IRCCS, Milan, Italy

³Hospital Clinico Universitario San Carlos, Madrid, Spain

⁴HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, Arizona, USA

⁵Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

⁶Yale University School of Medicine, New Haven, Connecticut, USA

⁷University of Texas Southwestern Medical Center, Dallas, Texas, USA

⁸University of Rochester Medical Center, Rochester, New York, USA

⁹Royal North Shore Hospital, St Leonards, NSW, Australia

¹⁰Centre Léon Bérard, University Claude Bernard, GINECO Group, Lyon, France

¹¹Sheba Medical Center, Ramat, Israel

¹²Kurume University School of Medicine, Kurume, Japan

¹³National Cancer Center Hospital, Chuo-ku, Japan

¹⁴Asan Medical Center, University of Ulsan, Seoul, Republic of Korea

¹⁵Hospital Universitario Ramon y Cajal, Madrid, Spain

¹⁶Ege University, Izmir, Turkey

¹⁷Eisai Inc., Nutley, New Jersey, USA

¹⁸Merck & Co., Inc., Rahway, New Jersey, USA

¹⁹Eisai Australia Pty Ltd, Melbourne, Victoria, Australia

²⁰Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy

Aims: The ph3 Study 309/KEYNOTE-775 demonstrated statistically significant improvements in PFS, OS and ORR with LEN + pembro versus TPC in pts with Aec. We report updated Study 309/KEYNOTE-775 analyses.

Methods: Patients (pts) with Aec and one prior platinum-based chemotherapy regimen (up to 2 if 1 given in neoadjuvant/adjuvant setting) were randomised to LEN 20 mg orally QD + pembro 200 mg IV Q3W or TPC [doxorubicin 60 mg/m² IV Q3W or paclitaxel 80 mg/m² IV QW (3 weeks on; 1 week off)]. Randomisation was stratified by mismatch repair (MMR) status; pts with proficient (p)MMR tumours were further stratified by ECOG PS, geographic region and pelvic irradiation. We report final pre-specified OS, PFS and ORR (BICR per RECIST v1.1), and safety (data cutoff: 1 March 2022). Analyses are descriptive.

Results: A total of 827 Pts (Pmmr, n = 697; deficient MMR, n = 130) were randomised to LEN + pembro (n = 411) or TPC (n = 416). Median follow-up was 18.7 months (LEN + pembro) and 12.2 months (TPC). Median PFS (months) remained longer with LEN + pembro versus TPC in Pmmr Aec (6.7 vs. 3.8; HR: .60 [95% CI: .50—.72]) and in all-comers (7.3 vs. 3.8; HR: .56 [95% CI: .48–.66]). Median OS (months) remained longer with LEN + pembro versus TPC in pMMR aEC (18.0 vs. 12.2; HR: .70 [95% CI: .58—.83]) and in all-comers (18.7 vs. 11.9; HR: .65 [95% CI: .55–.77]), despite some pts in the TPC arm receiving subsequent LEN + pembro (pMMR, 10.0%; all-comers; 8.7%). ORR (95% CI) for LEN + pembro versus TPC was 32.4% (27.5–37.6) versus 15.1% (11.5–19.3) in pMMR pts and 33.8% (29.3–38.6) versus 14.7% (11.4–18.4) in all-comers. 90% of pts with LEN + pembro and 74% of pts with TPC had grade ≥3 TEAEs.

Conclusions: LEN + pembro continued to demonstrate improved efficacy versus TPC in pts with aEC who received prior platinum therapy. Safety was generally consistent with the primary analysis.

Previously presented at ESMO 2022, FPN: 525MO, V. Makker et al. Reused with permission.

Grace Butson¹, Lara Edbrooke^1,2, Hilmy Ismail¹, Linda Denehy^1,2

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²University of Melbourne, Melbourne, Victoria, Australia

Introduction: Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity; however, it is resource intensive and has limited availability. This study aimed to determine: (1) the association between the 6-min walk test (6MWT) and the 30-s sit-to-stand test (30STS) with CPET peak oxygen uptake (VO_2peak) and anaerobic threshold (AT) and (2) determine 6MWT and 30STS cut points associated with higher risk of postoperative complications.

Methods: A cross-sectional study, retrospectively analysing data collected from a tertiary cancer centre over a 23-month period. Measures included CPET VO_2peak and AT, 6MWT and 30STS test. Correlations were used to characterise relationships between variables. ROC analyses determined 6MWT and 30STS cut points that aligned with CPET variable cut points.

Results: A total of 156 participants were included. The 6MWT and 30STS displayed moderate correlations with VO_2peak, rho = .65, p = 0.01 and rho = .52, p < 0.005, respectively. Fair correlations were observed between AT and 6MWT (rho = .36, p = 0.01) and 30STS (rho = .41, p < 0.005). The optimal cut points to identify VO_2peak < 15 mL/kg/min were 493.5 m on the 6MWT and 12.5 stands on the 30STS test and for AT <11 mL/kg/min were 506.5 m on the 6MWT and 12.5 stands on the 30STS test.

Morgan J Farley¹, Kirsten N Adlard², Alex Boytar², Mia A Schaumberg³, David G Jenkins³, Tina L Skinner²

¹University of Technology Sydney, Moore Park, NSW, Australia

²School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia

³University of the Sunshine Coast, Maroochydore, QLD, Australia

Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth, respectively. In these investigations, the anti-oncogenic effects of exercise were associated with the exercise-mediated release of myokines [i.e. interleukin (IL)-6 and IL-15] (1, 2). However, no study has quantified the acute myokine response in human cancer survivors, or whether physiological adaptations to exercise training (i.e. body composition and cardiorespiratory fitness) influence the myokine response.

Aims: The aim of this study was to explore the acute myokine response to a bout of high-intensity interval exercise (HIIE) and examine the relationships with body composition and cardiorespiratory fitness before and after 7-months of high-intensity interval training (HIIT) in cancer survivors.

Methods: Breast, prostate and colorectal cancer survivors (n = 14) completed 7-months of HIIT. Blood was sampled immediately before and after an acute bout of HIIE at baseline, which was repeated following 7-months of training. Post-HIIE myokine responses (IL-15, IL-6, IL-10 and IL-1ra) were compared to body composition (dual-energy X-ray absorptiometry) and cardiorespiratory fitness (V̇O₂peak) at baseline and after 7-months of HIIT.

Results: An acute bout of HIIE increased (35%–100%) post-exercise concentrations of IL-15, IL-6, IL-10 and IL-1ra at baseline and after training (p < 0.05). There was no significant effect of training on the post-HIIE myokine response. Higher post-HIIE concentrations of myokines were positively associated with lean mass (p < 0.05), but not cardiorespiratory fitness, before and after HIIT. Increases in lean mass in response to HIIT were positively associated with post-HIIE myokine concentrations (r = .618–.867, p < 0.05).

Conclusion: High intensity interval exercise can significantly increase myokine concentrations in cancer survivors. The anti-inflammatory effect of exercise was mediated, at least in part, by lean mass. Exercise interventions that target improvements in lean mass may lead to superior myokine responses, which have been associated with the anti-oncogenic effect of exercise thus improving outcomes for survivors.

Frank Griesinger¹, Marina Garassino², Enriqueta Felip³, Hiroshi Sakai⁴, Xiuning Le⁵, Remi Veillon⁶, Egbert Smit⁷, Jo Raskin⁸, Michael Thomas⁹, Myung-Ju Ahn¹⁰, Soetkin Vlassak¹¹, Stephanie Gasking¹², Rolf Bruns¹³, Andreas Johne¹⁴, Paul K Paik¹⁵

¹Department of Hematology and Oncology, Pius-Hospital, University of Oldenburg, Oldenburg, Germany

²Department of Medicine, Section of Hematology/Oncology, Knapp Center for Biomedical Discovery, The University of Chicago, Illinois, USA

³Department of Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain

⁴Department of Thoracic Oncology, Ageo Central General Hospital, Ageo, Japan

⁵Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

⁶CHU Bordeaux, Service des Maladies Respiratoires, Bordeaux, France

⁷Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, The Netherlands

⁸Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital (UZA), Edegem, Belgium

⁹Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany

¹⁰Section of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

¹¹Global Medical Affairs, Merck N.V.-S.A., An Affiliate of Merck KGaA, Overijse, Belgium

¹²Medical Science Liaison, Merck Healthcare Pty. Ltd., An Affiliate of Merck KGaA, Macquarie Park, Australia

¹³Department of Biostatistics, Merck Healthcare KGaA, Darmstadt, Germany

¹⁴Global Clinical Development, Merck Healthcare KGaA, Darmstadt, Germany

¹⁵Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Background: Tepotinib is an MET TKI approved for METex14 skipping NSCLC. We report treatment sequencing prior/post-tepotinib of immunotherapy (IO), chemotherapy (CT) and METi (post only) in VISION (data cut-off: 20 February 2022).

Methods: Patients with advanced/metastatic METex14 skipping NSCLC received 500 mg (450 mg active moiety) tepotinib QD. Primary endpoint was objective response (RECIST 1.1) by IRC. Prior/post-tepotinib treatment was investigator's choice; outcomes were reported per investigator.

Results: Of 313 patients (median age 72), 164 were treatment-naïve (median age 74) and 149 pre-treated (median age 70.8). Among pre-treated patients, the most common 1L regimens prior to enrolling in VISION were platinum-CT without IO (58%), IO monotherapy (23%) and IO-CT (13%).

Across all those prior 1L regimens, median treatment duration was 4 months (IQR 1.8–7.3), with an ORR of 24.8%, mDOR of 6.0 months and mPFS of 4.0 months. 1L treatment outcomes with tepotinib were greatly improved (ORR, 56.1%; mDOR, 46.4 months; mPFS, 12.6 months).

Overall, 265 patients (84.7%) discontinued tepotinib; 124 patients (46.8%) received subsequent treatment. Forty-eight patients received subsequent METi (crizotinib, n = 20; capmatinib, n = 15; bozitinib, n = 4; tepotinib, n = 3; amivantamab, n = 3; cabozantinib, n = 3; other, n = 4; different METi in subsequent lines, n = 4). Thirty-one patients received subsequent METi immediately after tepotinib (1L, n = 11; 2L+, n = 20). BOR across all subsequent METi was 3 PR (all after a break in METi treatment), 11 SD; longest mDOR and mPFS were 4.0 and 2.5 months, respectively. Outcomes with subsequent CT/IO were comparable to prior CT/IO as well as those in literature.

Conclusions: Robust and durable efficacy, particularly in the 1L setting, support early use of tepotinib in the treatment sequence. Almost half of this elderly population received subsequent treatment, higher than the 20%–30% reported for 1L CT/IO IPSOS trial in elderly patients (median age 75). METi treatment sequencing analyses are ongoing.

Lucy Gately^1,2, Carlos Mesia³, Juan Manuel Sepúlveda⁴, Sonya del Barco⁵, Estela Pineda⁶, Regina Gironés⁷, José Fuster⁸, Wei Hong², Sanjeev Gill¹, Luis Miguel Navarro⁹, Ana Herrero¹⁰, Anthony Dowling¹¹, Ramón De La Peñas¹², Maria Angeles Vaz¹³, Miriam Alonso¹⁴, Zarnie Lwin¹⁵, Rosemary Harrup¹⁶, Sergio Peralta¹⁷, Peter Gibbs², Carmen Balana^18,19

¹Medical Oncology, Alfred Hospital, Melbourne, Australia

²Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

³Medical Oncology Service, Hospitalet de Llobregat, Barcelona, Spain

⁴Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain

⁵Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain

⁶Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain

⁷Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain

⁸Medical Oncology Service, Hospital Son Espases, Palma De Mallorca, Spain

⁹Medical Oncology Service, Hospital de Salamanca, Salamanca, Spain

¹⁰Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain

¹¹Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia

¹²Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain

¹³Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain

¹⁴Medical Oncology Service, Hospital Virgen del Rocio, Sevilla, Spain

¹⁵Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia

¹⁶Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia

¹⁷Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain

¹⁸Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain

¹⁹Applied Research Group in Oncology (B-ARGO), Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain

Introduction: The optimal duration of post-radiation temozolomide in newly diagnosed glioblastoma remains unclear. A combined analysis of two randomised trials, GEINO14-01 (Spain) and EX-TEM (Australia) studies, recently demonstrated no benefit from extending post-radiation temozolomide.

Objective: Here, we report a sub-group analysis of elderly patients (EP).

Methods: EP (aged 65 years and over) were identified in the combined dataset. Relevant intergroup statistics were used to identify differences in tumour, treatment and outcome characteristics based on age. Survival was estimated using the Kaplan–Meier method.

Results: Of the combined 205 patients, 57 (28%) were EP. 95% of EP were ECOG 0–1 and 65% underwent gross total resection compared with 97% and 61% of younger patients (YP), respectively. There were numerically less MGMT methylated (56% vs. 63%, p = 0.4) and IDH mutated (4% vs. 13%, p = −0.1) tumours in EP versus YP. At diagnosis, EP were more likely to receive short course radiotherapy (17.5% vs. 6%, p = 0.017), however per protocol completion was similar. At recurrence, there was a trend for EP to receive non-surgical options (96.2% vs. 84.6%, p = 0.06) or best supportive care (28.3% vs. 15.4%, p = 0.09). EP were less likely to receive bevacizumab at any time during treatment (23.1% vs. 49.5%, p = 0.0013). Median progression free survival was similar at 9.3 months in EP and 8.5 months in YP, with median overall survival being 20 months for both.

Conclusion: EP in these trials had similar baseline characteristics but received less aggressive therapy at diagnosis and recurrence. Despite this, survival remains similar compared to YP. Further examination into assessment of fitness in EP and utility of salvage therapies is required.

Priscilla Gates^1,2,3,4, Haryana M Dhillon⁵, Mei Krishnasamy^2,3, Carlene Wilson^6,7,8, Karla Gough^2,9

¹Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia

²Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

³Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁴Cognitive Neuroscience Lab, School of Psychology, Deakin University, Burwood, Victoria, Australia

⁵Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia

⁶School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia

⁷Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

⁸Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia

⁹Department of Health Services Research, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

Aim: Cancer-related cognitive impairment is a recognised adverse consequence of cancer and its treatment but there is little research including patients with aggressive lymphoma. The aim of this study is to describe self-reported cognitive function and neuropsychological performance in a lymphoma population and compare their function and performance with healthy controls. We also examine the associations between patients’ neuropsychological performance, cognitive function and distress.

Method: Secondary analysis of data from a longitudinal feasibility study of 30 patients with newly diagnosed aggressive lymphoma, and a cohort study that included 72 healthy controls was undertaken. Patients completed self-report measures and neuropsychological tests before and 6–8 weeks after chemotherapy, including the PROMIS Anxiety 7a/Depression 8b and FACT-Cog; and the Trail Making Test, Hopkins Verbal Learning Test and WAIS-R Digit Span. Healthy controls completed the FACT-Cog and neuropsychological tests at study enrolment and 6 months later. Mixed models were used to analyse FACT-Cog and neuropsychological test scores. Kendall's Tau provided a measure of association between global deficit scores and scores from other measures.

Results: Patients and healthy controls were well matched on key demographic variables. Most differences between patients’ and healthy controls’ neuropsychological test scores were large-sized; the performance of patients was worse both before and after chemotherapy (most p < 0.001). The same pattern of results was observed for the impact of perceived cognitive impairment on quality-of-life (both p < 0.001), but not perceived cognitive impairment or abilities (all p > 0.10). Associations between neuropsychological performance, self-reported cognitive function and distress were trivial to small-sized (all p > 0.10).

Conclusion: For many patients with aggressive lymphoma, impaired neuropsychological test performance and the impact of perceived impairments on quality-of-life precede chemotherapy and are sustained 6–8 weeks after chemotherapy. Our data support the need for further longitudinal studies in this population to inform development of targeted interventions to address cognitive impairment.

Lilian Gauld^1,2, Greg Kyle², Arjun Poudel², Helen Kastrissios², Lisa Nissen²

¹Sunshine Coast University Hospital, Birtinya, QLD, Australia

²Queensland University of Technology, Brisbane, QLD, Australia

Aims: To review evidence behind therapeutic use of granulocyte colony stimulating factor (GCSF) and investigate if real-world data on dose timing and neutrophil recovery is representative of simulation studies that report a potential for detrimental outcomes.

Methods: A retrospective medical records review in adult cancer patients undergoing parenteral chemotherapy, dosed within the 30 days preceding admission for chemotherapy induced febrile neutropenia (CIFN) was done. Only medical oncology diagnoses treated with a 21-day chemotherapy protocol were included. Fever was defined as ≥38.0°C and neutropenia as <1.0 × 10⁹/L. Data was analysed using descriptive and regression analyses. The research questions were, (i) Does the timing of therapeutic GCSF impact neutrophil recovery? (ii) Is the proposed relationship between monocyte and neutrophil count demonstrable in real-world practice? (iii) Do the factors in questions (i) and (ii) have an impact on length of stay?

Results: Of 100 admissions eligible for inclusion, 61 received therapeutic GCSF, 59 had complete data and were analysed. Incidences of worsened neutropenia were seen on initiation of GCSF therapy between days 8 and 21. Worsened monocyte count was seen on initiation of therapy between days 10 and 17. Neutrophil recovery and length of admissions were longer in participants who had initial drop in cell count on initiation of GCSF. The small sample size did not yield statistically significant outcomes for dose timing (p = 0.674, odds ratio 1.61 [95% CI .175, 14.809]) or monocyte count (p = 0.096, odds ratio .413 [95% CI .146, 1.169]) as predictors of neutrophil recovery. The plotted trends for both neutrophils and monocytes were longer cell count recovery with GCSF dosing between days 7 and 18 as has been reported in simulations.

Kazzem Gheybi¹, Vanessa Hayes¹, Riana Bornman², Weerachai Jaratlerdsiri¹, Shingai Mutambirwa³

¹University of Sydney, Camperdown, NSW, Australia

²School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa

³Department of Urology, Sefako Mekgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Medunsa, South Africa

Germline testing has recently become widespread for prostate cancer (PCa) to indicate precision treatment strategies and also provide further malignancy risk for patients and their relatives. The panels for germline testing, however, are solely designed based on studies on European ancestral patients, while African ancestry is a known risk factor for the advanced disease and mortality. We have recently shown that these panels are not ideal for detection of pathogenic variants in Black South African patients and there is a significant loss of sensitivity when compared with non-African populations (5.6% vs. 11%–17%), which concurs with previous, yet limited, African American and west African studies. As such, a whole genome approach is required to identify African-relevant pathogenic variants that may be contributing to the associated health disparity. Here, we interrogate whole genome data for 119 Black South African men diagnosed with a bias towards high-risk PCa. Of the 13.3 million single nucleotide variants (SNV) and 2.1 million Indels (insertion/deletions, <50 bp) identified, we found 104 (82 SNVs and 22 Indels) known pathogenic variants in 98 genes of which only BRCA2, ATM, RAD50, CHEK2 and TP53 are included in current PCa germline testing guidelines. Aware that current pathogenic variant databases have been derived from predominantly non-African patient data, after excluding for common and benign variants, we performed further functional (SIGT, PolyPhen2) and oncogenic (CGI) prediction identifying 399 potentially oncogenic variants with uncertain significance in 234 genes. Remarkably, while 94 of 119 patients (79.0%) presented with a known pathogenic variant, all patients presented with at least two potentially oncogenic variants with uncertain significance (mean = 6.31). Based on the frequency of impact, we generate a 40 gene African-relevant candidate panel, recommending clinical-trial studies to determine applicability to predict PCa risk and therapeutic implication. Ultimately, we provide the first available data for novel gene candidates for inclusion in PCa germline testing panels to allow for African inclusion.

Lee-att Green, Andrew Mant

Oncology, Eastern Health, Melbourne, VIC, Australia

Background: Adjuvant anti-PD1 immunotherapy for resected stage IIIB–IV melanoma significantly improves progression free survival (‘PFS’) and has been available in Australia in routine clinical practice since 2018.^1,2 Yet, no overall survival (‘OS’) benefit has been demonstrated and it can result in long-term toxicity, hospitalisation and prolonged steroid use.

We aimed to assess real world efficacy, toxicity, hospitalisation rates and steroid use in melanoma patients treated with adjuvant immunotherapy.

Methods: This is a retrospective audit of patients treated with adjuvant immunotherapy for resected stage IIIB–IV melanoma between May 2018 and 2023 at Eastern Health, Melbourne. Patient demographics, disease characteristics, treatment details, toxicity outcomes (including hospitalisation and steroid use) recurrence and survival outcomes were recorded.

Results: Twenty-eight patients were identified; mean age was 64 years; 61% were male. 79% of patients had resected stage III melanoma. 32% of patients had a BRAF mutation. 89% of patients received nivolumab.

14% of patients ceased treatment due to toxicity; 18% due to recurrence. 57% experienced at least one immune-related adverse event (irAE). The most common were: dermatitis (50%), arthritis (44%) and thyroiditis (38%). Four patients experienced a grade three irAE; no patients had a grade 4 or 5 irAE; only two patients required hospitalisation due to an irAE. 29% of patients required systemic steroids for an irAE; 18% required systemic steroids for >12 weeks. Except for endocrinopathies all irAEs resolved. Of the 10 patients with disease recurrence, five occurred during adjuvant treatment. Median PFS and OS were not reached.

Conclusion: Real world efficacy and toxicity of adjuvant immunotherapy was similar to clinical trial data. Hospitalisation was rare and all irAEs resolved however a significant proportion of patient required systemic steroids.

Subhash Gupta, Haresh KP, Bharti Devnani, Suman Bhasker, Suhani S, Seenu V, Bansal V K, Rajinder Parshad, Asuri Krishna, Omprakash P, Goura K Rath

AIIMS New Delhi, New Delhi, India

Background: Trastuzumab, a recombinant antibody targeting HER2, is a gold standard for treatment of HER2-positive breast cancer. However, cost-related factors impede trastuzumab use in 12%–54% patients. The current study assessed the outcomes of 437 HER2 neu +ve breast cancer patients who received trastuzumab.

Methodology: Data of patients treated between September 2006 and July 2018 was analysed. The primary endpoint was overall survival (OS) and secondary endpoint was event-free survival (EFS) and safety. Survival outcomes in the study were compared with historical data.

Results: The median age was 55 years. Out of 437, 75 were positive for oestrogen receptor and 60 were positive for progesterone receptor. In this study, 194 patients (44.39%) had cancer in right breast and 242 (55.37%) had cancer in left breast and one had bilateral breast cancer. 3.49% had family history of breast cancer.

While 240 patients received trastuzumab in adjuvant setting, 197 patients received neoadjuvant trastuzumab. Median OS median EFS is shown in the table.

Mean baseline ejection fraction was 59.42. Posttreatment mean ejection fraction was 57.32. Although the mean post-treatment ejection fraction was lower after trastuzumab, only 13 patients had to discontinue trastuzumab because of drop in ejection fraction to less than 45. Other adverse events were generally mild and were of grades 1–2. In the subset analysis, there was no difference in the safety and efficacy parameters between the different brands of trastuzumab used in the study.

Conclusion: In the present study, the median OS and event free survival rates with both adjuvant and neoadjuvant trastuzumab are comparable with data from historical studies. Safety in terms of ejection fraction was not a concern in the study.

Omid Hamid¹, Amy Weise², Meredith McKean³, Kyriakos P Papadopoulos⁴, John Crown⁵, Sajeve S Thomas⁶, Janice Mehnert⁷, John Kaczmar⁸, Kevin B Kim⁹, Nehal J Lakhani¹⁰, Melinda Yushak¹¹, Tae Min Kim¹², Guilherme Rabinowits¹³, Alexander Spira¹⁴, Giuseppe Gullo¹⁵, Jayakumar Mani¹⁵, Fang Fang¹⁵, Shuquan Chen¹⁵, JuAn Wang¹⁵, Laura Brennan¹⁵, Vladimir Jankovic¹⁵, Anne Paccaly¹⁵, Sheila Masinde¹⁵, Israel Lowy¹⁵, Mark Salvati¹⁵, Matthew G Fury¹⁵, Karl D Lewis¹⁵

¹The Angeles Clinical and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA

²Henry Ford Hospital, Detroit, Michigan, USA

³Sarah Cannon Research Institute/Tennessee Oncology PLLC, Nashville, Tennessee, USA

⁴START Center, San Antonio, Texas, USA

⁵St Vincent's University Hospital, Dublin, Ireland

⁶University of Florida Health Cancer Center at Orlando Health, Orlando, Florida, USA

⁷Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA

⁸MUSC Hollings Cancer Center, North Charleston, South Carolina, USA

⁹Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, California, USA

¹⁰START Midwest, Grand Rapids, Michigan, USA

¹¹Department of Hematology and Medical Oncology at Emory University School of Medicine, Atlanta, Georgia, USA

¹²Seoul National University Hospital, Seoul, South Korea

¹³Department of Hematology and Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA

¹⁴Virginia Cancer Specialists and US Oncology Research, Fairfax, Virginia, USA

¹⁵Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA

Aims: In two cohorts with advanced PD-(L)1 naïve metastatic melanoma, an ORR of 63.8% was previously reported with anti-LAG-3 (fianlimab) + anti-PD-1 (cemiplimab) treatment (NCT03005782); we present Phase 1 safety and clinical activity data, including patients who received prior adjuvant systemic treatment.

Methods: The analysis population included three expansion cohorts with unresectable/metastatic melanoma who were anti-PD-(L)1 treatment-naïve for advanced disease. Patients received fianlimab 1600 mg + cemiplimab 350 mg intravenously Q3W for 12 months, plus a further 12 months if clinically indicated.

Results: Ninety-eight patients were enrolled and treated (1 November 2022 data cutoff); 2% had received prior metastatic treatment (not anti-PD-(L)1) and 24% prior adjuvant/neoadjuvant treatment (anti-PD-1, 13%), with 6 months’ disease-free interval. Median follow-up was 12.6 months; median treatment duration was 33 weeks. Grade ≥3 TEAEs, serious TEAEs and irAEs occurred in 44%, 33% and 65% of patients, respectively; 16% of patients discontinued treatment due to TEAEs. Rates of irAEs were similar to rates for anti-PD-1 monotherapy, except for adrenal insufficiency (all grades, 11%; grade ≥3, 4%). Overall ORR was 61% (60/98; CR, n = 12; PR, n = 48), with mDOR NR (95% CI: 23–NE). KM estimation of mPFS was 15 (95% CI: 9–NE) months. In patients with any prior adjuvant treatment, ORR, mDOR and mPFS were 61% (14/23), NR and 13 months, respectively. In patients with prior anti-PD-1 adjuvant treatment, ORR, mDOR and mPFS were 62% (8/13), NR and 12 months, respectively.

Conclusions: In advanced melanoma patients, fianlimab + cemiplimab showed high clinical activity that compares favourably with other approved combinations of immune checkpoint inhibitors in the same clinical setting. This is the first indication that dual LAG-3 blockade can produce high levels of activity following adjuvant anti-PD-1 treatment. A Phase 3 trial (NCT05352672) of fianlimab + cemiplimab in treatment-naïve patients with advanced melanoma is ongoing.

Chad Han¹, Raymond Chan¹, Yogesh Sharma^2,3, Alison Yaxley¹, Claire Baldwin¹, Michelle Miller¹

¹Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia

²General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia

³College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Background: Frailty in older adults, especially during hospitalisation, is associated with prolonged hospital stay.

Objective: To compare the prevalence, characteristics and length of stay of pre-frailty and frailty between older adults with and without a cancer diagnosis in an acute medical unit (AMU).

Methods: A cohort of hospitalised older adults ≥65 years (n = 329), admitted to the AMU, Flinders Medical Centre, Adelaide, South Australia were recruited. All eligible patients ≥65 years, admitted between February to September 2020 to the AMU were invited to participate in this study within 48 h of their hospital admission.

Results: In this cohort, 22% hospitalised older adults (n = 71) were cancer survivors. Cancer types included prostate (n = 20), breast (n = 13), lung (n = 8), gastrointestinal (n = 8), skin (n = 6), colorectal (n = 5), head and neck (n = 2), liver (n = 3), ovarian (n = 2) and others (n = 4). Eight patients had metastatic disease. The prevalence of pre-frailty and frailty (58%) within the cancer survivors were similar to those with no history of cancer (57%). Cancer survivors in this cohort had a range and median (IQR) length of stay of 1–28 and 3 (2–6) days, respectively. Binary logistic regression analysis suggested that the cancer survivors were more likely to be associated with a higher comorbidity burden (OR: 1.23, 95% CI: 1.03–1.47, p = 0.022) and were less likely to be female (OR: .40, 95% CI: .22–.70, p = 0.002) compared to those without a history of cancer. Multinomial logistic regression analysis suggested that compared to those that were robust, older cancer survivors who were pre-frail or frail were significantly more likely to have a higher number of medications (OR: 1.24, 95% CI: 1.01–1.53, p = 0.038; OR: 1.30, 95% CI: 1.07–1.58).

Conclusion: There is a high prevalence of pre-frailty and frailty amongst hospitalised older adults in the acute medical unit regardless of cancer diagnosis. Older adult cancer survivors that are pre-frail or frail were more likely to experience polypharmacy.

Lauren Hanna¹, Judi Porter^1,2, Judy Bauer¹, Kay Nguo¹

¹Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia

²Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia

Aims: Cancer-associated malnutrition is associated with shorter survival and poor quality of life and is prevalent in people with upper gastrointestinal (GI) cancers. Effective nutrition interventions providing adequate energy to meet metabolic demand are needed to prevent or treat malnutrition. In practice, energy needs of people with cancer are often estimated from predictive equations known to be inaccurate in the cancer population. The purpose of this scoping review was to synthesise the existing evidence regarding energy expenditure in people with upper GI cancer.

Methods: A systematic search was conducted across three databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus) to identify studies using reference methods to measure resting energy expenditure (REE) using indirect calorimetry, and total energy expenditure (TEE) using doubly labelled water (DLW), in adults with any stage of upper GI cancer, at any point from diagnosis.

Results: Fifty-seven original research studies were eligible for inclusion, involving 2125 individuals with cancer of the oesophagus, stomach, pancreas, biliary tract or liver. All studies used indirect calorimetry to measure REE, and one study also used DLW to measure TEE. Energy expenditure was unadjusted in 42 studies, adjusted for body weight in 32 studies, and adjusted for fat-free mass in 13 studies. Energy expenditure was compared to non-cancer controls in 19 studies, and measured versus predicted energy expenditure was reported 31 studies. There was between-study heterogeneity in study design and in reporting of important clinical characteristics. There was also substantial variation in energy expenditure between studies, and within and between cancer types.

Andrew Haydon¹, Dirk Schadendorf^2,3, Reinhard Dummer⁴, Keith T Flaherty⁵, Caroline Robert⁶, Ana Arance⁷, Jan Willem B de Groot⁸, Claus Garbe⁹, Helen J Gogas¹⁰, Ralf Gutzmer¹¹, Ivana Krajsová¹², Gabriella Liszkay¹³, Carmen Loquai¹⁴, Mario Mandalà¹⁵, Naoya Yamazaki¹⁶, Carolin Guenzel¹⁷, Anna Polli¹⁸, Mahgull Thakur¹⁹, Aleesandra di Pietro¹⁸, Paolo A Ascierto²⁰

¹Alfred Hospital, Melbourne, VIC, Australia

²University Hospital Essen, West German Cancer Center and German Cancer Consortium, Essen, Germany

³National Center for Tumor Diseases (NCT)-West, Campus Essen, & Research Alliance Ruhr, University Duisburg-Essen, Essen, Germany

⁴University Hospital Zurich, Zurich, Switzerland

⁵Massachusetts General Hospital, Boston, Massachusetts, USA

⁶Gustave Roussy and Paris-Saclay University, Villejuif, France

⁷Hospital Clinic of Barcelona and IDIBAPS, Barcelona, Spain

⁸Isala Oncology Center, Zwolle, The Netherlands

⁹University Hospital Tubingen, Tubingen, Germany

¹⁰National and Kapodistrian University of Athens, Athens, Greece

¹¹Hannover Medical School, Hannover and Ruhr-University Bochum, Minden Campus, Germany

¹²University Hospital Prague, Prague, Czech Republic

¹³National Institute of Oncology, Budapest, Hungary

¹⁴University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

¹⁵University of Perugia, Perugia, Italy

¹⁶National Cancer Center Hospital, Tokyo, Japan

¹⁷Pfizer, New York City, New York, USA

¹⁸Pfizer, Milan, Italy

¹⁹Pfizer, Sandwich, UK

²⁰Melanoma Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy

Background: The randomised, 2-part, multicentre, open-label, phase 3 COLUMBUS study demonstrated enco + bini improved PFS and OS rates versus vemu in pts with BRAF V600-mutant metastatic melanoma. Here, we report the 7-year analysis of COLUMBUS part 1.

Methods: Pts with advanced or metastatic BRAF V600-mutant melanoma were randomised 1:1:1 to enco 450 mg QD + bini 45 mg BID, vemu 960 mg BID or enco 300 mg QD. Pts were treatment (tx)-naïve or progressed after 1L immunotherapy, with no prior BRAF/MEKi tx. Randomisation was stratified by cancer stage (IIIB + IIIC + IVM1a + IVM1b vs. IVM1c), ECOG PS (0 vs. 1), and prior 1L immunotherapy (yes vs. no).

Results: A total of 577 pts were randomised to enco + bini (n = 192), vemu (n = 191) or enco alone (n = 194). Updated analyses were conducted after >93 months of minimum follow-up (cutoff: 13 January 2023). Seven-year PFS and OS rates (95% CI) were 21.2% (14.7, 28.4) and 27.4% (21.2, 33.9) in the enco + bini arm and 6.4% (2.1, 14.0) and 18.2% (12.8, 24.3) in the vemu arm, respectively. TEAEs (≥30% with enco + bini) were nausea, diarrhoea, vomiting, arthralgia and fatigue. Grade 3/4 TEAEs (≥5% with enco + bini) were: increased γ-glutamyltransferase, blood CPK and ALT; hypertension; and anaemia. 16%–20% of pts discontinued tx due to AEs. After tx discontinuation, 15% of pts from the enco + bini arm, 42% from the vemu arm and 28% from the enco alone arm received BRAF/MEKi tx; 42% from the enco + bini arm, 49% from the vemu arm and 43% from the enco alone arm received checkpoint inhibitors.

Conclusions: After 100 months of follow-up, the 7-year analysis from COLUMBUS part 1 confirms the long-term sustained efficacy and known safety profile of enco + bini in pts with BRAF V600-mutant metastatic melanoma.

Clinicaltrials.gov identification: NCT01909453

Jolyn Hersch, Lauren O'Hara, Ilona Juraskova, Wei Wang, Zilai Qian, Phyllis Butow

The University of Sydney, Sydney, NSW, Australia

Aims: Gaining informed consent from participants is a vital but challenging aspect of conducting clinical research. We did a systematic review to describe interventions designed to support patients with communication and decision making about whether to take part in health research.

Methods: Eligible papers were peer-reviewed journal articles reporting any study design focussing on an intervention for adult patients capable of deciding about their participation in health research. Eligible interventions aimed to improve decision quality by enabling users to address their own information needs (e.g. question prompt list) and/or incorporate their values into decision making (e.g. decision aid). We searched five databases (1990–2022), Google Scholar and reference lists of included papers and related reviews.

Results: We included 15 studies (13 in cancer) of which nine were randomised trials (all in cancer). In five papers, resources addressed participation in a specific study (three in cancer); the other 10 were generic but focussed on clinical trials (all in cancer). Seven tools were on paper; eight were computer- or web-based, which facilitated greater interactivity and/or tailoring. About half the papers cited a relevant health psychology or decision-making theory, model, framework or standards. Studies assessed various measures of patient engagement; the most commonly used outcome was knowledge.

Conclusions: While the reviewed literature highlights the potential utility of tools to support patients considering health-related research participation, we identified some gaps. Future interventions should address study types other than clinical trials, settings other than cancer, and important emerging areas like genomics and precision medicine.

Nicole Kiss¹, Anna Ugalde², Carla Prado³, Linda Denehy⁴, Robin Daly¹, Shankar Siva⁵, David Ball⁵, Andrew Wirth⁵, Greg Wheeler⁵, Steve Fraser¹, Lara Edbrooke⁴

¹Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia

²Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia

³Department of Agricultural, Food and Nutrition Science, University of Alberta, Edmonton, Canada

⁴Physiotherapy Department, University of Melbourne, Melbourne, Victoria, Australia

⁵Lung Service, Peter MacCallum Cancer Centre, Malbourne, Victoria, Australia

Aim: Low muscle mass (LMM) affects up to 61% of people with lung cancer prior to chemo-radiotherapy. This study aimed to explore the experience of undergoing treatment while living with LMM or muscle loss on ability to cope with treatment, complete self-care, receptiveness and preferences for nutrition and exercise intervention.

Methods: This study utilised a qualitative approach through semi-structured interviews. Participants included people with a diagnosis of non-small cell lung cancer (NSCLC) or small-cell lung cancer (SCLC), treated with curative intent chemo-radiotherapy (CRT) or radiotherapy, and who presented with computed tomography defined LMM at treatment commencement or experienced loss of muscle mass over the duration of treatment. Recruitment occurred at three tertiary hospitals with radiotherapy centres. Interviews were audio recorded, transcribed verbatim and analysed with thematic analysis.

Results: Seventeen participants have been involved in the study. The mean age was 72 years (range 58–90 years), the majority were male (N = 10, 59%), had NSCLC (N = 13, 76%) and were treated with CRT (N = 13, 76%). Three themes were identified: (1) patient experience; (2) self-management; and (3) impact and influence of extrinsic factors. Although patient experience varied, participants reported substantial impact on day-to-day functioning, eating and ability to be physically active. Participants were aware of the importance of nutrition and exercise and engaged in self-initiated or health professional supported self-management strategies to cope with their situation. Early provision of nutrition and exercise advice, guidance from health professionals and support from family and friends were valued, albeit with a need for consideration of individual circumstances.

Conclusion: Participants described a diverse range of experiences and ability to cope with treatment. The types of support required were highly individual, highlighting the crucial role of personalised identification of needs and subsequent intervention. The impact of low muscle mass and muscle loss requires further consideration within clinical practice.

Alexandra Knesl¹, Melissa Arneil¹, Victoria Atkinson^1,2

¹Princess Alexandra Hospital, Brisbane, Queensland, Australia

²University of Queensland, Brisbane, Queensland, Australia

5FU remains the most widely used chemotherapeutic agent for CRC. Cape is a 5FU pro-drug developed to mimic the continuous infusion of 5FU while avoiding complications and inconvenience of intravenous administration.¹ This study presents an assessment of prescribing patterns and causes of toxicity for 104 CRC inpatients at the PAH during the 2020–2021 financial year. Data was collected using electronic medical records and prescribing software, and includes patient demographics, mutation status, treatment and reason for hospital admission.

In the study cohort of 104 patients (pts), 63 were males and 41 were females, with a median age of 59 years. Of these, 80 pts had metastatic disease and 24 received adjuvant chemotherapy. The majority of pts were prescribed 5FU, of which 66 were on 5FU-oxaliplatin, 19 were on 5FU-irinotecan and 9 were on 5FU-oxaliplatin–irinotecan. In the Cape cohort, eight undertook Cape-monotherapy and two were on Cape-oxaliplatin. Thirty-seven patients exhibited KRAS mutations, while four presented BRAF mutations. Additionally, 11 were receiving Anti-VEGF therapy and four were receiving Anti-EGFR therapy. 20% of the CRC pts were admitted due to 5FU related toxicity and 2.8% were due to Cape related toxicity. The most common side effects with 5FU were cytopenia, fevers and colitis (33%), with one coronary vasospasm. In Cape pts, hand foot syndrome was frequently reported and colitis was not a predominate cause of admission.

Neil Lam¹, Ian Kei Yee², Linda Nguyen¹

¹Icon Wesley Pharmacy, Icon Cancer Centre, Brisbane, QLD, Australia

²School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia

Aims: Carboplatin dosing, based on the Calvert Formula, requires the patient's glomerular filtration rate (GFR) in its calculation. Historically, the Cockcroft–Gault equation was used to determine estimated GFR (eGFR), by calculating creatinine clearance. However, the recently introduced International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) recommend the Chronic Kidney Dysfunction-Epidemiology Collaboration 2009 equation (eGFR_CKD-EPI) to replace the Cockcroft–Gault (CG) equation in determining eGFR. This study aimed to compare the carboplatin dose variations between Cockcroft–Gault and body surface area (BSA)-adjusted eGFR_CKD-EPI equations.

Method: A retrospective audit of initial carboplatin doses (n = 127) administered between January and December 2022 at a day oncology clinic was conducted. Patient parameters included age, sex, weight, height, serum creatinine and target AUC (area under the curve). Carboplatin doses were calculated using both CG and BSA-adjusted eGFR_CKD-EPI equations. Statistical analysis was performed using the paired t-test. The Pearson correlation coefficient was calculated to investigate the relationship between patient parameters and percentage dose variation.

Results: 70.9% of doses (90/127) had ≤10% dose variation between the CG and BSA-adjusted eGFR_CKD-EPI method. 23.6% of doses (30/127) had a >10% to ≤20% dose variation. The mean dose difference between the two methods did not reach statistical significance (p = 0.06). There was a weak correlation between weight and percentage variation (r = −.39) with a trend suggesting that extremes in body weight resulted in larger percentage dose variation.

Conclusion: In this study, the majority of doses calculated using the BSA-adjusted eGFR_CKD-EPI method were within 20% compared to the CG method. The mean dose difference did not reach statistical significance. With implementation of the BSA-adjusted eGFR_CKD-EPI equation in practice, this may provide some reassurance to clinicians regarding dose variances between the two equations; however, further study is required to determine clinical significance.

Wing Kwan Winky Lo^1,2, Katrina Tonga^1,2,3, XinXin Hu², Christopher Rofe^1,4, Elizabeth Silverstone⁵, Brad Milner⁵, Eugene Hsu⁵, Duy Nguyen⁵, Ian Yang^6,7, Henry Marshall^6,7, Annette McWilliam^8,9, Fraser Brims^10,11, Renee Manser^12,13,14, Kwun M Fong^6,7, Emily Stone^1,2,15

¹St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia

²Department of Respiratory Medicine, St Vincent's Hospital, Sydney, NSW, Australia

³Northern Clinical School, University of Sydney, Sydney, NSW, Australia

⁴Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia

⁵Department of Medical Imaging, St Vincent's Hospital, Sydney, NSW, Australia

⁶Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia

⁷Thoracic Research Centre, University of Queensland, Brisbane, QLD, Australia

⁸Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia

⁹Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia

¹⁰Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia

¹¹Curtin Medical School, Curtin University, Perth, WA, Australia

¹²Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia

¹³Department of Medicine (RMH), The University of Melbourne, Melbourne, VIC, Australia

¹⁴Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

¹⁵The Kinghorn Cancer Centre, Sydney, NSW, Australia

Background and aims: Low-dose computed tomography (LDCT) imaging for lung cancer screening can detect nodules and emphysema. The association between lung nodules and emphysema is unknown. We aimed to evaluate the relationship between severity of emphysema and presence of lung nodules ≥3 mm in the NSW, Australia cohort of the International Lung Screening Trial (ILST).

Methods: Candidates who met lung cancer screening criteria for the ILST had baseline LDCT chest and spirometry performed. Lung nodules were evaluated using the PanCan protocol. Emphysema was quantified using standardised threshold of −950 Hounsfield Units (CT COPD, Philips Healthcare). Emphysema extent was calculated as the ratio between emphysema volume and lung volume [% low attenuation area (LAA)]. Emphysema severity was determined by %LAA thresholds of ≤1%, between 1%–5% and >5%. Chi-square tests assessed for differences between the %LAA groups. Multiple linear regression assessed for predictors of lung nodules ≥3 mm.

Results: A total of 307 participants (48.5% male, 98% Caucasian) were included [mean ± SD: age 64.4 ± 6 years, smoking history 47.4 ± 20.6 pack-years, BMI 27.5 ± 5.2 kg/m², forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) .74 ± .08]. Median %LAA was 2.03 (IQR .62%–4.36%). Most participants had %LAA between 1% and 5% (%LAA ≤1% n = 103, 1%–5% n = 134, >5% n = 70). In the group with the greatest amount of emphysema (%LAA >5%) participants were mostly male (n = 65.7%, p = 0.004), older (66.1 ± 6.0 years, p = 0.01), had higher smoking pack-years (51.8 ± 25.0 years, p < 0.0001), lower BMI (25.3 ± 4.4 kg/m², p < 0.0001) and most had spirometric airflow obstruction (FEV₁/FVC < .7) (n = 58.6%, p < 0.0001). Independent predictors of lung nodules ≥3 mm were the presence of micro-nodules and emphysema extent (p < 0.05).

Conclusion: In the NSW ILST Cohort, cross-sectional analysis of LDCT suggests that quantifying emphysema and detection of lung micro-nodules predicts presence of lung nodules ≥3 mm. Emphysema severity appeared more extensive in older men, with greater smoking history, and lower BMI. Further longitudinal analysis is needed to determine whether the location of emphysema relative to nodules is important.

Andre van der Westhuizen¹, Megan Lyle², Ricardo Vilain³, Nikola Bowden⁴

¹Calvary Mater Newcastle, Newcastle, Australia

²Cairns Hospital, Cairns, QLD, Australia

³NSW Health Pathology, Newcastle, Australia

⁴Hunter Medical Research Institute, Newcastle, Australia

Aims: To determine if a new combination of existing drugs, azacitidine and carboplatin can be used as a priming regime for metastatic melanoma to be re-challenged with ipilimumab and nivolumab.

Methods: The Phase 1b treatment regime consisted of two cycles of azacitidine and carboplatin over 6 weeks followed by two cycles of azacitidine and carboplatin combined with ipilimumab and nivolumab for 6 weeks. Ipilimumab and nivolumab was then given in combination for 24 months. RECIST 1.1 and iRECIST were used to determine complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) and best overall response rate (BOR) after (i) two cycles of priming (azacitidine and carboplatin) and (ii) after two and four cycles of immunotherapy induction (ipilimumab and nivolumab), respectively.

Results: Patient 1 is a 70 year old female with acral lentiginous vulval metastatic melanoma with primary resistance to combination ipilimumab and nivolumab. Patient 1 had SD after two cycles (6 weeks) of priming and iUPD after two further cycles of priming and ipilimumab/nivolumab (12 weeks). A PR was achieved after an additional two cycles of ipilimumab/nivolumab (week 20) that was maintained until week 56 when a CR occurred. The CR remains ongoing. Patient 2 is a 75-year-old male with metastatic melanoma with primary resistance to ipilimumab and nivolumab. Patient 2 had SD after two cycles of priming, followed by a PR (37.9%) after four cycles (12 weeks) that has steadily increased to PR (−78%) at 56 weeks. No treatment related grade 3 or 4 adverse events have been reported.

Conclusions: The two cases reported here provide evidence that sequential treatment with azacitidine and carboplatin can ‘prime’ for immunotherapy rechallenge with ipilimumab and nivolumab, via stabilisation and decrease in the disease burden and re-establishment of immune sensitivity.

Ari David Baron¹, Carlos López López², Stephen Lam Chan³, Fabio Piscaglia⁴, Min Ren⁵, Kasey Estenson⁵, Chunyan Ma⁶, Arndt Vogel⁷, Pierre Gholam⁸

¹Sutter/California Pacific Medical Center, San Francisco, California, USA

²Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain

³The Chinese University of Hong Kong, Shatin, Hong Kong

⁴IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

⁵Eisai Inc., Nutley, New Jersey, USA

⁶Eisai Australia Pty Ltd, Melbourne, Victoria, Australia

⁷Hannover Medical School, Hannover, Germany

⁸Case Western Reserve University School of Medicine, Cleveland, Ohio, USA

Background: The randomised phase 3 REFLECT trial (NCT01761266) demonstrated that lenvatinib was non-inferior to sorafenib in OS in 1L uHCC (HR: .92; 95% CI: .79–1.06). PFS (HR: .64; 95% CI: .55–.75; p < 0.0001) and ORR (odds ratio: 5.01; 95% CI: 3.59–7.01; p < 0.0001) by IIR per mRECIST favoured lenvatinib versus sorafenib. Recent data suggest that viral/nonviral aetiology may impact treatment outcomes. This post-hoc analysis evaluated patients with nonviral aetiology in REFLECT.

Methods: In REFLECT, 1L uHCC patients were randomised to lenvatinib (12 mg/day, bodyweight ≥60 kg; 8 mg/day, bodyweight <60 kg) or sorafenib (400 mg twice-daily) in 28-day cycles. This post-hoc analysis included patients without hepatitis B/C (medical history) who were randomised to receive lenvatinib or sorafenib. PFS, ORR (by IIR per mRECIST) and OS were analysed.

Results: A total of 127 patients randomised to lenvatinib and 108 patients randomised to sorafenib had nonviral aetiology. Among these patients, mOS was 13.8 months (95% CI: 10.5–18.7) with lenvatinib and 13.9 months (95% CI: 11.7–17.5) with sorafenib (HR: 1.03; 95% CI: .75–1.43). mPFS was 7.4 months (95% CI: 5.5–8.7) in the lenvatinib arm and 4.0 months (95% CI: 3.6–5.5) in the sorafenib arm (HR: .60; 95% CI: .42–.87). ORR was 39.4% (95% CI: 30.9–47.9) in the lenvatinib arm and 20.4% (95% CI: 12.8–28.0) in the sorafenib arm. Fewer (n = 34 [26.8%]) patients with nonviral aetiology randomised to lenvatinib received anticancer medication during survival follow-up than those randomised to sorafenib (n = 46 [42.6%]).

Masafumi Ikeda¹, Naoya Kato², Shunsuke Kondo³, Yoshitaka Inaba⁴, Kazuomi Ueshima⁵, Mitsuhito Sasaki¹, Hiroaki Kanzaki², Hiroshi Ida⁵, Hiroshi Imaoka¹, Yasunori Minami⁵, Shuichi Mistunaga¹, Naoshi Nishida⁵, Sadahisa Ogasawara², Kazuo Watanabe¹, Takatoshi Sahara⁶, Nozomi Hayata⁶, Shintaro Yamamuro⁶, Takayuki Kimura⁷, Toshiyuki Tamai⁶, Chunyan Ma⁸, Masatoshi Kudo⁵

¹National Cancer Center Hospital East, Kashiwa, Japan

²Graduate School of Medicine, Chiba University, Chiba, Japan

³National Cancer Center Hospital, Tokyo, Japan

⁴Aichi Cancer Center Hospital, Nagoya, Japan

⁵Kindai University Faculty of Medicine, Osaka, Japan

⁶Eisai Co. Ltd, Tokyo, Japan

⁷Eisai Co. Ltd, Ibaraki, Japan

⁸Eisai Australia Pty Ltd, Melbourne, Victoria, Australia

Background: The objectives of the dose-escalation part of this study (NCT04008797) included safety/tolerability, pharmacokinetics, biomarkers and preliminary efficacy of E7386 (a novel oral anticancer agent modulating Wnt/β-catenin signalling) plus lenvatinib in patients with HCC or other solid tumours. We present results from the HCC subpart.

Methods: In cycle 0, E7386 was administered orally in escalating doses QD or BID for 5 or 6 consecutive days. From cycle 1, E7386 QD or BID, plus daily oral lenvatinib (<60 kg: 8 mg; ≥60 kg: 12 mg), were administered in 28-day cycles. TEAEs were graded using CTCAE v5.0. Prophylactic antiemetics were not allowed during DLT evaluation but were permitted after nausea/vomiting. Tumour response was assessed by investigators using mRECIST.

Results: By data cutoff (9 December 2022), 25 patients with HCC were treated with E7386 doses ranging from 10 to 80 mg QD and 60 to 120 mg BID. Among the E7386 120 mg BID cohort (n = 3), grade 3 maculopapular rash (one patient) and grade 5 acute kidney injury (one patient) DLTs were observed. No other DLTs were observed. The most common TEAEs across cohorts were nausea (76.0%), vomiting (60.0%), constipation (52.0%), palmar-plantar erythrodysesthesia syndrome (48.0%), diarrhoea (44.0%) and proteinuria (40.0%). The most common grade ≥3 TEAEs were proteinuria (20.0%) and aspartate aminotransferase level increased (8.0%). Nausea and vomiting were well controlled by a 5HT3 antagonist. Among treated patients, nine (36.0%) partial responses (PRs) were observed, including three PRs in 10 patients previously treated with lenvatinib. C_max and AUC for E7386 increased with increasing E7386 dose.

Wing Tung Michelle Ma¹, Peey Sei Kok^2,3,4, Ben Kong^2,4,5, Melvin Chin^1,2

¹Randwick Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia

²Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia

³School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

⁴NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia

⁵SPHERE Clinical Academic Group, UNSW, Sydney, NSW, Australia

Background: Clinical trials have opened the door to immunotherapy for NSCLC treatment. Reported patient outcomes outside of these highly selective studies are limited. This retrospective study aimed to evaluate the mortality risk and overall survival (OS) of metastatic NSCLC patients who received first-line pembrolizumab plus carboplatin doublet chemotherapy or pembrolizumab alone – aligned with KEYNOTE-189 and KEYNOTE-024 trials, in the real-world setting of oncology practice in Australia.

Methods: From the hospital records, metastatic NSCLC patients who received pembrolizumab were identified. Patient demographics, smoking history, EGFR/ALK/ROS1 mutation status, Eastern Cooperative Oncology Group (ECOG) performance status, programmed death-ligand 1 (PD-L1) tumour proportion score (TPS) were noted. Eligible patients were selected between 1 January 2019 and 31 July 2022 to allow for at least 1 year of follow-up. Kaplan–Meier method was used to estimate OS.

Results: Of the 42 patients with metastatic nonsquamous NSCLC, 6 (14.3%), 21 (50%) and 9 (21.4%) had PD-L1 TPS of ≥50%, 1%–49% and ≤1%, respectively. PD-L1 status was unknown for six patients (14.3%). Median age at diagnosis was 67 years and 52.4% were women. Thirty-six patients (85.7%) were smokers. After a median follow-up period of 32.3 months, the median OS was 15.8 months (95% CI: 17.0–24.9). The rate of OS at 12 and 24 months were 59.4% and 50.3%, respectively. Of the 21 patients with metastatic NSCLC who received first-line pembrolizumab, high PD-L1 was found in 16 patients (76.2%), low PD-L1 in four (19%) and one undocumented. Estimated OS at 6 and 12 months were 87.5% and 53.8%, respectively.

Alina Mahmood¹, Masarra Al Deleemy^1,2, Jocelyn Finney¹, Sanjeev Kumar¹, Lisa Horvath¹, Susanna Park^1,2

¹Chris O'Brien Lifehouse, Camperdown, NSW, Australia

²University of Sydney, Sydney, NSW, Australia

Trial in Progress

Aims: Chemotherapy-induced peripheral neuropathy (CIPN) is recognised as a potentially permanent side effect of chemotherapy and can lead to functional disability and require cessation of chemotherapy, potentially limiting treatment success. There is limited understanding of the mechanisms responsible for CIPN and currently no preventative or curative treatment. The aim is to identify the most sensitive method to accurately evaluate CIPN severity and outcome in patients receiving neurotoxic chemotherapies and to evaluate if cryotherapy during treatment reduces this outcome.

Methods: This investigation is a cross sectional and prospective, longitudinal study of nerve function in chemotherapy treated patients. The previously published data described historical cohorts who underwent a battery of clinical, psychophysical and neurophysiological assessments while undergoing chemotherapy but without cryotherapy intervention.

In the cryotherapy substudy, we aim to recruit 150 participants who will undergo cryotherapy during chemotherapy. They will have a nerve assessment, including relevant medical history, standard physical examination and questionnaires about neuropathy symptoms. Ice gloves and ice socks will be worn for the duration of chemotherapy. Assessments will include calibrated fibre fingertip sensation, sensation of grooved plastic discs, fine motor task of filling small pegs into a board and lifting a small object to a given height, nerve conduction studies, nerve excitability studies and skin wrinkle assessment. These will be undertaken at baseline, mid treatment and final treatment as well as follow-up assessments after completion of chemotherapy to determine changes in nerve function during and at the end of chemotherapy treatment. The 150 patients in this substudy will be compared to historical cohorts who did not receive cryotherapy to evaluate differences.

Jane McKenzie¹, Sarat Chander^1,2, Jeremy Lewin^1,3,4

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Department of Pathology, University of Melbourne, Parkville, Victoria, Australia

³ONTrac at Peter Mac, Victorian Adolescent & Young Adult Cancer Service, Melbourne, Victoria, Australia

⁴Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia

Introduction: Angiosarcomas are aggressive cancers arising from lymphatic or vascular endothelium, comprising 1% of all soft tissue sarcomas. Primary aortic angiosarcomas are a rare subtype of angiosarcoma, frequently diagnosed in advanced stages due to initial misdiagnosis. Early surgical resection offers the best chance of survival, and despite use of palliative radiotherapy and chemotherapy for locally advanced or metastatic angiosarcoma, survival remains poor.

Case: A 67-year-old woman initially presented with a distal thoracic aorta thrombus and symptomatic bilateral popliteal emboli, underwent right popliteal artery thrombectomy and left popliteal vein patch, and was commenced on warfarin. Histology revealed bland thrombus and thrombophilia screen was unremarkable. Over subsequent months she experienced progressive lower limb pain and intermittent claudication. Surveillance ultrasound showed occluded popliteal arteries with good collateralisation and lower limb symptoms were attributed to known degenerative spinal canal stenosis. Twelve months following initial presentation, she re-presented with constitutional symptoms, 20 kg loss of weight, progressive lower limb claudication and melaena. CT abdomen and pelvis revealed a new solid right renal lesion and a persistent distal thoracic aorta lesion now causing 90% luminal stenosis. Subsequent MRI favoured primary malignancy rather than bland thrombus and PET revealed FDG-avid bilateral renal and soft tissue metastatic deposits. Renal biopsy was diagnostic for metastatic angiosarcoma. She commenced palliative radiotherapy to the primary aortic lesion for symptom control with evidence of response, however died following embolic complications with small bowel ischemia.

Conclusion: Primary aortic angiosarcoma is an aggressive malignancy where early recognition is vital to improve outcomes. Suspicion should be raised in the case of thrombus in unusual segments (e.g. thoracic aorta) or progressive course despite anticoagulation. Multimodal imaging including PET is useful to distinguish from benign etiologies.

Luke S McLean^1,2, Annette M Lim^1,2, Mathias Bressel^2,3, Jenny Lee^4,5, Rahul Ladwa^6,7, Brett GM Hughes^7,8, Alexander Guminski⁹, Samantha Bowyer¹⁰, Karen Briscoe¹¹, Sam Harris¹², Craig Kukard¹³, Rob Zielinski^14,15, Muhammad Alamgeer^16,17, Matteo Carlino^18,19,20, Jeremy Mo¹⁸, John J Park²¹, Muhammad A Khattak^22,23, Fiona Day²⁴, Danny Rischin^1,2

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

³Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

⁵Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia

⁶Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

⁷School of Medicine, The University of Queensland, Brisbane, Queensland, Australia

⁸Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

⁹Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia

¹⁰Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

¹¹Department of Medical Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia

¹²Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia

¹³Department of Medical Oncology, Central Coast Cancer Centre, Gosford, New South Wales, Australia

¹⁴Department of Medical Oncology, Central West Cancer Centre, Orange, New South Wales, Australia

¹⁵Western Sydney University, Sydney, New South Wales, Australia

¹⁶Department of Medical Oncology, Monash Health, Clayton, VIC, Australia

¹⁷Monash University, Clayton, Victoria, Australia

¹⁸Department of Medical Oncology, Blacktown and Westmead Hospitals, Sydney, New South Wales, Australia

¹⁹Melanoma Institute of Australia, Sydney, New South Wales, Australia

²⁰The University of Sydney, Sydney, New South Wales, Australia

²¹Department of Medical Oncology, Nepean Cancer Care Centre, Kingswood, New South Wales, Australia

²²Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia

²³Edith Cowan University, Perth, Western Australia, Australia

²⁴Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia

Aims: Immunotherapy has revolutionised the management of advanced cutaneous squamous cell carcinoma (CSCC).^1–5 However, the stringent inclusion criteria of clinical trials results in key populations with advanced CSCC being excluded in the key registrational studies. This includes the elderly, the immunocompromised, those with autoimmune disease and organ transplant recipients. This has generated interest in reviewing real-world populations treated with immunotherapy via access schemes, however, to date many of these reports have been limited by small patient numbers.^6–9 To our knowledge this is the largest real-world report of advanced CSCC patients treated with immunotherapy.

Methods: This was a multi-centre national retrospective review performed across 15 Australian institutions of patients with advanced CSCC who received immunotherapy via an access program. The primary endpoint was the best overall response rate (ORR) as per standardised assessment criteria using the hierarchy of Response Evaluation Criteria in Solid Tumours 1.1, modified World Health Organisation clinical response criteria or Positron Emission Tomography Response Criteria 1.0. We assessed toxicity as per Common Terminology Criteria for Adverse Events version 5 and correlated baseline clinico-pathological features with both overall (OS) and progression free survival (PFS).

Results: A total of 286 patients were analysed. Median age was 75.2 years (range 39.3–97.5); 81% were male, 31% immunocompromised, 9% had an autoimmune disease and 21% were ECOG 2+. ORR was 63% with 28% complete responses, 35% partial responses, 22% stable disease and 16% with progressive disease. Median follow-up was 12 months. The 12-month OS and PFS were 78% (95%CI: 72–83) and 65% (95%CI: 58–70), respectively. In multivariate analysis poorer ECOG and immunocompromised status were associated with worse OS and PFS. 19% of patients reported grade 2+ immune-related adverse events.

Luke S McLean^1,2, Karda Cavanagh¹, Annette M Lim^1,2, Anthony Cardin^1,2, Danny Rischin^1,2

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

Aims: Immunotherapy is the standard of care for advanced cutaneous squamous cell carcinoma (CSCC) resulting in durable responses.^1,2 CSCC has a propensity for perineural spread (PNS) which is associated with poorer treatment outcomes.³ PNS is not captured by traditional response assessment criteria used in clinical trials, such as RECIST 1.1, and there is limited literature documenting radiographic PNS responses to immunotherapy. In this study, we assess PNS responses to immunotherapy using a new grading system.

Methods: This is an Australian single-centre retrospective review of patients with advanced CSCC who were treated with immunotherapy between April 2018 and February 2022 who had evidence of PNS on MRI post multidisciplinary review. The primary outcome was overall blinded radiological response in PNS (using graded radiographic criteria) postcommencement of immunotherapy at three defined timepoints (<5, 5–10 and >10 months). A secondary outcome included a correlation between RECIST1.1 and PNS assessments.

Results: Twenty patients were identified (cemiplimab 17, pembrolizumab 3). Median age was 75.7 years and 75% (n = 15) were male. All patients had locoregionally advanced disease and no distant metastases. Median follow-up was 18.5 months. 75% (n = 15) demonstrated a PNS response by 5 months. Three patients experienced pseudoprogression in both their PNS and RECIST1.1 measurable disease. Two patients had PNS progression by the end of study follow-up. RECIST1.1 and PNS responses were largely concordant (Cohen's Kappa .62). Two pseudoprogressive cases ultimately demonstrated improvement in PNS with immunotherapy, whilst the third had a near complete pathological response at surgery.

Tara McSweeney¹, Ashley Tan², Nisha Sikotra¹, Naomi Van Hagen¹, Tom Van Hagen¹, Andrew Dean¹, Tarek Meniawy¹, Eli Gabbay¹, Timothy Clay¹

¹SJOG Subiaco, Subiaco, WA, Australia

²Royal Perth Hospital, Victoria Square, Perth, WA, Australia

Introduction: Immunotherapy (IO) is a well-established cancer therapy; however, a subset of patients experiences severe immune related adverse events (irAEs) necessitating hospitalisation and resulting in treatment discontinuation. We examined the safety of rechallenging this cohort of patients.

Methods: A comprehensive, retrospective, single centre analysis was conducted, examining medical records of cancer patients who received immune checkpoint inhibitors at St John of God Subiaco Hospital between 2016 and 2018. Data from patients who required hospitalisation was recorded from 2016 to 2022. Patients’ cancers, immunotherapies, toxicities, hospital management and outcomes were analysed.

Results: Of the 307 patients that received IO over 2 years, 22% (n = 69) had irAEs requiring hospital admission. Of those 69 patients, 68% (n = 47) were rechallenged with immunotherapy. The median duration between toxicity and rechallenge was 49 days, the shortest duration was 17 days and the longest was 994 days. 40% (n = 19) were readmitted with irAEs. The median toxicity grade of those readmitted was three, two of these patients required ICU admission, one died as a result of their toxicity. 40% (n = 19) of the 47 patients that were rechallenged were alive at the end of 2022. Of the 19 patients that were still alive, 95% (n = 18) had a diagnosis of metastatic melanoma. Of the 18 metastatic melanoma patients, 100% had a complete metabolic response (CMR) at the end of 2022, one of whom ceased IO due to toxicity but then proceeded to have a CMR.

Conclusion: The decision to rechallenge patients subsequent to hospitalisation for irAEs is nuanced. Our review found that rechallenging can be safely performed; however, it underscores the value of a tailored approach in a carefully selected subset of patients.

Inderjit Mehmi¹, Amy Weise², Meredith McKean³, Kyriakos P Papadopoulos⁴, John Crown⁵, Sajeve S Thomas⁶, Janice Mehnert⁷, John Kaczmar⁸, Kevin B Kim⁹, Nehal J Lakhani¹⁰, Melinda Yushak¹¹, Omid Hamid¹, Tae Min Kim¹², Guilherme Rabinowits¹³, Alexander Spira¹⁴, Giuseppe Gullo¹⁵, Jayakumar Mani¹⁵, Fang Fang¹⁵, Shuquan Chen¹⁵, JuAn Wang¹⁵, Israel Lowy¹⁵, Mark Salvati¹⁵, Matthew G Fury¹⁵, Karl D Lewis¹⁵

¹The Angeles Clinical and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, California, USA

²Henry Ford Hospital, Detroit, Michigan, USA

³Sarah Cannon Research Institute/Tennessee Oncology PLLC, Nashville, Tennessee, USA

⁴START Center, San Antonio, Texas, USA

⁵St Vincent's University Hospital, Dublin, Ireland

⁶University of Florida Health Cancer Center at Orlando Health, Orlando, Florida, USA

⁷Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA

⁸MUSC Hollings Cancer Center, North Charleston, South Carolina, USA

⁹Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, California, USA

¹⁰START Midwest, Grand Rapids, Michigan, USA

¹¹Department of Hematology and Medical Oncology at Emory University School of Medicine, Atlanta, Georgia, USA

¹²Seoul National University Hospital, Seoul, South Korea

¹³Department of Hematology and Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA

¹⁴Virginia Cancer Specialists and US Oncology Research, Fairfax, Virginia, USA

¹⁵Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA

Aims: Co-blockade of LAG-3 improves the effectiveness of anti-PD-1 treatment in advanced melanoma patients. We present updated efficacy data for poor prognosis patients from three Phase 1 expansion cohorts with advanced melanoma: anti-PD-(L)1/systemic treatment-naïve (cohorts 6 and 15); previously exposed to adjuvant/neoadjuvant systemic treatment, including anti-PD-1 (cohort 16).

Methods: Patients with advanced melanoma were treated with fianlimab 1600 mg plus cemiplimab 350 mg intravenously Q3W for 12 months, with a further 12 months if clinically indicated (NCT03005782). Tumour measurements were assessed by RECIST 1.1 every 6 weeks for 24 weeks, then every 9 weeks.

Results: Forty patients each in cohorts 6 and 15, and 18 patients in cohort 16, were enrolled and treated (N = 98; 1 November 2022 data cutoff). In the adjuvant/neoadjuvant setting, 24% of patients had received prior systemic treatment for melanoma, including 15% with prior exposure to immune checkpoint inhibitors (ICI). Median follow up: 12.6 months; median treatment duration: 33 weeks. Overall ORR (N = 98) was 61%, and among patients with prior ICI (n = 15) was 60%. In patients with LDH>ULN (n = 32), ORR, DCR and mDOR were 53%, 72% and NR (95% CI: 7–NE), respectively. In patients with liver metastases at baseline (n = 21), ORR, DCR and mDOR were 43%, 57% and 9 months (95% CI: 3–NE), respectively. In patients with any M1c disease and LDH>ULN at baseline (n = 17), ORR, DCR, mDOR were 35%, 59% and NR (95% CI: 6–NE), respectively. Overall, 44% of patients reported grade ≥3 TEAEs and 33% reported serious TEAEs.

Conclusions: Fianlimab plus cemiplimab showed high activity in patients with advanced melanoma and poor prognosis features at baseline; ORR and DCR observed compare positively with available data for approved ICI combinations in the same clinical setting. A Phase 3 trial (NCT05352672) of fianlimab plus cemiplimab in treatment-naïve advanced melanoma patients is ongoing.

Wing Sze L Chan^1,2, Vasi Naganathan^1,3,4, Abby Fyfe⁵, Alina Mahmood^6,7, Arnav Nanda⁷, Thi Thuy Duong Pham⁸, Natalie Southi^7,8, Sarah Sutherland^6,7, Erin Moth^5,6

¹Geriatrics, Concord Repatriation General Hospital, Sydney, NSW, Australia

²Geriatrics, Royal Prince Alfred Hospital, Sydney, NSW, Australia

³Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, NSW, Australia

⁴Academic Faculty of Medicine and Health Concord Clinical School, University of Sydney, Sydney, NSW, Australia

⁵Oncology, Macquarie University Hospital, Sydney, NSW, Australia

⁶University of Sydney, Sydney, NSW, Australia

⁷Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁸Concord Cancer Centre- Concord Repatriation General Hospital, Sydney, NSW, Australia

Background: Older adults value the perspectives of significant others and carers regarding decision-making about cancer treatment. The support provided by carers of older adults with cancer, and carer perspectives on treatment decision-making, requires evaluation.

Aims: To describe the roles, experiences and decision-making preferences of carers of older adults with cancer.

Methods: Carers of older adults (≥65 years) with cancer at three centres completed an anonymous survey. Carer preferred and perceived role in treatment decision-making was assessed by modified Control Preferences Scale and carer burden by Zarit Burden Index. Comparison of roles and burden between groups (culturally and linguistically diverse background, gender and carer age) were made by Chi- or T-tests.

Results: Eighty-four surveys were returned (15 partial responses). Carer characteristics: median age 54 years, female (75%), child (51%) and spouse (34%) of care-recipient. Care-recipient characteristics: median age 75 years, receiving anti-cancer treatment (88%), diagnosis of haematological (22%) and colorectal (18%) cancer. About half (46%) of care-recipients were CALD. Carers more frequently supported instrumental (42%–76%) over personal activities of daily living (3%–12%) and were often involved in communication and information gathering (43%–79%). Carer burden was ‘low’ in 39%, ‘moderate’ in 24% and ‘high’ in 37%. Most carers (91%) preferred to be present for treatment-related discussions. Preferred role in decision-making was passive in 63%, collaborative in 34% and active in 3%. Most (72%) played their preferred role. There were no associations between (i) carer burden or (ii) preferred decision-making role and CALD background or gender. Younger carers (<65 years) preferred a passive role compared to older carers (71% vs. 46%, p = 0.04). There was no significant difference in preferred decision-making roles between spousal and filial carers (p = 0.14).

Conclusion: Carers of older adults with cancer play varied support roles. Carers prefer to be present for discussions about treatment options, though favour playing a passive or collaborative role in treatment decision-making.

Woo Jun Park¹, Udit Nindra^1,2,3, Gowri Shivasabesan¹, Sarah Childs¹, Jun Hee Hong⁴, Robert Yoon^1,2,3,4, Martin Hong¹, Sana Haider^2,3,5, Adam Cooper^1,2,3, Aflah Roohullah^1,2,3,5, Kate Wilkinson^1,2,3, Wei Chua^1,2,3, Abhijit Pal^1,6

¹Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia

²Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

³Western Sydney University, Sydney, NSW, Australia

⁴Princess Mary Cancer Centre, Westmead, NSW, Australia

⁵Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia

⁶Department of Medical Oncology, Bankstown-Lidcombe Hospital, Bankstwon, NSW, Australia

Background/aims: Early phase clinical trials (EPCT) represent access to novel therapeutics for patients who have exhausted standard care options. Although EPCTs play a major role in advancing cancer care, culturally and linguistically diverse (CALD) patients have notably lower rates of participation. Our main aim was to assess and characterise social demographics of CALD patients recruited for EPCTs at the Liverpool Cancer Centre including geography, country of birth, language spoken at home (LSAH) as well as socio-economic indexes for areas (SEIFA).

Methods: We conducted a 10-year retrospective audit of all patients treated on EPCTs at Liverpool Hospital between 2013 and 2023. Index of Relative Socio-economic Disadvantage (IRSD) scores were used from SEIFA data based on the postcode enrolled in EPCT.

Results: Our cohort contained total of 233 patients. Patients had a median age of 65 years (31–88) and 90 (41%) were identified as CALD. Forty-three (18%) patients spoke language other than English at home, and 112 (48%) were born outside Australia. Vietnamese was the most common LSAH amongst CALD (19 patients, 44%) and was the most common place of birth. The median IRSD value for our enrolled EPCT population was 941 which is marginally higher than the ISRD value for Liverpool (931). 58% (n = 136) of patients resided in areas that were less socioeconomically disadvantaged than Liverpool. Additionally, there was an almost statistically trend towards lower median values of IRSD scores amongst CALD versus non-CALD patients (904 vs. 975, p = 0.06).

Conclusion: There is a trend towards, greater socioeconomic disadvantage amongst the CALD patients who are enrolled in the EPCT. Our analysis provides an example of the socioeconomic and cultural landscape of patients treated at the Liverpool Hospital EPCT unit. There needs to continue to be ongoing efforts from all units to ensure limitation of inequity of access to trials unit in Australia.

Nick Pavlakis

Department of Medical Oncology, Royal North Shore Hospital, New South Wales, Australia

Aim: Tepotinib + osimertinib has shown promising efficacy in patients with EGFRm METamp NSCLC, who have a high unmet need after 1L osimertinib. We report the primary analysis of tepotinib + osimertinib from INSIGHT 2 (NCT03940703) in patients with ≥9 months’ follow-up (data-cut: 28 March 2023).

Methods: Patients with advanced EGFRm METamp NSCLC detected by tissue biopsy (TBx) FISH and/or by liquid biopsy (LBx) NGS, following progression on 1L osimertinib received tepotinib 500 mg (450 mg active moiety) + osimertinib 80 mg once daily. Primary endpoint was objective response by IRC in patients with FISH⁺ METamp.

Results: Of 481 patients prescreened, METamp was identified by TBx FISH in 169 (35%) patients and by LBx NGS in 52 (11%) patients. A total of 128 patients received tepotinib + osimertinib (median age 61 years [range 20–84], 57.8% female, 61.7% Asian, 67.2% never smoker, 72.7% ECOG PS 1). Treatment was ongoing in 22 patients at data cut-off.

In 98 patients with TBx FISH METamp, response rate (ORR) was 50.0% (95% CI: 39.7, 60.3). Median (m) DOR was 8.5 months (95% CI: 6.1, NE), mPFS was 5.6 months (95% CI: 4.2, 8.1) and mOS was 17.8 (11.1, NE). Outcomes were also meaningful in LBx NGS⁺METamp group; ORR, mDOR, mPFS and mOS were 54.8% (95% CI: 36.0, 72.7), 5.7 months (2.9, 15.4), 5.5 months (2.7, 7.2) and 13.7 months (2.9, 15.4), respectively.

The most common TRAEs (n = 128) were diarrhoea in 63 (49.2%; Grade ≥3, 1 [.8%]) and peripheral oedema in 52 (40.6%; Grade ≥3, 6 [4.7%]) patients. Thirteen patients (10.2%) discontinued treatment due to TRAEs; 6 (4.7%) patients due to pneumonitis.

Conclusions: Tepotinib + osimertinib demonstrated durable responses and a manageable safety profile, making it a potential chemotherapy-sparing oral targeted therapy option in patients with EGFRm METamp NSCLC following 1L osimertinib.

Nick Pavlakis

Royal North Shore Hospital, St Leonards, NSW, Australia

Aim: Tepotinib + osimertinib has shown promising efficacy in patients with EGFRm METamp NSCLC, who have a high unmet medical need after 1L osimertinib. We report the primary analysis of tepotinib + osimertinib from INSIGHT 2 (NCT03940703) in patients with ≥9 months’ follow-up (data-cut: 28 March 2023).

Methods: Patients with advanced EGFRm METamp NSCLC detected by FISH tissue biopsy (TBx) and/or by NGS liquid biopsy (LBx), following progression on 1L osimertinib received tepotinib 500 mg (450 mg active moiety) + osimertinib 80 mg once daily. Primary endpoint was objective response by IRC in patients with FISH⁺ METamp.

Results: Of 481 patients pre-screened, METamp was identified by FISH TBx in 169 (35%) patients and by NGS LBx in 52 (11%) patients. A total of 128 patients received tepotinib + osimertinib (median [m] age 61 years [range 20–84], 57.8% female, 61.7% Asian, 67.2% never smoker, 72.7% ECOG PS 1).

In 98 patients with FISH⁺METamp, ORR was 50.0% (95% CI: 39.7, 60.3). mDOR was 8.5 months (95% CI: 6.1, NE), mPFS was 5.6 months (95% CI: 4.2, 8.1) and mOS was 17.8 (11.1, NE). Outcomes were also meaningful in patients with LBx NGS⁺METamp; ORR, mDOR, mPFS and mOS were 54.8% (95% CI: 36.0, 72.7), 5.7 months (2.9, 15.4), 5.5 months (2.7, 7.2) and 13.7 months (2.9, 15.4), respectively.

In 128 patients treated with tepotinib + osimertinib, the most common TRAEs were diarrhoea in 63 (49.2%; Grade ≥3, 1 [.8%]) and peripheral oedema in 52 (40.6%; Grade ≥3, 6 [4.7%]) patients. Thirteen patients (10.2%) discontinued treatment due to TRAEs; pneumonitis (n = 6 [4.7%]) was the most common reason.

Conclusions: Tepotinib + osimertinib exhibited durable efficacy and a tolerable safety profile, making it a potential chemotherapy-sparing oral targeted therapy option in patients with EGFRm METamp NSCLC after 1L osimertinib.

Graham Pitson, Melinda Mitchell, Leigh Matheson, Alison Patrick

Barwon South Western Region Integrated Cancer Services, Geelong, Australia

Aims: Primary brain cancers are uncommon tumours with high morbidity and mortality. The most common brain cancer in adults is glioblastoma (GBM). The standard of care for good performance status patients after surgical debulking is post-operative radiotherapy and oral temozolamide. Older and poorer performance status patients generally receive lower doses of radiotherapy. The aim of this study was to review population-based outcomes for GBM in the Barwon South West Region (BSWR) of Victoria.

Methods: The Evaluation of Cancer Outcomes (ECO) Registry records clinical and treatment information on all newly diagnosed cancer patients in the BSWR encompassing approximately 380,000 people. This study analysed patterns of care and outcomes for all GBM patients diagnosed in the BSWR from 2009 to 2019. Death data was available through to end of 2020.

Results: There were 321 primary brain cancers diagnosed during the study period. GBM was the most common diagnosis (208 cases), followed by astrocytomas, other gliomas and oligodendrogliomas (42, 32 and 12 cases, respectively). The median age of all GBM patients was 76 and median survival 11 months. Sixty patients had no record of radiotherapy in the BSWR - this group had a median age of 81 and median survival of 3.1 months. Patients known to receive radiotherapy were split into high, medium and low dose groups with median ages and survivals of 68 years and 15.4 months, 78 years and 7.5 months, 83 years and 5.9 months, respectively. Palliative care referrals were in place for approximately 50% of patients, while advanced care plans (ACP) were more frequent from 2015 onwards (19% of cases).

Conclusions: Although the BSWR lacked neurosurgical services during the study period, GBM patients appeared to have care patterns and outcomes in line with major published studies. Given the poor outcomes, referrals to palliative care services and lodgement of ACP appeared lower than might be expected.

Lucy Porter¹, Phillip Parente^2,3, Grace Gard^4,5, Benjamin Brady⁶, Wasek Faisal^7,8, Dishan Herath⁴, Margaret Lee^2,3, Peter Gibbs^4,5, Ben Markman^6,5, Rachel Wong^2,3

¹School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

²Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia

³Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

⁴Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia

⁵Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia

⁶Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia

⁷Grampians Integrated Cancer Service, Grampians Health, Ballarat, Victoria, Australia

⁸School of Health, La Trobe University, Melbourne, Victoria, Australia

Aim: To determine potential adjuvant atezolizumab eligibility rates among non-small cell lung cancer (NSCLC) patients enrolled in a multi-site registry. Atezolizumab has been PBS-subsidised since November 2022 for resected stage II–IIIa NSCLC patients with PD-L1 ≥ 50%, with no EGFR/ALK gene abnormalities (confirmed on tumour testing) who have been treated with platinum-based chemotherapy. EGFR and ALK FISH tissue testing are not currently MBS-reimbursed for squamous cell carcinoma lung (SqCC). The proportion of patients who undergo genomic testing and are eligible for PBS-subsidised atezolizumab treatment in Australian hospitals is unknown.

Methods: Patients enrolled in the multi-site INHALE lung cancer registry between February 2020 and January 2023 at four Australian sites (n = 448) were retrospectively analysed. NSCLC patients who underwent surgical resection were included (n = 115) and analysed for stage, genomic testing, treatment details and outcomes.

Results: 90/115 resected NSCLC patients were treated with curative-intent. 77/90 had non-squamous histology. 63/90 received surgery alone, 25/90 received adjuvant systemic therapy and/or radiotherapy and 2/90 received neo-adjuvant systemic therapy and/or radiotherapy. 70/90 curative-intent resected patients had PD-L1 testing. 56/90 underwent genomic testing. Of the 70 PD-L1 tested patients, eight were PD-L1 ≥ 50%. One patient met current PBS-eligibility criteria for adjuvant atezolizumab. Reasons for being ineligible were: stage I tumour n = 3, EGFR/ALK test not done n = 2 (1 SqCC) and did not receive platinum-based chemotherapy n = 2 (1 no EGFR/ALK mutations, 1 EGFR/ALK test not done).

Conclusion: In this real-world analysis of resected NSCLC patients, very few routine care patients were eligible for PBS-subsidised atezolizumab. We anticipate that PD-L1 and genomic testing rates will increase in response to the availability of adjuvant atezolizumab on the PBS and as evidence supporting neo-adjuvant/adjuvant use of immunotherapy and/or targeted agents continues to emerge. The discrepancy between PBS-eligibility requirements and MBS genomic testing reimbursement warrants review.

Benjamin N Rao^1,2, Kumaran Manivannan³, Phillip Parente^2,3, Rachel Wong^2,3

¹Eastern Health Clinical School, Deakin University School of Medicine, Melbourne, Victoria, Australia

²Department of Oncology, Eastern Health, Box Hill, Victoria, Australia

³Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

Aim: Carboplatin chemotherapy doses have traditionally been calculated using the Cockcroft–Gault (CG) formula when direct GFR measurement is not available. The eviQ ADDIKD guidelines now recommend using the BSA-adjusted Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We reviewed the potential impact of this change in a real-world setting.

Methods: This is a retrospective audit of patients receiving carboplatin-based chemotherapy regimens between January 2022 and January 2023. Baseline characteristics recorded included sex, height, weight, serum creatinine, treatment intent and single agent versus combination regimen. Actual C1D1 carboplatin dose was compared to dose calculated using the CG and CKD-EPI formulae, accepting a 25 mg variation. C1 treatment-related toxicity, including myelosuppression requiring dose modification, was also recorded.

Results: A total of 163 patients were identified; mean age 63 years; 97 (60%) female. Treatment intent was curative in 60, palliative in 100 and unknown in three patients. A total of 150 received carboplatin monotherapy and 13 combination regimens.

Compared to actual dose received, the CKD-EPI calculated carboplatin dose was within 25 mg for 49 (30%), >25 mg higher for 92 (57%) and >25 mg less for 21 (13%) of patients. Compared to the CG calculated dose, the CKD-EPI carboplatin dose was within 25 mg for 60 (37%), >25 mg higher for 51 (32%) and >25 mg less for 51 (32%) of patients.

Of the 34 patients experiencing myelotoxicity requiring dose reduction, the CKD-EPI dose was >25 mg higher than actual dose in 20 (59%) patients and >25 mg higher than CG dose in nine (27%) patients.

Conclusions: Carboplatin doses calculated using the eviQ-endorsed CKD-EPI formula compared to actual and CG calculated doses were similar in 30%, and were higher than actual dose in 57% of patients. The CKD-EPI dose was higher than actual dose in 59% of patients with clinically significant myelotoxicity. This highlights the ongoing importance of clinician input when dosing carboplatin, taking into account individual patient characteristics.

Danny Rischin¹, Fiona Day², Hayden Christie³, Gerry Adams⁴, James E Jackson⁵, Yungpo Su⁶, Vishal A Patel⁷, Joanna Walker⁸, Paolo Bossi⁹, Maite De Liz Vassen Schurmann¹⁰, Gaelle Quereux¹¹, Amarnath Challapalli¹², Suk-Young Yoo¹³, Shikha Bansal¹³, Israel Lowy¹³, Matthew G Fury¹³, Petra Rietschel¹³, Priscila Goncalves¹³, Sandro V Porceddu¹⁴

¹Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

²Department of Medical Oncology, Calvary Mater Newcastle, Waratah, Australia

³Cancer Care Centre Hervey Bay, Urraween, Australia

⁴Radiation Oncology, Genesis Cancer Care, Bundaberg, Australia

⁵Icon Cancer Centre Gold Coast, Southport, Queensland, Australia

⁶Head and Neck Medical Oncology, Nebraska Cancer Specialists, Omaha, Nebraska, USA

⁷Institute for Patient-Centered Initiatives and Health Equity, George Washington University School of Medicine & Health Science, Washington, DC, USA

⁸Department of Dermatology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

⁹Head and Neck Medical Oncology Unit, Humanitas University and Humanitas Cancer Centre, Milan, Italy

¹⁰Animi Oncology Treatment Unit, University Planalto Catarinense (UNIPLAC), Centro, Lages, Brazil

¹¹Nantes Université, CHU Nantes, Department of Dermatology, Nantes, France

¹²Bristol Cancer Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK

¹³Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA

¹⁴School of Medicine, University of Queensland, Herston, Queensland, Australia

Aims: Cure rates after surgery for cutaneous squamous cell carcinoma (CSCC) are >95%; however, radiation therapy (RT) is recommended postoperatively for patients at high risk of recurrence. Despite this, locoregional recurrence or distant metastases may still occur. The ongoing C-POST study (NCT03969004) is evaluating cemiplimab adjuvant therapy for patients with high-risk CSCC with recurrence after surgery and RT.

The key primary objective is to evaluate disease-free survival following treatment with adjuvant cemiplimab versus placebo in patients with high-risk CSCC who have tumour recurrence after surgery and RT. Secondary objectives include overall survival, freedom from locoregional or distant relapse and treatment-emergent adverse events.

Methods: Patients with high-risk CSCC aged ≥18 years are eligible if they have undergone surgery and completed post-operative RT (minimum total bioequivalent dose 50 Gy) ≤10 weeks before randomisation and if the tumour presents with ≥1 of: (1) nodal disease with either extracapsular extension (ECE) and ≥1 node ≥20 mm, or ≥3 nodes denoted as positive for CSCC regardless of ECE; (2) in-transit metastases; (3) T4 lesion; (4) perineural invasion by clinical symptoms or radiological involvement and (5) recurrent CSCC with ≥1 other risk factor.

The study has two parts. In part 1, patients will be randomised (1:1, blinded) to either intravenous cemiplimab 350 mg or placebo every 3 weeks for 12 weeks, followed by cemiplimab 700 mg or placebo every 6 weeks for 36 weeks. After 48 weeks of double-blind treatment, there is an optional part 2, where patients in either group who experience recurrence after a minimum of 3 months may receive open-label (unblinded) cemiplimab for up to 96 weeks.

Results: Ongoing enrolment is currently expected to reach 412 patients from approximately 100 sites across North and South America, Europe and the Asia-Pacific region.

Conclusions: The study is ongoing and actively recruiting.

Bhavini Shah, Bridget Josephs, Mahesh Iddawela, Hieu Chau, Evangeline Samuel, Cassandra Moore, Sophie Tran, Danielle Roscoe

Latrobe Regional Health, Traralgon, VIC, Australia

This study presents a comprehensive analysis of survival outcomes and prognostic implications associated with brain metastasis in lung cancer patients across the Gippsland region. The primary objective of this research is to compare the survival rates of patients diagnosed with lung cancer accompanied by brain metastasis to those with metastatic lung cancer alone. Additionally, the study evaluates brain metastasis as an independent predictor of mortality and morbidity in lung cancer patients across Gippsland.

Utilising retrospective data between January 2017 and December 2022, the study examines clinical records of 101 patients from Latrobe Regional Hospital in Gippsland. Statistical analyses were conducted to assess differences in survival rates between patients with and without brain metastasis, accounting for various demographic and clinical variables. Furthermore, the research investigates the relationship between brain metastasis and its impact on overall patient outcomes, considering factors such as treatment modalities, disease stage and comorbidities.

The findings of this study reveal significant disparities in survival rates between patients with lung cancer and brain metastasis compared to those without brain involvement. The implications of these findings are crucial for oncologists, healthcare providers and policymakers in refining treatment strategies, enhancing patient care and allocating resources effectively.

In conclusion, this study underscores the importance of recognising brain metastasis as a pivotal factor influencing the survival and prognosis of lung cancer patients in the Gippsland region. By elucidating the distinct survival outcomes in patients with and without brain metastasis, and by establishing brain metastasis as an independent predictor of mortality and morbidity, this research contributes valuable insights to the field of oncology. Ultimately, these insights have the potential to drive improvements in clinical decision-making and patient outcomes across various cancer types in Gippsland and beyond.

Rahul Sisodia, Sai Kumar, Subhash Gupta, Haresh KP, Suman Bhasker, Suhani S, Omprakash P, Asuri Krishna, Maroof A Khan, Seenu V, Bansal V K, Rajinder Parshad

AIIMS New Delhi, New Delhi, India

Background: Triple negative breast cancer (TNBC) is a distinct, aggressive breast cancer subtype. Devoid of oestrogen, progesterone and HER-2/neu receptors, it resists standard hormonal therapies, urging specialised research and targeted therapeutic strategies.

Methods and materials: A retrospective analysis was conducted on TNBC records from 2010 to 2020. We analysed 970 patients of breast cancer out of which TNBC constitutes 21.6%. We captured patient demographics, tumour profiles, treatments and outcomes. Survival rates were analysed using the Kaplan–Meier method, correlated with tumour and patient factors. Stata 14.0 and SPSS 24.0 enabled data interpretation.

Results: From the 150 TNBC cases examined, the median age at presentation was 47 years. The dominant histological feature was invasive ductal carcinoma. Tumour staging showed T4 stage (32.7%), T2 stage (31.3%), T3 stage (30.7%) and T1 stage (5.3%). In terms of N-stage, 41.3% had N1 disease, followed by N0 (35.3%), N2 (17.3%) and N3 (6%). About 64% displayed nodal involvement. Neoadjuvant chemotherapy was received by 57.3% with the taxane-based regimen being predominant. After this, 22% achieved a complete pathological response. Recurrence patterns were alarming with a significant risk within the first 2 years post-diagnosis, primarily in the lungs. The 3-year data recorded an overall survival of 85.2% and progression-free survival of 72.6%.

Conclusion: TNBC's inherent aggressiveness underscores the importance of early detection and precision-based therapies. The study emphasises frequent lung recurrences, advocating intensive post-treatment monitoring. The substantial benefits of adjuvant chemotherapy on survival were clear. Enhanced research is vital to improve treatment strategies and outcomes for TNBC patients.

Tharani Sivakumaran^1,2, Anthony Cardin^1,3, Jason Callahan⁴, Hui Li Wong^1,2, Richard Tothill^1,5,6, Rod Hicks^4,7, Linda Mileshkin^1,2

¹Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

²Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Melbourne Theranostic Innovation Centre, Melbourne, VIC, Australia

⁵Department of Clinical Pathology, University of Melbourne, Melbourne, VIC, Australia

⁶University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia

⁷The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia

Aims: We aimed to describe the Peter MacCallum Cancer Centre experience with 18F-FDG PET/CT in cancer of unknown primary (CUP) with respect to detection of a primary site and its impact on management. Secondary aim was to compare overall survival (OS) in patients with and without a detected primary site.

Methods: Retrospective analysis of CUP patients identified from medical oncology clinics and PET/CT records between 2014 and 2020. Clinicopathologic, treatment details and genomic analysis were used to determine the clinically suspected primary site and compared against two independent blinded nuclear medicine specialist 18F-FDG-PET/CT reads to determine sensitivity, specificity, accuracy and detection rate of primary site.

Results: A total of 147 patients were identified of whom 65% underwent molecular profiling. Median age at diagnosis was 61 years (range 20–84) with 93% being ECOG 0–1 and 82% classified as unfavourable CUP subtype as per ESMO guidelines. 18F-FDG-PET/CT detected a primary site in 41%, changed management in 22% and identified previously occult disease sites in 37% of patients. The sensitivity, specificity and accuracy were 61%, 34% and 52%, respectively. Median OS for all patients was 17.4 months. Median OS in patients with a detected primary site on 18F-FDG-PET/CT scan concordant with clinicopathological and genomic information was 19.8 months compared with 8.5 months in patients without a detected primary site (p = 0.008). Multivariable analysis of survival adjusted for age and sex remained significant for identification of potential primary site (p = 0.007), favourable CUP (p < 0.001) and ECOG ≤ 1 (p < 0.001).

Conclusions: 18F-FDG-PET/CT plays a complementary role in CUP diagnostic work-up and in 41% of cases a potential primary site was identified. OS is improved with primary site identification, demonstrating the value of access to a diagnostic 18F-FDG-PET/CT scan for CUP patients.

Christopher Swain¹, Shaza Abo¹, Lara Edbrooke¹, Lucy Troup², Clare O'Donnell³, Joanne Houston⁴, Gerald Yeo⁴, Sangeeta Sathyanath², Vinicius Cavalheri⁵, Linda Denehy¹

¹University of Melbourne, Melbourne, VIC, Australia

²Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Austin Health, Heidelberg, VIC, Australia

⁴Fiona Stanley Hospital, Murdoch, WA, Australia

⁵Curtin University, Bentley, WA, Australia

Aims: Physical activity (PA) is important for people with cancer but is often reduced following treatment. Here, we describe the baseline functional exercise capacity and PA levels in patients with haematological cancer following bone marrow transplant (BMT).

Methods: Within 45 days post-BMT, participants undertook a 6-min walk test, were asked to wear a Fitbit Charge 5 for 7 consecutive days and completed the International Physical Activity Questionnaire Short Form (IPAQ-SF). Continuous data are presented as means and standard deviation (SD) for normal distributions and median and interquartile range (IQR) for non-normal distributions. Categorical data are presented as frequencies and percentages.

Results: Fifty participants (age 56 ± 13 years; 20 females) were recruited a median (IQR) 34 [27, 38] days after allogeneic (n = 16) or autologous (n = 34) BMT. Six-minute walk distance was 484 (106) m for all participants. This represents 84% of age-based reference values for the test. Objective PA (mean, SD) = 5374 (3109) steps/day and distance = 3.8 (2.3) km/day per participant. Steps = 4605 (3528) after allogeneic BMT and = 5732 (2893) after autologous BMT. Steps and distance were achieved via a median (IQR) 5.5 [0, 25] min of vigorous, 8.4 [0, 27] min of moderate and 145 [111, 216] min of light PA/day. Nine (18%) participants self-reported (IPAQ-SF) and 20 (40%) participants objectively met COSA recommendations for moderate to vigorous physical activity.

Conclusion: Functional exercise capacity, daily steps and moderate to vigorous intensity PA are low 30 days following BMT. This may indicate the unmet need for physical activity support and rehabilitation programs following BMT.

Sim Yee (Cindy) Tan^1,2, Janette Vardy^1,2, Jane Turner¹, Sarah Ratcliffe³, Mona Faris⁴, Prunella Blinman¹, Haryana Dhillon^3,4

¹Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia

²Sydney Medical School, University of Sydney, Concord, NSW, Australia

³Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia

⁴Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, Sydney, New South Wales, Australia

Background: Cancer cachexia syndrome occurs in up to 15%–20% of patients with advanced cancer, but it is poorly understood, and the pathophysiology is likely multifactorial. We conducted a feasibility study assessing a 12-week supervised resistance exercise program with protein and fish oil supplements in patients with advanced upper gastrointestinal (UGI) cancer or lung cancer.

Aims: Here, we aimed to report the participants’ perceptions of the program.

Methods: The study population comprised people diagnosed with upper gastro-intestinal or lung cancers without weight loss >10% in past month or >3 kg over prior 3 months. All provided informed consent. Participants were randomised 2:1 to intervention (twice weekly supervised exercise sessions + protein supplement drinks for 12 weeks + daily fish oil supplement) or standard of care. Patients randomised to intervention arm were invited to complete an exit interview post-intervention or at withdrawal. Interviews were audio-recorded, transcribed and analysed using codebook thematic analysis by two coders in an iterative process to ensure rigor.

Results: The population comprised 21 participants (13 male, 8 female) with median age 61 years (range 21–84), with 13 randomised to intervention and invited to interview. Interviews were completed with nine participants. We identified four thematic areas: Program Specific, Program Influences, Cancer-related and Statements. Within the program influences area five subthemes were extracted: affect and coping, behaviour, physical function, cognitive function and weight. Experiences of affect and coping varied with some participants valuing the programs’ contribution to how they were feeling physically and emotionally. Others indicated difficulty with coping, largely related to their deteriorating health condition. Improved physical function largely manifest as increased energy, strength and stamina.

Conclusions: Intervention participants reported broad impacts of the intervention across a range of physical, emotional and functional domains. Incorporating theoretically derived approaches are important to ensuring improved coping and self-efficacy for self-management.

Teresa Brown^1,2, Liang-Dar Hwang³, Elise Treleaven¹, Anita Pelecanos⁴, Brett GM Hughes^1,5, Charles Y Lin^1,5, Lizbeth M Kenny^1,5, Penny Webb⁴, Judy D Bauer⁶

¹Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia

²Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia

³Institute for Molecular Science, The University of Queensland, Brisbane, Queensland, Australia

⁴QIMR, Berghofer Medical Research Institute, Brisbane, Queensland, Australia

⁵School of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁶Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

Aims: Patients with head and neck cancer (HNC) undergoing chemoradiation often experience loss or alteration of taste which impacts oral intake and increases malnutrition risk. An individual's inborn ‘taster status’ is primarily determined by genetic variation within the bitter taste receptor gene TAS2R38. This taster status has been shown to affect the perception and consumption of food in healthy populations, however, has never been investigated in cancer patients.

Methods: Patients with HNC cancer undergoing curative intent chemoradiation were eligible. Taster status was determined using kits supplied by Monell Chemical Sense Center, USA. Taste perception, nutritional status (PGSGA) and dietary intake (online 24-h recall ASA-24) were measured at baseline, and 1-, 3- and 6-months post-treatment. Primary outcomes were feasibility measures (recruitment and retention rates; acceptability of assessment tools), with clinical secondary outcomes (nutritional and taste).

Results: Twenty-four patients enrolled; 92% male, mean age 63.1(SD 9.4) years. Most (92%) had oropharyngeal cancer. All had concurrent chemoradiation. Eight (33%) were classified as non-tasters. Only two patients withdrew. All patients easily completed taste assessments and PGSGA (median 9–10/10). The online 24-h recall was rated more difficult (5–7/10) with lower completion rates (83%–96%).

At 1-month, 70% and 83% of patients correctly identified sweet and salty, respectively, however was lower for sour (48%), bitter (52%), cool (43%) and burn (65%). Taste perceived intensity improved over 6-months, although sour remained low (36%). Taster patients had steadier energy, protein, fat and carbohydrate intakes over time, whereas non-tasters experienced the greatest decrease in intake at 1-month and were slower to recover. Non-tasters had higher rates of malnutrition at 1-month (88% vs. 53%) and 3-months (50% vs. 21%).

Conclusions: Study design was feasible and assessment tools acceptable. Non-tasters appear to have greater impacts from chemoradiation on their oral intake and nutritional status compared to tasters which warrants further investigation.

Tania Moujaber¹, Ben Tran², Elizabeth Liow³, Timothy Clay⁴, Annalisa Varrasso⁵, Greer Bennett⁵, Mairead Kearney⁶, Alison Gibberd⁷, Howard Gurney⁸

¹The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia

²Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

⁴Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Western Australia

⁵Merck Healthcare Pty Ltd, an affiliate of Merck KGaA, Macquarie Park, NSW, Australia

⁶Merck Healthcare KGaA, Darmstadt, Germany

⁷Hunter Medical Research Institute, Newcastle, NSW, Australia

⁸Macquarie University and Westmead Hospital, Sydney, NSW, Australia

Aims: In the phase 3 JAVELIN Bladder 100 trial (NCT02603432), avelumab first-line maintenance (1LM) + best supportive care (BSC) significantly prolonged overall survival versus BSC alone in patients with advanced urothelial carcinoma (aUC) that had not progressed after 1L platinum-based chemotherapy (PBC). Avelumab 1LM is now recommended as standard of care in international guidelines with level 1 evidence. We report real-world data from early access and patient access programs (EA/PAPs) of avelumab 1LM therapy in patients with aUC in Australia.

Methods: Data were collected from Australian EA/PAPs from February 2021 to September 2022, before the reimbursement of avelumab in Australia (October 2022). Patients eligible for data collection had aUC, were progression-free following 1L PBC and had received ≥1 avelumab dose. Avelumab treatment duration was estimated by the Kaplan–Meier method.

Results: A total of 295 patients (median age, 73.9 years [interquartile range, 67.0–78.5]) received avelumab; the majority were male (79%) and from New South Wales (34%) or Victoria (27%). Most patients had received carboplatin and/or cisplatin + gemcitabine (94%), and the median number of 1L PBC cycles was 4. For 164 patients with available data, the median treatment-free interval (date from end of 1L PBC to avelumab initiation) was 35 days (interquartile range, 28–49). At the time of analysis, 123 of 295 patients (42%) had discontinued avelumab, most commonly due to progressive disease (66%) and adverse events (15%). Of 264 patients with available data, an estimated 35.1% (95% CI: 27.1–43.1) remained on avelumab after 1 year. The estimated median time on avelumab treatment was 37 weeks (95% CI: 31–42).

Conclusions: These real-world data provide insights about how avelumab 1LM, which is the standard-of-care treatment for patients with aUC whose disease has not progressed with 1L PBC, is being incorporated into treatment practice in Australia.

Previously presented at ANZUP 2023, ‘FNP: 47’, ‘Tania Moujaber et al.’ – Reused with permission.

Shilpa Gupta¹, Miguel A Climent Duran², Srikala S Sridhar³, Thomas Powles⁴, Joaquim Bellmunt⁵, Annalisa Varrasso⁶, Karin Tyroller⁷, Silke Guenther⁸, Alessandra di Pietro⁹, Petros Grivas¹⁰

¹Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA

²Instituto Valenciano de Oncología, Valencia, Spain

³Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

⁴Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK

⁵Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA

⁶Merck Healthcare Pty Ltd, An Affiliate of Merck KGaA, Macquarie Park, NSW, Australia

⁷EMD Serono Research & Development Institute, Inc., An Affiliate of Merck KGaA, Billerica, Massachusetts, USA

⁸Merck Healthcare KGaA, Darmstadt, Germany

⁹Pfizer srl, Milano, Italy

¹⁰University of Washington; Fred Hutchinson Cancer Center, Seattle, Washington, USA

Aims: In the phase 3 JAVELIN Bladder 100 trial (NCT02603432), avelumab 1L maintenance therapy + best supportive care (BSC) significantly prolonged overall survival (OS) and progression-free survival (PFS) versus BSC alone in patients with aUC without progression following 1L platinum-based chemotherapy (PBC). Avelumab 1L maintenance had a tolerable and manageable safety profile and also had minimal impact on quality of life. Here, we report long-term efficacy and safety outcomes in subgroups based on older age (≥65 years).

Methods: Eligible patients with locally advanced or metastatic UC without progression following four to six cycles of 1L PBC were randomised 1:1 to receive avelumab + BSC (n = 350) or BSC alone (n = 350). For this post hoc analysis, subgroups aged ≥65 to <75 years, ≥75 years and ≥80 years were analysed; patients aged <65 years were not included.

Results: At data cutoff (4 June 2021), median follow-up in both arms was ≥38 months. In the avelumab + BSC and BSC alone arms, age was ≥65 to <75 years in 136 and 163 patients, ≥75 years in 85 and 80 patients and ≥80 years in 28 and 27 patients, respectively. Across all subgroups, OS and investigator-assessed PFS were prolonged with avelumab + BSC versus BSC alone. HRs (95% CI) for OS were: ≥65 to <75 years, .73 (.543–.974); ≥75 years, .59 (.401–.877) and ≥80 years, .57 (.284–1.155). HRs (95% CI) for PFS were: ≥65 to <75 years, .51 (.389–.666); ≥75 years, .38 (.266–.554) and ≥80 years, .27 (.129–.560). Long-term safety of avelumab 1L maintenance was similar across subgroups.

Neil Milloy¹, Diah Elhassen², Melissa Kirker³, Mia Unsworth¹, Rachel Montgomery¹, Allison Thompson³, Caspian Kluth¹, Annalisa Varrasso⁴, Greer Bennett⁴, Mairead Kearney⁵, Nuno Costa⁶, Jane Chang³

¹Adelphi Real World, Bollington, Cheshire, UK

²Pfizer, Sydney, NSW, Australia

³Pfizer, New York, New York, USA

⁴Merck Healthcare Pty Ltd, An Affiliate of Merck KGaA, Macquarie Park, NSW, Australia

⁵Merck Healthcare KGaA, Darmstadt, Germany

⁶Pfizer, Porto Salvo, Portugal

Aims: Treatment guidelines for metastatic urothelial cancer (mUC) recommend first-line (1L) treatment based on platinum eligibility. In Australia, at data collection, the standard approach for 1L treatment of mUC was platinum-based chemotherapy (PBC), whilst immune checkpoint inhibitors (ICIs) were commonly used as second-line treatment. This study investigated treatment patterns and clinical practice criteria used to determine platinum eligibility in patients with mUC in Australia.

Methods: Data were drawn from the Adelphi mUC Disease-Specific Programme, a cross-sectional survey conducted in December 2021–June 2022 in Australia. Oncologists/urologists extracted data from medical charts for their next eight consecutive eligible adult patients with mUC. Demographics, clinical characteristics and treatment patterns were collected. Descriptive analyses were conducted.

Results: Twenty-nine physicians provided data on 239 patients (mean age, 70 years [SD 9.61]); male, 72%; ECOG performance status (PS) 0–1, 71%. The most common initial tumour location was bladder (84%), and the most common metastatic sites were lymph node (66%), visceral organ (64%) and bone (32%); 30% of patients had 1 metastasis, 38% had 2 and 32% had ≥3. Of patients with known platinum-eligibility status at 1L (n = 236), 90% (n = 213) were platinum-eligible (54% cisplatin-eligible, 36% carboplatin-eligible/cisplatin-ineligible). Renal function and ECOG PS were considered most frequently regarding eligibility for cisplatin (92%/65%) and carboplatin (86%/40%). On average, cisplatin-eligible patients were younger than carboplatin-eligible/cisplatin-ineligible patients (66.0 vs. 73.5 years). Of cisplatin-eligible patients (n = 128), 84% received PBC (cisplatin in 81% [n = 104]; carboplatin in 3% [n = 4]), and 16% (n = 20) received ICI treatment. Of carboplatin-eligible/cisplatin-ineligible patients (n = 85), 91% (n = 77) received PBC (cisplatin in 2% [n = 2]; carboplatin in 88% [n = 75]).

Shalini K Vinod^1,2, Angela Khoo³, Megan Berry^1,2, Katherine Bell⁴, Elhassan Ahmed⁵, Josephine Campisi⁶, Cara Gollon⁶, Abhijit Pal¹, Sau Kwan Seto⁶, Elise Tcharkhedian⁵, Thomas Tran¹, Victoria Bray^1,7

¹Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia

²South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia

³Department of Geriatrics, Liverpool Hospital, Liverpool, NSW, Australia

⁴Dietetics Department, Liverpool Hospital, Liverpool, NSW, Australia

⁵Physiotherapy Department, Liverpool Hospital, Liverpool, NSW, Australia

⁶Occupational Therapy Department, Liverpool Hospital, Liverpool, NSW, Australia

⁷School of Medicine, Western Sydney University, Penrith, NSW, Australia

Introduction: A total of 35%–44% of all lung cancers occur in patients aged 75+ years. Geriatric screening and assessment is recommended in older patients but only 17%–29% of clinicians do this. We aimed to implement and evaluate a geriatric oncology model of care (GOMOC) for older patients with lung cancer.

Methods: Key stakeholders were brought together to design a GOMOC within existing resources. The geriatric 8 (G8) screening tool was used to screen patients with a new diagnosis of lung cancer aged 70+ years guided by traffic light criteria to select patients for screening. G8 score <15 prompted referral for a comprehensive geriatric assessment with a geriatrician and allied health at a fortnightly clinic. A virtual geriatric oncology multidisciplinary team meeting (MDM) was held following the clinic to discuss management with oncologists.

Results: Over 12 months, 73 patients were eligible for screening and 62 (85%) were screened. Seven ineligible patients were screened (three mesothelioma, four recurrent lung cancer). 74% (51/69) had a G8 score <15 and were referred but only 59% (30/51) were assessed in clinic. The geriatrician diagnosed new cognitive issues in 30% (7) patients and recommended medication changes in 83% (25) patients. Physiotherapy recommendations were made in 77% (20/26 seen) and occupational therapy recommendations in 65% (17/26 seen). 100% (8/8) and 88% (7/8) stated that this was an acceptable and feasible model of care, respectively. Barriers to screening were lack of time in clinic with multiple competing priorities. Facilitator to screening was a simple screening tool incorporated into electronic medical records. Strengths of GOMOC included the multidisciplinary assessment, proactive care and MDM discussion. Weaknesses included the lack of clinic capacity and fortnightly frequency.

Conclusion: An acceptable GOMOC was implemented for older patients with lung cancer. However further modification is needed to improve the number of eligible patients undergoing comprehensive geriatric assessment.

Michael Thomsen¹, Luis Vitetta²

¹Eusano Healthcare, South Hobart, Tasmania, Australia

²Department of Medicine, Sydney Medical School, Sydney, NSW, Australia

Introduction: The efficacy of cancer treatments has links to the intestinal microbiome. Mucositis is a dose-limiting side-effect of cancer treatments, that can progress adverse effects such as increased diarrhoea, mucositis, and in severe cases the development of febrile neutropenia.

Methods: The effect of cancer treatments on quality of life (QoL) was assessed using the FACT-C questionnaire that included patient well-being and gut adverse symptoms (e.g. diarrhoea). Bacterial DNA was extracted from faecal samples, sequenced and taxonomically examined. Participants rated faecal samples via the Bristol Stool Chart. The incidence/severity of neutropenia was assessed with white blood cell and neutrophil counts. Circulating SCFAs and plasma lipopolysaccharide (LPS) endotoxin levels were recorded and correlated to intestinal mucositis.

Results: Improvement in bowel function, with reduction in constipation and or diarrhoea or absence of significant disturbance to bowel function was observed in 85% of participants. One participant developed febrile neutropenia and two developed bowel toxicity during the study, unrelated to the probiotic formulation. No significant changes in microbiome diversity from baseline to end of study was observed. None of the participants had raised plasma endotoxin during cancer treatments. Probiotics were deemed overall as safe and tolerable. No significant changes in QoL scores were reported as cancer treatments progressed. In a related observational study of exceptional responders to chemotherapy, participants were found to have had a high intake of fruits, vegetables and fibre.

Conclusion: A multi-strain probiotic formulation was safe and tolerated by patients diagnosed with cancer undergoing chemotherapy and radiotherapy treatments. The probiotic formulation alleviated diarrhoea, constipation and maintained stool consistency/frequency during the treatments. Although the study has limitations, the probiotic intervention provided support to the patients. Future studies warrant larger sample sizes, control groups and limit recruitment to a homogenous group of patients.

Madeleine Washbourne¹, Lynn Peng², Michael Whordley¹, Elizabeth Luo¹

¹Princess Alexandra Hospital, Brisbane, Queensland, Australia

²Queensland University of Technology, Brisbane, Queensland, Australia

Aims: To investigate the incidence of febrile neutropenia (FN) and time to count recovery (TTCR) between varying pegylated granulocyte-colony stimulating factor (G-CSF) in patients with acute myeloid leukaemia (AML) during high-dose cytarabine (HiDAC) consolidation chemotherapy.

Methods: A retrospective observational audit at a single tertiary centre was conducted between 1 January 2016 and 31 December 2022 to capture prescribing practice of pegfilgrastim and lipegfilgrastim. Patients with a diagnosis of AML receiving non-trial HiDAC chemotherapy with pegylated G-CSF support were included. Data collection parameters included prior chemotherapy exposure, cytogenetics, G-CSF choice, TTCR (absolute neutrophil count [ANC] >.5 and >1) and length of admission. Data was extracted using digital patient records and analysed through Microsoft Excel.

Results: A total of 60 patients were identified with seven patients in the pegfilgrastim group and 53 patients in the lipegfilgrastim group. Following this, seven patients in the lipegfilgrastim group were randomly extracted to compare against the pegfilgrastim group. The incidence of FN for pegfilgrastim and lipegfilgrastim in HiDAC cycles was 39.1% and 52.4%, respectively. Median TTCR to ANC >.5 and >1 was 19 and 23 days in the pegfilgrastim group with lipegfilgrastim demonstrating 20 and 23 days, respectively. Infection risk was comparable for both pegfilgrastim and lipegfilgrastim at ∼21%. The calculated length of admission was 8 days for both groups. Higher HiDAC doses correlated with high rates of FN in the lipegfilgrastim group. Despite differences between some results, nil statistical significance was reached.

Conclusion: Pegfilgrastim had fewer rates of FN and a shorter TTCR compared to lipegfilgrastim in patients with AML during HiDAC consolidation; however, statistical significance was not achieved. Pegfilgrastim appears as effective as lipegfilgrastim from this audit despite what the theoretical difference in drug pharmacokinetic properties would infer. Therefore, a greater sample size is required for more robust data.

Adam P Whibley¹, Polly Dufton², Sharon De Graves³, Sagun Parakh⁴

¹N/A, Berwick, Victoria, Australia

²Oncology, Austin Health, Melbourne, Victoria, Australia

³VCCC Alliance, Melbourne, Victoria, Australia

⁴Oncology, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia

Background: The comprehensive geriatric assessment (CGA) has shown to improve health related outcomes, quality of life and reduction in health service use in older persons with cancer. However, there is limited data of barriers and enablers to the uptake of allied health referrals by older persons with cancer following a CGA.

Objective: To undertake a Scoping Review to identify barriers and enablers to the uptake of allied health referrals for elderly patients with cancer.

Design: A systematic Scoping Review of published literature using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension methodology.

Data sources: Pubmed, OVID Medline, Embase and CINAHL were searched.

Eligibility criteria for selecting studies: Articles published between 2010 and 2022, excluding grey literature, that included adults with cancer referred to outpatient allied health services and reported on the barriers and/or enablers to uptake of referrals to these services.

Data extraction and synthesis: Data from peer-reviewed literature was extracted by a single reviewer (AW).

Results: Of a total of 36 articles, 10 articles met eligibility criteria. Key barriers identified were socio-economic, a lack of patient understanding or confidence in referred services and social determinants of health. Key enablers included multidisciplinary communication between health care professionals (HCPs) and referred service providers, the location of services, utilisation of patient navigators, availability of patient education, telephone or remote technology follow-ups by HCPs and patient input into care decisions.

Conclusions: A variety of factors impact on uptake of allied health services. Interventions are required to implement enablers to increase uptake of allied health referrals following CGA.

Colin Williams¹, Vishal Boolell²

¹Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Medical Oncology, Northern Hospital, Melbourne, VIC, Australia

Introduction: Immunotherapy checkpoint inhibition (ICI) has heralded dramatic survival advances in many tumour types and its use is increasingly prevalent throughout oncology. Immune-related adverse events (irAE) are being experienced with variable frequency and wide-ranging organ involvement. To our knowledge we describe the first published case of immunotherapy related epiglottitis.

Case: A 75-year-old man with extensive stage small cell lung cancer was initiated on carboplatin, etoposide and atezolizumab. Despite radiological response, after five cycles he developed a productive cough, with slowly progressive odynophagia and dysphagia over 4 months associated with weight loss of 10 kg. After un-impactful courses of antibiotics and antifungals a gastroscopy noted pharyngitis with thick mucus and mid-section oesophagitis. A bronchoscopy failed due to the enlarged and oedematous epiglottis prompting a panendoscopy with microlaryngoscopy which confirmed a thick, erythematous epiglottis with circumferential thickening around aryepiglottic folds. Multiple epiglottic biopsies revealed a heavily inflamed squamous mucosa with ulceration and a dense, mixed subepithelial inflammatory infiltrate with plasma cells, lymphocytes and neutrophils. No evidence of fungal, viral or dysplastic elements were identified. 50 mg of oral prednisolone was commenced and led to a significant improvement in cough, mucous production and oral intake within 2 weeks. Symptoms resolved within 6 weeks. Atezolizumab was not re-challenged due to disease progression and the patient subsequently completed 11 cycles of second-line irinotecan before further progression.

Discussion: It is important to consider immunotherapy toxicity in the context of any unexplained symptomatology given the broad spectrum of irAE as its use becomes increasingly commonplace. For patients receiving immunotherapy with unexplained productive cough, odynophagia or dysphagia, a prompt infectious work-up, multi-disciplinary involvement and endoscopy should be considered. Whilst ICI's most directly expand cytotoxic T cell activity, their impact on the immune system is complex resulting in variability of diagnostic histological pattern.

Dennis Slamon¹, Daniil Stroyakovskiy², Denise A Yardley³, Chiun-Sheng Huang⁴, Peter A Fasching⁵, John Crown⁶, Aditya Bardia⁷, Stephen Chia⁸, Seock-Ah Im⁹, Miguel Martin¹⁰, Sherene Loi¹¹, Binghe Xu¹², Sara Hurvitz¹³, Carlos Barrios¹⁴, Michael Untch¹⁵, Belinda Yeo¹⁶, Rebecca Moroose¹⁷, Frances Visco¹⁸, Rodrigo Fresco¹⁹, Tetiana Taran²⁰, Gabriel N Hortobagyi²¹

¹David Geffen School of Medicine at UCLA, California, USA

²Moscow City Oncology Hospital #62 of Moscow Healthcare Department, Moscow Oblast, Russia

³Sarah Cannon Research Institute, Tennessee Oncology, Nashville, Tennessee, USA

⁴National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan

⁵University Hospital Erlangen Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany

⁶St. Vincents Hospital, Dublin, Ireland

⁷Mass General Cancer Center, Harvard Medical School, Boston, Massachusetts, USA

⁸British Columbia Cancer Agency, Vancouver, BC, Canada

⁹Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

¹⁰Instituto de Investigación Sanitaria Gregorio Marañon, Centro de Investigación Biomédica en Red de Cáncer, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid, Spain

¹¹Peter MacCallum Cancer Centre, Melbourne, Australia

¹²Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences (CAMS), and Peking Union Medical College (PUMC), Beijing, China

¹³University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, California, USA

¹⁴Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil

¹⁵Interdisciplinary Breast Cancer Center, Helios Klinikum Berlin-Buch, Germany

¹⁶Olivia Newton-John Cancer Research Institute, Austin Hospital, Heidelberg, Melbourne, VIC, Australia

¹⁷Orlando Health Cancer Institute, Orlando, Florida, USA

¹⁸National Breast Cancer Coalition (NBCC), Washington DC, USA

¹⁹TRIO – Translational Research in Oncology, Montevideo, Uruguay

²⁰Novartis Pharma AG, Basel, Switzerland

²¹Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Background: The phase III NATALEE trial (NCT03701334) evaluated adjuvant ribociclib + endocrine therapy (ET) in a broad population of patients with stage II/III HR+/HER2− early breast cancer (EBC) at risk for recurrence, including patients with no nodal involvement (N0).

Methods: Men and pre- or postmenopausal women were randomised 1:1 to ribociclib (400 mg/day; 3 week on/1 week off for 3 years) + ET (letrozole 2.5 mg/day or anastrozole 1 mg/day, for ≥5 years) or ET alone. Men and premenopausal women also received goserelin. Eligible patients had ECOG PS 0–1 and stage IIA (either N0 with additional risk factors or 1–3 axillary lymph nodes), stage IIB or stage III EBC per AJCC; prior (neo)adjuvant ET was allowed if initiated ≤12 month before randomisation. This prespecified interim analysis of invasive disease-free survival (iDFS, primary-endpoint), defined per STEEP criteria, was planned after ≈425 events (≈85% of planned total).

Results: A total of 5101 patients were randomised (ribociclib + ET, n = 2549; ET alone, n = 2552). As of the data cutoff (11  January  2023), median follow-up was 34 months (min, 21 months). Three- and 2-year ribociclib treatment was completed by 515 patients (20.2%) and 1449 patients (56.8%), respectively; 3810 (74.7%) remained on study treatment (ribociclib + ET, n = 1984; ET alone, n = 1826). iDFS was evaluated after 426 events (RIB + ET, n = 189; ET alone, n = 237). Ribociclib + ET demonstrated significantly longer iDFS than ET alone (HR: .748; 95%CI: .618–.906; p = 0.0014); 3-year iDFS rates were 90.4% versus 87.1%. iDFS benefit was generally consistent across stratification factors and other subgroups. Secondary endpoints of overall survival, recurrence-free survival and distant disease-free survival consistently favoured ribociclib. Ribociclib 400mg showed a favourable safety profile with no new signals.

Conclusions: Ribociclib added to standard-of-care ET demonstrated a statistically significant, clinically meaningful improvement in iDFS with a well-tolerated safety profile. These data support ribociclib + ET as the treatment of choice in a broad population of patients with stage II or III HR+/HER2− EBC, including patients with N0 disease.

Wan Zhou, Pan Xu

University-Town Hospital of Chongqing Medical University, Chongqing, China

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death, worldwide. We aimed to assess the efficacy of immunotherapy or targeted therapy as the first-line strategy for unresectable HCC (uHCC) using parametric survival models.

Methods: We used PubMed, Embase and Cochrane Library databases for systematic retrieval. Individual patient data (IPD) for overall survival (OS) and progression-free survival (PFS) were recreated from published Kaplan–Meier curves using digitisation software. A pooled analysis of parametric survival curves was performed using a Bayesian framework.

Result: Twelve randomised controlled trials were included. The log-normal and log-logistic distributions provided the best fits for OS and PFS data, respectively, suggesting that the proportional hazard assumption was not valid. Sintilimab plus bevacizumab biosimilar was continuously superior to sorafenib over time (HR < 1) in terms of OS and PFS. For the majority of the time, the efficacy of sintilimab plus bevacizumab biosimilar ranked first.

Conclusions: Our analysis provided evidence that the HRs were not constant over time. Sintilimab plus bevacizumab biosimilar is expected to be more efficacious than all its comparators in terms of OS and PFS during the analysed 60 months.

Yvonne Zissiadis¹, Nina Stewart², Kathryn Hogan¹, Peter Purnell³, Daniel Cehic⁴, Jamie Morton⁴, Jo Toohey⁵, Jack Dalla Via⁶, Mary Kennedy⁶

¹Genesiscare, Hollywood Private Hospital, Fiona Stanley Hospital, WA, Australia

²Genesiscare, Bunbury, WA, Australia

³Advara Heartcare, Perth, WA, Australia

⁴Advara Heartcare, Adelaide, SA, Australia

⁵Genesiscare, St Vincent's Private Hospital, Sydney, NSW, Australia

⁶Edith Cowen University, Perth, WA, Australia

Introduction: Patients undergoing thoracic radiotherapy for cancer treatment routinely undergo a planning CT scan, which presents a unique opportunity to identify those at the highest risk of cardiac events. Radiation dose to the heart can lead to cardiotoxicity and accelerate pre-existing atherosclerosis.

Aims: To investigate the feasibility of using Coronary Artery Calcium (CAC) scores calculated on thoracic RT planning CT scans to identify a subset of patients at increased risk of future cardiac events, to establish and evaluate a referral pathway for assessment and management in a cardio-oncology clinic.

Methods: This is an ongoing observational, prospective study of 101 cancer patients commencing radiotherapy. Participants had CAC scored from thoracic radiotherapy planning CT scans. Patients with CAC score > 0 (double-read) were referred to a cardio-oncology clinic. Feasibility, adherence to the recommended pathway, and impact on quality of life and anxiety were assessed. Ethics approval obtained.

Results: A total of 101 eligible participants were enrolled in the study. The median age was 59 years and 99/101 patients had breast cancer. CAC scores were zero for 68 participants and more than zero for 32 participants (32%).

At present, cardio-oncology outcomes are available for 28 participants with elevated CAC, of which 24 were referred to a cardio-oncology clinic. Following referral, 22 (of 24) of the participants attended the cardio-oncology clinic as recommended, one did not and the outcome for one participant is unknown.

Conclusions: Early results show thoracic radiotherapy planning CT scans successfully calculated CAC scores. The accumulating data indicates that patients with elevated CAC scores who are referred onto a cardio-oncology clinic are highly compliant with attending this appointment. This study has significant implications in proactively addressing ways of reducing late cardio-toxicity in survivors of cancer.

Roos CTG, van den Bogaard VAB, Greuter MJW, et al. Is the coronary artery calcium score associated with acute coronary events in breast cancer patients treated with radiotherapy? Radiother Oncol. 2018;126(1):170-176.

Emma-Kate Carson^1,2,3, Janette L Vardy^3,4,5, Haryana M Dhillon^5,6, Christopher Brown⁷, Kelly N Nunes-Zlotkowski^5,6, Stephen Della-Fiorentina^2,8,9, Sarah Khan⁹, Andrew Parsonson^10,11, Felicia Roncolato^1,2,3, Antonia Pearson^3,12, Tristan Barnes^3,12, Belinda E Kiely^1,2,3,7

¹Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia

²School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

³Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia

⁴Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia

⁵Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia

⁶Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia

⁷NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia

⁸Cancer Services, South Western Sydney Local Health District, Liverpool, NSW, Australia

⁹Southern Highlands Cancer Centre, Southern Highlands Private Hospital, Bowral, NSW, Australia

¹⁰Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia

¹¹Nepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW, Australia

¹²Northern Beaches Cancer Care, Northern Beaches Hospital, Frenchs Forest, NSW, Australia

Aim: Sleep quality commonly deteriorates in women receiving chemotherapy for early breast cancer (BC). We sought to determine the feasibility and acceptability of telehealth delivered cognitive behaviour therapy for insomnia (CBT-I) in women with early BC receiving (neo)adjuvant chemotherapy.

Methods: In this multi-centre, single arm, phase 2 feasibility trial, women with stage I to III BC received four sessions of telehealth CBT-I over 8 weeks, during (neo)adjuvant chemotherapy. CBT-I was delivered by psychologists and started before cycle 2 chemotherapy. Participants completed Pittsburgh Sleep Quality Index (PSQI) and other patient reported outcome measures (PROM) (FACT-B, FACT-F, HADS, Distress Thermometer) at baseline, post-program (week 9) and post-chemotherapy (week 24); and an Acceptability Questionnaire at week 9. Bedtime, awake-time, use of steroids and rescue sleep medications were recorded. Primary endpoint was proportion of women completing four sessions of telehealth CBT-I.

Results: Forty-one participants were recruited: mean age 51 years (range 31–73). All four CBT-I sessions were completed by 35 (85%) participants. Of 31 participants completing the post-program questionnaire, 74% reported ‘the program was useful’, 83% ‘would recommend the program to others’ and 66% believed ‘the program was generally effective’. There was no significant difference in the number of poor sleepers (PSQI score ≥5) at baseline 29/40 (73%) and week 24 17/25 (68%); or in the mean PSQI score at baseline (7.43, SD 4.06) and week 24 (7.48, SD 4.41). From baseline to week 24, 7/25 (28%) participants had a ≥3 point improvement in sleep quality on PSQI, and 5/25 (20%) had a ≥3 point deterioration. There was no significant difference in mean PROM scores.

Conclusion: It is feasible to deliver telehealth CBT-I to women with early BC receiving chemotherapy. Sleep quality did not deteriorate, as predicted from the literature, and for most, sleep quality was unchanged. Telehealth CBT-I has a potential role in preventing and managing sleep disturbance during chemotherapy.

Annalee L Cobden, Jake Burnett, Alex Burmester, Priscilla Gates, Mervyn Singh, Juan F Domínguez D, Jacqueline B Saward, Karen Caeyenberghs

Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia

Aim: After completion of treatment, breast cancer survivors experience cancer-related cognitive impairments such as problems with memory and attention. Cognition is described as varying from day-to-day yet is typically measured using one-time assessments which do not capture these fluctuations. The present study aims to assess the feasibility, validity and usability of our novel ecological momentary assessment (EMA) app of cognition.

Methods: Nineteen breast cancer survivors 6–36-month post-chemotherapy and 26 healthy controls participated. Participants completed the NIH Toolbox Cognition Battery in person followed by the EMA. The EMA app contains four cognitive tasks which assess processing speed, executive working memory, spatial working memory and inhibition/attention. Participants completed the tasks once a day for 30 days on their smart phones, thereafter, completing an app usability questionnaire. Pearson's whole group correlations were conducted between the NIH scores and the dependent variables of the EMA app to assess construct validity. Inductive qualitative analysis was also conducted on the open-ended usability questions.

Results: Our EMA response rates were 78.8% across all participants demonstrating the app and study design were feasible. Overall, correlations were significant between expected NIH tasks and EMA cognitive tasks. For example, EMA assessed processing speed was negatively correlated with the NIH pattern-comparison task (r[45] = −.573, p < 0.001), which assesses processing speed. Further, the EMA processing speed task was also negatively correlated with NIH Toolbox card sorting task (r[45] = −.557, p < 0.001), a measure of executive function. Qualitative analysis highlighted four themes contributing to app usability, namely self-development, altruism, engagement and functionality.

Conclusions: Our correlation analysis suggests that our novel app tasks have good construct validity. Further we present valuable insights into what participants find important for app usability. Our results show that objective ambulatory measures of cognition are feasible, valid and show acceptable usability in breast cancer survivors and healthy comparison groups alike.

Udari N Colombage¹, Aditi A Prasad¹, Ilana Ackerman^1,2, Sze-Ee Soh^1,2

¹Physiotherapy, Monash University, Frankston, Victoria, Australia

²School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Aim: To investigate physiotherapists’ knowledge, beliefs and current practice around falls prevention in the setting of breast cancer.

Method: This cross-sectional study invited currently registered, practising Australian physiotherapists who care for people with breast cancer to participate. A comprehensive online survey was used to collect data that were analysed descriptively. Free-text responses were classified into key themes for analysis.

Results: Of the 52 physiotherapists who completed the preliminary screening questions, complete responses were received from 42 eligible physiotherapists, with broad representation across community and clinical practice settings. Despite the majority (71%) having specific training or access to falls educational resources, physiotherapists reported only moderate confidence in assessing falls risk [median 6, interquartile range (IQR) 4–8; scale 0 (not at all confident) – 10 (extremely confident)] and delivering falls prevention care (median 6, IQR 5–8). Whilst a small proportion used falls risk screening tools (29%), most assessed standing balance either as part of an overall mobility or functional assessment or by using a specific balance outcome measure (60%). Time constraints were the most frequently perceived barrier to including falls prevention activities within breast cancer care.

Conclusion: This preliminary study has identified some clear opportunities to optimise clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies in people with breast cancer.

Virginia Dickson-Swift¹, Jo Adams¹, Evelien Spelten¹, Irene Blackberry², Carlene Wilson^3,4,5, Eva Yuen^6,7

¹Violet Vines Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia

²La Trobe University Rural Health School, John Richards Centre for Ageing Research Chair and Director of the Care Economy Research Institute, Bundoora, Victoria, Australia

³Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia

⁴Melbourne School of Population and Global Health, Melbourne University, Melbourne, Victoria, Australia

⁵School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia

⁶Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia

⁷Centre for Quality and Patient Safety – Monash Health Partnership, Monash Health, Clayton, Victoria, Australia

Aim: Breast cancer screening continues to be the most effective means of detecting breast cancer. Like many countries internationally, the Australian breast cancer screening service specifically targets women aged 50–74. A significant risk factor for breast cancer is age, yet little is known about the risks and benefits of breast cancer screening after age 74. Breast cancer screening behaviours and motivations of women aged ≥75 years were explored in a study funded by the Australian Department of Health. The study aimed to better understand the breast cancer screening motivations and behaviours of women in this age group. This focussed on how decisions were made and how past experiences and access to information shaped screening perspectives.

Method: An exploratory qualitative methodology was followed in the conduct of in-depth interviews with 60 women aged ≥75 years from metropolitan, regional and rural locations across Australia. The sample included women from culturally and linguistically diverse backgrounds.

Results: Following thematic qualitative analysis, it was found that many women wished to continue breast cancer screening, particularly if they had been regular screeners. There was limited information available to women to guide decision making surrounding breast cancer screening and very few women discussed this with health professionals. Many women felt alienated from the health system when reminders for breast cancer screening ceased after age 74. Women in rural areas accessing mobile breast cancer screening services experienced greater disadvantage in no longer receiving reminders to participate in screening.

Conclusions: Women aged ≥ 75 years require more comprehensive information in order to make informed decisions regarding ongoing breast cancer screening. Opportunities to formalise conversations with health professionals regarding screening should be sought. The unique nature of access to mobile breast screening services should be more closely considered for older women to avoid disadvantage.

Thomas Fontes Andrade, Abbey Diaz, Shafkat Jahan, Gail Garvey

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Background/aim: While it is biologically plausible that pre-cancer diagnosis use of beta-blockers could potentially prevent the development and reduce the growth of cancer tumours, existing evidence regarding this has not been synthesised. This review aimed to gain a greater understanding of the effect of pre-diagnosis beta blocker use on survival in breast cancer patients.

Methods: A systematic search of PubMed, Web of Science and Embase was conducted for studies published 2010–2022, that reported breast cancer-specific and/or overall survival by pre-diagnosis beta-blockers use (users vs. non-users) in people diagnosed with breast cancer. Results were exported into Covidence software and screened against pre-defined eligibility criteria. Key information was extracted using a standardised form in Excel, including the adjusted hazard ratios. PRISMA guidelines were used.

Results: Seven articles reported the association between pre-diagnosis beta-blocker use and survival in people with breast cancer. Three articles reported on overall survival; all reporting small and non-significant point estimates (HRs ranged 1.02–1.13). Six of the seven articles reported on breast cancer-specific survival. These studies suggest that pre-diagnosis beta blocker use may have a protective effect (HR range .19–.94), although only three of these studies were statistically significant (HR: .19–.42, p < 0.05). Two studies reported the association between survival by type of beta-blocker used prior to breast cancer diagnosis; indicating that non-selective beta-blockers may be more effective.

Conclusion: The existing literature investigating the effect of pre-diagnosis beta blocker use on survival in people with breast cancer is limited. While not all studies found statistically significant findings, the results indicate that pre-diagnosis beta blocker use may result in improved breast cancer survival, but not overall survival. This presentation will discuss potential explanations for these findings, including inadequate adjustment for confounding variables and confounding by indication.

Julia Freckelton¹, Daphne Day^1,2, Michelle White¹, Piyumini Weerakoon Mudiyanselage², Satish Ramkumar¹, Sean Tan^1,2

¹Monash Health, Clayton, Victoria, Australia

²Medicine, Monash University, Clayton, Victoria, Australia

Aims: HER2 directed therapies increase the risk of left ventricular (LV) dysfunction with reported incidence of asymptomatic LV dysfunction and congestive heart failure of ∼10%–20% and <4%, respectively. We performed a retrospective study in a major tertiary centre in Melbourne, Australia to characterise patterns and outcomes of cardiac toxicity resulting from HER2 directed therapy in patients with breast cancer.

Methods: Patients who completed five serial studies for LV assessment (baseline then 3-monthly) during the first 12 months of HER2 directed therapy from 2010 to 2020 were included. We recorded demographics, cancer history, cardiovascular risk factors and outcomes. LV dysfunction was defined as >10% reduction in LV ejection fraction (LVEF) to LVEF <50%.

Results: Of 518 patients who commenced HER2 directed therapy (trastuzumab ± pertuzumab) during the study period, 222 (42.9%) completed recommended cardiac surveillance [all were female, median age 53 years, 145 (65%) prior anthracycline]. Seventeen (7.7%) patients developed LV dysfunction (16 detected on surveillance; 13 asymptomatic, 4 symptomatic; 11 had LVEF nadir 45%–50%, 6 of <45%). Of these, nine had prior anthracycline chemotherapy and 10 had other cardiovascular risk factors. Thirteen patients had treatment interruption because of cardiac toxicity, 14 patients were referred to a cardiologist, 10 started angiotensin converting enzyme inhibitor treatment and 11 beta blocker therapy. Of these, seven were successfully rechallenged.

Conclusions: Most patients treated with HER2 directed therapies did not undergo recommended cardiac surveillance in the first year of treatment. Among those that did, only a small proportion of patients developed symptomatic cardiac toxicity. Current surveillance guidelines are resource intensive and more prospective research is needed to determine the optimal cardiac surveillance frequency for these patients.

Tamzin Hall¹, Arlene Chan^1,2, Amanda Goddard², Catherine Griffiths²

¹Curtin University, Como, WA, Australia

²Breast Cancer Research Centre – WA, Nedlands, WA, Australia

Background: Weight gain is a common concern for breast cancer patients receiving chemotherapy. Published data reports differing incidence and causative factors for weight gain. Our study aimed to assess factors which may influence weight changes (loss or gain) in early (EBC) and metastatic breast cancer (MBC) patients receiving chemotherapy.

Method: Patient and treatment factors were collected prospectively for patients under care of medical oncologist, A.C. Weight on first and last treatment dates were collected through file review. Weight change was categorised as mild weight change (MC) for ± up to 1 unit BMI; ≥1 unit decrease as weight loss (WL); ≥1 to 2 unit increase as moderate weight gain (MG), ≥2 unit increase as significant weight gain (SG). Consecutive patients receiving parenteral chemotherapy were included. Patients provided written consent to use of deidentified medical information. Approval was given by hospital ethics lead.

Results: Between January 2021 and January 2023, 273 patients (227 EBC, 46 MBC) were included. Mean age was 55 and 61 years, respectively. Patients were underweight 2%, healthy 44%, overweight 25% and obese 28% at baseline. At end of chemotherapy, MG was seen in 15.4% and SG 8.1%. Significant WL was seen in MBC patients (p < 0.0001). MG and SG occurred in patients aged >60 years (p = 0.0034) or if patients were overweight or obese at baseline (p = 0.0014). In EBC patients, those <40 years were more likely to experience SG and those aged 40–60 years more likely MG (p = 0.024). No other variables (alcohol intake, menopausal status, dexamethasone use or chemotherapy type) had a significant influence on weight change.

Conclusions: More than half of patients had mild weight change with one-quarter gaining moderate or significant weight, and similar proportion losing weight. Age was a consistent factor that impacted on weight gain, with all other treatment variables not playing a significant impact.

Jolyn Hersch^1,2, Brooke Nickel^1,2, Jesse Jansen³, Alexandra Barratt², Nehmat Houssami⁴, Christobel Saunders⁵, Andrew Spillane⁶, Claudia Rutherford⁴, Kirsty Stuart⁷, Geraldine Robertson⁸, Ann Dixon⁹, Kirsten McCaffery^1,2

¹Sydney Health Literacy Lab (SHeLL), School of Public Health, The University of Sydney, Sydney, NSW, Australia

²Wiser Healthcare, Sydney, NSW, Australia

³CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

⁴The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

⁵Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia

⁶Northern Clinical School, The University of Sydney, Sydney, NSW, Australia

⁷Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia

⁸Breast Cancer Network Australia, Melbourne, VIC, Australia

⁹Sydney Neuropsychology Clinic, School of Psychology, The University of Sydney, Sydney, NSW, Australia

Aims: Management of low-risk ductal carcinoma in situ (DCIS) is controversial, with clinical trials currently assessing the safety of active monitoring amidst concern about overtreatment. Little is known about general community views regarding DCIS and its management. We aimed to explore women's understanding and views about low-risk DCIS and current and potential future management options.

Methods: This mixed-method study involved qualitative focus groups and brief quantitative questionnaires. Participants were screening-aged (50–74 years) women, with diverse socioeconomic backgrounds and no personal history of breast cancer/DCIS, recruited from across metropolitan Sydney, Australia. Sessions incorporated an informative presentation interspersed with group discussions which were audio recorded, transcribed and analysed thematically.

Results: Fifty-six women took part in six age-stratified focus groups. Prior awareness of DCIS was limited; however, women developed reasonable understanding of DCIS and the relevant issues. Overall, women expressed substantial support for active monitoring being offered as a management approach for low-risk DCIS, and many were interested in participating in a hypothetical clinical trial. Although some women expressed concern that current management may sometimes represent overtreatment, there were mixed views about personally accepting monitoring. Women noted several important questions and considerations that would factor into their decision making.

Conclusions: Our findings about women's perceptions of active monitoring for DCIS are timely while results of ongoing clinical trials of monitoring are awaited, and may inform clinicians and investigators designing future, similar trials. Exploration of offering well-informed patients the choice of non-surgical management of low-risk DCIS, even outside a clinical trial setting, may be warranted.

Alison Hiong, Mitchell Chipman, Maggie Moore, Mark Shackleton, Lucy Gately

Alfred Health, Melbourne, Victoria, Australia

Aims: To describe the use and determine the practical impact of routine baseline left ventricular function testing prior to administration of anthracycline chemotherapy in breast cancer patients.

Methods: We conducted a single-centre retrospective study of breast cancer patients who received, or were planned to receive, treatment with an anthracycline-containing regimen in the neoadjuvant or adjuvant setting from 1 July 2013 to 31 December 2022. Patients were excluded if they also received anti-HER2 therapy. The use of investigations to determine baseline left ventricular ejection fraction (LVEF), the impact of these investigation results on anthracycline prescribing, and their relationship to the development of cardiotoxicity were evaluated.

Results: Ninety-nine patients fulfilled eligibility criteria. Median age was 55 years, 100% (n = 99) were female and 86% (n = 85) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. 41% (n = 41) had no traditional cardiovascular risk factors out of smoking, diabetes, hypertension and obesity, whereas 34% (n = 34) had 1 factor and 24% (n = 24) had 2 or more. 87% (n = 86) underwent LVEF assessment before commencing anthracycline chemotherapy, with echocardiogram and nuclear medicine gated blood pool scan utilised in 53% (n = 46) and 47% (n = 40) of cases, respectively. Baseline LVEF ranged from 49% to 76%. No patients were deemed ineligible for anthracycline treatment on the grounds of their pre-chemotherapy LVEF result. Of the 98 patients who went on to receive at least one cycle of anthracycline chemotherapy, 2% (n = 2) developed symptomatic reduction in LVEF to a value below 50% or by a total of 10% or more from baseline.

Conclusions: Over a 9.5-year period, baseline LVEF testing was commonly performed, but failed to detect any cases of pre-existing left ventricular dysfunction that altered physicians’ decisions to prescribe anthracycline chemotherapy.

Tamara Jones¹, Lara Edbrooke^2,3, Jonathan Rawstorn⁴, Linda Denehy^2,3, Sandi Hayes^5,6, Ralph Maddison⁴, Aaron Sverdlov⁷, Bogda Koczwara⁸, Nicole Kiss⁴, Camille Short^1,2

¹Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia

²Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia

³Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia

⁵Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia

⁶School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia

⁷Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia

⁸Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia

Aims: This study aimed to identify demographic and health characteristics associated with perceived likelihood of uptake of digitally delivered cardiac rehabilitation among breast cancer survivors, and to explore intervention topics and service fees.

Methods: Breast cancer survivors (n = 208) completed a cross-sectional survey collecting likelihood of uptake of digitally delivered cardiac rehabilitation, demographic and health characteristics, knowledge of treatment side-effects, exercise behaviour, intervention interests (e.g. diet, fatigue) and service fees. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake (1) generally, (2) before, (3) during and (4) after treatment.

Results: Participants had a mean age of 57(11) years and BMI of 27(6) kg/m². Participants were generally representative of the Australian breast cancer population; however, those meeting exercise guidelines (44% meeting both aerobic and resistance) were oversampled. Living in an outer regional area was consistently identified as the strongest predictor of likelihood of uptake at all phases (OR = 3.86–8.57). Receiving a high number of cardiotoxic treatments was associated with higher uptake generally (OR = 1.4). In comparison, those with higher BMI's (OR = .93–.95) and lower education (OR = .30–.48) were less likely to uptake during various treatment phases. More comorbidities were associated with lower odds of uptake during treatment (OR = .66). Secondary outcomes highlighted the need for education about cardiotoxic treatment effects, and multifaceted interventions that are free or low cost (median, IQR = 10, 10–15 AUD).

Conclusions: Digitally delivered cardiac rehabilitation may help address equity of access issues for those living regionally, and may help reach those at high risk of cardiotoxicity. However, those with a high BMI, low education and comorbidities may be at risk of falling through the gaps with this model. This information can inform future research and the development of intervention techniques that are critical to improve the delivery of a digital-service model that is effective, equitable and accessible.

Bei Zhang¹, Lisa Beatty¹, Emma Kemp²

¹College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia

²College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Introduction: Engagement with digital health services may be limited for individuals living with socioeconomically disadvantaged circumstances, due to such factors as potential lack of reliable access to, proficiency with, and/or relevance of digital resources.^1,2 However, individuals with strong social support may have increased digital health engagement through assistance from family members or friends (e.g. being taught to use computers, help with practical barriers).³ This study aimed to investigate the impact of socioeconomic factors and social support on engagement with the Finding My Way and Finding My Way-Advanced digital psychosocial interventions, for individuals diagnosed with breast cancer.

Method: A secondary analysis was conducted to examine associations between socioeconomic factors (education, employment, income, area-level advantage/disadvantage) and levels of social support reported at baseline, and indices of intervention engagement (number of modules accessed, number of pages viewed, number of logins). An individual socioeconomic status index (SESI) was calculated from education, employment and income data. Level of association between variables was analysed using Spearman's correlation coefficient, as data were ranked/non-parametric in nature.

Results: Data from 116 participants with breast cancer were analysed. Of the socioeconomic factors assessed, only employment status was weakly associated with intervention engagement, with employed participants viewing a greater number of pages (r = .21, p = 0.024). Social support was weakly associated with all engagement indices [number of modules accessed (r = .20, p = 0.031), number of pages viewed (r = .282, p = 0.002) and number of logins (r = .19, p = 0.045)].

Gillian Kruss^1,2, Pheona vanHuizen³, Thi Thuy Ha Dinh³, Jessica Delaney⁴, Ladan Yeganeh³, Kerryn Ernst¹, Jane Mahony¹, Gabrielle Brand^3,5, Julia Morphet³, Olivia Cook^1,3

¹McGrath Foundation, North Sydney, NSW, Australia

²Monash Health, East Bentleigh, Victoria, Australia

³Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia

⁴Southern Melbourne Integrated Cancer Services, East Bentleigh, Victoria, Australia

⁵Monash Centre for Scholarship in Health Education, Clayton, Victoria, Australia

Background: Since 2010 McGrath Foundation has funded and placed 43 new dedicated metastatic McGrath Breast Care Nurse (mMBCN) positions across Australia. With no existing education program available, an innovative practicum was developed incorporating telepresence robot technology to educate new mMBCNs during the COVID-19 pandemic and beyond.

Aim: To explore mMBCN, facilitator, and clinicians’ perceptions and experiences of robot-assisted learning as part of a pilot Metastatic Breast Cancer Nurse Education Program (MBCNEP) delivered in a clinical setting.

Method: Program facilitators (n = 2) and clinicians (n = 7) were interviewed pre and post the first intake of the MBCNEP. Participating mMBCNS (n = 8) from all intakes of the MBCNEP were interviewed pre and post their 3-day practicum. Of these, n = 6 participated in the program via the robot and n = 2 participated in-person alongside another nurse in the robot. Interviews were conducted online, digitally recorded and transcribed. A realist approach to data analysis identified patterned responses and meaning across the data related to the research question.

Results: At baseline mMBCN participants reported uncertainty around the use of a telepresence robot. Clinicians were concerned about how patients would perceive and interact with the robot in consults. All participants were positive about trialling the technology to facilitate nurse learning during the pandemic and reported the greatest benefit was accessibility to education without the economic or time implications of travel. The main issues reported by all participants were technical, relating to Wi-fi connection and robot battery life. mMBCNs who participated via the robot reported feeling ‘present’ and were able to communicate directly with patients and clinicians as if they were in the clinic.

Conclusion: The trial of telepresence robots to provide clinical education to remotely located nurses was largely acceptable to nurses and clinicians. Use of the technology for education purposes has continued beyond the pilot and is now in regular use to deliver the MBCNEP at Monash Health.

Prabhakar Ramachandran¹, Tracey Guan², Parthiban Vinaiourappan¹, Daniel Arrington¹, Danica Cossio², Zachery Colbert¹, Ben Perrett¹, Margot Lehman¹

¹Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

²Cancer Alliance Queensland, Queensland Health, Brisbane, Queensland, Australia

Aims: The objective of this study is to assess the long-term incidence of contralateral second breast cancer in patients who have undergone breast cancer radiotherapy. Artificial intelligence and advanced analytics are employed to establish the correlation between radiation dose distributions and the risk of developing a second cancer.

Methods: Approximately 40,000 patients received radiotherapy for invasive breast cancer in Queensland over the past two decades. Among these patients, 1448 individuals were identified from the Queensland Oncology Repository who were subsequently diagnosed with a second cancer at a different site. In this preliminary study, we collected DICOM image and RT datasets from a single institution for patients who had developed contralateral breast cancers following radiotherapy. The dose to the contralateral breast was compared against patients who had received radiotherapy but remained free from contralateral breast cancer. Deep learning autosegmentation models were generated to segment organs at risk (OAR), including the right and left breasts, right and left lungs, and heart. Autosegmentation was performed on all datasets missing contours for these structures.

Results: Preliminary findings indicate that patients who subsequently developed contralateral breast cancer received a mean dose of .68 ± .62 Gy to the contralateral breast, while those who did not develop contralateral breast cancer received a mean dose of .33 ± .24 Gy. Dice similarity coefficients for segmentations generated by the model for the left breast, right breast, heart, left lung and right lung were calculated as .91, .89, .92, .97 and .97, respectively.

Conclusion: This is an ongoing study and is being extended to collaborate with other institutions. It will enable a more precise assessment of the treatment-related risk factors for radiation-induced breast cancers and this information can be used to optimise existing treatment techniques.

Gay M Refeld¹, Christobel M Saunders^1,2, Niloufer Johansen¹, Elizabeth Sorial^1,3, Alannah L Cooper¹

¹St John of God Subiaco Hospital, Subiaco, Western Australia, Australia

²Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia

³Medical School, Surgery, The University of Western Australia, Perth, Western Australia, Australia

Aims: To compare the needs and issues faced by breast cancer survivors who received chemotherapy as part of their treatment with those who did not and to assess satisfaction with a Specialist Breast Nurse-led survivorship clinic.

Methods: A multi-method evaluation included the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 (version 3), EORTC QLQ-BR23 (version 1), reviews of wellness plans and a patient satisfaction survey. All breast cancer survivors who attended a Specialist Breast Nurse-led survivorship clinic at a Western Australian private-not-for-profit hospital between 6 November 2017 and 20 June 2019 who were >18 years, any gender, had surgery alone or received any type of adjuvant/neo-adjuvant breast cancer treatment in addition to surgery were eligible to participate.

Results: A total of 68 breast cancer survivors participated, the majority received chemotherapy (66%, n = 45) as part of their treatment and were female (99%, n = 67). The level of significance for the study was set at .05 with a confidence level of 95%. Significant differences were found in the quality of life between chemotherapy and non-chemotherapy groups for financial difficulties (p = 0.002), body image (p = 0.017), future perspective (p = 0.022) and arm symptoms (p = 0.007). A wide range of issues and symptoms were identified in the review of wellness plans. The most frequently reported problems were with mood, fatigue, menopause symptoms and bone health. Feedback from the patient satisfaction survey indicated the Specialist Breast Nurse-led clinic was appropriately timed and highly valued.

Imogen IS Smith, Whiter WT Tang, Hala HM Musa, Elani EV Vellios, Ralphel RH Hallal

Chris O'Brien Lifehouse, Camperdown, NSW, Australia

Aims: To evaluate the impact of the use of different supportive care measures to prevent and manage common adverse events (AEs) of Sacituzumab govitecan (SG).

Methods: This was a retrospective single-centre cohort study which included all patients given at least one dose of SG between January 2022 and March 2023. Supportive measures to prevent and manage neutropenia, diarrhoea and nausea were evaluated alongside rates of AEs.

Results: Nine patients were included with a median age of 60 (range 40–73). Neutropenia emerged as the main dose-limiting factor with six patients (67%) experiencing any grade neutropenia. Three patients (33%) required dose reductions or delays due to neutropenia and there were no differences in rates whether prophylactic growth-factor support was given on day 2 or 9. Nausea cases were generally mild (only grade 1 and 2) and well managed with a 3-drug regimen (dexamethasone, 5-HT3 antagonist and NK-1 receptor antagonist) as pre-medications and metoclopramide for breakthrough nausea. Diarrhoea was consistently observed with seven patients (78%) with diarrhoea (five patients grade 1–2, two patients grade 3) and was usually worse after day 8 SG. Three patients experienced alternating constipation and diarrhoea. Atropine as a pre-medication was only added on for two patients and loperamide was given to all patients to take at home if needed. Paracetamol, nizatidine and loratadine pre-medication was routinely given and there were no reports of hypersensitivity reactions.

Conclusions: Diarrhoea was a significant toxicity and the use of prophylactic atropine could be considered early on. Routine use of 3-drug anti-emetics and metoclopramide was effective in minimising nausea. Lastly, there was no observed differences in the prophylactic use of growth-factor support on either day 2 or 9 in rates of neutropenia. Further studies to include data from other centres will be useful to help optimise supportive care measures for SG.

Kellie Toohey^1,2, Maddison Hunter¹, Catherine Paterson^1,2,3, Murray Turner¹, Ben Singh⁴

¹University of Canberra, Bruce, ACT, Australia

²University of Canberra, Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Bruce, ACT, Australia

³Robert Gordon University, Aberdeen, Scotland

⁴University of South Australia, Adelaide, SA, Australia

Aims: To provide an updated critical evaluation on the effectiveness of high intensity interval training (HIIT) on health outcomes among cancer survivors.

Method: A systematic review and meta-analysis was conducted using databases CINAHL and Medline (via EBSCOhost platform), Scopus, Web of Science Core Collection and the Cochrane Central Register of Controlled Trials. Randomised, controlled, exercise trials involving cancer survivors were eligible. Data on the effects of HIIT among individuals diagnosed with cancer at any stage were included. Risk of bias was assessed with the Mixed Methods Appraisal Tool (MMAT). Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Meta-analyses (including subgroup analyses) were undertaken on the primary outcome of interest, which was aerobic fitness. Secondary outcomes were fatigue, quality of life, physical function, muscle strength, pain, anxiety, depression, upper-body strength, lower-body strength, systolic and diastolic blood pressure.

Results: Thirty-five trials from 47 publications were included, with intervention durations ranging between 4 and 18 weeks. Most trials involved breast cancer participants (n = 13, 36%). Significant effects in favour of HIIT exercise for improving aerobic fitness, quality of life, pain and diastolic blood pressure were observed (SMD range: .25–.58, all p < 0.01). A total of 1893 participants were represented in this review. Specifically, the studies were inclusive of participants diagnosed with breast (n = 13), prostate (n = 5), lung (n = 5), mixed (n = 4), colorectal (n = 4), haematological (n = 2), testicular (n = 1) and bladder (n = 1).

Conclusions: Participation in HIIT exercise was associated with higher retention and improvements in aerobic fitness, quality of life, pain and diastolic blood pressure. The results provide updated contemporary evidence for clinicians (e.g. exercise physiologists and physiotherapists) to prescribe HIIT exercise for cancer survivors to improve health before, during and following treatment.

Michelle White^1,2, Lisa Grech^1,2, Sok Mian Ng², Alastair Kwok^1,2, Kate Webber^1,2

¹Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia

²Department of Oncology, Monash Health, Clayton, VIC, Australia

Aims: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) can enhance supportive care and clinical outcomes. However, their implementation in Australian settings is limited and often excludes people from culturally and linguistically diverse (CALD) backgrounds. This study explored the perceptions, barriers and facilitators in patients with breast cancer and clinicians to the planned implementation of real-time collection and use of PROMs and PREMs at oncology outpatient clinics.

Methods: Between December 2022 and March 2023, patients (n = 21) and healthcare staff (n = 14) from a large Victorian cancer service participated in individual and focus group interviews, conducted in-person or online. Participants were asked about the implementation of pre-clinic administered PROMs and PREMs, available electronically in 11 languages, distributed up to 2 days before their scheduled oncology consultation with the aim of guiding supportive care provision. Data saturation informed the sample size. A qualitative framework analysis of the transcribed interview data was conducted. Results from the breast oncology outpatient clinics are reported here.

Results: Six patients [100% female, mean age 59 (SD 14) years, 50% metastatic staging, 33% CALD] and seven clinicians participated. There was agreement from both patients and healthcare personnel that pre-clinic administered PROMs and PREMs would improve patient-clinician communication and assist with identifying and addressing patient's symptoms and concerns. The provision of translated PROMs and PREMs was considered a facilitator for engagement with patients from CALD backgrounds. Patients expressed concern about the length of electronic PROMs and PREMs and the need for technological skills. Clinicians highlighted the potential time and workload impacts of using the PROMs and PREMs.

Conclusions: Key stakeholders at a breast oncology clinic were supportive of the planned implementation of the real-time collection and use of PROMs and PREMs. Identifying and addressing potential barriers will support inclusive implementation and enhanced supportive care of patients with breast cancer.

Kim Wuyts¹, Vicki Durston², Lisa Morstyn², Sam Mills², Victoria White¹

¹Deakin University, Burwood, VIC, Australia

²Breast Cancer Network Australia, Melbourne, VIC, Australia

Background: For those considering Breast Reconstruction after mastectomy, information is essential to ensure informed decisions are made. Using free text responses from a survey of members of Breast Cancer Network Australia (BCNA), this study aims to understand the type of information women want in relation to BR and identify gaps in information provided.

Method: At the end of an online survey assessing BR experiences, participants were asked the open-ended question: ‘Thinking about women who may experience BR in the future, is there anything you think needs to change so that they have a better experience’. Free text responses were analysed thematically utilising an experiential perspective with codes and themes capturing respondents’ viewpoints. Codes sharing similar meaning were amalgamated into subthemes, which were grouped to form overarching themes.

Results: Of those completing the survey, 2077 (61%) provided a response to the open-ended question. Three overarching themes were identified. Theme 1, ‘content of information’, reflected the need for information to cover a broad range of topics including BR options (types of procedures); risks and recovery. Information on the psychological impact of BR was also needed, with comments indicating many were not prepared for this. Theme 2, ‘managing expectations’, stressed the importance of realistic information about BR outcomes and processes, with this information seen as essential to reducing dissatisfaction arising from discrepancies between actual and expected outcomes. Theme 3 ‘information sources’ focussed on sources of information that could provide realistic information. Access to those with previous BR experience and photos were mentioned as important sources of realistic information.

Conclusions: Multiple gaps exist in current information regarding BR. Those considering BR want information that is comprehensive, realistic, and provided at the right time to inform decision-making. Developing new resources where needed and ensuring adequate distribution of existing information might enhance overall experiences of BR.

Robyn Brennen^1,2, Sze-Ee Soh³, Linda Denehy^1,4, Kuan-Yin Lin⁵, Tom Jobling⁶, Orla McNally^1,4,7, Simon Hyde^1,8, Jennifer Kruger⁹, Helena Frawley^1,7,8

¹University of Melbourne, Carlton, VIC, Australia

²University of South Australia, Adelaide, SA, Australia

³Monash University, Frankston, VIC, Australia

⁴Peter MacCallum Cancer Centre, Melbourne, VIC, Austraia

⁵National Taiwan University, New Taipei, Taiwan

⁶Monash Health, Moorabbin, VIC, Australia

⁷Royal Women's Hospital, Melbourne, VIC, Australia

⁸Mercy Hospital for Women, Heidelberg, VIC, Australia

⁹University of Auckland, Auckland, New Zealand

Aim: To assess the feasibility of telehealth-delivered pelvic floor muscle training for patients with incontinence after gynaecological cancer surgery.

Design: Pre-post single cohort clinical trial.

Methods: Women with urinary and/or faecal incontinence after gynaecological cancer surgery underwent a 12-week physiotherapist-supervised telehealth-delivered pelvic floor muscle training program. The intervention involved seven videoconference sessions with real-time feedback from an intravaginal biofeedback device, and a daily home exercise program using a mobile app. Feasibility outcomes included the proportion of eligible patients recruited, attendance at videoconference sessions and adherence to the home exercise program. Participant satisfaction and acceptability was rated on a 7-point scale ranging from 1 = very unsatisfied/very unacceptable to 7 = very satisfied/very acceptable.

Clinical outcomes were assessed at baseline, immediately post-intervention and at 3-months follow-up using the ICIQ-UI-SF, the ICIQ-B and the intravaginal biofeedback device. Means and 95%CIs were analysed using bootstrapping methods.

Results: A total of 63 women were eligible, of which 39 (62%) consented to the study. Three participants did not complete baseline outcome measures and were not enrolled in the trial. Of the 36 participants who enrolled in the trial, 32 (89%) received the intervention. The majority (n = 30, 94%) demonstrated high engagement, attending at least six videoconference sessions. Adherence was moderate, with 24 participants (75%) completing five-to-seven pelvic floor muscle training sessions per week during the intervention. Three months after intervention, 24 participants (77%) rated the videoconference sessions ‘very acceptable’, 14 (44%) rated the intravaginal sensor ‘very acceptable’ and 25 (78%) reported doing regular PFMT.

All clinical outcome measures improved immediately post-intervention; however, the magnitudes of these improvements were small. At 3-months follow-up, improvements were sustained for prevalence, ICIQ-UI-SF and ICIQ-B domains but not PFM outcomes.

Conclusion: Telehealth-delivered pelvic floor muscle training is a feasible and acceptable option to treat incontinence after gynaecological cancer surgery. Large randomised controlled trials are warranted to investigate clinical effectiveness and cost-effectiveness.

Robyn Brennen^1,2, Kuan-Yin Lin³, Linda Denehy^1,4, Sze-Ee Soh⁵, Tom Jobling⁶, Orla McNally^1,4,7, Simon Hyde^1,8, Helena Frawley^1,7,8

¹University of Melbourne, Carlton, VIC, Australia

²University of South Australia, Adelaide, SA, Australia

³National Taiwan University, New Taipei, Taiwan

⁴Peter MacCallum Cancer Centre, Melbourne, VIC, Austraia

⁵Monash University, Frankston, VIC, Australia

⁶Monash Health, Moorabbin, VIC, Australia

⁷Royal Women's Hospital, Melbourne, VIC, Australia

⁸Mercy Hospital for Women, Heidelberg, VIC, Australia

Aims: To investigate pelvic floor disorders, physical activity levels (PA) and health-related quality-of-life (HRQoL) in patients undergoing hysterectomy for gynaecological cancer, and to identify changes in pelvic floor disorders, HRQoL and PA before and after surgery.

Methods: Longitudinal study of patients undergoing hysterectomy for gynaecological cancer. Outcomes were assessed at baseline (pre-surgery symptoms), 6-weeks and 3-months post-surgery using the ISI, PFDI-20 and FSFI, IPAQ-7 and EORTC-QLQ-C30. Changes over time were analysed using linear mixed models, and generalised estimating equations.

Results: Of 277 eligible patients, 126 consented to participate. The majority had stage 1 cancer (62%) and the most common cancer was endometrial cancer (69%). The prevalence of urinary incontinence was 66% pre-surgery and 59% 3-months post-surgery, while the prevalence of faecal incontinence was 12% pre-surgery and 14% 3-months post-surgery, these differences were not statistically significant. However, there was a significant decrease in the prevalence of pelvic floor symptoms (PFDI-20 MD = −14%; 95%CI: −23, −5) and urogenital symptoms (UDI-6 subdomain MD = −20%; 95%CI: −31, −9). The incidences of new urinary and faecal incontinence 3-months post-surgery were 10% and 8%, respectively. Three-months post-surgery, 42% of participants reported sexual activity compared to 27% pre-surgery (p = 0.003). The prevalence of dyspareunia was high in those who attempted penetrative intercourse both pre-surgery (n = 11/17) and 3-months post-surgery (n = 11/20). Only 39% of the participants met PA guidelines pre-surgery, increasing significantly to 53% 3-months post-surgery (p = 0.020). EORTC-QLQ C30 global health status/QoL domain scores did not change significantly from pre-surgery (M = 64.8/100; 95%CI: 61.2, 68.4) to 3-months post-surgery (M = 69.4/100; 95%CI: 65.6, 73.2) (MD 4.6; 95%CI: −.6, 9.8).

Conclusions: Patients with gynaecological cancer experienced high rates of pelvic floor disorders before and after hysterectomy. New cases of urinary and faecal incontinence developed between pre-surgery and 3-months post-surgery. Physical activity increased significantly, and HRQoL did not change significantly over this time. Clinicians working with gynaecology-oncology patients undergoing hysterectomy may want to consider screening and providing treatment options for pelvic floor disorders.

Robyn Brennen^1,2, Kuan-Yin Lin³, Linda Denehy^1,4, Sze-Ee Soh⁵, Tom Jobling⁶, Orla McNally^1,4,7, Simon Hyde^1,8, Helena Frawley^1,7,8

¹University of Melbourne, Carlton, VIC, Australia

²University of South Australia, Adelaide, SA, Australia

³National Taiwan University, New Taipei, Taiwan

⁴Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁵Monash University, Frankston, VIC, Australia

⁶Monash Health, Moorabbin, VIC, Australia

⁷Royal Women's Hospital, Melbourne, VIC, Australia

⁸Mercy Hospital for Women, Heidelberg, VIC, Australia

Aims: To examine associations between (1) treatment type or stage of cancer and pelvic floor symptoms after hysterectomy for gynaecological cancer, and (2) pelvic floor symptoms and both physical activity and health-related quality-of-life after hysterectomy for gynaecological cancer.

Design: Longitudinal observational study.

Methods: Patients undergoing hysterectomy for gynaecological cancer were assessed before and 3-months after surgery. Pelvic floor symptoms were assessed using the Incontinence Severity Index and Pelvic Floor Distress Inventory short form (PFDI-20). Physical activity was assessed using the International Physical Activity Questionnaire short form and health-related quality-of-life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30). Associations were analysed using logistic regression models and analyses of variance.

Results: Of 277 eligible patients, 126 participated in this study. Sixty-four participants (50.8%) received surgery only and 60 participants (47.6%) received surgery and adjuvant or neo-adjuvant therapy. Participants who had adjuvant/neo-adjuvant therapy were more likely to experience moderate-to-severe urinary incontinence 3-months after surgery than those who had surgery only (OR = 4.98; 95%CI: 1.63, 15.18). There was no association between treatment type and other pelvic floor symptoms, or stage of cancer and any pelvic floor symptoms. Pelvic floor symptoms were not associated with physical activity levels. Participants reporting pelvic floor symptoms on the PFDI-20 had lower scores on the EORTC-QLQ C30 global health status/QoL domain compared to those who did not report pelvic floor symptoms on the PFDI-20 (MD = −9.59; 95%CI: −17.8, −1.81).

Conclusions: Adjuvant therapy may increase the odds of developing moderate-to-severe urinary incontinence. Pelvic floor symptoms may have a negative impact on health-related quality-of-life after gynaecological cancer treatment.

Ashleigh R Sharman¹, Verity Chadwick², Kirsty F Bennett³, Samantha Rowbotham⁴, Kirsten J McCaffery⁵, Rachael H Dodd^1,6,5

¹Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

²Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia

³Cancer Communication and Screening Group, University College London, London, England, UK

⁴Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia

⁵Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia

⁶The Daffodil Centre, The University of Sydney, Sydney, NSW, Australia

Aims: The incidence and mortality of cervical cancer has steadily declined since the introduction of Australia's National Cervical Screening Program; however, changes to the program in 2017 have caused some confusion among participants. The aim of this study was to explore how women receive their cervical screening test results, how they interpret their result, and their understanding of what the result meant.

Methods: Women aged 25–74 who received a cervical screening test after 2017 were recruited via social media and citizen science organisations. Participants answered a short questionnaire on how they received cervical screening test results, their interpretation of these results and levels of distress, whether additional information was sought, and if there were unanswered questions regarding their results. Participants also had the option to upload de-identified results from their most recent test.

Results: The 465 participants reported wide variation in the process of result dissemination; the majority (43.4%) received their results verbally from a GP or practice nurse, and over one third (35.4%, n = 118) of participants stated they looked for extra information or spoke to someone about what their cervical screening test results meant. Seventy-four (15.9%) participants stated they had unanswered questions about their test result. This raises key issues including the adoption of new media forms for communicating results, provision of scientific versus lay-person wording of results, and the potential to use existing healthcare portals to record and provide access to information.

Conclusions: Cervical screening test results can be challenging to convey effectively, and may lead women to misunderstand or have misconceptions about their results. Given the variability in how women receive their results, there is a need to address the current standards of practice and consider women's information needs about their test results.

Will Ashwell¹, Charlotte Kelly¹, Melanie Keats², Ashley Tyrell², Cynthia Forbes¹

¹University of Hull, Hull, East Yorkshire, UK

²Dalhousie University, Halifax, Canada

Background: Evidence shows that physical activity (PA) can reduce the impact of cancer-related side-effects, yet many survivors are not active enough to gain benefits. Personal barriers like time and energy are not the only factors moderating PA, neighbourhood characteristics also have impact.

Aim: To assess characteristics related to walkability, activity levels and health outcomes, and explore associations between PA, walkability and self-rated health among gynaecological cancer survivors (GCS) in Nova Scotia, Canada.

Methods: This is a secondary analysis of data collected in 2014 from GCS identified through the Nova Scotia Cancer Registry. Eligible participants, aged 18–69, were diagnosed with a histologically confirmed gynaecological cancer. A total of 239 respondents (26.6% response rate) completed the International PA Questionnaire (IPAQ). Walk Scores, reflecting walkability, were calculated based on postcodes, considering factors such as block length, intersection density and distance to preselected destinations.

Results: Walkability was significantly associated with marital status, as 68.1% of married GCS lived in unwalkable postcodes versus 31.9% of unmarried GCS (p = 0.038). PA duration was not significantly linked to self-rated health; however, uterine cancer survivors reported 219 min of PA, compared with 175 for cervical or ovarian cancer survivors (p = 0.028). Education level correlated with PA duration (p = 0.012), but not sitting duration. Income level was associated with quality of life (QoL) (p = 0.040). No association was found between Walk Score and PA duration, sitting duration, self-rated health or cancer-specific QoL.

Conclusions: Walkability, as measured by Walk Scores, showed no direct association with PA, self-rated health or QoL among GCS in this study. However, marital status was associated with built environment. PA correlated with education level and cancer type, whereas self-rated health and cancer stage related to sitting duration. Further research is necessary to understand the interactions of built environment and PA and QoL.

Gabrielle C Gildea^1,2, Melanie L Plinsinga^1,2, Nicole M McDonald^1,2, Rosalind R Spence^1,2, Tamara L Jones^1,3, Carolina X Sandler^1,4,5, Sandi C Hayes^1,2

¹Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia

²School of Health Science and Social Work, Griffith University, Brisbane, QLD, Australia

³Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC, Australia

⁴Kirby Institute, University of New South Wales, Sydney, NSW, Australia

⁵School of Health Sciences, Western Sydney University, Sydney, NSW, Australia

Aims: The purpose of this qualitative study was to explore the barriers, facilitators, perceptions and preferences of physical activity across the cancer continuum in women diagnosed with recurrent ovarian cancer.

Methods: Women enrolled in the Exercise During Chemotherapy for Recurrent Ovarian Cancer (ECHO-R) phase II clinical trial were invited to participate. Semi-structured interviews, guided by social cognitive theory, were conducted by two interviewers via video conferencing. All interviews were recorded, and audio was transcribed verbatim. Transcripts were coded and data were analysed using an adaptive thematic approach. Recruitment, data collection and analysis proceeded concurrently until data saturation was reached.

Results: Six themes emerged from 13 participant interviews: (1) impediments and facilitators of physical activity; (2) perceived benefits and risks of physical activity; (3) the importance of receiving physical activity information, advice and support from healthcare professionals; (4) use of personal and learnt strategies to facilitate participation in physical activity; (5) experience with physical activity and satisfaction with the ECHO-R trial and (6) preferences for physical activity participation (type, location and company during activity). Findings suggest that some barriers, facilitators, perceptions and preferences evolve following diagnosis of primary ovarian cancer, and that a diagnosis of recurrent disease influence some factors further. The importance of receiving information, advice and support for participating in physical activity was emphasised by participants.

Conclusion: Physical activity participation post-cancer diagnosis requires consideration of individual circumstances among implementation of behaviour change strategies.

Lizzy Johnston^1,2,3, Torukiri Ibiebele³, Michael Friedlander^4,5, Peter Grant⁶, Jolieke van der Pols^2,3, Penelope Webb³

¹Cancer Council Queensland, Fortitude Valley, QLD, Australia

²School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

³Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

⁴University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, NSW, Australia

⁵Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

⁶Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, VIC, Australia

Aims: Malnutrition is common during treatment of ovarian cancer, and one in three patients report multiple symptoms affecting food intake post-treatment. Current knowledge regarding dietary intake post-treatment in relation to ovarian cancer survival is limited. General guidelines recommend cancer survivors maintain a higher level of protein intake to support recovery and minimise nutritional deficits. Therefore, this study investigated whether intake of protein and protein food sources following primary treatment of ovarian cancer is associated with recurrence and survival.

Methods: Intake levels of protein and protein food groups were calculated from dietary data collected ∼12 months post-diagnosis using a validated food frequency questionnaire in an Australian cohort of women with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 years follow-up). Cox proportional hazards regression was used to calculate adjusted HRs and 95% CIs for protein intake and progression-free and overall survival.

Results: Among 591 women who were progression-free at 12 months follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1–1.5 compared with ≤1 g/kg body weight, HR_adjusted: .69, 95% CI: .48, 1.00; >1.5 compared with ≤1 g/kg, HR_adjusted: .61, 95% CI: .41, .90; >20% compared with ≤20% total EI from protein, HR_adjusted: .77, 95% CI: .61, .96). There was no evidence for better progression-free survival with any particular protein food sources. No overall survival advantage was observed with a higher level of protein intake, although there was a suggestion of better overall survival among those with higher total intakes of animal-based protein foods, particularly dairy products (HR: .71; 95% CI: .51, .99, for highest vs. lowest tertiles).

Conclusions: After primary treatment of ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.

Senara Kulatunga¹, Stacey Rich², Irene Blackberry², Tshepo Rasekaba², Christopher B Steer^1,2,3,4

¹Rural Clinical Campus, Albury, UNSW School of Clinical Medicine, Albury, NSW, Australia

²John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, VIC, Australia

³Albury Wodonga Health, Albury, NSW, Australia

⁴Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia

Background: Fear of cancer recurrence (FCR) can be a constant feature of cancer survivorship that can negatively impact quality of life. Whilst the symptom burden from FCR is higher in younger patients, the impact of FCR in older adults is poorly understood.

Objectives: To explore FCR, survivorship and the coping strategies associated with FCR in older women in remission after treatment of gynaecological cancer.

Methods: This study utilised qualitative interviews designed to explore the experience of FCR in older women. Females treated for ovarian or uterine cancer at a regional cancer centre, who have not previously experienced recurrence and were aged ≥65 years were invited to participate in interviews. Thematic analysis was undertaken to uncover themes related to the experience of FCR and coping strategies employed. Interviews were preceded by a demographic questionnaire and the Fear of Cancer Recurrence Inventory – Short Form.

Results: Ten older women (age range 68–87 years) with gynaecological cancer (ovarian = 5, uterine = 5) were interviewed. Regarding the experience of FCR, emergent themes included fear of burdening others, the emotional impact of the death of close others, and positive or negative experience of prior treatment. Emergent themes in coping with FCR in survivorship included helping others, comparison to others, keeping occupied and support from others. Patients discussed preferring not to dwell on thoughts of recurrence.

Conclusion: The desire to not be a burden on others was a prominent, emergent theme of the FCR experience in this group of older women with gynaecological cancer. These findings are novel in FCR literature as they point to an experience of FCR in older women that may not fit the profile of FCR in the general population. Whilst further work is needed, these findings support the need for a tailored approach to supporting older women through survivorship to ensure optimal quality of life.

Ben Smith^1,2,3,4, Hayley Russell⁵, Adeola Bamgboje-Ayodele⁶, Lisa Beatty^4,7, Haryana Dhillon^4,8,9, Joanne Shaw^4,8, Jan Antony⁵, Joanna Fardell¹⁰, Verena Wu^3,11, Anupama Pangeni^3,11, Cyril Dixon⁵, Orlando Rincones^3,11, Laura Langdon⁵, Daniel Costa⁸, Afaf Girgis¹

¹South West Sydney Clinical Campuses, University of New South Wales (UNSW) Sydney, Liverpool, NSW, Australia

²The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

³Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

⁴Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia

⁵Ovarian Cancer Australia, Melbourne, VIC, Australia

⁶Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

⁷Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia

⁸School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

⁹Centre for Medical Psychology & Evidence-Based Decision Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

¹⁰UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia

¹¹South West Sydney Clinical Campuses, University of New South Wales (UNSW) Sydney, Liverpool, NSW, Australia

Aims: Women affected by ovarian cancer (OC) face an uncertain prognosis and report high fear of cancer recurrence (FCR). This pilot randomised wait-list controlled trial aimed to evaluate the acceptability, feasibility and safety of iConquerFear, a self-guided online FCR intervention for OC survivors.

Methods: We recruited women (≥18 years) post-treatment for stage I–III OC via Ovarian Cancer Australia from October to December 2022. Eligible women were randomised to access iConquerFear immediately (intervention) or after 8 weeks (wait-list control). Outcomes assessed were: feasibility – ≥50% of women expressing interest access iConquerFear, and ≥50% of those complete ≥3/5 therapeutic modules; acceptability – mean post-intervention satisfaction rating ≥75/100; safety – ≤5% withdrawals due to worsened FCR/distress from iConquerFear. Semi-structured interviews with a sub-sample explored factors influencing iConquerFear uptake, engagement and benefit.

Results: Ninety women expressed interest, 62 completed eligibility screening; 58 (64%) were randomised (intervention n = 27, wait-list n = 31). Most participants had stage III OC (n = 34, 59%); mean FCR = 20/36 (SD = 6.7). Of those randomised 27 (47%) accessed iConquerFear (13 intervention, 14 wait-list participants), and 59% completed ≥3/5 therapeutic modules. Post-randomisation, 19 women (33%) withdrew, 8 (14%) due to recurrence, 3 (5%) due to increased FCR/distress. Mean post-intervention satisfaction (n = 25) was 80/100 (SD = 26). Thematic analysis of 14 interviews generated six themes: (1) Varying perspectives on timing and method of recommending iConquerFear, (2) Participant factors influencing engagement, (3) Website factors influencing engagement, (4) Need to balance flexibility of self-guided online programs and opportunities for personal connection, (5) Desire for deeper, more specific discussions of lived experiences and (6) Personal impact of iConquerFear.

Conclusions: Feasibility of iConquerFear was limited by low uptake. Women who accessed iConquerFear generally completed the recommended dose and were satisfied. More tailored website content and greater personal support are needed, particularly in cases of increased distress during iConquerFear use.

Rosalind Spence¹, Tamara Jones², Carolina Sandler³, Sandi Hayes^1,4

¹Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia

²Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

³Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, NSW, Australia

⁴School of Health Science and Social Work, Griffith University, Brisbane, Queensland, Australia

Introduction: Treatment-related adverse effects (AEs) are a common consequence of cancer therapies, with ovarian cancer treatment associated with severe toxicity. Exercise can mitigate treatment-related morbidity and improve quality of life. However, exercising while experiencing AEs is challenging. To support the integration of exercise into cancer care, healthcare professionals must understand the bi-directional relationship between treatment toxicities and exercise – AEs inform exercise prescription, and concurrently, exercise participation may influence AEs. The aim of this research was to describe the relationship between AEs and exercise by using data collected as part of the Exercise during CHemotherapy for Ovarian cancer (ECHO) trial.

Methods: The ECHO intervention involves the addition of exercise therapy (target dosage 150 min, moderate-intensity, multi-modal exercise/week; average intervention duration: 18 weeks) to first-line chemotherapy for ovarian cancer. Study-trained exercise professionals prompted exercise group participants (n = 187) to self-report AEs during weekly telephone sessions. Frequencies of AEs by subgroups (e.g. grade, causality, impact on exercise prescription) were recorded and assessed. Case studies were developed from case notes to provide contextualised examples of the inter-relationship between exercise and AEs.

Results: An average of 25 (min: 2; max: 87) AEs (98% grade 1–2) per person were recorded throughout the intervention period. Of these, the minority (5%) were exacerbated by exercise (most common: fatigue, dyspnoea, pain), and only 7% required subsequent exercise prescription modification or interruption to exercise. Examples of cases whereby exercise improved AEs, as well as when AEs were exacerbated by exercise, and subsequent changes to exercise prescription will be described during the presentation.

Conclusions: These findings highlight that AEs during chemotherapy for ovarian cancer are common and that exercise prescription during this period requires advanced clinical judgment and regular communication between the patient and their allied health professionals.

Bree Stevens¹, Aimhirgin Byrne¹, Helen Gooden¹, Jane Power¹, Clare L Scott AM^1,2,3

¹ANZGOG, Camperdown, NSW, Australia

²Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

³Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia

Introduction: More than 6700 women are diagnosed with gynaecological cancer in Australia each year.¹ Ovarian cancer is the leading cause of death from gynaecological cancer – 5-year survival rate 49%.²

The National Framework for Gynaecological Cancer Control³ identified priorities: ‘greater awareness of symptoms of gynaecological cancer, timely investigation and referral of women who may have symptoms…improve earlier detection, enabling more timely treatment and improving the chances of long-term survival.’

Despite its prevalence, cancer forms a very small component of the medical student curriculum,⁴ with some graduates reporting feeling under-prepared for patient interactions.^5,6 The proposed Cancer Education Framework for Australian Medical Schools⁷ identifies patient-centred care and developing understanding of the patient experience, psychosocial impacts, as key aspects of cancer education.

Aim: Through the sharing of lived experience, gynaecological cancer survivors and caregivers strengthen cancer education by advocating for increased understanding of gynaecological cancers, timely diagnosis, good health communication and compassionate care.

Method: Survivors Teaching Students is an experiential learning program for medical and nursing students. The international, volunteer-led program supplements traditional teaching providing unique insights into the patient and caregiver experience. The program provides a voice for those affected by gynaecological cancer and the opportunity to effect change for the future.

Results: Student evaluations (n = 10,300 students) demonstrated the effectiveness of this learning which provides ‘a deeper insight into the human aspect of cancer’ and increased understanding of gynaecological cancers. The results support the findings of Burch et al.⁸ that ‘students experienced superior learning outcomes when experiential pedagogies were employed.’ Survivors (n = 97) reported participation in the program to be an empowering and cathartic experience ‘We take students away from their textbooks and into real life…to improve survival rates and helping to shape future care.’

Susannah Jacob^1,2, Jesmin Shafiq^1,2, Shalini K Vinod^1,2,3

¹South West Sydney Clinical Campuses, University of New South Wales, Liverpool, New South Wales, Australia

²Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia

³Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia

Aim: To assess the feasibility of measurement of Quality Indicators (QIs) for the treatment of cervical cancer at a population level in NSW

Methods: Published QIs on management of cervical cancer were identified through a literature search; QIs on screening, diagnosis or quality of life were excluded. Identified QIs were assessed for feasibility of measurement based on the availability of routine patient data in cancer registries.

The NSW Clinical Cancer Registry (NSW ClinCR) has data on episodes of care for patients with cervical cancer from 2005 to 2013 in public hospitals across NSW. The NSW ClinCR treatment data were linked to selected variables from the NSW Cancer Registry (NSWCR), NSW Admitted Patient Data Collection (APDC) and the NSW Registry of births, deaths and marriages (RBDM) by the Centre for Health Record Linkage (CHeReL). All data were de-identified prior to analysis.

Results: We identified 86 QIs for the treatment of cervical cancer published between 2016 and 2023, classified as structural (N = 11), process (N = 65) and outcome (N = 10) QIs. Among the process QIs, the identified QIs focussed on radiotherapy (N = 36), surgery (N = 6), chemoradiotherapy or chemotherapy (N = 9) and general/pre-treatment (N = 14). 13/86 (15%) QIs were measurable based on the patient data items available from population-based cancer registries. These included 1 surgery, 4 radiotherapy, 2 chemoradiotherapy/chemotherapy and 6 outcome QIs. However, we were able to measure half (4/8) of treatment QIs selected by NHS Scotland¹ and 3/3 of the US Commission on Cancer quality measures.²

Gillian Blanchard¹, Sue Bartlett², Rebecca Booth³, Michael Cooney⁴, Michael Fitzgerald⁵, Justin Hargreaves⁶, Kristin Linke⁷, Vicki McLeod⁸, Marisa Stevens⁹, Gillian Kruss⁸

¹Calvary Mater Newcastle, Waratah, NSW, Australia

²Ballarat Health Services, Ballarat, Australia

³Westmead Hospital, Westmead, Australia

⁴The Northern Hospital, Epping, Victoria, Australia

⁵Flinders Medical Centre, Adelaide, SA, Australia

⁶Bendigo Health Cancer Centre, Bendigo, Victoria, Australia

⁷The Queen Elizabeth Hospital, Woodville, SA, Australia

⁸Moorabbin Hospital, Bentleigh East, Victoria, Australia

⁹St Vincents Private Hospital, Melbourne, Victoria, Australia

Aim: To describe how a National Cancer Nurse Practitioner (CNP) Specialist Practice Network (SPN) remains relevant in educating, adapting to change and how it continues to grow and foster professional collegial relationships through education, research and mentoring.

Methods: With the complexity and acuity of patient care changing and increasing demands on the medical workforce, a specialised CNP workforce is needed to help manage patients. Support, education and collaboration are considered pivotal to the success of the CNP role nationally, which has been reported as a significant gap by CNPs. In order to meet this gap, the Cancer Nurses Society of Australia (CNSA) CNP SPN was established with a shared vision for quality and relevant education amenable to this level of advanced practice and to allow for networking opportunities and peer support.

Results: From a core of 15 members, the group has grown to a membership of 103 from all Australian states and territories over the last 10 years. The SPN aims to provide 3 days of face-to-face education each year and adapted successfully during extended COVID-19 lockdowns by providing webinars. The education is made possible and sustainable through industry sponsorship support. This industry support and alignment with CNSA have ensured sustainability, allowed professional representation and provided logistical support. Not only does this group have the opportunity to educate its members, but it also provides them a voice by consulting on developing practices, emerging policies and significant issues that impact NP practice. Recently the SPN commenced work in CNP mentoring research and has developed and validated a self-assessment learning needs tool that has the potential to be rolled out both nationally and internationally.

Conclusion: The development and continued sustainability of the CNP SPN is vital. The CNP SPN helps develop and advance clinical practice for CNPs across Australia in a model that could be easily replicated.

Jo Collins

WA Youth Cancer Service, Nedlands, WA, Australia

Background: Lived experience is personal knowledge gathered through first-hand experience of situations or events.^1,2 The Western Australian Youth Cancer Service (WA YCS) collaborated with Matthew, a young consumer advocate diagnosed with synovial sarcoma soon after his 18th birthday, to create an educational resource featuring his lived experience of cancer and the widespread disruption it caused to his achievement of developmental milestones.

Methodology: As treatment options faded, Matt collaborated with health professionals in the WA YCS to make video recordings; sharing his personal experience to educate and inspire health professionals to consider the inherent difficulties of navigating cancer as a young adult and calibrate their care accordingly. These videos have been presented to health professionals in a variety of educational forums.

Results: The result of this collaboration between consumer advocate and health professionals is truly profound; a powerful, moving video recording detailing Matt's lived experience of cancer and its treatment on his physical, emotional, social and cognitive capacity. Matt openly describes experiencing helplessness, isolation and a loss of purpose coupled with feelings of gratitude at marrying the love of his life and spending his honeymoon in hospital. Anecdotal feedback from staff engaging with the videos has been overwhelmingly positive, with health professionals reporting having a greater understanding of the issues affecting young people with cancer and expressing a desire to reflect on their own practice.

Conclusion: Matt ultimately lost his life to synovial sarcoma soon after his 25th birthday. This video series lives on as a powerful tool to educate and inspire health professionals to consider the unique needs of young people with cancer, calibrate their provision of care and ultimately improve the cancer experience for other young people.

Duncan Colyer¹, Elizabeth Diao¹, Diane Pitropakis², Anita Rea³, Felicity Sutton⁴, Charmaine Smith⁵, Joanne Britto¹

¹VCCC Alliance, Melbourne, VIC, Australia

²Parkville Cancer Clinical Trials Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Western Health, Melbourne, VIC, Australia

⁴St Vincent's Hospital Melbourne, Melbourne, VIC, Australia

⁵Austin Health, Melbourne, VIC, Australia

Aim: Early phase clinical trials (EPCTs) possess unique recruitment challenges. EPCTs are defined by restrictive eligibility criteria, focus on safety, and testing novel treatments (often for the first time) in patients who may have limited options. Information to support a potential participant's decision to participate commonly relies on the patient information and consent form. However, the nature of EPCTs suggests that additional information is warranted. Research indicates that current resources, where available may not fit the information needs of its audience and were primarily available in English.

Method: Approached as a quality improvement exercise, the VCCC Alliance performed a literature review and contacted Clinical Trials Units (CTUs) regarding the information and process used in EPCTs. Four broad Consumer Focus Groups were undertaken to review the material and methods for their appropriateness. Recommendations were sought to address the shortfalls in resources and clinical usage.

Results: The literature review, scoping exercises and focus groups demonstrated the diverse range of materials available, yet the needs of the potential participants were not met. Distinctions and similarities from the focus groups have been identified, for example, some consumers were keen to see EPCTs with conversations around hope whereas others preferred to highlight if a dose was subtherapeutic. The role of the information consumers considered. These informed recommendations and will be provided, along with examples outlining the next steps in their distribution, including culturally and linguistically diverse (CALD) populations to make these recommendations widely available.

Conclusion: The participant-informed recommendations in the provision of EPCT information assist in addressing known barriers for potential participants considering these trials. Making such recommendations freely available will encourage participants and organisations to confidently use endorsed procedures and examples of appropriate materials and tailor to their purpose.

Amy M Dennett¹, Germaine Tan¹, Lacey Strachan², Jacinta Simpson³, Philip Parente², Christian Barton⁴

¹Allied Health Clinical Research, Eastern Health – La Trobe University, Box Hill, Victoria, Australia

²Cancer Services, Eastern Health, Box Hill, Victoria, Australia

³Learning and Teaching, Eastern Health, Box Hill, Victoria, Australia

⁴La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia

Aim: To develop a cancer rehabilitation training package for allied health professionals and its effect on clinicians learning needs and clinical practice.

Method: A mixed methods approach drawing on co-design methods was used to develop and evaluate the training package. Two online co-design workshops were conducted with representatives from each allied health discipline and consumers to identify learning needs for the training package. Allied health staff (e.g. physiotherapists, dietitians and occupational therapists) from four metropolitan health services were invited to participate in a hybrid 2-day training workshop and provide feedback via survey. Evaluation was based on the Kilpatrick model for learning evaluation. Surveys were completed before and after the workshop and a focus group and survey including the Determinants of Implementation Behaviour Questionnaire (DIBQ) completed 3-months after workshop participation to assess knowledge, skills and confidence. Thematic analysis of qualitative data was completed and paired t-tests used to assess changes in behaviour.

Results: Two consumers and eight clinicians (physical therapist n = 3, occupational therapist n = 2, social worker n = 1, nurse n = 1, allied health educator n = 1) attended the online co-design workshops. Key learning needs identified included information related to medical treatments, symptom management, multi-disciplinary care and communication skills. Twenty allied health professionals attended a hybrid 2-day workshop. Most participants were junior-mid level clinicians (n = 15, 76%) and primarily worked in an area other than cancer (n = 14, 72%). Overall, feedback about the workshop was positive. Training was reported as helping consolidate existing cancer knowledge and was applied to participant's clinical practice. Participants also valued the multidisciplinary focus and balance of content. Participants demonstrated greatest improvement in their confidence (Items 9, 10, 11, median 5 points, p < 0.05) to deliver cancer rehabilitation but also improved in the domains of skills and knowledge 3-months after workshop completion.

Conclusion: Allied health clinicians value education in cancer rehabilitation. Hybrid training workshops may be useful for building capacity in supportive cancer care.

Ashleigh R Sharman¹, Eliza M Ferguson², Haryana Dhillon², Paula Macleod³, Julie McCrossin⁴, Puma Sundaresan^1,5, Jonathan R Clark^1,6, Megan A Smith⁷, Rachael H Dodd^1,7,8

¹Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

²Faculty of Science, The University of Sydney, Sydney, NSW, Australia

³Northern Sydney Cancer and Palliative Care Network, Northern Sydney Local Health District, Sydney, NSW, Australia

⁴Advocacy, Cancer Voices SA, Adelaide, SA, Australia

⁵Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia

⁶Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁷The Daffodil Centre, The University of Sydney, Sydney, NSW, Australia

⁸Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia

Aims: The human papillomavirus (HPV) is well recognised as a factor in developing oropharyngeal cancer (OPC). An evidence-based booklet, developed in the UK, for HPV-related oropharyngeal squamous cell carcinoma (OSCC) patients, was informed by interviews with health professionals, patients and their partners. It aimed to deliver information in everyday language, and to communicate information while minimising negative psychological impacts on the patient. This study explored the suitability of the booklet for use in Australia and New Zealand.

Methods: Participants were recruited through social media (Twitter, Facebook). Twenty-four participants were interviewed via Zoom. All patients who participated (n = 19) had been diagnosed and treated for HPV-related OSCC. Survivors’ support people also participated (n = 5). Participants were shown the booklet and a Think Aloud method elicited real-time reactions to content. Responses were analysed for each section of the booklet and coded as either for or against content, with other responses thematically analysed using NVivo.

Results: All participants found the booklet useful and a large proportion wished the resource had been available previously. Some expressed the information was new to them. The majority of participants agreed the booklet would be best delivered by their specialist at point of diagnosis and would be a useful resource for friends and family. Most participants gave feedback on where the booklet could be improved in terms of comprehension and design. Overall, the booklet was well received, and participants found the content easy to understand. Most participants found the content helped reduce shame and stigma around the sexually transmitted nature of HPV.

Conclusions: Our research provides valuable insight into the target population's views of this resource, revealing an evidence-based booklet for HPV-related OSCC patients and their partners is acceptable. Implementation may be feasible in routine clinical practice, specifically at time of diagnosis. Revising content of the booklet could facilitate communication between patients, families and healthcare professionals.

Kath Dower^1,2, Georgia Halkett³, Haryana Dhillon⁴, Diana Naehrig⁴, Moira O'Connor³

¹Radiation Therapy, North Coast Cancer Institute, Lismore, NSW, Australia

²Radiation Therapy, Mid North Coast Cancer Institute, Port Macquarie, NSW, Australia

³Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia

⁴School of Psychology, The University of Sydney, Sydney, New South Wales, Australia

Background: The gold standard radiation treatment for left breast cancer patients is Deep Inspiration Breath Hold (DIBH) where patients hold a deep breath to reduce late cardiac and pulmonary effects from treatment.^1–4 DIBH can be challenging and induce or exacerbate anxiety in patients due to the perceived pressure to reduce radiation treatment side-effects.⁵

Objective: This study aimed to explore the experiences of patients treated with DIBH-RT to improve patient centred care and contribute to the co-design of multimedia educational tools for patients undergoing DIBH.

Methods: This descriptive qualitative study was underpinned by a socialist constructivist approach⁶ to create new educational and patient care approaches based on the previous patients’ experiences. Semi-structured interviews were conducted with patients who had completed DIBH for breast cancer. Data was analysed with reflexive thematical analysis.

Results: Twenty-two participants were interviewed with the sample size chosen by data saturation. We identified five main themes:

Informational needs pertaining to types of information, quality of information, processing information and scope of information.

Care needs with subthemes including how participants wanted to be cared for.

Autonomy with subthemes pertaining to control over breath hold.

DIBH performance influencers with subthemes pertaining to pre-existing conditions, capability to undertake DIBH and self-efficacy.

Other-centredness with subthemes pertaining to a self-perceived obligation towards other patients.

Vicki Durston¹, Amanda Winiata¹, Siobhan Dunne¹, Rae Clifton¹, Victoria White²

¹Breast Cancer Network Australia, Richmond, VIC, Australia

²Deakin University, Melbourne, VIC, Australia

Background: Consumer engagement is a critical step in developing and delivering effective, person-centred health care. Breast Cancer Network Australia's (BCNA) Seat at the Table (SATT) program is unique in how it recruits and trains consumer representatives (CRs) to engage with stakeholders across Australia and internationally. There is significant distinction between an individual consumer perspective and that of trained CRs who represent the broader cancer experience. In 2022, BCNA reviewed its training program to maintain its position as a leading cancer consumer organisation providing highly capable and effective CRs.

Aim: To update the curriculum, demonstrate its effectiveness in building CR's capacity to effectively engage in their role and elevate the SATT program.

Methodology: A CR working group was established to support the curriculum review and co-design. Instructional design processes were utilised, including multimedia tools and resources.

A hybrid training of online courses and an in-person workshop was trialled with 16 newly recruited CRs. Participants completed pre- and post-training surveys assessing their knowledge, attitudes and skills. Evaluation outcomes were analysed by Deakin University to inform a cycle of continuous improvement for future participants.

Results: Post-training, 90% of participants rated their knowledge of the training topics as high or very high compared to 31% in pre-evaluations. As CRs progressed through the curriculum, an increasing number felt more confident about taking on the role.

Discussion: The refreshed SATT training program is effective in increasing knowledge and confidence of CRs to engage with stakeholders across the sector. The innovative CR training could be adapted for delivery to other cancer or health consumer organisations to build a greater connection between the lived experience and decision-making, and contribute to meaningful research, change in policy, service delivery and health outcomes. BCNA is well positioned as leaders to support effective consumer engagement in external projects, research and activities.

Grace Gard, Joanna Oakley, Kelsey Serena, Michael Harold, Jo Cockwill, Katya Gray, Helen Anderson, Graeme Down, Judi Price, Peter Gibbs

WEHI, Parkville, VIC, Australia

Background and aims: In cancer research there is growing interest in consumers and researchers working together in partnership, yet the practicalities of partnering and how to optimise the co-design process have not been well established. A research group of health care professionals and consumers aimed to create a Personalised Care Plan for patients with newly diagnosed locally advanced rectal cancer. The group has reflected on and documented their experience of co-design.

Methods: Our research group includes consumers from the consumer program at WEHI, multidisciplinary colorectal cancer clinicians and project officers. Together they created the Personalised Care Plan template, to be provided to patients and their general practitioner. The team's reflections on the co-design process have been captured using Gibbs’ Reflective Cycle. Patients are currently enrolling into a prospective cohort to evaluate the impact of the Personalised Care Plan.

Results: In 2022, over six meetings, we created a two-page Personalised Care Plan to embed into the WEHI-CRC database. Personalised information for individual patients includes stage of disease, planned treatment and scheduled follow-up. Reflection on the co-design process highlighted the importance of establishing expectations, having expertise within the consumer group, and open communication and respect. Challenges included time commitment, power dynamics, diversity of representation and loss of consumers due to health reasons and time availability. Responses reflected a positive attitude-change of the researchers on the value of consumer input. Both consumers and researchers communicated the high objective and affective value of contributing to the project.

Conclusion: Reflecting on the co-design process for a patient education sheet, we found that essential components of a co-design group are having clear expectations, and strategies to address challenges such as time commitment and entrenched power dynamics. Meaningful input from consumers can objectively improve the outcome of the project while offering positive personal value for consumers and researchers involved.

Reegan K Knowles¹, Michelle Miller², Emma Kemp¹, Bogda Koczwara¹

¹Flinders Cancer Research, Flinders University, Adelaide, SA, Australia

²College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

Background and aim: Many people with cancer are not aware of cardiovascular (CVD) risk after cancer, nor guided to reduce their risk. In addition, their HCPs may not have adequate support to guide patients through CVD risk assessment and management. This research aims to codesign (with patient advocates and health care providers) a web-based resource to provide information and guidance about CVD risk to people affected by cancer, and their HCPs.

Methods: Up to 20 patient advocates and HCPs will participate in up to six rounds of codesign. In these semi-structured focus groups/individual interviews, participants will be encouraged to provide feedback, and discuss their needs, goals and preferences for the development of the web-based resource. Sessions will be audio-recorded and researchers will take field notes. Iterative development and revision of the wireframe will be facilitated through researcher discussions after each codesign session, in which the participant data will inform the next iteration of the wireframe to be considered in the subsequent codesign session.

Expected results: This research will produce a web-based resource to provide information and guidance to people with cancer and HCPs regarding CVD risk identification and management. It is anticipated the resource will allow for people with cancer and HCPs to navigate to separate sections, and will allow users an individualisable experience of navigating to specific information and guidance based on their own needs. The resource will likely include general information about CVD risk and cancer; advice regarding risk assessment, surveillance and management; and navigation assistance to resources and support.

Conclusions: It is anticipated the codesigned web-based resource for people with cancer and HCPs has the potential to reduce the impact of CVD risk in cancer through information provision and guidance regarding CVD risk assessment and management. The developed resource will be assessed for usability, feasibility and effectiveness.

Rebekah Laidsaar-Powell¹, Sarah Giunta¹, Phyllis Butow¹, Sandra Turner², Daniel Costa³, Christobel Saunders⁴, Bogda Koczwara⁵, Judy Kay⁶, Michael Jefford⁷, Penelope Schofield⁸, Frances Boyle⁹, Patsy Yates¹⁰, Kate White¹¹, Ilona Juraskova¹

¹Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia

²Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia

³School of Psychology, The University of Sydney, Sydney, NSW, Australia

⁴Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia

⁵College of Medicine and Public Health, Flinders University, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia

⁶University of Sydney, Sydney, NSW, Australia

⁷Peter McCallum Department of Oncology, University of Melbourne, Melbourne, Australia

⁸Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Australia

⁹Centre for Cancer Care and Research, Mater Hospital, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia

¹⁰Queensland University of Technology, Brisbane, Queensland, Australia

¹¹The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Australia

Aims: It is well established that family/friend carers have unique informational and emotional needs and navigating triadic (health professional-patient-carer) interactions can be complex. Despite this, oncology health professionals (HPs) typically receive limited education in effective communication with carers. We designed and piloted a novel evidence-based online education program for oncology HPs detailing strategies for managing and supporting carer involvement (eTRIO).

Methods: In this pre-post evaluation study, HPs completed baseline measures prior to eTRIO, with post-intervention measures at 1 and 12 weeks. Measures included: 13 item self-efficacy in carer communication scale (primary outcome), 7 item applied knowledge scale and single item attitudes towards carer involvement in decisions measure. A sub-set of participants completed feedback interviews. Qualitative data was analysed deductively using thematic analysis informed by Proctor's Implementation Outcomes.

Results: Forty-six HPs (16 nurses, 12 social workers, 4 doctors, 4 psychologists, 10 other allied health) completed the intervention (average time spent on module was 66 min) and 1-week follow-up measures, 41 completed 12-week follow-up. Health professionals showed a statistically significant increase in self-efficacy to communicate with carers post-intervention (CI [12.99, 20.47]), which was maintained at 12-weeks (CI [8.00, 15.72]). There was no change in applied knowledge or decision-making attitudes.

Fifteen HPs completed interviews. Implementation of eTRIO was deemed feasible and acceptable, with many clinicians finding the module engaging, particularly the clinical scenario videos and interactive activities. HPs found eTRIO appropriately addressed the issue of carer communication. Regarding adoption, HPs reflected that following training they implemented eTRIO strategies into their clinical work.

Conclusion: eTRIO provided HPs with confidence to effectively include and support carers, and to manage complex carer situations such as family conflict. These gains are noteworthy, as conflict with families/carers is a contributor to HP burnout and anxiety. eTRIO is brief, relevant and easy to disseminate, making it a suitable professional development tool for improving carer engagement.

Jane Lee¹, Chad Han¹, Carla Thamm¹, Fiona Crawford-Williams¹, Ria Joseph¹, Patsy Yates², Amanda Fox², Raymond Chan¹

¹Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia

²Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia

Aims: Registered nurse prescribing is an innovative approach to meet growing health care needs. This study explores cancer and palliative care nurses’ attitudes towards nurse prescribing and their perceptions about educational requirements for a nurse prescriber.

Methods: A cross-sectional survey was distributed to Australian nurses between March and July 2021. Data were collected using the Advancing Implementation of Nurse Prescribing in Australia online survey. Pearson χ² tests examined associations between nurses in cancer care, palliative care and all other specialties on demographics, attitudes to nurse prescribing and educational perspectives to become prescribers.

Results: A total of 4424 nurses participated in the survey, 161 nurses identified they worked in cancer care and 109 worked in palliative care settings. Improving patient care was the top motivator for becoming a prescriber for both nurses working in cancer and palliative care. However, nurses in cancer care were less certain than nurses in palliative care (χ²(2) = 6.68, p = 0.04), and nurses from all other specialities (χ²(2) = 13.87, p = 0 < 0.1) that nurse prescribing would reduce costs to the health care system, nor reduce patient risk. Nurses working in cancer care believed that successful implementation of nurse prescribing would require strong support from their medical and pharmacy colleagues.

Conclusion: The findings from this study indicate that nurses in the two care settings have differing perspectives on nurse prescribing, but are open to expanding their roles and responsibilities. For registered nurse prescribing to be adopted successfully in cancer and palliative care settings, support by other health care colleagues is essential – requiring strong inter-professional collaborative efforts and careful implementation planning.

Abbie Lockwood¹, Simon Baker²

¹Bendigo Community Health Services, Bendigo, VIC, Australia

²Loddon Mallee Integrated Cancer Service, Bendigo, VIC, Australia

Cancer Support for People of Refugee Background (CSPRBB) is a collaborative project between Bendigo Community Health Services, Loddon Mallee Integrated Cancer Service and the Bendigo Regional Cancer Centre. This 2-year project funded by the Victorian Department of Health is working with local Karen and Afghan communities and service providers to identify enablers, barriers and myths surrounding cancer and cancer care, system issues and refugee sensitive practice.

Bendigo is the second largest regional settlement site in Victoria. Estimated refugee populations – 3500 Karen, 300 Afghan. Humanitarian arrivals come to a new environment with limited knowledge of and access to preventative and primary care, limited health, service and digital literacy, having experienced decades of deprivation.

Throughout the settlement process, barriers to screening without culturally safe supports, limited capacity in symptom recognition and reporting, late diagnosis, refusal of treatment and palliative supports are evident. Anecdotal evidence shows these communities are underserved in cancer care. Presettlement experiences create high risk, and limited protective factors in cancer prevention, detection and treatment.

Aim: CSPRBB aims to improve health equity across the cancer continuum by supporting former refugees to better understand cancer prevention, screening, early intervention, treatment and optimal care pathways that are culturally safe and easily understood.

Preliminary findings: Needs analysis has revealed fear, mythical beliefs, mistrust in western treatments/clinicians, and confirmed literacy limitations. Scanning of translated information and emerging system barriers have revealed areas for improvement. These findings will be presented.

Courtney Oar, Lisa McLean, Tia Moeke, Catherine Bullivant, Shelley Rushton, Tracey O'Brien

Cancer Institute New South Wales, Sydney, NSW, Australia

Background: The lack of a standardised, freely accessible training pathway for pharmacists new to the cancer care practice setting in Australia poses a risk to safety and quality. In response, a seven-module blended learning program was co-designed in collaboration with cancer pharmacists.

Aim: To evaluate the effectiveness and feasibility of a novel, free-to-access, foundational blended-learning program for cancer pharmacists in Australia.

Methods: A 4-month pilot of one module (eLearning, eQuiz, workbook, competency assessment and workshop) was conducted to evaluate the effectiveness of the content and feasibility of implementation using learner-led and facilitator-led models of delivery. Three facilities were strategically selected from expressions of interest to ensure equitable and diverse representation across sectors/settings. Online surveys and semi-structured interviews of pilot leaders and learners were conducted and analysed.

Results: All pilot site facilitators used a mix of delivery models and reported high satisfaction (94%) with the program resources, agreeing no improvements were required. Overall, pilot leaders reported a ‘good’ (70%) experience implementing the program. The main enablers to implementation included (1) digital automation of the program, (2) support from program developers and (3) support from their workplace. Time was the most commonly reported implementation barrier. Twelve learners completed the module, nine completed the learner survey. The majority (89%) indicated the knowledge and skills gained enabled them to practice safely and independently. All learners agreed the module improved the patient care they provide.

Conclusions: The learning program was effective in improving the knowledge and skills of learners and the pilot confirmed the feasibility of implementation within the Australian setting. Results of this pilot will be used to inform the national implementation strategy of the program across Australia.

Dilu Rupassara¹, Sian Wright², Annie Williams², Angela Mellerick¹, Sandra Picken¹, Kath Quade¹, Michael Leach³, Eli Ristevski⁴

¹Western and Central Melbourne Integrated Cancer Services, East Melbourne, VIC, Australia

²Hume Regional Integrated Cancer Service, Shepparton, VIC, Australia

³School of Rural Health, Monash University, Bendigo, VIC, Australia

⁴School of Rural Health, Monash University, Warragul, VIC, Australia

Aim: To explore variation in health professionals’ knowledge, skills, professional/demographic background and confidence in relation to implementing the Optimal Care Pathway (OCP) for Aboriginal and Torres Strait Islander people with cancer in Victoria, Australia.

Methods: A cross-sectional survey was developed based on Cancer Australia's OCP Implementation Guide and distributed via convenience sampling to health professionals practicing in Victoria. The survey assessed self-perceived knowledge, skills, professional/demographic background and confidence in meeting clinical requirements of the OCP for Aboriginal and Torres Strait Islander people with cancer. Descriptive statistics were computed. Pearson's chi-squared test was used to assess whether associations were significant (p-values < 0.05).

Results: Overall, 114 health professionals responded: 44% were nurses, 50% worked in a metropolitan service and 73% had >10 years’ clinical experience. Forty-nine per cent were aware of the OCP for Aboriginal and Torres Strait Islander people with cancer and 65% were confident in asking patients if they identify as Aboriginal and/or Torres Strait Islander. Nineteen per cent of health professionals sometimes, often, or always used the Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP). OCP awareness was associated with attending cultural training. Practicing as a nurse and OCP awareness were associated with confidence in asking patients if they identify as Aboriginal and/or Torres Strait Islander. Use of the SCNAT-IP was associated with regional services, OCP awareness and confidence in asking patients if they identify as Aboriginal and/or Torres Strait Islander. Factors unrelated to the above-mentioned factors included Indigenous/non-Indigenous status of the participant, years of clinical experience and previously providing care to Aboriginal and Torres Strait Islander patients.

Helena Rodi^1,2, Linda Nolte¹, Nicole Kiss³

¹North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

²School of Exercise & Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia

³Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia

Aim: This study aimed to (i) examine the knowledge, skills, experiences, perspectives and applications in practice of advance care planning (ACP) by Australian oncology health professionals and (ii) to describe the barriers and facilitators to implementing ACP in oncology settings. Knowing and providing the treatment and care that a person with cancer would want is an integral part of cancer care. The goal of ACP is to align the care the person receives with their preferences for care.

Methods: A national, cross-sectional survey of Australian oncology health professionals was undertaken between November and December 2019. The 69-item purpose designed survey was distributed via key stakeholder organisations and advertising on social media.

Results: The 263 participants represented nurses (50%), allied health (24%), medical (21%) and other (5%) oncology health professionals. Overall, 49%–54% of participants reported having good or very good knowledge of ACP topics. With regard to assisting patients with advance care directive completion or appointing substitute decision-makers, 58% and 53%, respectively, reported feeling neutral, unskilled or very unskilled. Only 25% of oncology health professionals discussed ACP with most patients receiving treatment with curative intent however, 80% of health professionals agreed or strongly agreed that they should facilitate ACP. Oncology health professionals who had participated in ACP training had significantly more knowledge, felt more skilled, raised more ACP conversations and had a more positive perceptions of ACP compared with those who did not. Common barriers to ACP included lack of clinician time (40%), lack of ACP expertise (37%) and lack of role clarity (33%). Facilitators to ACP included more education (97%) and clearly defined roles (96%).

Conclusion: While perceptions of ACP are positive amongst oncology health professionals, knowledge, skills and application in practice are limited. Clearly defined roles and regular ACP training programs are recommended to improve implementation.

Joanne Shaw¹, Joan Cunningham², Brian Kelly³, Gail Garvey⁴

¹Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia

²Menzies School of Health Research, Brisbane, QLD, Australia

³School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

⁴School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

Aims: Aboriginal and Torres Strait Islander people make up 3.8% of the Australian population but cancer incidence is 1.2 times higher compared to other Australians and in 2019 the age standardised mortality rate was about 1.4 times higher for Indigenous compared to non-Indigenous people for all cancers combined (234 vs. 162 deaths per 100,000 population).¹ The inequity of outcomes spans across the cancer continuum and includes participation in clinical trials. Enablers to improved outcomes include cultural safety and communication and access to appropriate resources and tools. We aimed to develop e-learning modules to provide cancer clinicians and researchers with increased understanding of culturally inclusive clinical and research practices.

Methods: Three online learning modules were developed by an expert stakeholder group which included First Nations researchers. The modules aimed to increase knowledge about (i) Aboriginal and Torres Strait Islander health and current disparities in cancer outcomes; (ii) culturally inclusive communication with patients and carers and (iii) strategies to address the under representation of Aboriginal and Torres Strait Islander people in clinical trials. Module development was guided by adult learning principles. A webinar to reinforce the module content was conducted to provide participants with practical examples of implementation.

Results: The modules were promoted through cancer professional networks and cancer clinical trials groups to their membership. To date, 2000 participants have completed the modules and 220 registered to attend the webinar. Evaluations confirm perceived increased knowledge and confidence in working with Aboriginal and Torres Strait Islander people.

Whiter Tang¹, Caitlin Delaney², Michael Soriano¹

¹Pharmacy, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia

²CareFully Solutions, Sydney, New South Wales, Australia

Aim: To assess the impact of compassionate care training for oncology pharmacists and technicians in a cancer specialty hospital.

Method: Compassion training was provided by CareFully to 12 oncology pharmacists and four pharmacy technicians. This was a 5-h face-to-face training program which included both theory on compassion science and interactive activities which empower participants to deliver compassionate care.

Results: A survey was given to participants before, immediately after, and 3 months post-training to evaluate the impact of the program. It found a significant increase in participants’ understanding of components of compassionate care from a self-reported understanding of 55%–93% as an average. Participants also rated their skill in providing compassionate care increase from 62.5% to 82.7%. They were more confident in managing challenging situations with patients from an average rating of 60%–80%. When asked what they are doing differently as a result of training, most participants mentioned they are practicing more active listening and were able to think of specific examples of positive patient interactions and outcomes. Examples of pharmacy initiatives as an outcome from the training include a pharmacy restructure to have a pharmacist more accessible to patients, extra information brochures for patients at the pharmacy counter and introducing a follow up phone call and survey after cycle 1 counselling.

Conclusion: Compassionate care training should be integrated into standard education for all pharmacy staff to improve confidence and skills in providing compassionate care, especially in a cancer care setting. Further research on its impact on patient satisfaction and even the well-being of the healthcare provider could be explored.

Drew Meehan, Vi Vu, Amanda McAtamney, Tanya Buchanan, Megan Varlow

Cancer Council Australia, Sydney, NSW, Australia

The mechanisms through which climate change activities will affect both cancer control (including cancer prevention) and healthcare services are vast. They include extreme heat, natural disasters, vector ecology, air pollution, environmental degradation, water and food supply impacts. The published evidence in this field is rapidly evolving, garnering public interest and research funding, meaning that it is something that should be on everyone's watch list. As part Cancer Council Australia's policy development work, we have completed a desktop review of the literature and prepared a watching brief on the issue. While there is still a need for more robust evidence to fully understand the consequences of climate changes on cancer control, we believe future national policy should consider how to improve cancer prevention in light of increasing cancer risk due to the effects of climate change, and how to best support people affected by cancer when they encounter climate change-related barriers to optimal care. Potential policy priorities include; addressing air pollution through the lens of cancer prevention, investigating obesity risks and responses with climate change, exploring methods of cancer screening that are not temperature dependent, considering the design of programs which maintain cancer screening for those living in areas with extreme heat, encouraging resilient cancer care facilities which have contingencies for care during times of disaster, and supporting research outputs focussing on climate change and cancer in the Australian context. With the growing number of natural disasters, and increasingly dangerous levels of air pollution, now is the right time to be planning for the effects of climate change on cancer control.

Nienke Dr Zomerdijk, Lara Ms Stoll, Gail Prof Garvey

University of Queensland, Herston, QLD, Australia

Objectives/purpose: Clinician-patient communication can significantly influence a patient's health service experience. Clinician-patient communication has been identified as an important factor to improving patient care and outcomes for First Nations cancer patients. This presentation will report on the development, implementation and evaluation of Communication Skills Training (CST) to support health professionals providing radiation therapy education to First Nations cancer patients and their families.

Methods: The CST included three modules: the principles of cultural safety in healthcare, culturally safe communication and strategies to deliver patient-centred care for First Nations cancer patients and their families. The modules were developed iteratively with input from key stakeholders, including First Nations health professionals. The modules were delivered online to health professionals from three large cancer centres via Qualtrics. Participants completed a pre-/post-CST survey that included questions on confidence, knowledge, and skills.

Results: A total of 21 participants completed and evaluated the CST modules; most were radiation therapists (n = 13); and over 50% of participants were from one cancer centre. All participants (100%) rated the CST positively (52% ‘very good’, 48% ‘excellent’). Following completion of the CST modules, participants self-reported higher levels of confidence, skills and knowledge when working with First Nations cancer patients (increase from 66% ‘good’ or ‘excellent’ pre-CST to 91% ‘good’ or ‘excellent’ post-CST).

Conclusion and clinical implications: Providing culturally safe communication skills training is necessary to support health professionals to communicate effectively with First Nations cancer patients, improve their experiences with health services and to ultimately achieve better cancer outcomes.

Taha Al-Mufti¹, Sanjeev Sewak²

¹Medical Oncology, Latrobe Regional Health, Traralgon, VIC, Australia

²Medical Oncology, South Eastern Private Hospital, Melbourne, VIC, Australia

Background: With increasing cancer survivorship, understanding the risks and predictors of secondary primary malignancies (SPM) has become paramount. Our private oncology practice data revealed intriguing patterns that suggest a potential link between obesity and the occurrence of SPM, notably gastrointestinal (GI) malignancies.

Methods: We retrospectively analysed 30 patients who developed SPM after achieving remission from their initial cancers. Patients’ demographics, body mass index (BMI), type of first and second malignancies and other relevant factors were recorded.

Findings: The cohort had a mean age of 79 years; two-thirds were male. Strikingly, 22 patients were overweight, with 11 being morbidly obese. The predominant first malignancy was prostate cancer (n = 10), followed by breast (n = 5) and urothelial cancers (n = 5). Among the SPMs, GI cancers were the most prevalent (n = 8), trailed by lung (n = 6) and melanoma (n = 5).

Discussion: Our findings raise the suspicion of a significant association between obesity and the development of SPM, particularly GI malignancies. Given that 73% of our cohort were overweight or obese, this correlation warrants comprehensive research. The elevated incidence of GI cancers as a second malignancy could suggest shared aetiopathogenic pathways related to obesity, such as chronic inflammation or insulin resistance.

Conclusion: Patients cured of primary cancers, especially those overweight or obese, might represent a distinct population susceptible to SPMs. It is essential to consider tailored surveillance and interventions for these survivors. Additionally, a larger-scale study exploring the genetic predispositions, coupled with obesity, might uncover novel insights into mechanisms predisposing this cohort to secondary cancers, guiding future preventive strategies.

Benjamin Daniels¹, Maria Aslam^2,3,4, Marina T van Leeuwen⁵, Martin Brown⁶, Lee Hunt⁷, Howard Gurney⁶, Monica Tang^1,8, Sallie-Anne Pearson¹, Claire M Vajdic⁹

¹Medicines Intelligence Research Program, School of Population Health, University of New South Wales, Sydney, NSW, Australia

²Hunter New England Local Health District, Newcastle, NSW, Australia

³Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia

⁴School of Medicine and Public Health, University of Newcastle, Newcastle, Australia

⁵Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia

⁶Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia

⁷Cancer Voices, Sydney, NSW, Australia

⁸Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia

⁹The Kirby Institute, University of New South Wales, Sydney, NSW, Australia

Aim: Cardiovascular disease (CVD) and cancer are leading causes of death and people with cancer are at higher risk of developing CVD than the general population. Many cancer medicines have cardiotoxic effects but the size of the population exposed to these potentially cardiotoxic medicines is not known. We aimed to determine the prevalence of exposure to potentially cardiotoxic cancer medicines in Australia.

Methods: We identified potentially cardiotoxic systemic cancer medicines through searching the literature and registered product information documents. We conducted a retrospective cohort study of Australians dispensed potentially cardiotoxic cancer medicines between 2005 and 2021, calculating age-standardised annual prevalence rates of people alive with exposure to a potentially cardiotoxic medicine during or prior to each year of the study period.

Results: We identified 108,175 people dispensed at least one potentially cardiotoxic cancer medicine; median age, 64 (IQR: 52–74); 57% female. Overall prevalence increased from 49 (95%CI: 48.7–49.3)/10,000 to 232 (95%CI: 231.4–232.6)/10,000 over the study period; 61 (95%CI: 60.5–61.5)/10,000 to 293 (95%CI: 292.1–293.9)/10,000 for females; and 39 (95%CI: 38.6–39.4)/10,000 to 169 (95%CI: 168.3–169.7)/10,000 for males. People alive 5 years following first exposure increased from 29 (95%CI: 28.8–29.2)/10,000 to 134 (95%CI: 133.6–134.4)/10,000; and from 22 (95%CI: 21.8–22.2)/10,000 to 76 (95%CI: 75.7–76.3)/10,000 for those alive at least 10 years following first exposure. Most people were exposed to only one potentially cardiotoxic medicine, rates of which increased from 39 (95%CI: 38.7–39.3)/10,000 in 2005 to 131 (95%CI: 130.6–131.4)/10,000 in 2021.

Conclusions: The number of people exposed to efficacious yet potentially cardiotoxic cancer medicines in Australia is growing. Our findings can support the development of service planning and create awareness about the magnitude of cancer treatment-related cardiotoxicities.

Phyu Sin Aye¹, Joanne Barnes¹, George Laking¹, Laird Cameron², Malcolm Anderson³, Brendan Luey⁴, Stephen Delany⁵, Dean Harris⁶, Blair McLaren⁷, Ross Lawrenson⁸, Michael Arendse⁹, Sandar Tin Tin¹, Mark Elwood¹, Philip Hope¹⁰, Mark James McKeage¹

¹University of Auckland, Auckland, New Zealand

²Te Whatu Ora Health New Zealand, Auckland, New Zealand

³Palmerston North Hospital, Palmerston North, New Zealand

⁴Wellington Hospital, Wellington, New Zealand

⁵Nelson Marlborough District Health Board, Nelson, New Zealand

⁶Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand

⁷Southern District Health Board, Dunedin, New Zealand

⁸University of Waikato, Hamilton, New Zealand

⁹Waikato Hospital, Hamilton, New Zealand

¹⁰Lung Foundation New Zealand, Auckland, New Zealand

Background: The Epidermal Growth Factor Receptor (EGFR) inhibitors, erlotinib and gefitinib, were introduced into routine use in New Zealand (NZ) for treating advanced lung cancer in 2010, but their impact in that setting is unknown. This study aims to understand the effectiveness and safety of these new personalised lung cancer treatments. The study protocol and results of the validation sub-study are presented.

Methods: This retrospective cohort study will include all NZ patients with advanced EGFR mutation-positive lung cancer, who were first dispensed erlotinib or gefitinib up to 30 September 2020 and followed until death or ³1 year. Routinely collected health administrative and clinical data will be collated from national electronic cancer registration, hospital discharge, mortality registration and pharmaceutical dispensing databases, by deterministic data linkage using National Health Index numbers. The primary effectiveness and safety outcomes will be time-to-treatment discontinuation and serious adverse events, respectively. The primary variable will be concurrent use of high-risk medicines with erlotinib or gefitinib. A validation sub-study was undertaken of national electronic health databases as the data source, and methods for determining patient eligibility and identifying study outcomes and variables.

Results: National electronic health databases and clinical records agreed in determining patient eligibility and for identifying serious adverse events, high-risk concomitant medicines use and other categorical data, with overall agreement and Kappa statistics of >90% and >.8, respectively. Dates for estimating time-to-treatment discontinuation and other numerical data showed small differences, mostly with nonsignificant p-values and confidence intervals overlapping with zero difference.

Conclusions: A protocol is presented for a national whole-of-patient-population retrospective cohort study to describe the safety and effectiveness of erlotinib and gefitinib during their first decade of routine use in NZ for treating EGFR mutation-positive lung cancer. This validation sub-study demonstrated the validity of using national electronic health databases and methodologies to determine patient eligibility and identify study outcomes and variables. Study registration: ACTRN12615000998549.

Hieu Chau¹, Sriya Vure², Silvia Pongracic¹, Quan Tran¹, Bhavini Shah¹, Evangeline Samuel¹, Sachin Joshi¹, Mahesh Iddawela¹

¹Latrobe Regional Hospital, Traralgon, Victoria, Australia

²School of Rural Health, Monash University, Melbourne, Victoria, Australia

Introduction: The COVID-19 pandemic led to diminished services across all areas of healthcare. This is likely more pronounced within regional Victoria, with lockdown measures exacerbating the existing challenges faced by those with limited access to healthcare.

Methods: This is a retrospective audit of the four most common cancers (breast, lung, colorectal and prostate) to the Gippsland Cancer Centre (GCC) between 2020 and 2022. This was then analysed with timeframes correlating with Victorian COVID-19 lockdowns and compared to Victorian registry data.

Results: There was a 60%–70% increase in breast cancer patients in 2021–2022 compared to 2020. Despite this, the rates of stage four presentations fell by 3%.

2021 had the highest referrals of colorectal cancers with a 44% increase from 2020, but also had the lowest rate of stage 4 disease.

Lung cancer increased by 17% in 2021 from 2020, with a decrease of 16% in stage four presentations.

Majority of the prostate patients are stage 4, with a 70% increase in 2021 compared to 2020.

Quarter 3 and 4 of 2020 saw a decrease in new patient referrals due to the 1st lockdown, and then an increase in 2021 when lockdowns were lifted and vaccination rates increased.

Discussion: GCC clinics are comprised mainly of medical oncologists, who treat later stage cancers, which is one explanation for the higher rates of stage 4 cancer compared to Victorian data. Despite the large increase in referrals to GCC in 2021–2022, there was a decrease in stage 4 patients in breast and lung. The temporary pause of breast screening in 2020 could explain the lower numbers compared to 2021–2022. The increased awareness of respiratory symptoms due to COVID19 could explain the rise in lung cancer presentations. COVID 19 lockdowns did not appear to decrease the number of new cancer presentations as predicted, but it did decrease the proportion of patients presenting at a later stage.

Vicki Durston¹, Andrea Smith², Sam Mills¹, Claudia Rouse¹, Lisa Morstyn¹

¹BCNA, Camberwell, VIC, Australia

²The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

Introduction: People diagnosed with metastatic breast cancer (MBC) report feeling overlooked, even invisible. A key issue contributing to MBC's invisibility is that Australia's population-based cancer registries (PBCRs) do not routinely collect stage at diagnosis or recurrence data; consequently, we do not know the prevalence of MBC.

Objective: Accurate, national MBC prevalence data are vital for MBC surveillance, planning and delivery of treatment and supportive care, and identifying variation in outcomes.

Methodology: Between December 2022 and August 2023, Breast Cancer Network Australia (BCNA) engaged with key stakeholders (including PBCR staff, government, epidemiologists and professional bodies) to identify barriers, enablers and potential solutions for national stage and recurrence data. Expert interviews were conducted prior to a facilitated, in-person roundtable where recommendations were workshopped and prioritised across three areas: (1) data and processes, (2) resources and technology and (3) governance and policy. The project was co-designed with a group of BCNA's trained Consumer Representatives with early and MBC.

Results: There was widespread consensus among attendees (n = 35) regarding the need for national stage and recurrence data, and that cancer data must be considered an asset to leverage. Key barriers included: insufficient policy prioritisation of cancer data; differing state and territory legislative, governance and custodianship arrangements; methodological complexities; challenges relating to structured reporting of pathological data; workforce; and lack of enduring health data linkages. Key enablers included the inaugural Australian Cancer Plan, governments’ investment in digital health initiatives and opportunities offered by new technology. Recommendations workshopped and prioritised across the short, medium and longer term included: deriving MBC prevalence from existing and linked registry data, investment in smaller PBCRs to achieve minimum data standards, and the development/implementation of a National Cancer Data Strategy.

Conclusion: Significant consensus was identified across the sector regarding the need for national MBC prevalence. The project generated considerable momentum, providing a groundwork for new, inter-jurisdictional collaborations, and opportunities for leadership and investment.

Samuel Smith^1,2, Kate Drummond³, Anthony Dowling², Iwan Bennett⁴, Ronnie Freilich⁵, Claire Phillips⁶, Elizabeth Ahern⁷, Simone Reeves⁸, Robert Campbell⁹, Ian M Collins¹⁰, Julie Johns¹, Megan Dumas¹, Peter Gibbs^1,11, Lucy Gately^1,12

¹Walter and Eliza Hall Institue of Medical Research, Parkville, Victoria, Australia

²Medical Oncology, St Vincent's Hospital, Melbourne, Australia

³Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia

⁴Department of Neurosurgery, Alfred Health, Melbourne, Australia

⁵Department of Neurology, Cabrini Health, Melbourne, Australia

⁶Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

⁷Medical Oncology, Monash Health, Melbourne, Australia

⁸Radiation Oncology, Ballarat Austin Radiation Oncology Centre, Ballarat, Australia

⁹Medical Oncology, Bendigo Health, Bendigo, Australia

¹⁰Medical Oncology, South West Regional Cancer Centre, Warrnambool, Australia

¹¹Medical Oncology, Western Health, Melbourne, Australia

¹²Medical Oncology, Alfred Health, Melbourne, Australia

Background: Real-world data (RWD) collected routinely in clinical care forms the basis of cancer clinical registries. These registries are inclusive and provide valuable research outcomes, however missing data particularly survival compromise the accuracy of RWD. Here, we explore the utility of data linkage to state-based registries to enhance the capture of survival outcomes.

Methods: We reviewed prospectively collected data from consecutive patients with brain tumours in the Brain Tumour Registry Australia Innovation and Translation (BRAIN) database and included those treated in Victoria with no recorded date of death and no follow-up the preceding 6 months. Full name and birthdate were used to match patients in the BRAIN registry to those in the Victorian Births, Deaths and Marriages (BDM) Registry. Survival outcomes were compared, pre- and post-data linkage (DL).

Results: Of the 7735 patients contained in BRAIN, 5435 patients (70.3%) met eligibility criteria and had no recorded date of death. A total of 1611 (30%) of patients were matched with a date of death in BDM. More matches were found in tumours of highest malignant potential such as grade 4 glioma (67.2%), brain metastases (63.9%) and primary cerebral lymphoma (50.5%), compared with good-prognostic tumours such as meningioma (8.7%) and schwannoma (3.2%). Compared to post-DL, survival outcomes were significantly overestimated pre-DL for the entire cohort (30.3 vs. 17 m, p < 0.0001). This difference was most pronounced for Grade-3 glioma (93.7 vs. 38.1 m p = 0.008) but significant differences were seen across all tumour types.

Conclusion: Using an Australian brain-tumour population, this is the first study to demonstrate the importance of improved RWD accuracy through linking state-based registries to comprehensive cancer registries. This missing death data significantly compromises the potential quality of audit and research projects, driving a repeated over-estimate of survival. Routine periodic DL to pertinent registries should be considered to ensure accurate reporting and interpretation of RWD.

Arana Hankijjakul¹, Amy Body¹, Luxi Lai², Eva Segelov²

¹Monash University, Clayton, Australia

²Monash Health, Clayton, Australia

Background: Even with administration of COVID-19 vaccines, cancer patients still remain at a higher risk of COVID-19 infection, severe infection and poorer clinical outcome.^1–4 Current Australian guidelines recommend five doses of COVID-19 vaccine for cancer patients.

Methods: A telephone follow-up of COVID-19 infection in cancer patients at Monash Health, a health service in Southeast Melbourne, who had participated in a prospective study of COVID-19 vaccination, SerOzNET (ACTRN 12621001004853)⁵ study was conducted. A list of enrolled patients were extracted from SerOzNET study database. Patients were contacted via telephone to complete a brief survey of seven questions about COVID-19 infection during the period of 2021–2022. Hospital records and relevant information such as cancer diagnosis, treatment and number of COVID-19 vaccine doses were extracted from the database to aid in analysis.

Results: A total of 352 patients were included in this analysis, 198 contacted by phone, 98 uncontactable, on end-of-life care or withdrawn from follow-up. Of the 56 patients who died during the initial study and follow-up period, 49 were due to cancer and seven due to comorbidities, none died from COVID-19. Participants had a higher rate of COVID-19 infection and symptomatic infection, 50.5% and 88%, as compared to the general Australian population during the same time period, 30.4% and 64.9%, respectively.^6–8 There is no statistical difference in COVID-19 infection rates between different cancer types, cancer stages and number of doses of vaccines received. Out of seven patients who were hospitalised, two were hospitalised for COVID-19.

Grace Segall¹, Urpo Kiiskinen¹, Angela Lai², Kristine Mapstone², Isaac Sanderson³, Katie Lewis³, Alex Rider³

¹Eli Lilly and Company, Indianapolis, Indiana, USA

²Eli Lilly Australia Pty Ltd, Sydney, NSW, Australia

³Adelphi Real World, Bollington, Macclesfield, UK

Aims: RET-mutations occur in ∼60% of MTC and RET-fusions in ∼10%–20% of PTC patients.^1,2 Given limited research into MTC and PTC in Australia, this study describes RET-alteration testing and treatment patterns for these patients in Australia.

Methods: Data were drawn from the Adelphi Real World Thyroid Cancer Disease Specific Programme, a cross-sectional retrospective survey of physicians and their patients, conducted between September 2021 and February 2022. Medical records were descriptively analysed for physicians’ next five presenting advanced thyroid cancer patients.

Results: Data from 22 of 30 targeted Australian physicians were collected. Physicians abstracted medical records for 28 MTC and 81 PTC patients. Fifty (45–65) and 50 (38–65) years for MTC and PTC, respectively.

89% (n = 25) of MTC and 5% (n = 4) of PTC patients were tested for RET mutation and RET fusion, respectively. Of RET mutation-tested MTC patients, 68% were tested using Next-Generation Sequencing (NGS), 28% using Polymerase Chain Reaction; the rest were unknown. 52% of tested MTC patients were RET-mutation-positive. Three RET fusion-tested PTC patients were tested with FISH, one with NGS. All RET fusion-tested PTC patients were RET-fusion negative.

First line (1L) advanced systemic treatment was commonly managed by medical oncologists for MTC (72%) and endocrinologists or medical oncologists (36%, 34%) for PTC patients. 75% of MTC and 83% of PTC patients underwent surgery for advanced disease. At the time of data collection, 36% of MTC and 28% of PTC patients had received or were receiving 1L drug treatment; 40% of MTC patients received cabozantinib and 78% of PTC patients received lenvatinib.

Conclusion: Although most MTC patients were tested for RET mutation, PTC patients were rarely tested for RET fusion. As RET-targeted therapies could soon become available in Australia, testing must occur to identify patients who are likely to clinically benefit from them.

Joann JL Lee¹, Wei-Sen WL Lam¹, Samantha SB Bowyer², Ek Leone LO Oh², Trisha TK Khoo², Hsing Hwa HL Lee², Lydia LW Warburton¹

¹Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia

²Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Introduction: This study compares the outcomes and safety profile observed in IMpower133 trial to standard-of-care first-line treatment for ES-SCLC in a real-world Australian population.

Methods: Retrospective data from two centres in Perth, Western Australia (WA), between January 2020 and March 2023 was collected for patients with ES-SCLC who received atezolizumab plus platinum-etoposide chemotherapy. Outcomes assessed were overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and duration of response (DOR). Incidences of immune related adverse events (irAEs) were also collected. Median OS and PFS were calculated using Kaplan–Meier curves.

Results: This study included 101 patients, with a median age of 68 years. Forty-seven (46.1%) patients had ECOG performance status (PS) of 1. At baseline, 16 (15.7%) and 50 (49.0%) patients had brain and liver metastasis, respectively. Median PFS and OS were 5.0 (95% CI: 5.4–7.9) and 8.5 months (95% CI: 9.3–12.5) compared to 5.2 months (95% CI: 4.4–5.6) and 12.3 months (95% CI: 10.8–15.9) in IMpower133. Eighty-five patients (84.2%) died at time of analysis. ORRs were similar between both populations. Median DOR in our cohort was modestly longer (1.1 months) (Table 1). irAEs were seen in 22.7% (grade ≥3 – 11.9%) compared to 39.9% (grade ≥3 – 10.6%) in the trial population. Patients who experienced any grade irAE had benefits (p < 0.05) in OS and PFS compared to those who did not (Figure 1).

Conclusion: Median OS and PFS in our study cohort were shorter than those observed in IMpower133, our patients had higher ORRs and longer DOR. Poor prognostic factors, such as higher ECOG status ≥2 and presence of brain and liver metastases at baseline, likely contributed to shorter OS and PFS in this real-world setting. Presence of irAEs in our patient population showed improved OS and PFS compared to patients without irAEs. The association between irAEs and atezolizumab efficacy in ES-SCLC warrants further investigation.

Penny Mackenzie^1,2, Victoria Donoghue³, Bryan Burmeister^1,4, Tracey Guan³, Danica Cossio³

¹Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Cancer Sub-committee, Brisbane, Queensland, Australia

²Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

³Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

⁴GenesisCare, Fraser Coast, Queensland, Australia

Aims: To determine the actual radiotherapy utilisation (RTU) rate for older patients with Head and Neck Cancer in Queensland, and compare the actual rates with the optimal radiotherapy utilisation rates. Previous research has estimated that the optimal RTU rate for patients with head and neck cancer is 74%. That is, 74% of patients should receive radiotherapy after a diagnosis of head and neck cancer. However, there is limited data on the actual RTU rate for older patients with Head and Neck Cancer in QLD.

Methods: QLD Cancer Registry data linked to radiotherapy data and hospitalisation data using the combined data sources of Queensland Oncology Repository from 2012 to 2021 to determine the number of patients diagnosed with Head and Neck Cancer and the proportion of patients receiving radiotherapy according to the following age groups <65, 65–74, 75–84 and 85+ years.

Results: A total of 8150 patients were diagnosed with head and neck cancer from 2012 to 2021. 14% (1105 patients) were aged 75–84 years and 5% (367) aged 85+ years. The overall radiotherapy utilisation rate was 67%. The radiotherapy utilisation rate decreased with increasing age. For patients aged <65 years the actual RTU rate was 71%, for patients aged 65–74 years the actual RTU rate was 67%, for patients aged 75–84 years the actual RTU rate was 56% and for patients aged 85% years the actual RTU rate was 43%.

Bradley D Menz, Natansh D Modi, Michael J Sorich, Ashley M Hopkins

College of Medicine and Public Health, Clinical Pharmacology (Cancer), Flinders University, Bedford Park, South Australia, Australia

Aim: This study aims to explore the potential of generative artificial intelligence (AI) to facilitate the production of extensive volumes of cancer-related disinformation.

Methods: A healthcare researcher, without specialised knowledge of AI guardrails or safety measures, conducted an internet search to identify accessible large language models capable of producing human-like text. After identifying available models, the researcher sought to leverage the models to facilitate the generation of extensive volumes of cancer-related disinformation; specifically related to (1) alkaline diet being a cure for cancer, and (2) sunscreen as a potential cause of cancer.

Results: Eight large language models were identified. Five of these models were found to enable the mass production of cancer-related disinformation. Specifically, in under 3 h, 304 blog articles, totalling over 60,000 words of cancer-related disinformation were written. This included 133 blog articles purporting alkaline diet as a cure for cancer (with frequent claims to its superiority over chemotherapy), and 171 blog articles purporting sunscreen as a cause of cancer, recurrently asserting its harmful impacts on children. Notably, the models obeyed promoting to create engaging titles for each article, as well as include fabricated patient/clinician testimonials and scientific looking references. Further, the articles had been written to target diverse societal groups, including young parents, the elderly, pregnant women and individuals with chronic health conditions.

Conclusions: This study demonstrates an alarming ability to leverage accessible large language models to facilitate the rapid, cost-efficient, production of highly coercive, targeted cancer disinformation. The findings highlight a substantial lack of safety measures and guardrails within many readily available generative AI tools, emphasising an urgent need for improved regulatory oversight to guarantee public safety and protect public health.

Olga Ovcinnikova¹, Kayla Engelbrecht¹, Elizabeth Russell², Meenu Verma³, Rishabh Pandey⁴, Edith Morais⁵

¹Merck Sharpe and Dome (UK) Ltd., London, UK

²Merck & Co., Inc., Rahway, New Jersey, USA

³Parexel International, Mohali, India

⁴Parexel International, Bangalore, India

⁵MSD France, Puteaux, France

Background/objectives: Adult-onset recurrent respiratory papillomatosis (AoRRP) is a severe recurrent disease caused by human papillomavirus (HPV) and characterised by the development of papillomas in the respiratory tract. The aim of this study was to assess the published evidence regarding the disease clinical, epidemiological and economic burden of AoRRP.

Methods: A systematic literature review (SLR) was conducted according to the Cochrane Group and PRISMA guidelines. MEDLINE, Embase and Cochrane Library databases and conference proceedings published in last 4 years were searched. The outcomes of interest were clinical (i.e. patient characteristics, risk factors, symptoms, treatment and procedures), humanistic, epidemiological (i.e. incidence, prevalence, genotype, recurrence frequency and mortality) and economic (i.e. costs, indirect costs and resource use) related.

Results: A total of 48 publications were included for analysis; 25 clinical, seven humanistic, five epidemiologic and 11 economic burden full-text articles. The major contributors to the clinical AoRRP burden are the frequent surgeries and disease-related symptoms impacting the voice and airway (hoarseness/loss of voice, stridor, rapid/difficult breathing, chronic cough and difficulty swallowing). AoRRP patients may require multiple surgical disease debridement, and there are no approved systemic adjuvant therapies to prevent/delay recurrence. These patients have more voice problems and a lower general health perception compared to general population. The treatment costs varied by treatment options, frequency and country. Due to the recurrent nature of AoRRP, the humanistic and economic burden is significant.

Conclusions: Limited AoRRP data are available for this high morbid disease. Reported disease management costs are likely underestimated due to ‘outdated’ treatments costs and limited projections to lifetime. Further research is necessary to obtain more robust data that will help address the information gap in clinical, epidemiological and economic burden.

Huah Shin Ng^1,2, Bogda Koczwara^1,3, Lisa Beatty⁴

¹Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia

²SA Pharmacy, Northern and Southern Adelaide Local Health Networks, Adelaide, SA, Australia

³Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia

⁴Flinders University Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia

Aims: Mental disorders are frequently reported among cancer survivors, but little is known about the patterns and characteristics associated with mental healthcare utilisation in the Australian cancer population. We compared the patterns of mental health service utilisation and their perceived needs between people with and without cancer.

Methods: We conducted a cross-sectional study using data of all respondents aged ≥25 years from the Australian National Study of Mental Health and Wellbeing 2020–2021. Comparisons were made between the two groups (cancer vs. non-cancer) using logistic regression models.

Results: The study comprised 318 people with cancer (55% female) and 4628 people without cancer (54% female). Cancer survivors had a higher prevalence of reporting poor health (38% vs. 16%) and mental distress (18% vs. 14%) than people without cancer. There were no significant differences between people with and without cancer in the odds of consulting general practitioner, psychiatrist and other health professionals for mental health, although people with cancer were significantly more likely to consult a psychologist than people without cancer [adjusted odds ratio (aOR) = 1.64, 95%CI: 1.05–2.48]. While the odds of being hospitalised for physical health was significantly higher in cancer survivors than people without cancer (aOR = 2.32, 95%CI: 1.78–3.01), there was only a negligible number of people reported being hospitalised for mental health between the two groups. There were also no significant differences between the two groups in their perceived needs for mental health services. Several factors were associated with higher odds of accessing mental health services among people with cancer including age, marital status and presence of a current mental condition.

Conclusions: Mental health service utilisation among cancer survivors was similar to that of the general population despite higher prevalence of reporting poor health status and mental distress. Further research to identify optimal approaches of mental health care delivery for cancer survivors are needed.

Marie Nguyen

Cancer Molecular Pathology, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia

Intrathyroid metastases are rare and often discovered incidentally. Hence, it is important to consider this differential when assessing thyroid masses, especially in patients with a history of non-thyroidal malignancy. A critical review of the literature was performed using data from both autopsy and clinical studies. Within clinical series, the most common source of secondary thyroid metastases are renal cell carcinomas followed by lung primaries. Metastases to the thyroid are more frequent in patients who have pre-existing thyroid pathology. There is no gender predominance with a median age between 54 and 68 years. Fine-needle aspiration, core-needle biopsy and surgical resection with histological and immunohistochemical analysis are the main methods to confirm diagnosis. Molecular studies can identify mutations (such as EGFR, K-Ras, VHL) and translocations (such as EML4-ALK fusion) important in selecting candidates for target therapies. Patients with advanced-stage primary cancers, widespread dissemination or unknown primary origin often have a poor prognosis. Systemic therapies, such as chemotherapy and hormonal therapy, are often used as adjuvant treatment post-operatively or in patients with disseminated disease. New targeted therapies, such as tyrosine kinase inhibitors and immune checkpoint inhibitors, have shown success in reported cases. Intrathyroid metastases require a high level of suspicion for diagnosis and tailored treatment based on primary tumour features, overall cancer burden and co-morbidities. This review provides a comprehensive update on the epidemiology, clinicopathological features and recent advancements in secondary thyroid cancer.

Suzanne Poulgrain^1,2, Mark B Pinkham¹, Rosalind L Jeffree^2,3, Catherine Bettington^2,3, Nicole Buddle⁴, Katharine Cuff¹, Hamish Alexander^2,3, David Walker⁵, Kimberley Budgen¹, Robert A Campbell^6,7, Alessandra Francesconi⁷, Zarnie Lwin^2,3, Cassie Turner², Helen Hunt⁸, Danica Cossio⁸

¹Princess Alexandra Hospital, Brisbane, Queensland, Australia

²Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

³The University of Queensland, Brisbane, Queensland, Australia

⁴Sunshine Coast University Hospital, Birtinya, Queensland, Australia

⁵BrizBrain Spine, Brisbane, Queensland, Australia

⁶Brisbane Clinical Neuroscience Centre & Mater Health Service Neuroscience Centre, Brisbane, Queensland, Australia

⁷Queensland Children's Hospital, Brisbane, Australia

⁸Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

Aim: To assess variations in patterns of care in first-line treatment and survival for people with glioblastoma (GBM) in Queensland.

Methods: This retrospective population-based study used data from the Queensland Oncology Repository (QOR), a comprehensive repository which contains administrative, demographic, diagnosis and treatment-related data on Queenslanders diagnosed with cancer. The study population included people diagnosed with GBM from 2011 to 2020. Variables examined include age, residential location, treatment location, surgery and radiotherapy details. Chemotherapy data was incomplete and inaccurate and therefore excluded from analysis. Multivariate regression models were used to model factors associated with the likelihood of receiving treatment and odds of death.

Results: There were 2113 people diagnosed with GBM during the study period; 60.2% male, median age at diagnosis 65 years (range 5–96) and 1.1% were First Nations peoples. Surgery and radiotherapy were delivered in 38 public and private centres, with 67% of care delivered in just five of these centres. Only 53% underwent both craniotomy and radiotherapy; 26% either craniotomy or radiotherapy alone; 21% received neither therapy. Median survival after craniotomy and radiation was 14.6 months. Median survival was 11.4 months for those patients receiving craniotomy or radiotherapy alone, compared to 1.8 months for those undergoing neither (p < 0.001). Increased odds of death were associated with increasing age, higher comorbidity burden, not receiving radiotherapy (each p < 0.001) and identifying as First Nations origin (p = 0.02) but not remoteness of residence.

Conclusion: Following a diagnosis of GBM. Only 53% of Queenslanders appear to receive the optimal treatment paradigm of craniotomy followed by radiotherapy, which warrants further investigation. Survival is comparable to other published data. Data surrounding chemotherapy for GBM is lacking from QOR and addressing this is important.

Robert F Power¹, Damien Doherty¹, Maeve A Lowery¹, David J Gallagher¹, Pat Fahey², Roberta Horgan², Karen A Cadoo¹

¹Trinity St James's Cancer Institute, Dublin, Ireland

²Lynch syndrome Ireland, Dublin, Ireland

Introduction: Lynch syndrome is the most common cause of hereditary colorectal and endometrial cancer. Lifestyle modification may provide an opportunity for adjunctive cancer prevention. In this study, we aimed to characterise modifiable risk factors in people with Lynch syndrome and compare this with international guidelines for cancer prevention.

Methods: An international, cross-sectional study was carried out utilising survey methodology. Following public and patient involvement (PPI), the survey was disseminated through patient advocacy groups and by social media. Self-reported demographic and health behaviours were collected in April 2023. Guidelines from the World Cancer Research Fund (WCRF) were used to compare percentage adherence to nine lifestyle recommendations, including diet, physical activity, weight and alcohol intake. Median adherence scores, as a surrogate for an individuals’ lifestyle risk, were calculated and compared between groups.

Results: A total of 156 individuals with Lynch syndrome participated from 13 countries. The median age was 51, and 54% (n = 88) were cancer survivors. Self-reported pathogenic variants included MSH2 (n = 54), MSH6 (n = 39), MLH1 (n = 38), PMS2 (n = 17) and EPCAM (n = 4). The mean BMI was 26.7 and the mean weekly duration of moderate to vigorous physical activity was 90 min. Median weekly consumption of ethanol was 60 g, and 3% reported current smoking. Adherence to WCRF recommendations for cancer prevention ranged from 9% to 73%, with all but one recommendation having <50% adherence. The median adherence score was 2.5 out of 7. There was no significant association between median adherence scores and age (p = 0.27), sex (p = 0.31) or cancer history (p = 0.75).

Conclusions: We have characterised the modifiable risk profile of people living with Lynch syndrome, outlining targets for intervention based on lifestyle guidelines for the general population. As evidence supporting the relevance of modifiable factors in Lynch syndrome emerges, behavioural modification may prove an impactful means of cancer prevention.

Ella Stuart^1,2, Tommy Wong^1,2, Danica Cossio³, Nathan Dunn³, Tracey Guan³, Nancy Tran³, Kathryn Whitfield², Euan Walpole^4,5,6

¹Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia

²Cancer Support, Treatment and Research, Department of Health, Melbourne, Victoria, Australia

³Cancer Alliance Queensland, Queensland Health, Brisbane, Queensland, Australia

⁴Queensland Cancer Control Safety and Quality Partnership, Cancer Alliance Queensland, Brisbane, Queensland, Australia

⁵Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia

⁶Department of Medicine, University of Queensland, Brisbane, Queensland, Australia

Introduction: Identifying unwarranted variations in cancer care between states highlights opportunities for improving patient care and provides real-world comparisons of cancer specific indicators based on clinical guidelines. This study aimed to compare state-wide cancer treatment and survival data among patients with breast or gynaecological cancers between Queensland (Qld) and Victoria (Vic).

Methods: Queensland data were obtained from the Qld Oncology Repository and Victorian data from the Centre for Victorian Data Linkage Integrated Data Resource. Both resources involved linkage with multiple state-wide datasets. Breast and gynaecological cancer patients diagnosed between 2015 and 2019 were included (breast cancer: Vic n = 22,433, Qld n = 17,586; gynaecological cancer: Vic n = 6707, Qld n = 5449). The datasets were not combined, and the methodology and indicators were based on Qld Cancer Quality Index.

Results: For breast cancer the outcomes were similar for surgical rates (Vic: 89%, Qld: 90%), radiation therapy rates (Vic 67%, Qld 69%), 90-day surgical mortality (.2% in both states) and 2-year surgical survival (97% in both states). Similar surgical and radiation therapy rates were observed for cervical, ovarian, uterine and vulva cancer patients. Mortality within 90 days of surgery was higher among gynaecological cancer patients in Vic (1.3%) than those in Qld (.7%), with 2-year surgical survival similar (Vic 89%; Qld 90%).

Further analysis is required; however, this initial comparison instils confidence to extend analyses to include other cancers and to investigate priority populations such as those living in rural and remote areas, elderly, lower socioeconomic status and First Nations peoples.

Conclusions: This project demonstrates the mutual benefit of identifying areas of improvement in Vic and Qld. It serves as a model for other Australian states to join and enable the development of reporting to drive tracking of healthcare performance towards best practice and improved outcomes for people with cancer.

Laura N Woodings, Sue Evans, Luc te Marvelde

Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia

Aims: The impact of cancer extends well beyond the diagnostic and treatment period. Sequalae of a cancer diagnosis include physical consequences of psychosocial impact and may include financial issues, all of which are likely to impact on quality of life in the medium and longer term. Cancer prevalence reflects the relationship between cancer incidence and survival and is impacted by the stage of cancer at the time of diagnosis and the effectiveness of available treatments. Understanding trends in prevalence enables forecasting of healthcare costs and services to ensure that the complex needs of cancer survivors are met.

Methods: The Victorian Cancer Registry (VCR) is a population-based registry since 1982 and undergoes routine data linkage to the Victorian and National Death Index to identify deaths. Limited duration prevalence was calculated using VCR data.

Results: Over 342,000 Victorians who are alive today have been diagnosed with cancer over the 40-year period since 1982. About one in three males and one in four females aged over 80 years have been diagnosed with cancer at some time in the last 40 years. The most prevalent cancer for Victorians aged 50 and over is prostate cancer for men, and breast cancer for women. The number of Victorians 50 years and over living with or beyond cancer who were diagnosed in the past 5 years has more than quadrupled in the last 40 years. Nearly 5000 Victorians alive today have a history of cancer diagnosed when they were aged less than 15 years.

Conclusions: The increasing prevalence of cancer is the result of Victoria's growing population, the increase in cancer incidence, and improved survival following cancer diagnosis.

Taha Al-Mufti¹, Gemma Downs¹, Trcia Wright¹, Quan Tran¹, Connor Ibbotson¹, Hari Sivaganabalan², Mahesh Iddawela¹, Evangeline Samuel¹

¹Medical Oncology, Latrobe Regional Health, Traralgon, VIC, Australia

²Interventional Radiology, I-MED, Regional, Traralgon, VIC, Australia

Background: The timely diagnosis and multidisciplinary management of cancer can be hindered in regional settings due to service limitations. Since early cancer detection is crucial for improving patient outcomes, understanding the barriers and facilitators in a regional context is of utmost significance.

Methodology: From 11 February to 30 May 2023, the Latrobe Regional Health (LRH) cancer services reviewed all primary care referrals for suspected cancer within the RDC. Patients were thoroughly assessed during their initial visit, focussing on comorbidities and functional status. Diagnostic plans either stemmed directly from clinic evaluations or were discussed in multidisciplinary meetings (MDM) and radiology biopsies meeting with interventional radiologist. Data collection encompassed demographics, ECOG status, comorbidities, symptom duration, biopsy type, final diagnosis and timing of treatment commencement.

Findings: Of the 70 patients assessed by August 2023, 50 completed investigations. Of these, 62% (31/50) received a cancer diagnosis, with 97% (30/31) presenting with stage 4 cancer. Diagnoses comprised 39% lung cancer, 19% lymphoma, 13% upper GI and other categories such as breast, genitourinary, melanoma and colorectal. Additionally, 24% (12/50) were diagnosed with non-malignant conditions, four of which had lung nodules. 42%(22/50) of patients required PET scans for diagnosis.

Conclusion: The RDC required advanced services beyond primary care capabilities, including PET scans and cancer MDMs. Predominantly diagnosed patients with lung cancer, non-Hodgkin lymphoma and upper GI cancer. Over half of the patients specialist cancer services required dedicated funding to fill this diagnostic gap.

Lizzy Johnston, Susannah Ayre, Belinda Goodwin

Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia

Aims: Group nutrition education and cooking programs for people affected by cancer have the potential to address unmet needs for dietary information whilst also providing opportunities for practical and social support. This scoping review describes the content, delivery, and outcomes of group nutrition education and cooking programs for people affected by cancer, and how these programs were developed, implemented and evaluated.

Methods: Four electronic databases were searched (CINAHL, Embase, PubMed and Web of Science) using key terms relevant to cancer, nutrition education and cooking. Screening and data extraction were conducted independently by two reviewers. Data extracted included program participants, topics, nutrition-related content, delivery, outcomes and information about how the program was developed, implemented and evaluated.

Results: Of the 2254 records identified, 40 articles met eligibility criteria, reporting on 36 programs. Most programs were designed for adult cancer survivors (89%) and were conducted after primary treatment (81%). Only four programs invited caregivers. Many programs were developed with dietitians or nutritionists, cancer survivors and researchers. Over half the programs were facilitated by dietitians or nutritionists (56%) and included hands-on activities (58%) and group discussion (56%). Outcomes included improvements in participants’ diet quality, nutrition knowledge, quality of life, fatigue, inflammatory markers, lipid profile and anthropometric measures. However, other program components (in addition to nutrition education and cooking), for example, exercise and support for mental wellbeing, may have contributed to these outcomes. No studies reported on sustainability of program delivery and program costs. Based on evaluations, participants valued the social support received, practical activities and delivery by qualified healthcare professionals.

Conclusions: Group nutrition education and cooking programs for people affected by cancer can improve participant health outcomes. Little is known about the maintenance of these outcomes long-term, in addition to the sustainability of program delivery, social value of the programs and benefits to caregivers.

Luna Rodriguez Grieve¹, Nicci Bartley¹, Laura Kirsten², Cindy Wilson³, Betsy Sajish², Claire Cooper¹, Joanne Shaw¹

¹The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, Sydney, NSW, Australia

²Nepean Hospital, Nepean Cancer and Wellness Centre, Nepean, NSW, Australia

³Nepean Blue Mountains LHD, Supportive and Palliative Care Service, Nepean, NSW, Australia

Aims: Evidence-based bereavement care is not routinely delivered in Australian hospitals, despite helping to facilitate adjustment to death. Approximately 10% of bereaved individuals do not adjust, and will experience Prolonged Grief Disorder (PGD), which is associated with increased morbidity, mortality and health service use. This research aimed to develop a bereavement model of care incorporating systematic screening and management of all bereaved within a diverse Australian healthcare setting.

Methods: A systematic review identified international bereavement care models and implementation factors relevant to the Australian context. Interviews with 34 staff/volunteers who provided bereavement support in an Australian public health service explored current practice, gaps in care and barriers/facilitators to implementing care. Data were triangulated to develop a bereavement model of care.

Results: The culturally inclusive evidence-based bereavement model recommends screening to identify those most at risk of PGD and a stepped care approach to the appropriate level of support (from universal care to specialist bereavement and psychological services for those at risk of PGD). The model recommends bereavement care be tailored to the health context and setting, such as cancer and palliative care/acute, pre-/post-death and sudden/expected death.

Underpinning the model is staff/volunteer training and support, resourcing, coordination of care and continual improvement.

Conclusions: The bereaved-centred model of bereavement care developed through this research is an overarching model of care, which can be tailored at a service level to consider the heath context and setting. Key to implementation success and model sustainability is appropriate resourcing, and training and support for staff/volunteers.

Stephanie Best^1,2,3,4, Karin Thursky¹, Mark Buzza⁵, Marlena Klaic⁴, Sanne Peters⁴, Lisa Guccione^1,4, Alison Trainer¹, Jillian Francis^1,4

¹Peter MacCallum Cancer Centre, Parkville, Victoria, Australia

²Health Services Research, VCCC Alliance, Melbourne, Victoria, Australia

³Implementation Research, Australian Genomics, Melbourne, Victoria, Australia

⁴Implementation Science, University of Melbourne, Melbourne, Victoria, Australia

⁵VCCC Alliance, Melbourne, Victoria, Australia

Implementation of evidence-based care is challenging with many innovations in cancer care failing to either scale up or be sustained, leading to research waste. Implementation science provides theories, models and frameworks to inform and investigate effective implementation. Prioritisation of implementation research activity should reflect organisation needs and stakeholder experiences.

Aims: (1) To establish a replicable process to identify stakeholder- and theory-informed organisation-level implementation science priorities in cancer care, (2) To identify and select a pilot implementation project.

Methods: We used a qualitative approach conducting semi-structured interviews with consumer advocates and staff that held a formal leadership role and/or are research active. Participants were based at either a specialist cancer centre or a cancer alliance. Thematic analysis was used to identify themes and content analysis to identify potential pilot projects. A synthesis of organisation and implementation prioritisation frameworks was used to select a pilot project.

Results: Participants (n = 31) reported four themes: (1) Addressing organisational priorities through integration of cancer services to minimise research waste; (2) Effective implementation of digital health interventions; (3) Identification of potential for implementation research, including de-implementation, that is discontinuing ineffective or low value cancer care and (4) Focussing implementation studies on direct patient/carer engagement.

We identified six potential pilot projects. Using the prioritisation framework, we selected the Test and Tell project (supporting clinicians to refer appropriate patients with cancer for germline genetic testing) to trial.

Conclusions: Our study trialled a replicable approach to aligning strategic organisational priorities and identification of implementation science priorities in the cancer setting. Using this targeted approach allowed for the combination of organisational knowledge and expertise with the structure of a theoretical approach bringing benefits of corporate memory, lived experience and transparency. The next steps in this study are the design, delivery and evaluation of the Test and Tell project.

Sean Black-Tiong¹, Lauren Whiting¹, Holly Evans^1,2, Sarah Harfield¹, Kate Gallasch¹, Jessica Hondow¹

¹Lift Cancer Care, Kurralta Park, SA, Australia

²Exercise Physiology, Flinders University, Adelaide, SA, Australia

Overview: Lauren will present an overview of a world-leading and only service of its kind in Australia providing medically supervised exercise medicine to cancer patients in conjunction with oncology specialised allied health services in the same location. This helps achieve evidence-based exercise doses for anti-cancer benefits in patients that would otherwise be unable to reach these doses safely.¹ We will present the barriers to implementation faced over our history which were overcome to deliver this novel approach and bridge the research-to-practice gap (e.g. funding models, stakeholder relationships, resistance from clinicians and lack of understanding of evidence base).

A facilitated expert panel discussion will then provide an overview of how cancer patients benefit from the respective service (common referrals/pitfalls, where patients get missed/dismissed, importance of integration with the entire team including continuity with their regular GP). Example cases will illustrate how a multidisciplinary allied health team is vital to best-practice cancer care.

Outcomes/learning objectives: Attendees (patients, allied health, nurses and doctors) will gain an understanding of the benefits of exercise in cancer patients and when prescribed and medically supervised this achieves better compliance with target dose. Additionally, patients that would otherwise not be able to safely exercise without medical supervision can be facilitated to achieve evidence-based exercise dose. Attendees will learn of barriers in our health system and bureaucracy that stifles innovation and hinders putting evidence-based care into real-world practice. The take-away message for all attendees is working collaboratively to advocate for innovation and support new models of care that are delivering positive outcomes and backed by a rigorous evidence base.

Amy Bowman^1,2, Linda Denehy^1,3, Lara Edbrooke^1,3

¹Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia

²Department of Physiotherapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Introduction: Cancer guidelines recommend pre- and rehabilitation exercise for people with cancer; however, current research shows these services are not well integrated into clinical practice. To date, there has been no prospective audit of Australian lung cancer exercise services or data collected on the characteristics of people with lung cancer accessing exercise services.

Aims: To describe the exercise pre- and rehabilitation services available to people with lung cancer and the characteristics of people with lung cancer attending these services in Australia.

Methods: Prospective, observational, multicentre, 5-day, point prevalence study. Australian health services providing specialist care to people with lung cancer and/or oncology or pulmonary rehabilitation were contacted to participate.

Results: A total of 402 services were contacted and 199 responded (50%). Of these, 69% (n = 137) accepted referrals for people with lung cancer and 107 sites (78%) completed the survey. Most exercise services were targeted at respiratory disease (58%, n = 60) compared with 31% cancer-specific (n = 33) and 5% lung cancer-specific (n = 5). Lung cancer and rehabilitation services were predominantly in metro or inner regional areas (83%, n = 89) and delivered in the public health setting (79%, n = 84). Data were collected for 73 participants attending programs at 41 sites (38%). Mean (SD) age was 68.5 (9.7) years. 4% of participants (n = 3) were culturally and linguistically diverse and no participants identified as Aboriginal or Torres Strait Islander. 96% (n = 70) of participants lived in major cities or inner regional areas. Program length was predominantly 3–7 weeks (58%, n = 42). Nineteen outcomes were used in 51 combinations to assess participants (n = 70) and 12 exercise interventions were delivered in 45 combinations (n = 67).

Conclusions: Only approximately one-third of responding exercise programs offered specific oncology programs. During the data collection period, almost two-thirds of services did not provide services to people with lung cancer. High heterogeneity in outcome measures and exercise interventions was observed.

Amy Bowman^1,2, Julia Staples^1,3,4,5, Tom Poulton^1,2,6, Kate Burbury^1,2, James Hibbard¹, Jessica Crowe^1,2, Kath Feely^1,3,4,5

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²University of Melbourne, Melbourne, Victoria, Australia

³The Royal Children's Hospital, Melbourne, Victoria, Australia

⁴The Royal Melbourne Hospital, Melbourne, Victoria, Australia

⁵The Royal Women's Hospital, Melbourne, Victoria, Australia

⁶University College London, London, UK

Introduction: Prehabilitation is a multidisciplinary model of care shown to decrease hospital length of stay and acuity of treatment required in the hospital, in addition to improving patient outcomes. Resource availability, structures to enable multidisciplinary collaboration and the digital infrastructures to support this have been proposed as barriers to the widespread implementation of prehabilitation. Clinician Electronic Medical Records (EMR) builder programs integrate clinicians into the process of digital health transformation within healthcare systems to develop and deliver workflow optimisation.

Aims: To implement and evaluate the impact of a clinician-led workflow review and digital optimisation project on system usability, data integrity and workflow efficiency within a multidisciplinary prehabilitation clinic at a tertiary cancer centre.

Methods: A clinician builder worked with digital health and prehabilitation specialists to scope, develop, build and deliver an optimised digital workflow for prehabilitation exercise professionals. A data dictionary was developed to standardise the collection of outcome measures. Clinicians (n = 5) were asked to complete the system usability scale (SUS) pre- and post-implementation. Routinely collected data about Occasions of Service (OOS) and outpatient encounter time were analysed pre- and post-implementation.

Results: Clinician-reported SUS scores improved from poor usability (33) pre-intervention to excellent usability (84) post-intervention. Comparisons of service utility data in the 3 months post-intervention compared with the 12 months prior to implementation revealed an average reduction of 8.2 min per encounter (from an average of 55–47 min), as well as a 29% increase in the number of outpatient OOS per week. Core data entry compliance improved to >95% post-intervention from 5% to 55% pre-intervention.

Conclusions: Clinician builder-led implementation fosters a collaborative design approach leading to enhanced utility of EMR systems for improved efficiency, data accuracy and system usability. Mapping and designing EMR change around core data and clinical workflows enhances data entry compliance.

Jessica Bucholc^1,2, April Murphy^1,3, Nikki McCaffrey^1,2, Clem Byard², Patricia Livingston⁴, Anna Steiner⁵, Victoria White⁶

¹Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia

²Cancer Council Victoria, Melbourne, VIC, Australia

³Faculty of Arts and Education, School of Humanities and Social Sciences, Deakin University, Burwood, Victoria, Australia

⁴Faculty of Health, Deakin University, Burwood, Victoria, Australia

⁵Consumer Representative, Melbourne, Victoria, Australia

⁶School of Psychology, Deakin University, Burwood, Victoria, Australia

Aim/introduction: Amidst the complexity of cancer care, nurse-led telephone cancer information support services are a potential resource to assist both healthcare professionals (HCPs) and policymakers in improving cancer outcomes. Understanding the benefits of such services from the perspectives of HCPs and policymakers is necessary for implementation and impact.

This study explored the perspectives of HCPs and policymakers about the benefits of Cancer Council Victoria's nurse-led telephone cancer information support service (131120). The study sought to identify the advantages and challenges of the service for HCPs and policymakers.

Methods: Online/virtual interviews were conducted with four HCPs and five policymakers involved in cancer care in Victoria, Australia, until data saturation was reached. Potential participants were identified through the study and project advisory groups, using convenience and snowball sampling and people who had called 131120. Thematic analysis was used to identify key themes and patterns from the qualitative data.

Results: Findings revealed that 131120 was perceived positively by HCPs and policymakers. Participants recognised the services’ ability to provide timely and accurate information to people affected by cancer, leading to improved understanding and empowerment. 131120 was seen to reduce the burden on HCPs by providing referral pathways, addressing patient inquiries and support needs, allowing HCPs to focus on more complex care. Policymakers recognised the potential of these services in contributing to Victorian cancer plan and priority areas by contributing to optimal care pathways, particularly in increasing access to supportive care in regional/rural areas.

Conclusion: This study highlighted the value and benefits of nurse-led telephone cancer information support services, 131120, for HCPs and policymakers. The findings support the potential of these services to improve outcomes for people affected by cancer and enhance healthcare delivery and efficiency. By understanding the views of those directly involved in cancer care and policy development, this research offers insights for optimising the implementation and further development of these services.

Ryan Calabro, Amanda Robertson

Cancer Council SA, Eastwood, South Australia, Australia

Aims: People with cancer and their caregivers have a broad range of supportive care needs. Understanding these needs is critical for focussing limited health resources and delivering client-centred care. This study aims to define supportive cancer care priorities in South Australia and identify potential differences across demographic factors and cancer characteristics.

Methods: A comprehensive survey was constructed based on existing supportive care needs surveys, covering six domains: psychological, informational, practical & financial, service access, physical & daily living and social. The survey also includes a measure of mental health (PHQ-4), and Cancer Council SA service awareness and utilisation.

Recruitment is ongoing with 71 responses so far, with a target of 200.

Results: The top five unmet needs for a person with cancer were: understanding government service entitlements (36%), information about healthy living (34%), feeling fearful about the future (30%), information about cancer and treatment (28%) and information helpful to their family/partner (28%).

The top five unmet needs for a caregiver were: understanding government service entitlements (38%), information about preparing for/managing grief and loss (33%), distress (e.g. anxiety, depression and stress) (29%), feeling fearful about the future (29%) and managing concerns about the wellbeing of those close to them (29%).

The number of needs (β = .18, 95%CI: .09–.26, p < 0.001) and number of unaddressed needs (β = .21, 95%CI: .11–.32, p < 0.001) were significantly associated with a higher score on the PHQ-4. Age (β = −.31, 95%CI: −.58 to −.05, p = 0.02) and being in a relationship were (β = −.28, 95%CI: −.51 to −.05, p = 0.02) significantly negatively associated with the number of needs.

Conclusions: This is the first study to investigate unmet needs for both people with cancer and carers in South Australia. Preliminary results reveal priority supportive care needs that are not currently being adequately addressed. These findings will help to advance supportive care cancer planning in South Australia.

Belinda A Campbell^1,2, Gabriel Gabriel^3,4,5, Geoffrey P Delaney^3,4,5, Miles Prince^1,2, Sandro V Porceddu^1,6,7, Karin Thursky^1,2,8

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia

³Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool, New South Wales, Australia

⁴Ingham Health and Medical Research Institute, Liverpool, New South Wales, Australia

⁵South-Western Sydney Clinical School, University of New South Wales, Liverpool, New Sauth Wales, Australia

⁶Department of Radiology, University of Melbourne, Parkville, Victoria, Australia

⁷Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁸Royal Melbourne Hospital, Parkville, Victoria, Australia

Aims: Cutaneous T-cell lymphomas (CTCL) are rare malignancies with increasing incidence. Typically incurable and highly morbid, patients with CTCL frequently require multi-lined therapies, over decades. Radiotherapy achieves high response rates, and constitutes the historical cornerstone of CTCL treatment. Total skin electron therapy (TSE) is a highly technical form of radiotherapy, with proven quality-of-life benefits for CTCL patients. However, with the advent of newer skin-directed and systemic therapies, no consensus exists on optimal treatment sequencing. International reports demonstrate wide variation in patterns of care and suggest declining radiotherapy-utilisation first-line. Herein, we investigated the incidence of CTCL and geographical patterns of radiotherapy-utilisation in a state-wide, population-based registry.

Methods: A retrospective study of NSW Cancer Registry dataset for all patients newly diagnosed with CTCL from 2009 to 2018, with data linkage to the NSW Outpatients Radiotherapy database. Patients with dual malignancies and/or whose closest radiotherapy centre (calculated by ArcGIS) was across NSW borders were excluded from radiotherapy analyses. Radiotherapy-utilisation included all treatment lines.

Results: A total of 553 patients were newly diagnosed with CTCL in NSW, with incidence of 7.1/million/year (<1 in 14,000 people). Median age at diagnosis was 64 (range, 11–98) years; 61% were men; 1.6% identified as Aboriginal. 33% of all CTCL patients lived in the two most disadvantaged Index of Relative Socio-economic Disadvantage quintiles. 13% resided in remote or moderately accessible locations; 16% resided >50 km from the nearest radiotherapy centre.

Over 10 years, the radiotherapy-utilisation rate was 29%. Patients residing in highly accessible areas had lowest radiotherapy-utilisation (24%). Regional variation in radiotherapy-utilisation existed between local health districts (range, 9%–50%). No pattern was observed between radiotherapy-utilisation and distance to the nearest radiotherapy centre. TSE-utilisation was only 1.8%, over 10 years.

Anna Chapman¹, Nicole M Rankin², Hannah Jongebloed¹, Sze Lin Yoong¹, Victoria White¹, Trish M Livingston¹, Alison M Hutchinson^1,3, Anna Ugalde¹

¹Deakin University, Burwood, VIC, Australia

²School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia

³Barwon Health, Geelong, VIC, Australia

Implementation science plays a vital role in the advancement of cancer care via the application of methods that facilitate the integration of evidence-based interventions into real-world healthcare settings. A diverse and expanding body of primary implementation research in cancer care now exists, that aims to enhance the quality and experience of care for people living with cancer, their caregivers and healthcare teams. Efforts to consolidate the available literature in this space has resulted in a proliferation of systematic reviews, yet review teams commonly face specific challenges when identifying, appraising and synthesising primary implementation research. To enhance the strength and applicability of review findings and optimise cancer care, we describe five key challenges unique to systematic reviews of primary implementation research. These challenges include (1) descriptors used in implementation science publications, (2) distinction between evidence-based interventions and implementation strategies, (3) assessment of external validity, (4) synthesis of implementation studies with substantial clinical and methodological diversity and (5) variability in defining implementation ‘success’. We outline possible solutions and highlight resources that can be used by authors of primary implementation research, as well as systematic review and editorial teams to address the identified challenges.

Saji Chathanchirayil, Debby Darmansjah

Goulburn Valley Area Mental Health Services, Shepparton, VIC, Australia

We reviewed 65 patients attended our monthly psycho oncology clinic from 2017 to 2021. 65% were females and 35% were males and 55% were below 65% and 45% were above 65 years of age. Most common cancer was breast (32%) followed up by lung and colorectal and around 25% had metastatic cancer. More than half of the patients (54%) attended the clinic within 12 months of the cancer diagnosis, out of that 15% within 3 months and 16% in 6 months of the cancer diagnosis. Most common psychiatric diagnosis was adjustment disorder (52%), followed by depression (14%) and nil psychiatry 12%. 54% did not have any past history of mental illness and 40% had past history of mental illness. Negative in 43% and 28% had positive family history. Around 55% had no significant substance use history. Majority (82%) had social supports and among that 66% were partners only 18% had no social supports. Among the interventions, 42% received psychological therapy (like mindfulness, acceptance commitment therapy, meaning centred therapy, psycho education, etc.), 14% received pharmacotherapy mainly and 45% received both. Most of them (68%) had follow up to 3 months. 51% were from within 7 km radius and 49% were within 20–100 km radius. Seventeen percent had the onset of emotional problem immediately after the diagnosis and 32% had within 1–12 months period.

The findings suggest that our clinic represents equal number of adult and aged cancer patients. The higher prevalence of adjustment disorder over major mental illnesses with no significant past, family or substance use history indicates that the psychological impact of cancer. This is further supported by the higher utilisation of psychological therapy. The clinic's proximity to patients’ homes indicates that we are providing care closer to home. Further improving access to all cancer patients within 3 month is our future goal.

Hieu Chau, Danielle Burge, Quan Tran, Evangeline Samuel, Bhavini Shah, Mahesh Iddawela

Latrobe Regional Hospital, Traralgon, VIC, Australia

Introduction: 5-Fluorouracil (5-FU) is commonly used in gastrointestinal and breast cancer regimens. Although the route of administration (oral and IV) does not affect the efficacy, each route does present a different set of toxicity profile. Dihydropyrimidine dehydrogenase (DPD) deficiency, although rare, can lead to lethal side effects. Testing for this is not readily available and funded by the PBS; however, patients can self fund through some pathology providers.

Methods: We did a retrospective audit of all new chemotherapy regimens containing 5-FU commenced in 2022 at Latrobe Regional Hospital. This was then cross referenced with calls to symptoms and urgent review clinic (SURC) and hospital admission in order to grade toxicities. Comparison was made between oral and IV administration to see if one route had more toxicities.

Results: In 2022 there were 100 patients started on 5-FU based regimen, 63 IV based and 37 oral based. There were a higher number of calls to SURC for chemotherapy related toxicities in the oral (67%) compared to the IV (39%). The most common toxicity was diarrhoea, accounting for 64% in IV compared to 50% in oral.

In terms of grade 3 toxicity leading to hospital admission, it was 7.9% in the IV compared to 13.5% in the oral group.

Further data collection and analysis is in progress.

Discussion: Oral 5FU, which is more convenient to administer, leads to more calls to SURC for chemotherapy related toxicities and higher percentage of hospital admissions. IV 5FU takes up more resources in the chemotherapy day unit but appears to be more tolerable. DPD testing on all new patients may lead to reduced number of admissions and chemo toxicities. The cost of DPD deficiency testing for all patients receiving 5-FU in 1 years would be around $16800.

Ashfaq Chauhan, Reema Harrison, Bronwyn Newman, Mashreka Sarwar

Australian Institute of Health Innovation, Macquarie University, Macquarie University, NSW, Australia

Aim: People from culturally and linguistically diverse (CALD) backgrounds are at higher risk of experiencing patient safety events in their healthcare. Evidence of the safety of cancer care for CALD communities is however lacking. This study aimed to determine the frequency and nature of safety events for people from CALD backgrounds accessing cancer services in Australia.

Methods: A two-stage retrospective medical record review was conducted using an adapted Oncology Trigger Tool at four cancer services, two each in New South Wales (NSW) and Victoria (VIC). Based on the sample size requirements, patient records of those from CALD backgrounds were identified based on administrative data of country of birth, language spoken at home, preferred language and interpreter required. In first stage, data extraction tool was used to collect administrative and safety event data by two researchers at each service. In second stage, service-specific cancer clinician reviewed the data collected for further validation/exclusion. Data analysis was conducted using SPSS software.

Results: A total of 640 patient records were reviewed across four cancer services of which 215 records (33.6%) had at least one safety event in a 12-month follow up period, with almost 15% (95/640) of records reporting two or more safety events. A total of 423 safety events were identified from the 215 patient records. Most safety events occurred in inpatient setting (328/423, 77.5%), with medication related safety events (127/423, 30%) most frequently documented followed by safety events in clinical processes for example skin breakdown or development of pressure sore (76–423, 18%).

Implications: Patient safety events in Australian cancer services occur among consumers from CALD backgrounds at approximately three times the rate of safety events in the general population. Strategies to create shared understanding of instructions relating to medication management and care processes between clinicians and consumers may contribute to addressing this inequity in safety outcomes.

Natalie Chilko¹, Craig Underhill^1,2,3,4,5,6, Frances Barnett^7,8

¹Border Medical Oncology, Albury, NSW, Australia

²Albury Wodonga Health, Albury, NSW, Australia

³Hume Regional Integrated Cancer Service, Albury, New South Wales, Australia

⁴La Trobe University, Melbourne, VIC, Australia

⁵Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia

⁶University of New South Wales, Sydney, NSW, Australia

⁷University of Melbourne, Melbourne, VIC, Australia

⁸The Northern Hospital, Melbourne, VIC, Australia

Background: The evidence for the benefit of surveillance and optimum surveillance schedules for patients with treated cancer is unclear. Service utilisation for this large group may be able to be reduced.

Aim: To develop a set of minimum recommendations of surveillance for patients with breast, lung (NSCLC and SCLC), colon and rectal cancer who have completed curative intent treatment.

Methods: The recommendations from international guidelines for surveillance follow-up and imaging after treatment for early stage or locally advanced cancer were compared. Recommendations were sought from ESMO, ASCO and NCCN. The minimum surveillance recommendations that could be implemented was then determined.

Results: There was significant heterogeneity across guidelines from the different organisations in terms of frequency and actual recommendations. The main minimum recommendations elucidated include: for breast cancer, a minimum of annual follow-up with annual mammography; for NSCLC, a minimum of 6 monthly follow-up for 2 years, then annual follow-up, with annual CT chest and upper abdomen imaging for 2 years, followed by low dose CT chest annually. For limited stage SCLC, the minimum recommendation for follow-up and imaging was 6 monthly for 2 years. For colon cancer, the minimum recommendation for follow-up was 6 monthly for 5 years, with annual CT imaging for 3 years. This is alongside separate recommendations regarding colonoscopy. For rectal cancer, the minimum recommended follow-up was 6 monthly for at least 3 years, with two CT scans in that time, and colonoscopies every 5 years.

Conclusion: A set of minimum surveillance recommendations was developed for common cancers after curative intent treatment. This could be helpful for local institutions to audit current practice and to implement for optimal resource utilisation. Further work can focus on what health professional is best suited for follow-up, including oncologist, surgeon and general practitioner.

*CT – computerised tomography

Holly Chung^1,2, Amelia Hyatt^2,3,4, Mei Krishnasamy^1,3,5,4

¹Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁴Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia

⁵Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia

Aims: People with lung cancer face significant unmet needs, impacting experiences and outcomes of care, and service costs. A value-based healthcare approach, seeking to optimise outcomes relative to healthcare expenditure, may help tailor service provision and improve efficiency. However, value-based approaches often specify clinical outcomes as target measures not always reflective of patient preferences. A bottom-up approach (where patients specify outcomes) promotes person-centred care, a central component of value-based care. This qualitative study illustrates this approach by exploring components of supportive care valued by people with lung cancer. We aimed to understand participants’ supportive care needs, valued components of care effective in addressing needs and the impact of service provision.

Methods: Participants comprised people with lung cancer attending two public, metropolitan health services. Purposive sampling was employed to include demographically diverse individuals. Qualitative semi-structured interviews were used to explore participant experiences of supportive care need, services received and valued, and outcomes of support received. Qualitative data were analysed thematically using interpretive description.

Results: Twenty-three people with lung cancer participated. Demographic and clinical data were analysed descriptively. Qualitative analysis revealed three themes: valued components of supportive care (sub-themes: ongoing opportunity for consultation and person-centred information), benefits of valued supportive care, and consequences of missed supportive care. Importantly, patients described absence of or generic approaches to supportive care as factors that led to disengagement from, loss of trust in, and feelings of not being valued by the healthcare system.

Conclusions: People with lung cancer valued ongoing opportunities for consultation and person-centred information, tailored to their supportive care needs. This study contributes new knowledge, describing what components of supportive care people with lung cancer value, highlighting opportunities to strengthen value-based lung cancer care. A bottom-up approach provides opportunity to establish models of care informed by outcomes that matter to patients.

Holly Chung^1,2, Elizabeth Crone¹, Amelia Hyatt^2,3,4, Donna Milne^3,5, Karla Gough^2,3,4, Mei Krishnasamy^1,4,6,7

¹Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia

⁴Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

⁵Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁶Department of Nursing, Peter MacCallum Cancer Centre, Melbourne, Victoria

⁷Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia

Aims: Social determinants of health and associated access barriers cause disparities in experiences and outcomes of cancer care, perpetuating disadvantage. To remove access barriers, they must first be identified; however, no evidence-based tool exists to facilitate timely identification of disadvantage among newly diagnosed cancer patients. Consequently, we developed a nursing checklist (the Checklist) in consultation with 100 senior cancer nurses and piloted with 50 cancer patients. The current study aimed to assess key clinical utility aspects (acceptability, appropriateness, practicability) of the Checklist in newly diagnosed cancer patients.

Methods: A prospective mixed-methods study was conducted at a specialist cancer hospital. Newly diagnosed genitourinary, gynaecological, head and neck, and lung cancer patients, and clinical nurse consultants involved in their care were invited to participate. A target of up to 60 newly diagnosed patients was stipulated but halted when data saturation was achieved. The Checklist was completed as part of usual care. Semi-structured interviews explored the Checklist's acceptability, appropriateness and practicability. Interview data were analysed using content analysis.

Results: Thirty-seven patients and seven nurses participated. Findings indicate the Checklist is highly acceptable and appropriate, and has potential to improve patient outcomes. Practicability findings suggested improvements to the Checklist and training, and barriers and enablers for implementation were discussed. Nurse participants highlighted the potential of the Checklist to inform optimal individual-level care, and improve service design at the health service-level through routine collection of social determinants data on service users.

Conclusions: Patients and cancer nurses affirmed the appropriateness and acceptability of the Checklist, and its potential to improve patient outcomes. Routine screening for social determinants of health may improve equity of opportunity for disadvantaged populations to access timely and appropriate care. A social determinants minimum dataset provides opportunity to embed an equity lens into health services research to guide service innovation.

Jennifer Cohen^1,2, Kristina Clarke², Esther Davis²

¹School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, University of NSW, Sydney, NSW, Australia

²Canteen Australia, Newtown, NSW, Australia

Aims: Adolescents and Young Adults (AYA) diagnosed with cancer face challenges in pursuing education and employment, leading to long-term declines in their QoL. Existing evidence-based education and career services (ECS) are limited. This study employs the participatory Intervention Mapping (IM) approach to collaboratively develop a service delivery framework for an ECS for a community-based youth cancer care organisation.

Methods: An integrative literature review and a cross-sectional survey of 82 AYA service users (mean age = 21 years;) were conducted to understand AYA education and career support needs. Key stakeholders, including health professionals and consumers, engaged in a series of eight co-design workshops that covered the six IM steps. These steps included conducting a needs assessment, defining service goals and principles, and planning program design, implementation and evaluation.

Results: Compared to their same-age peers, a smaller proportion of AYA were fully engaged in education (66%) or employment (81%). Nearly two-thirds of AYA reported altering their education (65%) and employment (57%) goals due to cancer, citing physical, emotional and cognitive impacts as barriers to goal achievement. The identified aims of the ECS were to provide support for AYA in achieving and sustaining personally-meaningful education and employment after a cancer diagnosis. Eight guiding principles were adapted from the Individual Placement Support model for AYA diagnosed with cancer. The recommended ECS features include providing AYAs with information on cancer impacts, career counselling and support in pursuing education and career goals. The service will encompass information resources, group skills programs, and career and peer mentoring.

Discussion: The findings strongly support the need for specialised ECS support for AYA with cancer diagnoses. The proposed service delivery framework will be implemented within a community-based youth cancer organisation and evaluated to assess its impact on AYAs’ engagement in education and employment and its effects on their long-term quality of life.

Prue Cormie^1,2, Chris Doran³, Boyd Potts³, Ashleigh Bradford¹, Peter Martin⁴, Meg Chiswell⁴, Mei Krishnasamy^1,2,5

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²University of Melbourne, Melbourne, VIC, Australia

³Central Queensland University, Brisbane, QLD, Australia

⁴Deakin University, Melbourne, VIC, Australia

⁵Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia

Aim: To determine cancer patients’ willingness to pay for exercise services and oncology health professionals’ perception of patient willingness to pay for exercise services.

Methods: An online questionnaire and semi-structured interviews were administered to: (1) people with any type of cancer within three years of starting treatment; and (2) registered health professional delivering clinical care to people with cancer. Questionnaire assessed likelihood of paying for: (1) a consultation with a cancer-trained exercise physiologist/physiotherapist at a Medicare subsidised cost of ∼$30; and (2) regular supervised exercise sessions at a cost of ∼$20 per session. Interviews probed factors associated with why patients would/would not be willing to pay. Data were analysed using standard descriptive statistics and interpretive description qualitative analysis framework.

Results: Patients (n = 453 questionnaire, n = 30 interview) were 63% female with 66% currently receiving treatment and 25% reported meeting exercise guidelines. Health professionals (n = 383 questionnaire, n = 31 interview) were 68% nurses with 15 ± 10 years oncology experience of whom 87% routinely recommend exercise to 75% ± 28% patients. 94% of people with cancer reported they would be willing to pay for a consultation with a cancer-trained exercise specialist. 40% of oncology health professionals thought the majority of their patients would be moderately-extremely likely to pay for a consultation. 83% of people with cancer would be willing to pay for regular supervised exercise sessions (58% extremely likely, 25% moderately likely). 37% of health professionals thought the majority of patients would be willing to pay for regular supervised exercise sessions (5% extremely likely, 32% moderately likely). Limitations include patient sample with socio-demographic characteristics not representative of all people with cancer.

Conclusions: People with cancer are willing to pay for cancer-specific exercise services. Oncology health professionals underestimate their patients’ willingness to pay. There is an opportunity to better align perceptions of willingness to pay among cancer patients and professionals involved in their care.

Annie R Curtis, Nicole Kiss, Katherine M Livingstone, Robin M Daly, Anna Ugalde

Deakin University, Melbourne, VIC, Australia

Aims: Dietitians are nutrition professionals equipped with specialised skills required to manage malnutrition in cancer. Optimisation of dietary intake is recommended as the primary nutrition strategy for the treatment of cancer-related malnutrition. However, it is unclear whether dietary patterns (DPs), described as the quality, variety and frequency of food consumption, are considered. This study examined dietitians’ food-based management of malnutrition; explored dietitians’ awareness of DPs and assessed barriers and enablers to the use of DPs in clinical practice.

Methods: A qualitative study was conducted using semi-structured interviews with oncology dietitians. Recruitment occurred through national nutrition societies, social media and professional networks. Data collection and analysis were conducted concurrently; recruitment ceased once data saturation was achieved. Inductive thematic analysis was used to identify key concepts. Qualitative description was used to interpret participants’ understanding of DPs and current dietetic practice.

Results: Fourteen oncology dietitians from four Australian states and territories participated. Three themes were identified: (i) principles to guide nutritional care, (ii) DPs as a gap in knowledge and practice and (iii) opportunities for better care with systems as both a barrier and enabler. Dietetic practice was food-focussed, encouraging energy- and protein-rich foods consistent with evidence-based guidelines. Dietitians encouraged one of two nutrition-related approaches: (i) intake of ‘any tolerated food’ or (ii) ‘foods supportive of longer-term health’. Dietitians were generally unaware of DPs and questioned their relevance in certain clinical situations. A multidisciplinary team approach, adequate food service and dissemination of DPs research and education were identified as opportunities for better patient care.

Conclusions: Recommendations for the treatment of malnutrition vary between oncology dietitians and uncertainty exists regarding DPs and their relevance in clinical practice. Further exploration into the role of DPs to treat cancer-related malnutrition and education for dietitians are required prior to implementation of a DPs approach into clinical practice.

Diane Davey, Oscar Ramsden, Virginia Mitsch

Albury Wodonga Health, Albury, NSW, Australia

Introduction: The Albury Wodonga Regional Cancer Centre (AWRCC) provides cancer services to North East Victoria and Southern NSW. Cancer services are provided by a number of different providers through public/private partnerships with service providers. Allied health services across the patient journey, when provided, can be fragmented and/or unavailable, impacting patient outcomes and patient experience. AWRCC's multiple supplier arrangements inhibit data sharing between clinicians and can result in inconsistencies in patient triaging/prioritisation as well as duplication of effort for allied health professionals.

Funded by Hume Regional Integrated Cancer Service (HRICS) service improvement grants, the project aims to identify the gaps in allied health services across the AWRCC cancer service and define a strategy and actionable roadmap for implementation.

Methods: This project will follow redesign methodology, using both qualitative and quantitative approaches to data collection. Project initiation, start up and diagnostics [current state analysis] will be completed as well as solution design/future state. Implementation planning will form the basis for the road map. The project will leverage existing frameworks and will include stakeholder consultation and collaboration with key allied health clinicians, Albury Wodonga Health stakeholders and service providers as well as consumer representatives, ensuring that patient outcomes and experiences are captured.

Results/findings: The findings from this project will be presented, including the key challenges and how these were managed by the project team. The outcomes will include an overview of current state and future state of allied health services for AWRCC patients and the implementation roadmap.

Candice Donnelly¹, Puma Sundaresan^2,3, Gabriel Gabriel^4,5, James Toh^2,6, Shalini Vinod^5,7

¹Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia

²Westmead Clinical School, University of Sydney, Sydney, NSW, Australia

³Radiation Oncology Network, Western Sydney Local Health District, Westmead, NSW, Australia

⁴Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

⁵South West Sydney Clinical Campuses, UNSW Medicine and Health, Liverpool Hospital, Liverpool, NSW, Australia

⁶Department of Surgery, Westmead Hospital, Westmead, NSW, Australia

⁷Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia

Aim: To determine the feasibility of utilising an Australian set of 26 multidisciplinary colorectal cancer (CRC) quality indicators (QIs) with population-based linked data.

Methods: Data were obtained on adult patients diagnosed with CRC (ICD-10-AM codes C18-C20) between 1 July 2005 and 31 December 2019 from the New South Wales (NSW) Cancer Registry. The NSW Cancer Registry data were linked to the NSW Clinical Cancer Registry (available for 1 July 2005–31 December 2014), NSW Admitted Patient Data Collection and NSW death records. The feasibility assessment was conducted in four stages: (1) data mapping to match variables required, (2) review of publicly available state-wide and site-specific reports using these datasets for routine reporting of the 26 QIs, (3) assess completeness and coverage of data variables using proportional analyses and (4) pilot calculation of feasible QIs where data exists.

Results: Data mapping found 14 of the 26 QIs were potentially feasible. Linked data of 38,430 CRC patients were available to test eight surgical QIs, and linked data of 8439 CRC patients were available to test six (neo)adjuvant therapy QIs. The data required to measure the these QIs had significant limitations in data coverage, completeness, and quality rendering the calculations unreliable, and some futile. The data completeness for staging ranged from 74%–85% and almost one half of diagnosis dates were illogical. Overall, six of the 26 QIs were feasible and reliable to measure using the linked dataset. These were all surgical and addressed unplanned re-operation/re-admission, colonoscopies, mortality and survival.

Conclusions: This study identified six clinically relevant QIs that were feasible to measure using available NSW population-based data. However, these QIs were restricted to surgical processes and outcomes. A large gap remains in the availability of adequate data to produce clinically meaningful quality measurements for a multidisciplinary CRC team, particularly in diagnostic work-up, (neo)adjuvant therapy and supportive care.

Catherine Dunn, Peter Gibbs

Walter and Eliza Hall Research Institute, Melbourne, VIC, Australia

Aim: Cancer care cost over $10 billion in Australia between 2015 and 2016, and with such considerable investment comes an obligation to ensure that the clinical care we deliver is of the highest possible standard. How cancer clinicians reflect on measuring and reporting the quality of their clinical work, and potential avenues for doing so, are not well understood.

Methods: A short online survey was emailed to a sample of 250 medical oncology clinicians, including advanced trainees and medical oncologists, exploring their perceptions, attitudes and understanding of the current measurement and reporting of quality in clinical practice.

Results: 137/250 clinicians responded (54.8%), comprising advanced trainees (19%) and oncologists of varying degrees of experience: 0–5 years (32%), 6–10 years (18%), 10–20 years (20%) and >20 years (11%). The majority responded that the measurement of quality in oncology practice should be routine (92%), but less than half (42%) were involved in any effort at routine reporting of quality; frequently cited barriers being uncertainty as to how to measure quality (30%), time limitations (27%) and the fear that quality appraisals could be misappropriated (10%). The majority of respondents desired more feedback about their personal practice standards (92%) and/or that of their institution (89%). Respondents reported that they either never received any feedback (21%), or only received informal/ad hoc feedback from either senior colleagues or peers (50%).

Conclusion: Based on this emailed survey of a cross-section of Australian cancer specialists there are many barriers to measuring and reporting quality of care. Respondents valued quality measurement highly but reported minimal routine involvement in quality assurance projects. The majority of respondents desired further feedback regarding their individual performance and the performance of their institution. Ad hoc informal feedback from peers and senior colleagues provided guidance for some. Defining, measuring and reporting of quality indicators is an urgent need for the medical oncology workforce.

Catherine Dunn¹, Wei Hong¹, Jeremy Shapiro², Matthew Loft^1,3, Belinda Lee^1,4, Rachel Wong^5,6,7, Margaret Lee^1,3,7, Azim Jalali^1,3,8, Hui-Li Wong⁹, Peter Gibbs^1,3,10,11

¹Walter and Eliza Hall Research Institute, Melbourne, VIC, Australia

²Cabrini Health, Melbourne, Australia

³Western Health, Melbourne, Australia

⁴Northern Health, Melbourne, Australia

⁵Monash University, Melbourne, Australia

⁶Epworth Eastern, Melbourne, Australia

⁷Eastern Health, Melbourne, Australia

⁸La Trobe Regional Hospital, VIC, Australia

⁹Peter MacCallum Cancer Centre, Melbourne, Australia

¹⁰Melbourne Private, Melbourne, Australia

¹¹Western Private, Melbourne, Australia

Aim: This study, the first part of the BETTER-TRACC (Benchmarking and Tracking TrEatment and Response in Advanced Colon Cancer) project, aimed to develop quality indicators (QIs) that can be extracted from existing comprehensive clinical registry data.

Methods: After an initial literature review, we defined a proposed set of 12 QIs that could be extracted from data collected in the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) clinical registry. A two-step modified Delphi method is being used to establish consensus. An expert panel comprising eight colorectal oncologists, representing different treatment sites, including public and private hospitals and a regional site, participated in round 1. Panel members were asked to review the definition, feasibility and utility of each QI, and propose additional QIs. The results of round one will be collated to refine, retain and/or exclude QIs before the second and final round.

Results: All invited participants responded promptly and completely to the surveys for their site. In round 1, all 12 proposed QIs were retained, with suggestions for refining the inclusion/exclusion criteria. Five further QIs were proposed for review, including use of next-generation sequencing, administration of additional biomarker-directed therapies, clinical trial participation and the uptake of Voluntary Assisted Dying. Outcomes from the full modified Delphi study and the final QI set will be presented at the meeting.

Conclusion: Clinicians were enthusiastic to engage in and supportive of this effort. This modified Delphi study will establish a set of QIs using clinical data from the TRACC registry. As part of the future plans for BETTER-TRACC pilot trial, Quality Appraisals will be circulated to participating sites, each site receiving summary data in comparison to other de-identified sites. The ultimate goal is continued measurement and reporting, with the plan to add new QIs with any new developments in the management of mCRC.

Kim Edmunds¹, Mary Kennedy², Pam Eldridge³, Taryn Kelly³, Yvonne Zissiadis³

¹Centre for the Business and Economics of Health, University of Queensland, St Lucia, QLD, Australia

²Nutrition and Health Innovation Research Centre, Edith Cowan University, Perth, Western Australia, Australia

³GenesisCare Oncology, Perth, Western Australia, Australia

Aim: Exercise is both effective and cost-effective in improving the health and wellbeing of cancer patients. COSA recommends all people with cancer receive: (1) discussion about the role of exercise in cancer recovery, (2) recommendation to follow appropriate exercise guidelines and (3) referral to an Accredited Exercise Physiologist (AEP) or physiotherapist with experience in cancer care. However, fewer than 15% of people receive a referral to exercise during treatment. GenesisCare Oncology undertook an implementation initiative to improve their exercise service by: (1) incorporating an AEP into their care team and (2) establishing an opt-out referral system to provide all patients with an AEP appointment. While initial evaluations suggest the service can enrol a higher number of people receiving cancer treatment, the value of this service remains unclear. One major impediment to value assessment is the lack of data required to conduct an assessment and/or economic evaluation. This aim of this pragmatic, real-world feasibility study is to use a quadruple aim, value-based framework to identify the value elements of existing exercise oncology implementation at two sites in WA to support future value assessment.

Methods: This value-based framework collects data via routine data collection, surveys and interviews on: (1) costs, (2) outcomes, (3) patient experience and (4) provider experience.

Results: Data collection is ongoing:

Conclusions: This value-based framework has the potential to inform the delivery of greater benefits for all stakeholders and better value (improved health outcomes and reduced costs) for the health system, contributing to the sustainability of exercise oncology.

Kim Edmunds¹, Yufan Wang¹, Sally Sara², Bernie Riley², Nicole Heneka², Haitham Tuffaha¹

¹Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia

²Prostate Cancer Foundation of Australia, Sydney, NSW, Australia

Aims: While provision of cancer supportive care services for prostate cancer (PCa) patients during and after treatment have demonstrated efficacy in mitigating consequences of the disease, there is a lack of robust economic evidence regarding the benefits of such services. The aim of this financial efficiency evaluation was to assess the value for money of the Prostate Cancer Foundation of Australia (PCFA) Prostate Cancer Specialist Nursing (PCSN) and Telenursing programs.

Methods: The six stage Social Return on Investment (SROI) framework was used to develop the financial efficiency model for the PCSN programs. Stakeholder consultations with the PCSN team were held to collect costs and generate the benefits associated with delivery of the PCSN program, supplemented with published evidence. Calculation of impact included dead weight loss, attribution, benefit time frame and discounting. Sensitivity analyses were conducted to test the robustness of the model.

Results: Costs of the program (including referral to other services) and seven major benefits were included in the final analysis: (1) Improved health related quality of life (HRQoL); (2) Reduced emergency department (ED) presentations and hospitalisations; (3) Reduced travel costs; (4) Reduced productivity losses; (5) Reductions in clinical consulting time; (6) Reductions in nurse coordination time and (7) Reductions in missed appointments. Intangible benefits which could not be monetised were also reported. The net social benefit and SROI for each program and a combined result are shown below.

Conclusions: A conservative SROI analysis was conducted and a strong positive return on investment demonstrated the successful implementation of the program. A qualitative assessment of intangible benefits for patients and healthcare providers showed high levels of satisfaction amongst all stakeholders and the reach of PCSNs across all six PCa survivorship domains.

Nicola Fearn^1,2, Nicole Heneka³, Lauren Christie^1,2, Rachel Dear^4,5, Venessa Chin^5,6,7, Leah Curran⁵, Michael Krasovitsky^4,5, Orly Lavee^5,6, Jeff Dunn^3,8, Suzanne Chambers^2,3

¹St Vincent's Hospital, Sydney, NSW, Australia

²Australian Catholic University, Sydney, NSW, Australia

³University of Southern Queensland, Brisbane, QLD, Australia

⁴St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia

⁵The Kinghorn Cancer Centre, Sydney, NSW, Australia

⁶St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia

⁷The Garvan Institute of Medical Research, Sydney, NSW, Australia

⁸Prostate Cancer Foundation of Australia, Sydney, NSW, Australia

Background: Survivorship care plans are recommended for use with all people living with cancer to support communication, surveillance and management of survivorship issues.¹ ‘My Personal Plan’ is a patient-centred prostate cancer survivorship care plan based on the Prostate Cancer Survivorship Essentials Framework²; however, none of the elements are unique to prostate cancer. This multi-methods study aimed to explore the acceptability of the Essentials Framework and My Personal Plan for people with other cancer types to determine if they can translate for generic use.

Methods: Qualitative data were collected from clinicians and cancer survivors from four cancer groups (breast, head and neck, lung cancer, bone marrow transplant). Interviews were completed with 11 clinicians (oncologists and haematologists, allied health professionals and specialist cancer nurses) and 25 cancer survivors. This sample size allowed in-depth insights and understanding of My Personal Plan acceptability. Thematic analysis was used to identify changes required to My Personal Plan to improve acceptability and usability for other cancer groups.

Results: Four themes regarding changes required to My Personal Plan were identified by clinicians and cancer survivors: (1) treatment regimen, (2) medication and appointment information, (3) problem checklist and (4) support services. Cancer survivors supported the use of My Personal Plan to improve navigation and information needs currently missing from survivorship care. Six themes were identified by clinicians regarding implementation barriers: (1) education needs, (2) electronic version, (3) allied health referral options, (4) time to complete, (5) staff responsible and (6) when to complete.

Michelle Forgione^1,2, Annabel Smith², Christopher Hocking^1,2

¹Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia

²Northern Adelaide Cancer Centre, Adelaide, South Australia, Australia

Background: Voluntary assisted dying (VAD) legislation came into effect in South Australia on 31 January 2023. A national survey of Medical Oncology Physicians conducted in 2017 demonstrated 47% of respondents had a philosophical disagreement towards VAD,¹ suggesting patient access to VAD assessments may be impacted by lack of availability of willing clinicians. The aims of this project are to assess Medical Oncologist perception of VAD legislation in South Australia at its inception, quantify willingness and identify barriers to participation in VAD activities/assessments.

Methods: A survey was developed and circulated electronically to Medical Oncology Consultants and Advanced Trainees currently practicing in South Australia. Responses were anonymised and analysed in aggregate using SPSS Version 27 software.

Results: Throughout May 2023, 41 responses were received from 67 invited participants (61% response rate). The rate of conscientious objection to VAD was 22% (9/41). Among non-conscientious objectors, lack of time was the most important barrier to participation (reported as the top barrier by 50% or 16/32 of respondents). The most important motivation for participation was beneficence (alleviation of suffering), ranked as the top motivation by 47.6% (10/21) of respondents. A total of 22% (9/41) reported a willingness to participate in VAD activities in the future and an additional 24.4% (10/41) are unsure whether they would be willing to participate. Mandatory training has been completed by 17.1% (7/41) of respondents and an additional 19.5% (8/42) intend to undertake training within the next 2 years.

Piers Gillett¹, Karen Trapani¹, Maike Trommer^2,3, Richard Khor^2,4,5, Fanny Franchini¹

¹The University of Melbourne, Parkville, Victoria, Australia

²Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Victoria, Australia

³Department of Radiation Oncology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

⁴La Trobe University, Melbourne, Victoria, Australia

⁵Monash University, Melbourne, Victoria, Australia

Aims: This study evaluated travel distances encountered by radiation therapy cancer patients across four cancer types in Victoria, Australia. Due to the specialised nature of radiotherapy facilities and their scarcity in regional areas, combined with patient specific needs per tumour type, extensive travel can be required. We analysed patient travel patterns across tumour types using a comprehensive statewide linked dataset.

Methods: Driving distance between postcode centroids of a patient's home address and the radiotherapy facilities were calculated using the Google Distance Matrix API, based on deidentified patient information and treating facility data. One-way travel distances per radiotherapy course were calculated for each of prostate, lung, breast and colorectal cancers separately in addition to all streams combined. Stratification by sex was performed where relevant.

Results: The combined mean (median) travel distance was 46 km (median: 18.6 km) for men and 37.9 km (median: 14.8 km) for women with maximums of 630 and 723 km, respectively. Colorectal cancer patients recorded mean travel distances of 47.85 km (median: 18.09 km) for men and 44.84 km (median: 17.7 km) for women with respective maximums of 600 and 588 km. For lung cancer, mean travel distances were 44.51 km (median: 18.12 km) for men and 42.35 km (median: 18.16 km) for women, and maximums of 630 and 588 km, respectively. Men with prostate cancer had a mean distance of 46.55 km (median: 19.25 km) and maximum of 598 km. For breast cancer, mean travel distances were 35.97 km (median: 14.1 km) for women and 45.64 km (median: 20 km) for men with maximums of 551 and 723 km, respectively.

Conclusions: Our study identifies consistent travel distances across the examined tumour types, with a notable exception in women with breast cancer. The underlying factors for this discrepancy warrant further investigation and may be attributed to common referral patterns stemming from disease prevalence, increased patient awareness influencing treatment location decisions, and widespread availability of centres equipped for breast cancer treatment.

Daniel Lindsay¹, Penelope Schofield², Matthew Roberts³, John Yaxley⁴, Robert (‘Frank’) Gardiner⁵, Steve Quinn⁶, Natalie Richards⁷, Allan White⁷, Fiona White⁷, Mark Frydenberg⁸, Suzanne Chambers⁹, Declan Murphy¹⁰, Lawrence Cavedon¹¹, Ilona Juraskova¹², Louisa Gordon¹

¹QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

²Department of Psychology, Swinburne University, Melbourne, Victoria, Australia

³Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

⁴Wesley Urology Clinic, Wesley Hospital, Brisbane, QLD, Australia

⁵Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

⁶Department of Health Science and Biostatistics, Swinburne University, Melbourne, Victoria, Australia

⁷Behavioural Science Unit, Peter MacCallum Department of Oncology, Melbourne, Victoria, Australia

⁸Department of Urology, Cabrini Institute, Melbourne, Victoria, Australia

⁹Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia

¹⁰Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

¹¹School of Science, RMIT University, Melbourne, Victoria, Australia

¹²School of Psychology, University of Sydney, Sydney, NSW, Australia

Background and aim: Men with prostate cancer in active surveillance are proactively monitored with regular prostate-antigen blood tests and biopsies to detect possible disease progression, with active (curative) treatment started as required. We examined the cost-effectiveness of the Navigate online decision aid guiding the choice of management option for men with prostate cancer compared with usual care (no decision aid).

Methods: A decision-analytic cohort model was constructed over a 10-year time horizon. Navigate trial data (n = 302) and estimates from relevant published studies were used for model inputs. The model incorporated costs and benefits over the short and long term, with disease progression occurring in some men. Incremental costs and health effects [quality-adjusted life years (QALYs)] were calculated for the two strategies from a government healthcare cost perspective. One-way and probabilistic sensitivity analyses were undertaken to address uncertainty in model inputs.

Results: The estimated mean cost per patient in the Navigate strategy was $8789 [95% Uncertainty Interval (UI): $7410, $10,273] and mean QALYs were 7.08 (95% UI: 6.72, 7.36) compared with $9373 (95% UI: $8081, $10,808) and 7.03 (95% UI: 6.67, 7.30) for the usual care group. The Navigate strategy produced cost-savings and higher QALYs, albeit small differences in both over 10 years. The findings were sensitive to the uptake of active surveillance, the cost of active treatment (i.e. surgery, radiation therapy), model duration and the probability of disease progression after active treatment, but variation in these did not alter the overall findings. The likelihood of Navigate being cost-effective was 99.8% at the acceptable level in Australia.

Conclusion: Using an online decision aid tool for men with prostate cancer appears to be cost-effective relative to usual practice in the Australian healthcare system, driven by the high acceptance and uptake of active surveillance.

Karla Gough, Amelia Hyatt, Allison Drosdowsky

Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia

Aims: Lack of inclusion of underserved groups in clinical trials and clinical research is well documented. This can lead to health data poverty and suboptimal care for poorly represented groups. Much less is known about representative diversity in supportive care trials. This study aimed to assess inclusion and bias in psychological intervention trials in people with cancer.

Methods: Primary studies from recent systematic reviews of psychological interventions targeting common issues (anxiety and fatigue) were assessed for barriers to inclusion and biases. Data on pre-specified items were extracted using a standardised data extraction form in Covidence to ensure data quality and rigour. Power to detect small (d = .4) and medium-sized (d = .5) effects, assuming a two-tailed alpha = .05 t-test, was assessed.

Results: A total of 104 primary studies were included (anxiety, n = 71; fatigue, n = 33). Most studies had poor ethnocultural representation and were under-powered considering published guidance for sample size calculations. Approximately two-thirds (n = 65, 63%) explicitly excluded people who could not speak the dominant language of the study country. Only one made reference to the use of bilingual researchers and translated study materials. Females were clearly over-represented, with 49% (n = 51) of studies recruiting breast cancer patients only. Studies rarely required participants to be experiencing the issues targeted by interventions (anxiety, 10%; fatigue, 45%). Only 53 (51%) studies were powered to detect a medium-sized effect and 36 (35%) powered to detect a small-sized effect.

Conclusions: Health services looking to implement psychological interventions for common issues experienced by cancer patients must be aware that evidence arises from samples that do not reflect the diversity of the population they serve. Frameworks and guidelines exist to promote inclusion and participation in health research, and these must be used to ensure meaningful diversity in study samples so all people with cancer have the opportunity to benefit from healthcare innovations.

Karla Gough¹, Rowan Forbes-Shepard¹, Nienke Zomerdijk², Alexander Heriot^3,4, Allison Drosdowsky¹, Amelia Hyatt¹, Mei Krishnasamy^1,4,6,5

¹Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia

²School of Public Health, University of Queensland, Brisbane, Australia

³Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia

⁴Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

⁵Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia

⁶Research and Education Division, Victorian Comprehensive Cancer Centre, Melbourne, Australia

Aims: There is increasing pressure to use patient-reported outcome (PRO) measures as part of the care provided to individual cancer patients. Yet, there is little consensus on the essential features or issues to be considered when developing real-world PRO systems. The aim of this study was to develop a comprehensive framework of key considerations and a roadmap to guide the development and implementation of such systems.

Methods: Peer-reviewed and grey literature relevant to policy makers, healthcare organisations and consumers was identified via a rapid review using PubMed and Google. These were combined with seminal works by recognised experts, and those identified via citation tracking activities. Essential features and issues were identified via a narrative synthesis of documents purposively selected as ‘exemplars’ in the field. Ad hoc searches were conducted on possible system strains. Implementation, clinical utility and construct validity frameworks were used to support the explanation and elaboration of key features. Then, all findings were used to create a roadmap/logic model intended to support development and implementation activities.

Results: A total of 24 essential features mapping to 10 domains were identified from 34 key documents. Requisite inputs such as funding and genuine partnerships, and known system strains including lack of fit-for-purpose tools were also identified. The roadmap, which should be used in tandem with the comprehensive framework, lays out the logical sequence of activities to deliver the outputs needed to optimise the likelihood that PRO systems are acceptable to all stakeholders, appropriate for their stated purpose and clinical application, and feasible and sustainable.

Conclusions: Real-world PRO systems that have not achieved their intended purpose or experienced significant issues during implementation have typically overlooked or not given due consideration to features forming part of the comprehensive framework. The framework and roadmap can inform the design of proof-of-concept tests and larger implementation studies.

Kate Graham¹, Nicole Kiss², Jenelle Loeliger^1,3, Belinda Steer^1,3

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia

³School and Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Burwood, VIC, Australia

Aims: Malnutrition and sarcopenia are often present at cancer diagnosis and can be exacerbated by the side effects of treatment. These conditions can have considerable effect on patient outcomes including reducing quality of life and increasing mortality. Immunotherapy treatments have significantly enhanced response and survival rates for many cancer types, whilst being cited as having reduced side effects compared to traditional treatments, for example chemotherapy. However, the impact of immunotherapy on patients’ nutritional status remains unexplored. The aim of this study was to determine the prevalence of malnutrition and risk of sarcopenia in Victorian adult cancer patients treated with immunotherapy compared to those treated with chemotherapy alone.

Methods: A multi-site point prevalence study was conducted across Victorian acute health services in July 2022. Malnutrition was assessed using the GLIM criteria and sarcopenia risk assessed using the Sarc-F and calf circumference tool in adult patients.

Results: A total of 1705 adult oncology patients were recruited across 21 health services. Of these, 172 were treated with immunotherapy and 934 with chemotherapy. Malnutrition prevalence was 31% (n = 54) in immunotherapy treated patients compared to 32% (n = 307) in chemotherapy treated patients and 32% (n = 550) in the total population. Only 34% (n = 20) of the malnourished immunotherapy patients had active dietetic intervention compared to 46% (n = 141) of chemotherapy patients. Sarcopenia risk was identified in 20% (n = 34) of immunotherapy treated patients with similar rates found in chemotherapy patients (n = 352, 21%) and the total population (n = 352, 21%).

Conclusions: Patients treated with immunotherapy appear to have similar malnutrition and sarcopenia risk profiles as those treated with chemotherapy. Health services should ensure immunotherapy treated patients have access to the same screening and referral pathways to dietetic services as traditional treatments to treat and prevent both conditions and minimise associated adverse outcomes.

Lisa Guccione¹, Sonia Fullerton¹, James Berrett², Jill Francis³, Stephanie Best¹

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Swinburne University, Melbourne, Victoria, Australia

³School of Health Sciences, Melbourne University, Melbourne, Victoria, Australia

Background: Advance care planning (ACP) is the process of individuals discussing and recording personal values, beliefs and preferences so that, in the event they lose capacity, a person receives care consistent with their preferences. Documentation of ACPs within oncology settings is often low, with national rates reported at 27% and rates as low as 9% of inpatients over 75 years of age at the Peter MacCallum Cancer Centre (PMCC), a world-leading comprehensive cancer centre in Melbourne. A series of educational videos on ACP were developed to improve uptake of ACP at PMCC, targeting healthcare professionals (HCPs), patients and families. The aim of this study was to retrospectively assess the appropriateness and acceptability of these videos as an intervention to improve ACP.

Methods: Two qualitative methods were used to address two research questions across two phases: (1) Evaluation of the appropriateness of the ACP videos to improve behaviours required for delivery of ACP. Here, we assessed the alignment of behaviour change techniques in the video with known empirical barriers using the Theoretical Domains Framework (TDF), a psychosocial behaviour change tool. (2) Assessment of the acceptability of the videos. Videos were presented to HCPs, or consumers and participants were asked a series of questions informed by the Theoretical Framework of Acceptability (TFA).

Results: Data collection will be completed by August 2023. We will conduct four focus groups with 12 HCPs and 12 consumers. In coding the behaviours in the videos, we anticipate a combination of behaviour change techniques that align with empirical barriers and others that do not. In assessing acceptability, we anticipate specific concerns relating to the perceived effectiveness of the ACP processes.

Conclusion: Retrospectively assessing the appropriateness and acceptability of an intervention provides an empirical bases for enhancing ACP processes to optimise uptake and effectiveness.

Tilini Gunatillake¹, Beverley Woon^1,2, Vijaya Joshi¹, Kalinda Griffiths^1,3, Stephanie Best^1,2, Jo Cockwill¹, Jennifer Philip^1,4,5

¹VCCC Alliance, Parkville, Victoria, Australia

²Peter MacCallum Cancer Centre, Parkville, Australia

³Flinders University, Poche SA + NT, Darwin, Australia

⁴Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia

⁵St Vincent's Hospital Melbourne, Victoria, Australia

Aim: To explore the current landscape and perceptions of health (in)equity across a cancer alliance health setting to enable successful development and implementation of a Cancer Equity Framework (CEF).

Methods: Thirty key stakeholders across metropolitan and regional Victoria were invited to partake in semi-structured interviews exploring: (1) perceptions of health (in)equity, (2) enablers and barriers of implementing a CEF within hospitals. Participants’ roles included executive, middle-management, policy development, Aboriginal health and diversity managers and clinicians.

Conclusions: This study provides important insights into the perceptions and impact of health (in)equity across health services. The importance of addressing inequities in service delivery through the development of a CEF was emphatic however there was recognition of well-established barriers that could prevent sustainable change. There is a clear call to action for health service leaders and workers to address these ongoing/persistent inequities by integrating equity into their core business and in turn start to promote a ‘culture change’ for prioritising equity across cancer care.

Reema Harrison, Bronwyn Newman, Ashfaq Chauhan, Mashreka Sarwar

Macquarie University, Canberra, NSW, Australia

Background: Widespread application of co-design methods in cancer research has highlighted its value for creating user-centric change to cancer care and service delivery models. Use of co-design has also revealed that whilst presenting opportunities for person-centric practice and enhanced services, the process is also fraught with a range of challenges for members, facilitators and service providers.

Aim: As we approach the end of a 4-year program of cancer service research (the CanEngage Project) to improve safety outcomes in cancer care among culturally and linguistically diverse communities, we will explore the learnings and practical suggestions that have resulted from the project for co-design in cancer service research with CALD communities.

Methods: We employed an adapted model of experience-based co-design in which consumer co-facilitators and multilingual fieldworkers supported participation and processes. Throughout the 4-year project, we gathered process analysis data via interviews with co-design members and facilitators to evaluate this adapted model.

Results: CanEngage has provided evidence and informal learning about the planning and practice of co-design with CALD communities and clinicians in cancer services, which will be reported through this session. Key learnings relate to the impacts of establishing and sustaining the CanEngage Network of 11 consumers and multilingual fieldworkers. With the CanEngage Network, we have collaboratively designed and delivered three series of co-design workshops with six cancer services in NSW and VIC. We have learnt that each co-design is different, with practice driven by group purpose and membership. Fostering close connection between those facilitating co-design was vital to navigate practice together. A co-facilitation model between clinician-academics and consumers underpinned the planning and conduct of co-design. Co-facilitation has enabled us to support diverse members to co-create service relevant tools and practices that support safer care. Co-facilitation itself requires reflective practice, with regular open discussion to plan and debrief about co-design practice being valuable to safely evaluate new approaches.

Reema Harrison¹, Bronwyn Newman¹, Bróna Nic Giolla Easpaig², Lucy Jones³, Lukas Hofstätter⁴, Judith Johnson⁵

¹Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

²Faculty of Health, Charles Darwin University, Sydney, Australia

³Neuroblastoma Australia, Sydney, Australia

⁴Carers NSW Australia, Sydney, Australia

⁵School of Psychology, University of Leeds, Leeds, UK

Aims: The provision of cancer care is reliant on the contribution of carers, who form an integral part of the care team. Carers simultaneously negotiate the challenges of being a family member experiencing distress due to their loved one's illness, while also managing stressors associated with caregiving. A review of reviews demonstrates the lack of programs designed to help prepare carers. In partnership with carers, support organisations and health professionals we sought to tailor an existing evidence-based resilience building intervention for use with carers in Australia.

Methods: An experienced-based co-design (EBCD) approach was employed, co-facilitated by consumer and academic facilitators. Co-design members were carers (n = 3), and a clinician alongside the support of a consumer co-facilitator. Two co-design workshops totalling 4 h were conducted, followed by 5 h of consultation with three stakeholder groups including 13 participants associated with carer support and consumer organisations. Sample sizes for were determined by EBCD best practice and data saturation. Transcripts from the co-design and consultation processes, along with fieldnotes and feedback from contributors were thematically analysed.

Results: Four themes were identified to guide program development: clarifying what the program offers, increasing user-friendliness, considering shared and unique elements of carer journeys and further embedding support. This resulted in the co-development of a novel program for caregivers: ‘CanSupport’. This is designed to facilitate the development of valuable resilience-promoting skills and strategies in preparation for caregiving. CanSupport is a multi-component intervention consisting of workbook activities, interactive peer workshops and personalised one-to-one coaching.

Conclusion: This innovative program of work combines the efforts of carers, carer support organisations and researchers to creatively respond to a community-identified gap in existing services. The process resulted in adaptations to program content and delivery to ensure CanSupport is relevant and fit for purpose. Program piloting and trialling will follow.

Sharon He^1,2, Heather Shepherd³, Meera Agar⁴, Joanne Shaw^1,2

¹School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia

²Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia

³Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

⁴Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia

Aims: Older adults with cancer make up a large proportion of cancer diagnoses in Australia and often have other health conditions which can make treatment decision-making and cancer care challenging. Geriatric assessments (GAs) can identify older adults at risk of treatment complications and help guide treatment decision-making. However, use of GAs and discussion of geriatric domains more broadly in Australian cancer services is low. This study aims to qualitatively explore Australian healthcare professionals’ experiences and perceptions of management for older adults with cancer.

Methods: This study involves a short online survey and qualitative telephone interviews with up to 30 Australian healthcare professional's providing care for older adults with cancer to explore their perceptions and experiences of treatment decision-making, and management of older adults with cancer. Purposive sampling will ensure representation across disciplines. Thematic analysis using a framework approach identified key themes.

Results: To date seven interviews have been conducted. Interviews are ongoing. Preliminary analysis suggests three themes: (1) Definition of an older adult with cancer, (2) Formal versus informal screening and assessment and (3) Management of older adults with cancer. These themes inform the barriers and facilitators to implementation of screening and geriatric assessments of older adults with cancer. The final data will be presented.

Conclusion: This study will provide insight into current practice of cancer care for older adults with cancer and identify the barriers and facilitators to use of GAs within Australian cancer services. This will help inform development of a care pathway that incorporates GAs to improve management of older Australians with cancer.

Nicole Heneka¹, Suzanne K Chambers², Isabelle Schaefer³, Michael Steele², Haitham Tuffaha⁴, Kelly Carmont⁵, Melinda Parcell⁵, Shannon Wallis⁵, Stephen Walker⁵, Jeff Dunn^1,6

¹University of Southern Queensland, Springfield, QLD, Australia

²Australian Catholic University, Banyo, Australia

³University of Technology Sydney, Ultimo, Australia

⁴University of Queensland, Brisbane, Australia

⁵West Moreton Health, Brisbane, Australia

⁶Prostate Cancer Foundation Australia, Sydney, Australia

Aim: To determine the acceptability and feasibility of an evidence-based prostate cancer survivorship virtual care intervention, tailored to post-surgical care, and delivered through a novel nurse-led approach.

Methods: This multi-methods pilot comprised a quasi-experimental pre-/post-test design and an exploratory qualitative study using the Theoretical Framework of Acceptability (TFA). Study participants comprised: men newly diagnosed with localised prostate cancer who had undergone radical or robotic prostatectomy within the previous 3 months; and clinicians/stakeholders involved in the development and/or delivery of the program.

The intervention was tailored to the post-operative recovery journey targeting symptom management, psychoeducation, problem solving and goal setting, delivered over 12-weeks via videoconference. The primary outcome measure for this study was program acceptability. Secondary outcome measures included: quality of life, prostate cancer related distress, insomnia severity, fatigue severity and program costs.

Results: Both men (n = 17) and service stakeholders (n = 6) reported very high levels of program acceptability across all constructs of the TFA. For men negligible burden and opportunity costs related to program participation, coupled with a strong sense of program ethicality, were key drivers of adherence and perceived program effectiveness. Clinically, the program improved care co-ordination, expediated identification of survivorship care needs and met service priorities of providing quality care close to home

At baseline, almost half (47%) of men reported clinically significant psychological distress which had significantly decreased at 24-weeks (p = 0.020). There was significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from baseline to 24-weeks. Current fatigue (p = 0.024) and the degree to which fatigue interfered with life in the past 24-h (p = 0.041) significantly increased from baseline to 24-weeks, reflecting persistent fatigue associated with major surgery.

Conclusions: Findings from this study suggest virtual post-surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting.

Martin Hong¹, Rebecca Nguyen¹, Tamiem Adam², Po Yee Yip³, Victoria Bray¹, Ina Nordman⁴, Fiona Day⁴, Hiren Mandaliya⁴, Abhijit Pal¹

¹Liverpool Hospital, Liverpool, NSW, Australia

²Department of Medical Oncology, Bankstown Hospital, Bankstown, NSW, Australia

³Campbelltown Hospital, Campbelltown, NSW, Australia

⁴Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia

Background: Extensive stage small cell lung cancer (ES-SCLC) has a poor prognosis with a median survival of 10 months with platinum and etoposide (EP) chemotherapy.¹ IMpower133 showed the addition of atezolizumab to platinum and etoposide (EP + atezolizumab) chemotherapy led to modest improvements in both progression free survival (PFS) and overall survival (OS).²

It is recognised that clinical trials are not equal to real world practice due to heterogeneity of many factors in real world patients controlled in randomised clinical trials. Real world practice provides further information about an intervention's efficacy and safety.^3–5

This study aimed to investigate the outcomes seen in real world patients treated in four centres in Australia to assess the efficacy of the addition of atezolizumab.

Methods: We retrospectively reviewed patients with ES-SCLC who had systemic treatment between 2018 and 2021. The primary endpoint was OS, and the secondary endpoint was PFS.

Baseline characteristics were analysed using descriptive statistics. OS and PFS were assessed using Kaplan–Meier method, and hazard ratios (HRs) were calculated using Cox proportional hazards method.

Results: A total of 156 patients with ES-SCLC underwent treatment at our centres between 2018 and 2021. The median OS was 9.2 months for EP compared to 9.5 months with EP + atezolizumab (HR: 1.52 [1.05–2.19], p = 0.026). The 12 month OS was 31% versus 42%, respectively. The median PFS was 5.7 versus 6.4 months, respectively (HR: 1.53 [1.06–2.22], p = 0.023). In univariate analysis, there were no associations between survival and known prognostic variables such as age, sex and ECOG.

Megan Prictor^1,2, Amelia Hyatt^3,4

¹Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia

²Melbourne Law School, University of Melbourne, Melbourne, VIC, Australia

³Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

⁴Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aims: The recording of medical appointments is common worldwide, with both patients and health professionals reporting key benefits including improved knowledge, understanding, engagement, satisfaction with care and care quality. However, in Australia there is a current lack of data regarding current consultation recording activity. This study therefore aimed to capture data regarding consultation audio-recording practices in Australia, including covert recordings, reasons for making, using and sharing recordings (including via social media), and perspectives regarding implementation of consultation recording as part of routine care.

Methods: A mixed-methods online national survey was developed comprising 21 quantitative and qualitative (open text) items to explore project aims. The survey was open from 11 May to 31 August 2022. Quantitative data were analysed descriptively, and qualitative data analysed using content analysis.

Results: A total of 236 responses were included for analysis. Of these, 26% (n = 61) reported having previously recorded a medical appointment with permission, and a further 22% (n = 51) had or knew someone who had made a recording secretly. Importantly, participants outlined novel use of recordings such as to improve understanding for consent for medical procedures or clinical trials, or to overcome access barriers associated with disability. Participants overwhelmingly were against sharing recordings on social media, stating this to be a breach of trust and privacy. The majority 63% (n = 122) of participants would consider recording a future visit and 56% (n = 128) wanted their clinic to facilitate this service. Notably, questions about recording and the law were common.

Conclusions: The results of this survey highlighted the breadth and scope of current consultation recording use in Australia, while also emphasising increased patient demand for recording to become part of standard care. Results also demonstrated the potential for consultation recording to reduce inequity in care, and reduce or remove existing access barriers. More research will be needed to support clinics implement consultation recording as part of standard care.

Mahesh Iddawela^1,2, Leah Savage¹, Koku Tamariat³, Nisulie Manamperi², Berlinda Zhang², Micheal Leach⁴, Sachin Joshi⁵, Eli Ristevski³

¹Latrobe Regional Hospital, Traralgon, VIC, Australia

²Monash University, Traralgon, VIC, Australia

³Monash Rural Health, Monash University, Warrigaul, VIC, Australia

⁴Monash University, School of Rural Health, Bendigo, VIC, Australia

⁵Latrobe Regional Health, Traralgon, VIC, Australia

Introduction: As a result of the progress in cancer treatment, numbers of cancer survivors are rapidly increasing. There is a need to address some of the physical, psychological and financial needs of patients who complete treatment. There is limited data on the survivorship needs of large cohorts in Australia, as well as how such services can be embedded in cancer services. Here, we report the needs of a cohort of patients managed in a public cancer survivorship clinic (CSC).

Methods: Between June 2017 and June 2022, cancer patients undergoing breast, prostate, lymphoma and colorectal cancer treatment in the Gippsland were invited to participate in the nurse lead CSC. The participants complete the NCCN Distress Thermometer (DT) on their first visit. Those who reported a score £ 4 on the DT were asked to complete the Kessler Psychological Distress Scale (K10). A cohort also completed the Financial Toxicity (FT) assessment and descriptive statistics were calculated (COST FACIT Score questionnaire).

Results: A total of 454 patients were seen, of whom included 46% (208/454) were breast, 14% (63/454) prostate, 5% (21/454) colorectal cancer and 5% (25/454) lymphoma patients. Overall, 65% (294/454) completed the DT, and 34% (101/294) of patients were invited to complete a K10. Among 165 patients with complete data, and there was no difference in DT according to gender, age or cancer, but higher distress on the DT was associated with higher FT (COST FACIT Score £32) (78% distressed vs. 53% non-distressed, p = 0.002).

Conclusion: This prospective study details the survivorship needs of a large cohort of patients completing radical treatment and how a service can be developed and embedded in cancer services. There is a significant association between high FT and high DT scores, suggesting the needs for action to address this. This data provides valuable information about the cancer types and patient needs that is essential for developing services.

Donna O'Callaghan, Stewart Harper, Mahesh Iddawela

Gippsland Regional Integrated Cancer Service, Traralgon West, Victoria, Australia

Exercise programs have shown to provide both physical and psychological benefits to cancer patients and provide a valuable role in supporting cancer patients to return to function and wellbeing. Lack of structured services, in Gippsland, have limited the patient's ability to access these programs.

This pilot was a collaboration with acute care services, community health and local fitness facilities to provide an accessible and affordable exercise program for the local population in the Latrobe Valley.

Methods: A multidisciplinary working group of oncologists and exercise physiologists developed an appropriate and sustainable pathway to an exercise program for patients with cancer. A simple referral form was developed which was easily accessible, enabling participants to self-refer as well as allowing clinical referral.

Exercise Physiologists in Gippsland were provided with support to upskill by attending a course in the delivery of a cancer specific accredited exercise program.

The program was delivered by Exercise Physiologists from Latrobe Community Health Service, with the support of Allied Health Assistants (AHAs) and Morwell Leisure Centre (MLC) fitness professionals and was deemed to be of major benefit to cancer patients in the Latrobe Valley.

Results: Altogether, eight local exercise physiologists were trained and 70 patients participated in the program, three declined. There were group sessions that included between 4 and 19 patients and following the program eight patients continued to use the leisure centre for on-going activity. Feedback from the exercise group has been overwhelmingly positive.

Participants were able to access the leisure centre facilities with confidence as they already knew the fitness team, aiding in sustainability of exercise.

Conclusions: Collaboration between healthcare services and leisure centres is necessary to ensure sustainable exercise programs for oncology patients, outside of the healthcare service. Participants value the support of health professionals in a facility other than a healthcare service.

Angela Ives¹, Christobel Saunders², Karen Taylor³, Kathleen O'Connor³, Lesley Millar¹

¹Medical School, University of Western Australia, Perth, Western Australia, Australia

²University of Melbourne, Melbourne, Australia

³CPCN, WA Health, Perth, WA, Australia

Background: The Cancer Network WA commissioned a Cancer Patient Experience Survey, recognising patient voice as an important pillar of health sustainability. The project aimed to identify areas in cancer care that are important to patients, through determining health service gaps and variations in patient experience across their cancer journey. This work complimented a UWA research programme in value-based cancer care, the CIC Cancer project.

Methods: The All.Can International patient experience survey was adapted for use. Data collected reflected patient experiences of diagnosis, care and treatment plus continuing support and financial impacts of cancer on quality of life. Surveys were mailed to all 10,348 people over 18 years diagnosed with cancer in WA in 2019 and were posted back or completed on-line.

Results: A total of 3238 (31.3%) surveys were received, 3182 via mail and 56 online. Respondents were representative across WA in respect of age, sex, cancer type and location. A strength of findings was the breadth of cancers represented, providing significant insight into diverse cancer journey pathways. More respondents were treated privately (n–1295, 40.0%) than publicly (n–1123, 34.7%) with 742 (22.9%) indicating both. The most commonly reported cancers were prostate (23.3%), breast (19.1%), melanoma (11.5%) and colorectal (9.9%). Well over 80% of respondents were satisfied with their cancer experience.

Rural and remote respondents had additional costs compared to metropolitan respondents if treatment occurred in Perth, especially related to running dual households and travel. Younger respondents indicated every area of their care could be improved, possibly due to higher expectations. Opportunities for improvements, as highlighted by respondents, include improved communication, efficient and timely access, and support.

Conclusion: This is the first cancer population patient experience research conducted in Western Australia. Findings will inform the planning and development of future cancer services. It is recommended further surveys occur regularly.

Angela Ives¹, Karen Taylor², Kathleen O'Connor², Christobel Saunders³

¹The University of WA, Crawley, WA, Australia

²Cancer Network WA, Perth, WA, Australia

³University of Melbourne, Melbourne, Victoria, Australia

Background: The Cancer Network WA commissioned a Cancer Patient Experience Survey, recognising patient voice as an important pillar of health sustainability. The project aimed to identify areas in cancer care that are important to patients, through determining health service gaps and variations in patient experience across their cancer journey. This work complimented a UWA research programme in value-based cancer care, the CIC Cancer project.

Methods: The All.Can International patient experience survey was adapted for use. Data collected reflected patient experiences of diagnosis, care and treatment plus continuing support and financial impacts of cancer on quality of life. Surveys were mailed to all 10,348 people over 18 years diagnosed with cancer in WA in 2019 and were posted back or completed on-line.

Results: A total of 3238 (31.3%) surveys were received, 3182 via mail and 56 online. Respondents were representative across WA in respect of age, sex, cancer type and location. A strength of findings was the breadth of cancers represented, providing significant insight into diverse cancer journey pathways. More respondents were treated privately (n–1295, 40.0%) than publicly (n–1123, 34.7%) with 742 (22.9%) indicating both. The most commonly reported cancers were prostate (23.3%), breast (19.1%), melanoma (11.5%) and colorectal (9.9%). Well over 80% of respondents were satisfied with their cancer experience.

Rural and remote respondents had additional costs compared to metropolitan respondents if treatment occurred in Perth, especially related to running dual households and travel. Younger respondents indicated every area of their care could be improved, possibly due to higher expectations. Opportunities for improvements, as highlighted by respondents, include improved communication, efficient and timely access, and support.

Conclusion: This is the first cancer population patient experience research conducted in Western Australia. Findings will inform the planning and development of future cancer services. It is recommended further surveys occur regularly.

Bishma Jayathilaka^1,2,3, Fanny Franchini², George Au-Yeung^3,4, Maarten Ijzerman^2,5

¹Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

³Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

⁴Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁵Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands

Background: As immune checkpoint inhibitor (ICI) use expands, immune-related adverse events (irAE) emerge as a treatment-limiting factor. (1) Identification of reliable irAE risk predictors is a growing research area.^2,3 Clinical guidelines recommend assessing irAE risk before and during treatment.^4–6 This study explores factors oncology clinicians consider, their perceptions on irAE risk prediction value and potential clinical practice adoption.

Methods: An electronic survey was developed with three sections: (1) current practice, (2) value of risk prediction and (3) vignette study, which contained three clinical scenarios where respondents selected treatment strategy at baseline and with increasing irAE risk. The target audience were health professionals who prescribe or manage patients receiving ICI, including nurse specialists, nurse practitioners, medical oncology trainees and consultants. The survey was validated with 12 clinicians and distributed to members of professional cancer organisations. Data collection occurred between February and July 2023.

Results: Forty responses were included for analysis from consultants (57.5%), trainees (17.5%), nurse specialists (17.5%) and nurse practitioners (7.5%) who practise in various settings and cancer sub-groups. None of the respondents used a risk assessment system/method beyond general risk profiling. If validated, a risk prediction tool was reported to certainly (30%), likely (53%) or possibly (17%) be used in clinical practice. The most preferred value of risk prediction was to tailor patient education, inform frequency of clinic review and follow-up. Perceived barriers include cost, time for pre-treatment assessment and unknown accuracy/specificity. The vignette study underscored potential implications of irAE risk prediction. When confronted with higher predicted irAE risk, clinicians demonstrated a propensity to adjust treatment strategies. Across all scenarios, the choice of single-agent ICI therapy was favoured over combination ICI therapy as predicted irAE risk increased.

Conclusion: Clinicians perceive potential benefits to cancer care and practice from irAE risk prediction, endorsing research into risk identification. A predicted increase in irAE risk was found to be important for ICI treatment selection.

Ria Joseph¹, Nicolas H Hart^1,2,3,4,5, Natalie Bradford², Fiona Crawford-Williams^1,2, Matthew P Wallen^1,6, Matthew Tieu¹, Reegan Knowles¹, Chad Y Han¹, Vivienne Milch^1,7,8, Justin J Holland⁹, Raymond J Chan^1,2,10

¹Caring Futures Institute, Flinders University, Adelaide, SA, Australia

²Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

³Faculty of Health, Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia

⁴Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia

⁵Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia

⁶School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia

⁷Cancer Australia, Sydney, NSW, Australia

⁸The University of Notre Dame, Sydney, NSW, Australia

⁹School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia

¹⁰Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia

Background: Service referrals are required for cancer survivors to adequately access dietitians and exercise professionals (i.e. exercise physiologists and physiotherapists) for specialist dietary and exercise care. Many system-level factors influence the quality and effectiveness of existing referral practices within the healthcare system in Australia. Understanding how those factors are interconnected, and leveraging existing and promoting new synergies between them, can help to identify strategies to enhance facilitators and overcome barriers to referral. The aim of this study was to pioneer a systems-thinking approach to identify system-level factors and innovative strategies for optimising dietary and exercise referral practices.

Methods: A workshop involving national stakeholders by invitation was held to explore these system-level factors. Facilitated group work and discussion were employed to identify barriers and facilitators to referral practices based on the six World Health Organisation building blocks. The systems-thinking approach involved using six cognitive maps, each representing a building block. The characteristics and interactions of the healthcare system that may impact dietary and exercise referral practices for cancer survivors were mapped, highlighting the relationships between system-level factors. A causal loop diagram was developed to enable visualisation of the factors that influence dietary and exercise referral practices. Strategies were identified by leveraging system-level facilitators and addressing system-level barriers.

Results: Twenty-seven stakeholders participated in the workshop, including consumers, cancer specialists, researchers, and representatives of peak bodies, not-for-profit organisations and government agencies. Common system-level factors included funding, accessibility, knowledge and education, workforce capacity and infrastructure. A total of 15 system-level strategies to improve referral practices were also identified.

Conclusions: This study is the first to use a systems-thinking approach to identify system-level factors impacting referral practices for cancer survivors in Australia. Future research and policy efforts should leverage existing system-level factors to optimise dietary and exercise advice and improve referral practices for cancer survivors.

Bridget Josephs¹, Cassie Moore¹, Ash de Silva², Tricia Wright¹, Mahesh Iddawela^1,3, Evangeline Samuel^1,4

¹Latrobe Regional Hospital, Traralgon, VIC, Australia

²Pharmacy, Gippsland Health Alliance, Traralgon, VIC, Australia

³Central Clinical School & Department of Rural Health, Monash University, Melbourne, VIC, Australia

⁴School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Aim: To describe patient and disease characteristics, patterns of care and real-world outcomes in small cell lung cancer (SCLC) in a single regional centre.

Methods: Retrospective audit of all Medical Oncology inpatients and outpatients diagnosed with SCLC between 1 January 2020 and 30 June 2023.

Results: During 1 January 2020 to 30 June 2023, 76 patients were diagnosed with SCLC. 60% were male (n = 45) and 4% (n = 3) were Indigenous Australian. Median age at diagnosis: 66 (range 40–82 years). All had a current or prior smoking history. Most patients had extensive-stage (ES) disease (n = 60, 79%). Limited-stage (LS) SCLC (n = 16, 21%) comprised the remainder. Hyponatremia was present in 25% at diagnosis (n = 19). ECOG performance status at presentation included: 0 (n = 12, 16%), 1–2 (n = 46, 61%), 3 (n = 4, 5%), not documented (n = 14, 18%). Of those with ES-SCLC, brain and liver metastases were present in 18% (n = 11) and 47% (n = 29) patients at diagnosis, respectively.

FDG-PET was utilised for staging in n = 50 patients (66%), including 15 of 16 patients with LS-SCLC. Brain staging was most frequently performed with a CT [CT-brain alone: n = 49 (65%); MRI-brain alone: n = 9 (12%); both modalities: n = 14 (18%)].

Seventy-two patients (95%) received active treatment. Median time from biopsy to first treatment was 9 days [interquartile range (IQR) 6–19 days]. By subgroup: 14 days (IQR 9–25) for LS-SCLC, 8 days (IQR 6–15) for ES-SCLC patients.

MRI-brain surveillance, rather than prophylactic cranial irradiation (PCI), was more frequent in patients with LS-SCLC following completion of definitive treatment (n = 1 received PCI).

At time of analysis, eight (50%) patients with LS-SCLC had relapsed. Of 44 ES-SCLC patients that received first-line carboplatin, etoposide and atezolizumab, survival ranged from 13 days to alive at 25 months and 14 (32%) and 2 (5%) patients had survived ≥12 and ≥24 months, respectively. Fourteen (23%) patients with ES-SCLC received ≥2 lines systemic treatment.

38%(n = 29) of the cohort had brain metastases during their disease course.

Conclusion: We report on SCLC in a regional setting. In identifying opportunities to improve patient care, reviewing supportive and palliative care referral practice would also be useful.

Sachin Joshi, Quan Tran, Mahesh Iddawela, Bhavini Shah

Latrobe Regional Hospital, Traralgon, VIC, Australia

Aim: To evaluate the uptake and utility of the Advance Cancer MDT in Gippsland.

Method: Data was prospectively collected from September 2021 patients referred to the MDT and age, sex, cancer type, cancer stage, type clinical question addressed, clinical trials, precision oncology and palliative care were collected.

Results: Total of 100 patients were discussed and median age was 69 (53–85), 55% of patients were male and 45% were female. Colorectal, breast, lung and prostate cancer were the most frequently discussed among 21 different tumour types including cancer of unknown origin and suspected cancer. 93% of the patients had metastatic cancer 7% of the patients were at early stage. Thirty-one cases were discussed first time in the Gippsland MDT.

This MDT facilitated the management of the patients which included systemic chemotherapy in 39 patients, palliative radiation in 12, symptom control in 10, radiology review for the assessment of the treatment reasons or in diagnostic pathway in 29 patients. In 12 patients, it was decided to stop the systemic treatment and recommended best supportive care only.

Role of the palliative care was discussed in 72 patients.

Clinical trials were discussed in 29 patients and 56 patients were deemed to be eligible for the precision oncology if one to be available.

Conclusion: Advance Cancer MDT is a useful tool in the regional setting to provide evidence-based optimal care. It has a potential to link de novo or recurrent cancer care in MDT setting. ADMDT can be used for wide purposes of care of the patient and has a potential to link the patient to clinical trials, palliative care and supportive care. It has potential to support the clinician to stop the futile management.

Yoon-Jung Kang¹, Qingwei Luo¹, Jeff Cuff¹, John Zalcberg², Karen Canfell¹, Julia Steinberg¹

¹Daffodil Centre, Woolloomooloo, NSW, Australia

²Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia

Publish consent withheld

Mary A Kennedy¹, Annie De Leo¹, Sara Bayes¹, Kim Edmunds², Daniel Galvão¹, Jonathan Hodgson¹, Emily Jeffery³, Joshua Lewis¹, Rob Newton¹, Yvonne Zissiadis⁴

¹Edith Cowan University, Joondalup, WA, Australia

²University of Queensland, Brisbane, QLD, Australia

³Curtin University, Bentley, WA, Australia

⁴GenesisCare Oncology, Perth, WA, Australia

Introduction: Provision of evidence-based exercise and nutrition services in standard oncology care is rare despite national and international calls for widespread implementation. The resultant evidence-to-practice gap means most patients do not receive optimal care, especially in regional areas where accessibility is a known issue. Research is needed to understand and address implementation determinants for exercise and nutrition services in regional oncology care.

Methods/design: This mixed-methods study is a hybrid effectiveness-implementation trial of exercise and nutrition referrals in oncology care in the South West region of Western Australia. The 3-year trial employs a Participatory Action Research (PAR) approach, is governed by Stakeholder and Consumer Advisory Councils and is guided by the Exploration, Preparation, Implementation and Sustainment Framework (EPIS). Exploration: We will use clinical audits, patient surveys, interviews and focus groups to identify existing service gaps and elicit patients’ experiences of receiving care, including mapping existing exercise and nutrition services currently available in the region. Preparation: Using the information collected during the Exploration phase, and in consultation with a Stakeholder Advisory Committee, we will develop a referral system and supporting implementation and evaluation strategies to integrate exercise and nutrition services into standard oncology care. Implementation and sustainment: We will test the effectiveness of the referral system in routine practice, monitoring for necessary adaptations to ensure best-fit solutions. The exploration phase is currently underway.

Discussion: The study will assess the implementation and effectiveness of an integrated referral pathway for exercise and nutrition services in oncology care in regional Australia. Findings from this study will inform future efforts to provide optimal supportive cancer care for all people living with and beyond cancer and improve health outcomes for people receiving cancer treatment in regional settings.

Youngeun Koo¹, Jesmin Shafiq^1,2,3, Jana Yanga¹, Sandra Avery¹, Shalini Vinod^1,2,4

¹Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia

²Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

³School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia

⁴South West Sydney Clinical Campuses, UNSW, Liverpool, Sydney, Australia

Background: Multidisciplinary meetings (MDMs) play a vital role in cancer care, and there is a growing focus on improving their decision-making efficiency. Various validated tools have been utilised to assess MDM performance across the UK, Austria, Germany, Sweden and I Netherlands. However, there have been no studies examining this matter within the Australian context. We present a prospective study examining various MDMs across three cancer centres within the South Western Sydney Local Health District.

Methods: This prospective observational study encompassed 14 different MDMs across three cancer centres. For each MDM, two trained observers participated in four meetings, assessing the quality of information presented and the team members’ contributions to cases in real time. This evaluation utilised the validated Metric for the Observation of Decision-Making (MDT-MODe) tool, scoring behaviours on Likert scales, with five representing the evidence-based optimal behaviour, and one representing behaviour contrary to the defined optimum.

Results: A total of 64 MDMs were observed (N = 498 patients), averaging seven cases per meeting (range 2–15), with management decisions made in 99% of the cases. Patient's psychosocial factors (M = 1.27, SD = .70), comorbidities (M = 1.69, SD = 1.13) and patient's views (M = 1.12, SD = .51) were notably less comprehensively addressed compared to radiology (M = 4.10, SD = 1.52), pathology (M = 3.73, SD = 1.54) and patient history (M = 4.60, SD = .73) (p < 0.05). Regarding disciplinary contributions, cancer specialist nurses scored considerably lower (M = 1.04, SD = .38) compared to other team members (surgeons, M = 3.33; radiation oncologists, M = 3.93; medical oncologists M = 3.05; pathologists, M = 3.34; radiologists, M = 3.74) (p < 0.05).

Conclusion: Evaluating MDMs through observation and a validated tool provides valuable insights into decision-making quality across various MDMs. Our investigation revealed a consistent standard of comprehensive medical information and team contributions, while also highlighting certain areas for improvement. Analysing behaviour ratings across different MDMs will yield further insights into the strengths and weaknesses of each group. These combined findings provide an opportunity for offering feedback to MDMs, facilitating identification of potential interventions for improvement.

Judith Lacey^1,2,3, Kim Kerin-Ayres¹, Suzanne Grant^1,2, Justine Stehn¹, Geraldine McDonald⁴

¹Chri’ O'Brien Lifehouse Comprehensive Cancer Centre, Camperdown, NSW, Australia

²NICM Health Research Institute, Western Sydney university, Sydney, New South Wales, Australia

³The University of Sydney, Sydney, Australia

⁴Prevention & Wellbeing, Peter MacCallum Cancer Centre, Melbourne, Melbourne, Victoria, Australia

Aim: To develop key recommendations to guide safe and effective integration of Integrative Oncology programs into comprehensive cancer care in Australia and identify advocacy strategies.

Background: The development of Integrative Oncology (IO) can be considered as a natural evolution and needed contribution to caring for the whole person with cancer from the time of diagnosis and beyond. Services using various models to deliver IO have been developed globally to meet patient demand and address the growing population of people living with cancer.

To build sustainable IO services which are part of standard oncology care, advocacy to our local and national governing bodies whether government, health service providers, funding bodies or a combination of these is essential. Advocacy for funding with increasingly challenging health budgets, clarity around workforce skills, training and credentialing, research and affordable service provision is required to enable the seamless integration into comprehensive cancer care.

Method: National representatives from the major IO and wellbeing services aided by external independent academics and consumer advocates collaborated to develop and publish a White Paper, Integrative Oncology and Wellbeing Centres in Cancer Care, to start a national conversation.

Results: The White Paper set out key priorities for making Integrative Oncology accessible and affordable to more Australians including developing a national strategy, accredited training programs, cost-effective delivery of therapies and ongoing investment in research. It was launched formally at national parliament late 2022 and endorsed by many key institutions.

Different models in Australia of IO and wellness service were identified demonstrating alignment with key principles of the Australia cancer plan. Six key recommendations to progress integration, and safety in development of services were made. Barriers and facilitators identified.

Conclusions: Six key recommendations will be used as a point of reference to identify shared experience and how we can work together to articulate a clear advocacy and service development strategy.

Julia Lai-Kwon^1,2, Claudia Rutherford³, Michael Jefford^1,2,4,5, Claire Gore⁶, Stephanie Best^2,4,7,8

¹Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Sydney Quality of Life Office, University of Sydney, Sydney, NSW, Australia

⁴Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

⁵Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁶Department of Psychology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁷Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia

⁸Australian Genomics, Murdoch Childr'ns' Research Institute, Melbourne, VIC, Australia

Background: Electronic patient-reported outcomes (ePROs) are an evidence-based means of detecting symptoms earlier and improving patient outcomes. However, there are few examples of successful implementation of ePROs in routine cancer care. Use of implementation science frameworks may support successful implementation. We conducted a qualitative study to identify barriers and facilitators to implementing ePRO symptom monitoring in routine cancer care using the Consolidated Framework for Implementation Research (CFIR).

Methods: Participants were adult cancer patients, their carers and a range of healthcare professionals who might be involved in ePRO monitoring and processes. Focus groups or individual interviews were conducted using a semi-structured approach informed by the CFIR, exploring barriers and facilitators to implementing ePRO monitoring. Data was analysed deductively using the CFIR. Barriers were matched to theory-informed implementation strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool.

Results: Thirty participants were interviewed: 22 females (73%), 31–70 years old (28, 94%), comprising: patients (n = 8), carers (n = 2), medical oncologists (n = 4), nurses (n = 4), hospital leaders (n = 6), clinic administrators (n = 2), pharmacists (n = 2) and IT specialists (n = 2).

Barriers pertaining to CFIR domains intervention characteristics (IC), inner setting (IS) and characteristics of individuals (CI) were identified and several were novel. An example of a novel IC barrier was the challenge of adapting ePROs for toxicities associated with different anti-cancer treatments. Facilitators pertaining to CFIR domains IC, outer setting, IS, CI and process were also identified. An example of a novel IS facilitator was leveraging technological advances in remote care post-COVID-19 to drive implementation. Conducting local consensus discussions, identifying/preparing champions, and assessing readiness and identifying barriers and facilitators were the most frequently recommended implementation strategies.

Conclusion: The CFIR facilitated identification of known and novel barriers and facilitators to implementing ePRO monitoring in routine cancer care. Facilitators and theory-informed implementation strategies will be used to co-design an ePRO system for monitoring for possible side-effects of immunotherapy.

Cheng Ming Li¹, Elizabeth Austin², Brette Blakely², Ann Carrigan², Karen Hutchinson², Jessica L Smith³, Robyn Clay Williams²

¹Faculty of Medicine, Health and Human Services, Macquarie University, Macquarie Park, NSW, Australia

²Centre for Healthcare Resilience and Implementation Science, Australian institute of health innovation, Sydney, NSW, Australia

³School of Medicine, University of Western University, Sydney, NSW, Australia

The oncology patient's journey in a clinical trials unit: the experienced and hidden activities

Aims: To understand the oncology patient's journey in the clinical trials unit (CTU) and analyse experience enhancers and barriers.

Method: Ethnographic field study utilising qualitative methods including patient shadowing, observations and semi-structured interviews to obtain primary data. Functional resonance analysis method (FRAM) was then used to create journey maps.

Results: Ten patients and seven staff consented and were recruited for the research. Two maps were built using FRAM visualiser pro software, the base model and the comprehensive model. The base model illustrated 21 tasks directly experienced by patients. The comprehensive model had an additional of 18 tasks (n = 39) identified that mainly related to the background task performed by staff that were essential for a smooth and efficient patient experience but not necessarily known to patients. By analysing the two models, the central role of the doctor and clinical trials coordinators were identified. Additionally, coherent transition of tasks and creativity in processes were factors that enhanced smooth and positive patient journeys within the clinic.

Conclusion: The patient journey in CTUs involved many tasks and interactions with different clinic staff of the clinic. This research has provided evidence on the complexity of the journey and revealed areas that can enhance or negatively impact the experience. Important enhancers include improved staff communication, collaboration and creativity; whilst main barriers identified include limitations in physical space and potential breakdowns in communication.

Dan Luo, Jane McGlashan, Klay Lamprell, Gaston Arnolda, Jeffrey Braithwaite, Yvonne Zurynski

Australian Institute of Health Innovation, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia

Background and aim: Consumer involvement is recognised as a crucial strategy to improve health services and is advocated by the World Health Organisation and many health systems. There is a significant gap in knowledge about consumer engagement in practice, including consumers’ involvement in the process of improving cancer services. Few studies have explored consumers’ own views about their involvement in cancer care and health service improvement. This study aimed to explore these perspectives.

Methods: Cancer consumer representatives were recruited through Integrated Cancer Services in Victoria, Australia. Eligible consumers were, or had been, a member of a health service improvement-related committee or project and attended at least one meeting with health professionals. Semi-structured qualitative interviews were conducted online and transcribed verbatim. Data were analysed using inductive thematic analysis.

Results: Six experienced participants were interviewed. Perspectives on their involvement in improving cancer services were categorised into three major themes. The first addressed personal aspects of involvement, in which participants described personal motivations (e.g. having lived experience of cancer themselves or in their family), challenges encountered, the need for greater diversity of consumer representation, evolving identity as a consumer representative, and support needed and received at committee and organisational levels. The second discussed practical contributions made by consumer advocates to improve systems and services. Participants detailed their active engagement with committees and consumer-led projects, contributing both their cancer experience and general or professional skills acquired over their lifespan. The third theme outlined potential improvements to support more meaningful and integrated involvement of consumers in the health system. Suggestions highlighted widening consumers’ representation to include often marginalised voices to inform decision-making at both local committee and health system levels.

Conclusions: The study enhanced our real-world understanding of the role that cancer consumers play in improving health services. Health leaders need to keep striving for greater inclusion of health consumers in service planning and implementation.

Vivienne Milch^1,2,3, Susan Hanson¹, Sarah McNeill¹, Helen Hughes¹, Serena Ekman¹, Claire Howlett¹, Dorothy Keefe^1,4

¹Cancer Australia, Surry Hills, NSW, Australia

²School of Medicine, The University of Notre Dame, Sydney, NSW, Australia

³Caring Futures Institute, Flinders University, Adelaide, SA, Australia

⁴School of Medicine, University of Adelaide, Adelaide, SA, Australia

Introduction: The use of genomics across the cancer continuum is expanding rapidly, with broad implications for cancer control, including patient care, service delivery, workforce, research and data, and policy.

Methods: Cancer Australia developed the Australian Cancer Plan with extensive consultation across the sector to determine a 10-year reform agenda to improve experience and outcomes for all Australians affected by cancer. Public submissions highlighted equitable access to genomics in cancer control as a key priority. A desktop review of national and international general and cancer-specific genomics policy frameworks identified an evidence gap in national cancer-specific genomic policy. A multidisciplinary expert advisory group was established to guide the development of a National Framework for Genomics in Cancer Control for Australia.

Results: Development of the Framework has commenced as an early implementation priority of the Australian Cancer Plan. Two key areas have emerged as critical for the Framework: the role of genetic testing in prevention, risk-stratified screening and early detection of cancer; and the use of genomics to inform clinical trials, personalised treatments and supportive care for cancer, in particularly for advanced and rare cancers. The Framework development process will adopt a co-design approach with Aboriginal and Torres Strait Islander communities to ensure that it is culturally appropriate and includes consideration of Indigenous Data Sovereignty.

Conclusions: An important opportunity exists to improve equitable cancer outcomes in Australia via a National Framework for Genomics in Cancer Control. The Framework will be for consumers, health professionals, policymakers, researchers, governments, non-government organisations, industry and the community. It will establish approaches to determining who, how and when people at risk of, and with cancer, will have access to genomics, with a focus on mitigating the risk of broadening disparities in care and outcomes.

David Mizrahi¹, Jonathan Lai², Hayley Wareing², Yi Ren², Tong Li¹, Christopher Swain³, David Smith¹, Diana Adams⁴, Alexandra Martiniuk¹, Michael David¹

¹The Daffodil Centre, A Joint Venture with Cancer Council NSW, The University of Sydney, Sydney, NSW, Australia

²University of Sydney, Sydney, Australia

³Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia

⁴Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia

Background: Exercise during cancer treatment is safe, reduces side-effects and can potentially reduce hospital length of stay. This systematic review and meta-analysis of randomised controlled trials is the first to investigate whether participating in an exercise intervention during chemotherapy, radiotherapy or stem cell transplant cancer treatment regimens reduced the duration and frequency of hospital admissions.

Methods: Four electronic databases (Medline, EMBASE, PEDro and Cochrane Central Registry of Randomised Controlled Trials) were systematically searched from inception until March 2023. Eligible studies included randomised controlled trials which evaluated exercise interventions implemented during chemotherapy, radiotherapy or stem cell transplant regimens compared with usual care, and which assessed hospital admissions. Study selection and data extraction were dual-screened. Study quality was assessed using the Cochrane Risk-of-Bias tool (RoB 2) and GRADE assessment. Meta-analyses were conducted by pooling the data using random-effects models.

Results: Of 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention, 1252 control, 62% female, mean age = 52.2 ± 10.9 years from 18 adult studies and 11.2 ± 3.5 years from two paediatric studies). Twelve studies were conducted during hematopoietic stem cell transplantation and eight during chemotherapy regimens. There was a small effect size in a pooled analysis that exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: −2.26 to −.54 days; low-quality evidence), and an 8% lower rate of hospital admission (difference in proportions = −.08, 95% CI: −.13 to −.03, low-quality evidence). Most interventions reporting safety reported no adverse events, with three adverse events reported in two studies.

Conclusion: Exercise during cancer treatment can decrease both hospital length of stay and admissions. A small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, its inclusion as standard practice for most patients who would benefit should be considered as cancer care pathways evolve.

Meng Tuck Mok¹, Tilini Gunatillake¹, Kalinda Griffiths², Vijaya Joshi¹, Jennifer Philip³

¹VCCC Alliance, Melbourne, Victoria, Australia

²College of Medicine and Public Health, Flinders University, Darwin, WA, Australia

³Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia

Aim: To identify and capture data on culturally and linguistically diverse (CALD) communities within Victorian cancer services to assist with the effective allocation of resources.

Methods: A round table discussion is scheduled for September 2023, bringing together stakeholders who have worked with or within CALD communities, and representatives from cancer services. A scoping paper on the current research on barriers faced by individuals within these communities from accessing and experiencing quality healthcare services and a data dictionary collating the recommended National Standards for Statistics on Cultural and Language Diversity will be presented. Main discussion topics include equity in cancer care and outcomes, measuring and reporting of diversity based on the lived experiences of the CALD community, defining the CALD population, identifying barriers to CALD data collection at various levels (hospital, state and national) and introducing strategies to overcome these barriers.

Results: The goal is to establish standardised data collection practices that will facilitate a better understanding of the systemic barriers within the cancer sector that CALD communities face.

Conclusions: Establishing baseline data on how CALD data is currently collected within Victorian Comprehensive Cancer Centre Alliance health services can identify shortcomings and areas for improvements. This will help define what dataset should be collected to help achieve better health outcomes and increase equity in cancer care for the broader CALD community.

Cassandra Moore

Latrobe Regional Hospital, Toongabbie, VIC, Australia

Introduction: Multidisciplinary meetings (MDM's) allow for joint decision making by a panel of experts, which in turn improves time to diagnosis, treatment decisions and patient quality of life. Latrobe Regional Hospital (LRH) hosts a centralised weekly Lung MDM to support the Gippsland population. Data from the Lung MDM is collected for quality improvement purposes.

Description/methodology: Between January 2019 and June 2022, retrospective data was obtained on all patients discussed at the Gippsland Lung MDM with a new diagnosis of lung cancer.

Preliminary results: A total of 420 patients were diagnosed with lung cancer. A total of 234 (55.7%) were male, 186 (44.2%) were female, including 10 (2.3%) Indigenous Australians. The median age at diagnosis was 74 years (40–94). Non-small cell lung cancer (NSCLC) histologies contributed to 344 (81.9%) of diagnoses and small cell lung cancer (SCLC) to 76 (18.0%). Thirty-seven (8.8%) patients did not receive a histological diagnosis. More than half of patients, 218 (56.0%) had stage IV disease at diagnosis, with stage I–III lung cancers recorded at 81 (19.2%), 444 (10.4%) and 92 (21.9%), respectively.

The most common methods of tissue diagnosis included Computer Tomography (CT) guided percutaneous biopsy (n = 128, 53%), bronchoscopy (n = 43, 10%), plural fluid cytology (n = 29, 6.9%), mediastinoscopy (n = 18, 2.2%) or other percutaneous or surgical biopsy (n = 68, 16.1%). A total of 103 (24%) of patients had an Endobronchial Ultrasound (EBUS) to obtain tissue or to confirm staging. All 480 patients had a CT chest scan and 187 (44.5%) had a Positron Emission Tomography (PET) scan. Brain imaging, including magnetic resonance imaging (MRI) and CT, occurred in 169 (40.2%) patients, including 118 (28%) and 55 (13%) patients, respectively.

Bronwyn Newman, Ashfaq Chauhan, Mashreka Sarwar, Reema Harrison

Macquarie University Sydney Australia, Macquarie University, NSW, Australia

Aims: To explore the health system factors that promote engagement between cancer care providers and culturally and linguistically diverse (CALD) consumers to enhance safety in cancer services.

Background: Patient engagement can enhance patient safety; this is crucial for people from CALD backgrounds who are at increased exposure to safety events. Yet there is a lack of knowledge about the system, service and interpersonal factors that facilitate engagement with patients from CALD backgrounds.

Methods: A cross-sectional qualitative descriptive study was conducted using semi-structured interviews with cancer service staff and consumers from CALD backgrounds from four cancer services in NSW and Victoria, Australia. Consumers included patients, family or supporters. Data was both deductively and inductively analysed by the research team using a Framework Analysis method grounded in Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 Model.

Results: We conducted a total of 72 interviews, 54 interviews with staff and 18 with consumers from CALD backgrounds who had accessed cancer care at participating sites. Shared understanding of care processes, tasks and instructions between staff and consumers from CALD backgrounds was identified as essential to enable consumers to seek timely, appropriate care. The theme of ‘establishing shared common understanding’ was evident in the data across the five SEIPS model domains of: person, task, tools and technology, environment and organisation. Strategies such as readily available interpreter services for both formal and informal interactions, translated information and flexibility to incorporate family members in activities or appointments were identified as supporting engagement.

Conclusions: This research underscores the need for a systemic health service commitment to creating and resourcing environments, processes and interactions that foster engagement with culturally and linguistically diverse consumer groups. Effective strategies and resources are available, but access is inconsistent. Organisational support is vital to develop and maintain service capacity to facilitate engagement.

Tri Nguyen, Kate Whittaker, Drew Meehan, Tanya Buchanan, Megan Varlow

Cancer Council Australia, Sydney, NSW, Australia

All Australians affected by cancer should be supported to access and receive optimal cancer care. However, the reality is many Australians affected by cancer experience significant financial burden, with the cost of cancer significantly impacting treatment decisions and cancer outcomes. Australians diagnosed with cancer and their families should not be financially ruined by cancer or receive sub-optimal cancer care because of the financial impact of cancer.

Further to work presented at the 2022 COSA ASM, Cancer Council Australia has now finalised the first chapter of the National Cancer Care Policy focussing on the Financial Cost of Cancer. The policy priorities in this chapter aim to address the financial cost of cancer in alignment with the three components of the COSA Financial Toxicity Working Group's definition of financial toxicity: (1) decrease the impact of the direct costs of cancer, (2) decrease the impact of the indirect financial costs of cancer and (3) address changing financial circumstances that arise due to cancer. The chapter was underpinned by several literature reviews, with policy priorities developed in consultation with individuals and organisations with expertise in the financial cost of cancer, and cancer care.

Four policy priority areas were identified: (1) Ensure the implementation of the Standard for Informed Financial Consent; (2) improve the experience of people with cancer who require income support payments; (3) improve financial support for people living in regional and remote areas to access cancer treatment and care and (4) support increased access to financial counsellors across Australia. A further five priority areas were suggested for future exploration and development.

The Financial Cost of Cancer chapter of the National Cancer Care Policy reflects the Australian cancer care environment and provides feasible and actionable policy solutions that would support more equitable cancer outcomes and support delivery of several of the goals and priorities of the Australian Cancer Plan.

Kelly F Nunes-Zlotkowski^1,2, Heather Shepherd^1,3, Lisa Beatty^1,4, Phyllis Butow^1,2, Joanne Shaw^1,2

¹School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, New South Wales, Australia

²School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia

³Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia

⁴Clinical Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia

Background: Lifetime prevalence estimates of major depression (18%) and anxiety (24%) in patients¹ with cancer are higher than those in the general population.^2,3 Despite availability of effective cancer-specific interventions for depression and anxiety, treatment uptake in psycho-oncology is low.^4,5 Reasons for low uptake include workforce issues and geographic barriers to access. Blended psychological therapy (BT) may help increase acceptability of and engagement with treatment in psycho-oncology as it combines patient-driven, online therapy with therapist-facilitated sessions.^6–8 BT may improve access to treatment, uptake and adherence, treatment maintenance and therapy effects.^9–11 Research supports the acceptability and feasibility of different models of BT in non-cancer context but evidence in psycho-oncology is limited.

Aim: This study aimed to explore psycho-oncology stakeholders (service managers, psychologists) views on the feasibility and acceptability of BT models and barriers and facilitators to implementation into psycho-oncology care in Australia.

Method: Psychologists working clinically with cancer patients and psycho-oncology service managers were recruited to participate in qualitative, semi-structured telephone interviews to explore feasibility and acceptability of BT models and to identify barriers and facilitators to implementation. Interviews were analysed qualitatively using a Framework Analysis approach.¹²

Results: Twenty-two participants (psychologists, n = 17; service managers, n = 5) were interviewed. Thematic analysis identified three themes: (i) patient engagement, (ii) perception of control and (iii) system factors. An overarching theme of trust underpins the themes. Specifically, the use of digital technology was perceived both as a barrier to patient engagement but also as providing flexibility for access. Clinicians voiced concerns regarding duty of care and lack of autonomy to deliver therapy but also noted BT could optimise clinician time and resources. Finally, there were concerns about service over-reliance on the digital component as a means of reducing dedicated psycho-oncology positions.

Jasmine Ekaterina Persson¹, Melanie Hamilton², Grace Mackie¹, Sophie Lewis³, Frances Boyle^1,4, Andrea Smith²

¹Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia

²Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

³Sydney School of Health Sciences, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia, Sydney, NSW, Australia

⁴Mater Hospital, North Sydney, Sydney, NSW, Australia

Background: Research demonstrates that stage-specific support groups for people living with metastatic breast cancer (MBC) are more appropriate and beneficial than mixed-stage groups. Despite this evidence, stage-specific MBC support groups are not widely available in Australia. This study aimed to explore the system- and organisational-level factors that potentially influence provision of MBC support groups from the perspective of key informants (KI) within cancer supportive care services.

Methods: Participants (n = 19) were identified based on their expertise in cancer supportive care and purposefully recruited using publicly available contact information. Data were collected through in-depth semi-structured interviews and analysed using inductive thematic analysis.

Results: We identified three themes relating to systemic barriers and challenges to the provision of professionally-led MBC support groups: (1) the lack of a national framework that informs the governance, standards, delivery model and running of MBC support groups; (2) the importance of appropriate facilitator training and (3) the reliance on inconsistent funding (including appropriate renumeration) to support the provision of support groups for MBC. Better understanding of research information and epidemiological data collection were stated to be a fundamental requirement for advocacy and service planning for the emergent MBC population.

Conclusions: Participants identified key system-level factors that must be addressed to ensure equitable and sustainable provision of support groups for people living with MBC.

Megan Prictor¹, Nikka Milani¹, Amelia Hyatt^2,3

¹University of Melbourne, Carlton, VIC, Australia

²Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

Aim: New technologies are harnessing recordings to populate medical records, offer clinical decision support and create useful summaries for patients. The benefits of allowing patients to record their healthcare consultation are supported by extensive evidence detailing improved recall, understanding, satisfaction and other outcomes. Nonetheless, recording is not always appropriate, and concern about medico-legal issues hampers its use. Subsequently, local policies are predominantly relied on to guide practice. This scoping review aims to (a) examine hospital policies that apply to audio-visual recording to provide an overarching picture of healthcare consultation recording policy in Australia, and (b) assess their alignment with relevant laws.

Methods: JBI methodology for scoping reviews was adopted. The websites of Australia's largest public hospitals were searched, and 43 hospitals contacted directly. Data from policies were extracted using Covidence software by one reviewer and checked by a second reviewer. Assessment included whether policies were publicly available, their intended audience, their scope and contents. Data were analysed using descriptive qualitative content analysis, and policies compared with law.

Results: Policies about recording were identified at 17/43 hospitals. Many contain little detail about the circumstances in which recording can/cannot occur, and provide no explanation for policy decisions. In 41% (n = 7) of hospitals, patients are permitted to make recordings with consent, whereas in 29% (n = 5) of hospitals, such recordings are entirely prohibited. In 59% (n = 10) of hospitals, there is no guidance about staff recording patients. In only 6% (n = 1), hospitals do the policy explicitly accord with legislation.

Conclusions: This review shows that Australian hospital policies about recording are largely inaccessible, contain minimal detail, and in almost all instances are more restrictive than statutory requirements. The lack of consistency between tertiary health service policies about consultation recording indicates a need for greater support of health services to encourage the lawful use of consultation recording.

Rebecca Purvis^1,2, Sharne Limb^1,2, Mary-Anne Young^3,4, Natalie Taylor⁵, Paul James^1,2, Laura Forrest^1,2

¹The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia

²Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

³Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia

⁴School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Clinical Campus, Sydney, New South Wales, Australia

⁵School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia

Polygenic scores (PGS) capture a proportion of the genomic liability for complex disease. There are evidence gaps regarding their clinical implementation, with little evidence on implementation determinants and no specific framework to guide a future implementation approach. The objective of this multi-phase mixed-methods study was to explore professionals’ views on the clinical implementation of PGS, including their expected barriers, enablers, priorities and needs. We conducted a landscape analysis of professional statements and guidelines via a systematic scoping review, informed by the Arksey and O'Malley framework and the PRISMA-ScR checklist. Data were collected through two search strategies across six databases and manual screening of 145 professional websites. Descriptive and deductive content analyses were completed using the Consolidated Framework for Implementation Research (CFIR) 2022. We concurrently conducted semi-structured interviews with genetic healthcare providers across Australia, examining their views towards implementation of PGS in the hereditary cancer setting, again using the CFIR 2022 to structure the interview guide and the multi-phase coding approach. Twenty-seven statements were included in the review, from 3553 identified records. Professional groups identified evidence strength and relative advantage of PGS as the highest intensity determinants, with structural characteristics and availability of resources within the implementation context also prioritised. Significant commonalities in determinants existed across healthcare contexts, suggesting the value of a transferable implementation approach. Interviews were conducted with 26 Australian providers across all States. Participants were majority female (88.5%) with 14.6 years of experience on average (range .5–35 years). Providers felt similarly to professional groups, although prioritisation of determinants differed by professional role. Providers felt implementation of PGS was inevitable and focussed on trust in the evidence and their colleagues, compatibility with current care pathways, and resourcing shortages as major barriers. This evidence can guide policy development, resource allocation and future priority setting in the hereditary cancer sector and other healthcare contexts.

Md Mijanur Rahman¹, Shafkat Jahan², Elysia Thornton-Benko^3,4,5, Mahesh Iddawela⁶, Raymond Chan⁷, Bogda Koczwara⁸, Nicolas Hart⁹, Gail Garvey¹⁰

¹The Daffodil Centre, The University of Sydney; A Joint Venture with the Cancer Council NSW, Figtree, NSW, Australia

²First Nations Cancer and Wellbeing Research Team School of Public Health, The University of Queensland, Brisbane, QLD, Australia

³School of Clinical Medicine, Faculty of Medicine and Health, The Behavioural Sciences Unit, University of New South Wales, Kensington, Sydney, NSW, Australia

⁴Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia

⁵Specialist General Practitioner/Primary Care Physician, Bondi Road Doctors, Bondi Junction, NSW, Australia

⁶Medical Oncologist, Alfred Health & Latrobe Regional Hospital, Melbourne, VIC, Australia

⁷Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

⁸Senior Staff Specialist, Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

⁹Human Performance Research Centre School of Sport, Exercise, and Rehabilitation INSIGHT Research Institute/Faculty of Health University of Technology Sydney (UTS), Sydney, NSW, Australia

¹⁰School of Public Health Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

Background: Chronic disease is prevalent among cancer survivors. This study aimed to examine the utilisation of Medicare-funded Chronic Disease Management (CDM) item numbers among cancer survivors and sociodemographic predictors of utilisation.

Methods: In this population-based retrospective study, we analysed CDM item number use for 86,571 adult cancer survivors who survived at least one year after a cancer diagnosis, identified in the CancerCostMod dataset – a linked administrative health dataset for all cancer diagnoses in Queensland between July 2011 and June 2015. The outcome was the initiation of at least one General Practitioner Management Plan (GPMP), Team Care Arrangement (TCA), Review (GPMP/TCA) or allied health services until June 2018.

Results: A total of 47,615 (55%) survivors initiated at least one GPMP; 43,286 (50%) initiated at least one TCA; 31,165 (36%) had at least one review of plan and 36,359 (42%) accessed at least one allied health service. Allied health services accessed include physiotherapists (41%, n = 14,907), podiatrists (27%, n = 9816) and accredited exercise physiologists (19%, n = 6908), with variations by cancer type. While survivors from lower socioeconomic groups had a higher likelihood of receiving GPMP (OR: 1.16, 95%CI: 1.11–1.21) and TCA (OR: 1.12, 95%CI: 1.07–1.16), they were less likely to access any allied health service (OR: .89, 95%C— .85–.93). Survivors living in remote areas were less likely to access TCA (OR: .84, 95%C— .80–.88) and allied health services (OR: .63, 95%C— .60–.67) than those in the metropolitan areas.

Conclusion: Moderate utilisation of CDM item numbers was observed, with notable variations by survivors’ characteristics and cancer type. Further research should comprehensively explore whether disparities in the utilisation of CDM items are greater in cancer survivors compared to other conditions, and whether the utilisation of the items meets cancer survivors’ service needs. Future research should also consider developing strategies to address disparities and improve equitable access to services provided under Medicare-funded CDM.

Sameerah Arif, Jesvinder Kaur, Stephanie Lawson, Claire Rickard, Linda Nolte

Austin Health, Heidelberg, VIC, Australia

Aim: To review cancer multidisciplinary meeting (MDM) practices and audit results of health services within the North Eastern Melbourne Integrated Cancer Service (NEMICS) region against the Victorian Cancer Multidisciplinary Team Meeting Quality Framework.¹

Methods: During September 2022 and May 2023, a mixed methods review of NEMICS MDMs was conducted. A desk-top review of past reported MDM performance against the eight quality standards and measures of the Quality Framework was undertaken. Current health services’ MDM policies, activity data, meeting practices and billing methods were examined. 2021 Cancer Service Performance Indicator (CSPI) MDM audit results were analysed.

Results: Thirty-seven MDMs across the four health services were included in the review. None of the health services were compliant with all the Quality Framework's standards. One of four health services had an MDM governance structure. Only 11% (n = 4) of MDMs had up-to-date terms of reference (TOR) to define their purpose, membership, documentation and evaluation requirements. Less than a quarter (22%, n = 8) of MDMs had a membership that aligned with the relevant Optimal Care Pathway (OCP).² MDM patient information was not available from any of the health services. Growth in patient presentations and activity demonstrated limited patient presentation time. The MDM software used in three of the four health services, did not capture the minimum MDM dataset. Current billing methods generate limited revenue. CSPI results indicate that none of the health services met targets such as relating to communicating the treatment plan to the patient's general practitioner.

Kate E Roberts^1,2, Bryan A Chan^3,4, Victoria Donoghue⁵, Paul Leo⁶, Hazel Harden⁵, Shoni Philpot⁷

¹Princess Alexandra Hospital, Brisbane, Queensland, Australia

²University of Queensland, School of Medicine, Brisbane, Queensland, Australia

³Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

⁴Griffith University, Nathan, Queensland, Australia

⁵Australian Families 4 Genomics (AF4G), Brisbane, Queensland, Australia

⁶Australian Translational Genomics Centre (ATGC), Brisbane, Queensland, Australia

⁷Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

Background: Madeline's Model offers free upfront genomic testing to Queenslanders with cancer aged 15–40 and people diagnosed with a rare cancer. When consenting for sequencing, patients are offered the option to donate their genomic and personal health data to the Australian Omics Library, where it can support a limitless number of ethically approved research projects and trials.

Methods: Person-centred design methods were adopted with young people and families leading the co-design process. The experiences of young people, families, clinicians, researchers, policy, legal and ethics professionals were explored during workshops using the world café method. Extensive consumer and stakeholder engagement was conducted to provide upfront genomic sequencing to people admitted at a metropolitan and regional hospital (Princess Alexandra and Sunshine Coast University Hospital). Dual consent allowed for, consent of whole exome sequencing and to donate genomic and omics information to the Australian Omics Library. The consolidated genomics library will allow approved researchers and clinicians to access peoples’ genome sequencing, medical history and treatment.

Results: The initial 16 sequenced patients, ages ranged from 18 to 68 years, median age 30. 59% (n = 10) were give a recommendation for targeted therapy or involvement in a clinical trial. This included the identification of an FGFR2 fusion in a cancer of unknown primary, and a PALB2 germline mutation in a patient with nasopharyngeal carcinoma.

Conclusion: Madeline's Model fills important gaps for young people and families in existing research-oriented approaches to genomics. The model has enabled young people to have an ongoing longitudinal summary of their cancer journey being compiled for their future access. It is a flagship patient and public voice initiative that supports precision medicine and accelerates research.

Luna Rodriguez Grieve¹, Nicci Bartley¹, Emily Pegler², Craig Carson², Laura Kirsten³, Cindy Wilson⁴, Betsy Sajish³, Joanne Shaw¹

¹The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, Sydney, NSW, Australia

²The University of Queensland, School of Public Health, First Nations Cancer and Wellbeing Research Team, Herston, QLD, Australia

³Nepean Hospital, Nepean Cancer and Wellness Centre, Nepean, NSW, Australia

⁴Nepean Blue Mountains LHD, Supportive and Palliative Care Service, Nepean, NSW, Australia

Aims: Bereavement care can help individuals adjust to the death of a loved one, reducing immediate distress and long-term morbidity. Bereavement resources that provide psychoeducation, and practical and legal information requirements, are key aspects of bereavement care. This research aimed to review the understandability, actionability, readability and cultural appropriateness of resources currently provided to bereaved individuals within palliative and cancer care at an Australian healthcare setting.

Methods: Resources were evaluated to assess (i) understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), (ii) readability using the Sydney Health Literacy Lab editor, (iii) cultural inclusivity for Aboriginal and Torres Strait Islander people and (iv) accessibility for culturally and linguistically diverse (CALD) populations.

Results: Thirty print resources were identified and assessed. The materials included information on grief (n = 12), bereavement resource lists (n = 8), practical guides (n = 7), bereavement pack introductions (n = 2) and a Memorial Day invitation.

The mean PEMAT score for understandability was 60% (range 46%–80%) and actionability was 27% (range 0%–80%), indicating poor understandability and actionability. The mean readability grade was 11.9, significantly higher than the grade 8 reading level recommended for the general public. Four resources scored 1 out of 7 for relevancy to Aboriginal and Torres Strait Islander people, the remaining resources scored 0, demonstrating minimal cultural inclusivity. Nine resources contained information aimed at CALD populations, but accessibility was limited.

Conclusions: Our review highlighted current bereavement resources require a high level of literacy and are not inclusive for diverse populations. Attention to health literacy principles and cultural inclusivity is required to ensure the needs of all bereaved people are met.

Lachlan Roth^1,2, Tara Poke¹, Marissa Ryan^1,3,4

¹Princess Alexandra Hospital, Brisbane, QLD, Australia

²Sunshine Coast University Hospital, Birtinya, QLD, Australia

³Centre for Online Health, University of Queensland, Brisbane, Australia

⁴Centre for Health Services Research, University of Queensland, Brisbane, Australia

Background: A significant proportion of patients with cancer experience Potentially Avoidable Readmissions (PARs). The complexity of cancer therapies and supportive medication regimens predisposes patients with cancer to non-adherence or misunderstanding. It is therefore imperative patients are provided with a Discharge Medication Record (DMR). The increasing number of outlying cancer inpatients and reduced weekend pharmacy staffing may impact DMR provision.

Aim: This study investigated the completion rate of DMRs for adult patients discharged from the care of oncology and haematology inpatient teams on weekdays, Saturdays and Sundays. A secondary aim was to determine if there was a difference in DMR provision between cancer and non-cancer wards.

Method: A retrospective audit of DMRs completed at discharge was conducted for patients at a metropolitan hospital. Data collected included whether a DMR was signed off at discharge, day of discharge, cancer ward or non-cancer ward, and whether the patient received any cancer treatment in the previous 14 days. Results were analysed using descriptive statistics.

Results: Completion rate for DMRs was significantly higher for the cancer ward compared to non-cancer wards (86% vs. 75%, p = 0.0005). DMR provision on the cancer ward on weekdays was similar to Saturdays (89% vs. 87%, p = 0.6580), but Sundays were significantly lower (89% vs. 62%, p < 0.0001). On non-cancer wards, compared to weekdays, DMR provision on Saturdays was significantly lower (78% vs. 57%, p = 0.0196), and non-significantly lower on Sundays (78% vs. 64%, p = 0.2373). The number of outlying cancer inpatients continued to increase over the data collection period.

Conclusion: DMR completion rates were lower on the weekend, and for cancer inpatients on non-cancer wards. The findings highlight the impact of having reduced weekend pharmacist staffing and present an opportunity for a specialist cancer pharmacist outlier service. Future studies should investigate the impact of DMR provision on PARs.

Marissa Ryan^1,2,3, Tara Poke², Elizabeth C Ward^4,5, Christine Carrington^2,6, Centaine L Snoswell^1,3,6

¹Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia

²Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia

³Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

⁴Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia

⁵School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia

⁶School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia

Aim: To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers and barriers.

Methods: A PROSPERO registered systematic review was conducted using PubMed, CINAHL and EMBASE in March 2023. Search terms included pharmacy, telepharmacy and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focussed services was applied; data extraction and narrative analysis were then performed.

Results: From 2129 non-duplicate articles, eight were eligible for inclusion, describing seven unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment and discharge follow-up. The studies primarily used telephone and compared to no contact (n = 3) or had no comparator (n = 3), while others compared videoconsults and telephone (n = 2). Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 278 telephone consults involved at least one intervention (41% of these relating to clinically significant immune-related adverse events). When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 vs. 3.7 months, p = .001). Reported enablers included physician buy-in, staff resources and proper utilisation of technology. Identified barriers included time investment required and technical issues.

Conclusion: Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care.

Marissa Ryan^1,2,3, Sarah Wong¹, Tara Poke¹, Nancy Pham¹, Sarah Frier¹, Samantha Yim¹, Luke Shuttleworth¹, Richard Gosling¹, Centaine Snoswell^2,3,4

¹Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia

²Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia

³Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia

⁴School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia

Background: Oncology and haematology specialty services provide pharmacy technicians (PTs) with opportunities to expand their scope of practice by completing structured competency assessments. The aims of this study were to review existing literature on expanded scope roles for PTs, and undertake a national survey to benchmark the prevalence of (a) authorising, which is the accuracy checking of electronically dispensed compounded parenteral cancer medicines (CPCMs), and (b) checking of CPCMs against a pharmacist clinically verified prescription. Across many cancer services sites pharmacists currently perform the tasks of authorising and checking of CPCMs, so implementation of an advanced PT role is likely to increase time pharmacists have available to spend on clinical activities.

Method: A brief literature review was carried out on expanded scope roles for PTs, and 13 pharmacists at separate cancer health centres were invited to participate in an online survey. Survey respondents were invited to provide information about whether PTs perform authorising and checking of CPCMs at their sites. Descriptive statistics were used to report results.

Results: Existing literature demonstrates PTs have similar or greater accuracy than pharmacists when performing dispensing and checking of medicines, alongside a pharmacist clinical check. Ten (67%) pharmacists responded to the survey. Nine responses were received from hospitals in Queensland, and one was from Western Australia. Eight responses were from public health services and two were from private health facilities. For dispensing and authorising, four pharmacies had a PT-only model in place. None of the cancer services pharmacies had PTs checking CPCMs against cancer therapy prescriptions.

Conclusion: Our review of literature and survey of pharmacies providing cancer services provides a snapshot of the existing advanced scope activities being undertaken by PTs in cancer services in Australia. This information will be used to create a pilot study on authorising and checking of CPCMs by PTs.

Sherine Sandhu¹, Sharnel Perera¹, Penelope Schofield^2,3, Paul Cohen⁴, Sue Hegarty⁵, Hayley Russell⁵, Robert Rome¹, Simon Hyde⁶, Kristin Young⁷, Yeh Chen Lee⁸, Gary Richardson⁹, Rhonda Farrell¹⁰, Mahendra Naidoo¹, Tahlia Knights¹, Tran Nguyen¹, John Zalcberg¹

¹Monash University, Melbourne, Victoria, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Swinburne University, Melbourne, Victoria, Australia

⁴University of Western Australia, Perth, Western Australia, Australia

⁵Ovarian Cancer Australia, Melbourne, Victoria, Australia

⁶Mercy Health, Melbourne, Victoria, Australia

⁷National Gynae-Oncology Registry, Melbourne, Victoria, Australia

⁸Prince of Wales Hospital, Sydney, New South Wales, Australia

⁹Cabrini Health, Melbourne, Victoria, Australia

¹⁰Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Aim: To evaluate the feasibility and acceptability of collecting patient reported outcome and experience data (PROMs and PREMs) in the National Gynae-Oncology Registry's ovarian cancer module (OvCR).

Methods: Prospective longitudinal pilot study with surveys at baseline, 6 and 12-months post-diagnosis. OvCR participants, newly diagnosed (≤3 months) with ovarian, tubal or peritoneal cancer at four Australian hospital sites were eligible to participate. Target sample size: 15–20 participants per hospital site. Survey distribution methods were electronic (email/SMS) and/or paper-based (sent by post). Follow-up attempts were made for incomplete surveys. Patient reported outcome measures were the European Organisation for Research and Treatment of Cancer's (EORTC) Quality of Life Questionnaire (QLQ-C30) and Ovarian Cancer module (QLQ-OV28). Patient reported experience measure was the Australian Hospital Patient Experience Question set (AHPEQ). In addition, 10 study-specific items measured survey acceptability. Baseline feasibility and acceptability data for December 2022–July 2023 are presented.

Results: Baseline surveys were sent to 61 eligible patients. Full and partial survey completion rates were 34% (n = 21) and 7% (n = 4), respectively. More surveys were completed online (n = 15) than on paper (n = 10). Twenty-two participants completed the survey acceptability measures, with almost all reporting the survey was ‘very easy’ to complete (n = 20) and understand (n = 20). Most considered the survey length ‘about right’ (n = 21). Preferred frequency to receive PROMs and PREMs was monthly (n = 8), followed by quarterly (n = 6). Fewer (n = 4) participants wanted to receive the surveys every 6-months. Preferred survey completion method was online (n = 12), followed by on paper (n = 8). Six participants believed the survey triggered thoughts about their experiences or outcomes that they had not previously considered or had forgotten.

Conclusion: Preliminary response rates for PROMs and PREMs by OvCR participants are low. The survey's readability, length, ease of completion and dissemination methods appear acceptable. Early results suggest patients prefer to receive these surveys more often than every 6-months.

Tess Schenberg, Georgina East, Frances Barnett

¹Oncology, The Northern Hospital, Melbourne, Victoria, Australia

Aims: The Symptom Urgent Review Clinic (SURC) commenced operation at the Northern Hospital in February 2018. Its purpose is to provide timely care of non-emergency cancer and treatment related symptoms and conditions. It also aims to decrease avoidable emergency department presentations and inpatient admissions. This review aimed to evaluate the clinical characteristic of patients presenting to SURC over a 7-month period.

Methods: Data about patient presentations was collected prospectively. Demographics captured included type of contact, contact source, tumour stream diagnosis, treatment, time since last treatment, timing of presentation, reason for presentation and outcomes. Data from a 7-month period from 3 January until 8 August 2023 was analysed.

Results: In the 7-month time period, 592 patients underwent 3054 episodes of care. This is an average of 436 encounters per month. The most common source of contact were phone calls initiated by the patient and/or carer (46.5%). 13% of these led to recommendations for the patient to present to SURC. 76% of episodes were for patients with solid tumours with the most common tumour stream being colorectal cancer (29%). 62% of patients were undergoing chemotherapy. For the patients undergoing treatment, 51% of presentations were in the week following administration. The most common presentations were gastrointestinal symptoms at 15%, followed by pain at 13% and care coordination at 12%. Only 5% of contacts required referral on to the emergency department and 3% required direct admission to the ward or transit lounge. Of the group requiring admission, the most common tumour stream was colorectal and the most common reason for admission were gastrointestinal symptoms.

Conclusions: The majority of presentations to SURC were patient and/or carer led and there was only a small need for inpatient admission or emergency department referral. Patterns about the type of presentations will help guide future service provision.

Manohan Sinnadurai¹, Cassandra Dickens¹, Ma'tina O'Neill¹, Greg Cadigan², Natalie Bradford³, Bryan A Chan^1,4

¹Adem Crosby Centre, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

²Healthcare Improvement Unit, Queensland Health, Brisbane, Queensland, Australia

³Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia

⁴Griffith University, Nathan, Queensland, Australia

Background: Complications from cancer or treatment toxicities often require urgent assessment and intervention, leading to emergency department (ED) presentations and hospitalisations. The treating oncology team is ideally placed to streamline patient care and minimise avoidable emergency presentations. In January 2023, we implemented an Oncology Nurse Practitioner-led Rapid Access Clinic Expansion (RACE) service to provide an efficient outpatient model of care for patients undergoing cancer treatment.

Aims: To evaluate the characteristics, interventions and outcomes for patients who accessed RACE.

Methods: Retrospective audit of all patients accessing the RACE service (January to June 2023). Demographics, presenting symptoms, interventions and outcomes were recorded. Data were analysed using descriptive statistics.

Results: RACE managed 157 patients in the study period. ED presentation was avoided in 134 (85%) patients, of whom 127 (95%) were managed entirely as outpatients. The remaining 23 (15%) were appropriately directed to ED. Females (59%) were the greatest proportion of service utilisers. The median age of patients accessing the service was 67 (range 28–84 years). The majority (64%) had metastatic disease and most frequent primary malignancies included: breast (25%), colorectal (14%), upper-gastrointestinal (11%), gynaecological (11%) and genitourinary (10%). Nausea, pain and dyspnoea were the most frequent presenting symptoms. All calls were triaged according to the United Kingdom Oncology Nursing Society criteria: 49% requiring self-care advice, 25% requiring clinical review within 24 h and 27% requiring urgent clinical assessment. Majority of patients (54%) were managed with phone advice and 100% of patients were satisfied with the service provided.

Conclusions: The RACE service provided streamlined and efficient outpatient care for oncology patients undergoing treatment, whilst avoiding ED presentations. It has been widely endorsed by cancer care staff and patients. Future work will evaluate the service further to evaluate long term outcomes, sustainability and health resource utilisation.

Zhicheng Li¹, Melanie Hamilton¹, Frances Boyle^2,3, Michele Daly⁴, Pia Hirsch⁵, Fiona Dinner⁶, Kim Hobbs⁷, Laura Kirsten⁸, Sophie Lewis³, Carolyn Mazariego⁹, Ros McAuley¹⁰,’Mary O'Brien¹¹, Amanda O'Reilly¹², Natalie Taylor⁹, Lisa Tobin¹³, Andrea Smith¹

¹The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

²Mater Hospital, Sydney, NSW, Australia

³Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

⁴Consumer Advisory Panel, Cancer Institute, Sydney, NSW, Australia

⁵Advanced Breast Cancer Group, Brisbane, QLD, Australia

⁶Consumer Representative, Melbourne, VIC, Australia

⁷Westmead Centre for Gynaecological Cancers, Sydney, NSW, Australia

⁸Nepean Cancer Care Centre, Sydney, NSW, Australia

⁹Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

¹⁰Think Pink, Melbourne, VIC, Australia

¹¹Advanced Breast Cancer Group, Brisbane, QLD, Australia

¹²Support Group Facilitator, Sydney, NSW, Australia

¹³Breast Cancer Network Australia, Camberwell, VIC, Australia

Aim: To understand factors critical to successful implementation of professionally led metastatic breast cancer (MBC) support groups in Australia.

Method: In-depth interviews with leaders of professionally led MBC support groups (n = 20) about experiences of running MBC groups, views on ideal group structure and perceptions of factors affecting implementation of groups. Recruitment ceased once thematic saturation was reached. Transcripts were analysed thematically, and implementation factors mapped to Proctor's Implementation Framework¹ and CFIR-2.0.²

Results: Interview data relating to implementation determinants were mapped to 13 constructs across four CFIR-2.0 domains: (1) Innovation (innovation complexity and adaptability); (2) Inner Setting (available resources, culture, compatibility, access to knowledge and information); (3) Individuals (needs, capability and motivation of the innovation deliverers; needs and opportunity of the innovation recipients) and (4) Outer Setting (critical incidents and local attitudes). The identified implementation determinants affected the acceptability, feasibility and sustainability of the support groups. Examples of key implementation determinants included: having suitably skilled and experienced support group leaders capable of managing and supporting a high-needs and potentially vulnerable population; access to sustainable funding and resources; an organisation's ‘patient-centredness’ and appreciation of the value and importance of MBC groups to patients; and leader's ability to adapt the group to an evolving membership base and changing needs over time. Implementation strategies identified included: collecting regular feedback to better understand members’ needs; improving access to clinical supervision; providing training tailored specifically for leaders of metastatic cancer support groups; improving public awareness of metastatic cancer; and shifting negative perceptions about metastatic cancer groups among patients and health professionals.

Jennifer Soon^1,2, Fanny Franchini¹, Maarten IJzerman^3,4, Grant A McArthur^2,5

¹Cancer Health Services Research, University of Melbourne, Melbourne, Victoria, Australia

²Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia

³Cancer Health Services Research, University of Melbourne, Melbourne, Victoria, Australia

⁴School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands

⁵Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Purpose: With the rising cost of healthcare, there is growing prioritisation of patient outcomes per healthcare dollar. De-escalation is the rationalisation of routine treatment without compromising patient outcomes. It has the potential to optimise value for the healthcare system and patients by reducing physical, time and financial toxicities. This scoping review will establish the role of systemic therapies in current and emerging opportunities to de-escalate cutaneous melanoma treatment. It will also seek to comment on the proportion of relevant studies that include patient-reported outcomes and quality of life measurements.

Methods: This scoping review will follow guidance provided by the JBI Manual for Evidence Synthesis. In consultation with a health sciences librarian, a systematic search strategy has been developed for MEDLINE and PubMed from 1 January 2013 to 30 June 2023. Additional sources will be included from grey literature, Google Scholar and reference scanning.

Abstract and full text screening, facilitated by the Covidence software, will be conducted by two reviewers with any disagreements resolved by consensus or a third reviewer. A data extraction tool will be implemented by one author, whilst a second will review a random selection of papers to ensure consistent interpretation. De-escalation strategies will be categorised by concept, potential impact on resource utilisation and patient outcomes, strength of evidence and estimated ease of implementation. Data will be synthesised qualitatively and quantitatively. Results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Preliminary results will be available for presentation at COSA ASM in November 2023. The final results of this scoping review will directly inform a melanoma consumer and clinician survey exploring their perspectives on de-escalation therapies. This survey will use a novel platform, Pol.is, that integrates machine learning to provide real-time feedback to participants.

Koku Sisay Tamirat¹, Michael Leach², Nathan Papa³, Jeremy Millar^4,5, Eli Ristevski¹

¹School of Rural Health, Monash University, Warragul, Victoria, Australia

²School of Rural Health, Monash University, Bendigo, Victoria, Australia

³School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

⁴Central Clinical School, Monash University, Melbourne, Victoria, Australia

⁵Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia

Aims: To explore treatment patterns among men with prostate cancer (PCa) from culturally and linguistically diverse (CALD) backgrounds in Victoria, Australia compared with their non-CALD counterparts.

Methods: We used data from men with an index diagnosis of PCa in Victoria, Australia between 2014 and 2022 in the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic). We defined CALD background as at least one of two indicators: born in a non-English-speaking country and preferring to speak a language other than English. We staged PCa using National Comprehensive Cancer Network risk of disease progression and defined treatment as the first PCa treatment type received after diagnosis. Descriptive statistics were produced.

Results: There were 29,556 men with PCa overall; 23,584 and 5972 men were from non-CALD and CALD backgrounds, respectively. Median (interquartile range) age at diagnosis was 68 (62–74) years overall, and 67 (61–73) and 70 (64–75) years for men from non-CALD and CALD backgrounds, respectively. At diagnosis, 21%, 46%, 21% and 11% of men from non-CALD and 20%, 39%, 24% and 15% of men from CALD backgrounds had low-risk, intermediate-risk, high-risk and metastatic PCa, respectively. Among those diagnosed with low-risk PCa, the rate of active surveillance and watchful waiting (ASWW) for men from CALD and non-CALD backgrounds increased from 58% and 55%, respectively, in 2014–2016 to 76% and 72%, respectively, in 2020–2022. Among those diagnosed with intermediate and high-risk PCa, CALD men received less surgical management (59% vs. 64% and 39% vs. 51%) and more radiation therapy (22% vs. 19% and 37% vs. 30%) than non-CALD men.

Conclusion: Among participants with low-risk PCa, rates of ASWW increased over 2014–2022 but were comparable between CALD and non-CALD men. Among participants with intermediate and high-risk PCa, CALD men had more non-surgical management than non-CALD men. We will continue to investigate potential underlying reasons for this variation.

Whiter Tang¹, Lily Yang², Michael Soriano¹

¹Pharmacy, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia

²University of Sydney, Sydney, New South Wales, Australia

Aim: To evaluate oncology day therapy pharmacists’ perception on current workload including the impact of electronic prescribing in a 44-chair day therapy unit with a staffing ratio of approximately 20–25 patients to one EFT pharmacist.

Method: A questionnaire was given to all day therapy pharmacists involved in the clinical verification of anti-cancer systemic treatment charts, coordination of treatment supply and counselling of take home medications. The survey evaluated their perception on current workload, impact of electronic prescribing and time it takes to review treatment plans and counsel patients with different complexities.

Results: Eight pharmacists responded to the questionnaire with five pharmacists having <5 years of oncology experience (group A) and three pharmacists with ≥5 years of experience (group B). 75% pharmacists considered the ratio of patient to pharmacist as appropriate and one pharmacist from each group considered it was too high. All the pharmacists with experience working with both paper and electronic prescribing thought the workload increased after the switch to electronic prescribing citing reasons such as extra information to navigate between and time for pages to load. The self-perceived time to review a chart ranged from 4 to 14 min for group B and 6 to 23 min for group A. For counselling, group B ranged from spending 9 to 16 min with patients and group A, 13 to 29 min.

Conclusion: Overall the day therapy pharmacists considered the current workload appropriate but it was interesting to note the perceived increase in workload from electronic prescribing. The time needed to review and counsel appears higher for the less experienced pharmacists. Further research as a time-motion study would be helpful in further analysing and optimising the work of a day therapy pharmacist.

April Morrow¹, Shuang Liang¹, Frank Lin^2,3, Milita Zaheed^3,4,5,6, Skye McKay¹, Bridget Douglas⁵, Priscilla Chan¹, Anna Byrne¹, Kathryn Leaney⁷, Christine Napier^4,6, Sandy Middleton⁸, Phyllis Butow⁹, Jane Young¹⁰, Bonny Parkinson¹¹, Mandy Ballinger^4,6,12, Kathy Tucker^5,13, David Goldstein^3,14, David Thomas^4,6,12, Natalie Taylor¹

¹School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia

²Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, Australia

³School of Clinical Medicine, UNSW, Sydney, NSW, Australia

⁴Genomic Cancer Medicine Program, Garvan Institute of Medical Research, Sydney, NSW, Australia

⁵Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia

⁶Omico, Sydney, Australia

⁷Consumer Involvement in Research, Cancer Voices, Sydney, NSW, Australia

⁸Nursing Research Institute, Australian Catholic University, Sydney, Australia

⁹School of Psychology, University of Sydney, Sydney, Australia

¹⁰School of Public Health, University of Sydney, Sydney, Australia

¹¹Centre for the Health Economy, Macquarie University, Sydney, Australia

¹²Centre of Molecular Oncology, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia

¹³Prince of Wales Medical School, UNSW, Sydney, NSW, Australia

¹⁴Department of Medical Oncology, UNSW, Sydney, NSW, Australia

Aims: Genomic diagnostics have accelerated therapeutic and preventative breakthroughs in oncology and cancer genetics. However, implementing genomics-based care (a complex clinical intervention) faces serious care fragmentation and scalability issues due to lacking system support. P-OMICs-flow, a novel model of care purposely designed to coordinate precision medicine in oncology, addresses the fundamental issues caused by the widening knowledge-service gap. This model aims to streamline decision support for referring clinicians, enhance quality of care through multifaceted and patient-centred communications and improve translational capacity by integrating implementation science and clinical informatics.

Methods: Utilising a Type II Hybrid effectiveness-implementation trial design, the P-OMICs-flow service intervention is the model of care – providing centralised multidisciplinary review to support clinicians in the precision oncology care provision. The implementation intervention is design of a platform – applying evidence-based implementation approaches and Learning Health System principles to enhance feasibility and sustainability. All adult patients across Australia referred to P-OMICs-flow (n = est. 100–300/year between 2023 and 2026), and healthcare professional stakeholders involved in delivery of precision oncology services (n = est. 600), are eligible to participate.

Study phases include: (1) using a mixed-methods approach to inform iterative co-design of an implementation platform for P-OMICs-flow, and a suite of outcome measures to assess clinical, service, implementation and cost-effectiveness; (2) the delivery of the P-OMICs-flow clinic and implementation platform, and evaluation of the outcome measures designed in Phase 1 and (3) a co-design and feasibility test to enable local adaptations and national roll out of the P-OMICs-flow model.

Conclusion: Simultaneously evaluating the clinical-, service-, implementation- and cost-effectiveness of this world-first precision medicine model within a routine healthcare setting will provide crucial insights into its potential impact, and inform evidence-based strategies for cost-effective widespread adoption and implementation. Ethics and governance approvals are in place, clinic rollout commenced in June 2023, and Phase 1 data collection is underway.

Luc te Marvelde¹, James A Chamberlain², Sue M Evans¹

¹Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia

²Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia

Background: The COVID-19 pandemic has been associated with a decline in cancer diagnoses in Europe, America, New Zealand and Australia. Recovery has been variable and impacted by underlying community COVID-19 infection rates, service delivery disruption and restrictions on movement of people. In Victoria, cancer diagnoses declined by 7% in 2020 and by 4.3% in 2021. We analysed preliminary incidence data for the further 6-month period to 30 June 2022.

Methods: New cancer diagnoses to 2019 were available to predict the number of new diagnoses up to July 2022. The latest historical period during which standardised incidence rate was linear was used, by tumour stream. Expected and observed counts were compared for the breast, lung, colorectal cancer and melanoma, and reported by age, sex, remoteness and area based socio-economic position. Cases identified through death certificate only (DCO) were excluded as DCOs were not yet processed for 2022.

Results: After the initial reduction following the first COVID-19 lockdown (Q2 2020), it took ∼6 months to return to expected numbers for some tumour steams (breast, colorectal). No clear ‘catch-up’ in diagnoses was seen following the initial dip in early 2020. Instead, in the first half of 2022, a substantial reduction in diagnoses was observed [colorectal −21% (95% CI: −19%, −23%), lung −12% (−11%, −14%), melanoma −10% (−8%, −13%), breast −5% (−3%, −7%)]. Reductions were seen in both males and females, and were generally larger in the more elderly age groups.

Conclusions: Over the first half of 2022, a second reduction in diagnoses was seen which coincided with a burst in COVID-19 infections after restrictions were lifted. The observed reduction in diagnoses compared to expected is concerning and signals a need for ongoing media campaigns and targeted interventions to encourage Victorians to seek medical advice if concerned and resume routine health checks.

Luc te Marvelde^1,2, Margaret Brand³, Udani Himalsha³, Shantelle Smith³, Sue M Evans¹, John R Zalcberg^4,5, Rob G Stirling^6,7

¹Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia

²School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

³Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

⁴Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

⁵Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia

⁶Allergy Immunology and Respiratory Medicine, Alfred Health, Monash University, Melbourne, Victoria, Australia

⁷Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia

Aims: To describe impact of COVID-19 on lung cancer incidence, stage at diagnosis, treatment utilisation and timeliness of care in Victoria, Australia.

Methods: Retrospective study using population wide Victorian Cancer Registry data and clinical data from the Victorian Lung Cancer Registry, comparing data pre-COVID (1 January 2019 to 31 March 2020) with the COVID era (1 April 2020 to 31 December 2021). Population wide data on 9857 lung cancer diagnoses diagnosed from 2019 to 2021 in Victorian residents, and 5984 cases with additional clinical data.

Results: Between Q2 2020 and end of 2021, 282 (95% CI: 190–374) fewer Victorians [127 (95%CI: 63–190) males and 154 females (95%CI: 88–222)] were diagnosed with lung cancer than expected. No differences were detected in clinical stage at diagnosis following the COVID-19 restrictions. No statistical difference was found in the proportion of patients receiving treatment comparing the COVID period (86.5%) with the pre-COVID period (88.0%; OR = .87 [.75–1.02]). The proportion of patients receiving a diagnosis within ≤28 days of referral was similar in the COVID period (69.4%) compared with the pre-COVID period (69.1%; OR = 1.02 [.91–1.14]). No differences were found between the proportion of cases who commenced treatment ≤42 days of referral between the pre-COVID and COVID period. Overall, timeliness measures were more likely to be met by younger patients. Time to treatment targets were less likely to be met for patients residing out of the major cities.

Conclusions: Compared to the expected number of diagnoses, 4.1% fewer lung cancer diagnoses were observed in 2020 and 2021 combined. Although the healthcare system in Victoria had many disruptions following COVID restrictions, no major negative impacts on treatment utilisation nor timeliness were observed.

Raymond J Chan¹, Carla Thamm^1,2, Jolyn Johal¹, Elise Button¹, Reegan Knowles¹, Aarti Gulyani¹

¹Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia

²Princess Alexandra Hospital, Woolloongabba, QLD, Australia

Aims: Comprehensive cancer centres (CCCs) are perceived as a hallmark of highest standard quality cancer care and research. However, variations exist across countries regarding key attributes, and no universal accreditation standards exist. Effectiveness of CCCs has also not been systematically synthesised. This review consists of (i) a scoping review (ScR) to identify attributes and benefits of CCCs and (ii) a systematic review (SR) to evaluate their effectiveness on patient outcomes.

Methods: The review was registered in PROSPERO (CRD42023387620) and prepared according to PRISMA guidelines. Searches were conducted in PubMed, Cochrane CENTRAL and Epistemonikos for English articles from 2002 through January 2023. Articles were screened and assessed using JBI critical appraisal tools by two independent authors. Data were extracted by two authors, with results narratively synthesised, and meta-analysis conducted where appropriate.

Results: Of the initial 3069 and 1085 records screened for the ScR and SR, a total of 70 and 32 articles were included, respectively. These were predominantly text and opinion journal articles (ScR) and observational cohort studies (SR). Most articles were conducted in the USA and Europe. Attributes of CCCs included a strong focus on research, education, collaboration, integrated care and adherence to accreditation programs. Benefits included attracting high quality staff, increased research funding and outputs, development of and adherence to quality standards and improved access to care through hubs of networks. CCCs were found to be associated with better surgical margins and patient survival outcomes. Second opinions at CCCs also had the potential to alter cancer diagnoses.

Conclusions: CCCs are centres of excellence in cancer care, research and education, commonly guided by accreditation standards. Benefits are perceived across the provider, organisation and system levels. CCCs demonstrate improvements in patient outcomes. Findings from this review can inform future development and evolution of CCCs and accreditation programs in Australia and internationally.

Elise Treleaven^1,2, Claire Blake^1,2, Adrienne Young^1,2,3, David Wyld⁴, Jenni Leutenegger⁴, Teresa Brown^1,2,5

¹Department of Dietetics & Food Services, Royal Brisbane an’ Women's Hospital, Brisbane, Queensland, Australia

²Nutrition Research Collaborative, Brisbane, Queensland, Australia

³Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁴Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

⁵School of School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia

Aims: Malnutrition prevalence in cancer patients is reported as high as 80%; however, staff-led screening and referral pathways for nutrition care can be suboptimal. Patient-led screening has been identified as a feasible solution, following local research demonstrating that patient self-screening using the Malnutrition Screening Tool (MST) is valid and well-accepted in Oncology. This study aimed to design, implement and evaluate patient-led malnutrition screening and referral pathways as routine practice.

Methods: A pre- and post-implementation prospective cohort study was conducted at a single, quaternary Cancer Care Service, utilising the i-PARIHS implementation framework with a range of stakeholders (clinicians, managers and consumers). The electronic patient-led nutrition screening tool (PLNST) was co-designed and rigorously tested with consumers. The tool is sent to patients via SMS on the day of their systemic therapy. Patients can opt-out or decline to respond at any time and nurse-led screening practice continued in parallel.

Study participants were consecutive adult patients presenting for initial systemic therapy for any solid tumours or haematological malignancies within a 1-month period in the pre (September 2018) and post (September 2020) groups. Self-screening and referral rates were collected from the electronic medical record during the 3-month follow-up period.

Results: Study participants included n = 41 in the pre-PLNST and n = 47 post-PLNST cohorts. Overall screening completion rates improved from 73% to 82%. In the post-group, 70% (n = 33) of patients completed the PLNST at any time and 47% (n = 22) completed multiple self-screens. The PLNST identified 45% (n = 15/33) at risk of malnutrition (compared to 21% by nurse-led screening) and 52% (n = 17/33) of patients requested dietetic input. In the 12-months post-implementation, dietetic activity increased by 192%.

Conclusions: Patient-led malnutrition screening was successfully implemented as routine practice in the Oncology Day Therapy Unit using an implementation science approach. Innovative models of care (including group nutrition education) are being investigated to meet increased patient-driven service demands.

Rebecca Fichera^1,2, Sarah Andersen^1,2, Claire Blake^1,2, Elise Treleaven^1,2, Teresa Brown^1,2,3, Helen MacLaughlin^1,2,4, Kylie Matthews^1,2

¹Department of Dietetics & Food Services, Royal Brisbane an’ Women's Hospital, Brisbane, Queensland, Australia

²Nutrition Research Collaborative, Brisbane, Queensland, Australia

³School of School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia

⁴School of Exercise and Nutrition Sciences, Faculty of Health,Queensland University of Technology, Brisbane, Queensland, Australia

Aims: Patients receiving autologous stem cell transplants (ASCT) are at risk of malnutrition due to poor oral intake secondary to gastrointestinal toxicity of the conditioning protocol. Evidence for optimal nutrition interventions to prevent malnutrition in this patient group is limited. A new nutrition care pathway was trialled to identify patients earlier if they developed an indication to commence enteral nutrition (i.e. consuming <60% estimated requirements orally). The aim of this study was to investigate clinical and patient-reported outcomes of enteral nutrition following implementation of this nutrition care pathway.

Methods: This was a quantitative observational prospective cohort study of patients admitted for ASCT at RBWH between July 2019 and June 2020 who remained an inpatient following D + 1 post-ASCT. Data collected included demographics, clinical data, nutritional status via Subjective Global Assessment, nutritional intake, functional status and quality of life.

Results: Eighteen (50% M, ∼60% myeloma diagnosis) of 30 eligible patients admitted during the study period consented to participate. Forty percent (n = 7/18) were recommended to commence enteral nutrition [median 5 (0–7 days) post-ASCT]; however, six of the seven patients declined nasogastric tube insertion. These patients consumed <60% of their energy requirements for another 4–11 days post this recommendation. At admission and on discharge all patients were well-nourished. At 2-weeks post-discharge, one patient was moderately malnourished (missing data n = 2).

Conclusions: An unanticipated finding from this study was that patient-decision was the biggest barrier to enteral tube placement when clinically indicated. This is dissimilar to other studies in the allograft population whereby patients receive education from members of the multidisciplinary team and patient-acceptance of enteral tube placement is high. Unfortunately, the cohort was too small resulting in inadequate evidence to draw conclusions on nutrition, clinical or patient-reported outcomes.

Haitham Tuffaha¹, Kim Edmunds¹, David Fairbairn², Matthew Roberts³, Lisa Horvath⁴, David Smith⁵, Shiksha Arora¹, Suzanne Chambers⁶, Paul Scuffham⁷

¹Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia

²Pathology Queensland, The Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia

³Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia

⁴Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁵The Daffodil Centre, Sydney, NSW, Australia

⁶The Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia

⁷Menzies Health Institute Queensland, Gold Coast, Queensland, Australia

Aim: Genetic testing could inform precision treatment and early cancer detection; however, there are no Australian guidelines for genetic testing in prostate cancer (PCa). We aimed to estimate the consensus of Australian consumers and health providers on international genetic testing recommendations for PCa.

Methods: We conducted a Delphi study that involved a scoping review of current international guidelines for genetic testing in PCa. Recommendations from the review were synthesised into an online survey that was administered over two rounds. Two panels were surveyed: a patient/carer (P/C) panel (n = 27) and a multidisciplinary healthcare provider/researcher (HP/R) panel (n = 36). Consensus was set at 70% threshold. Descriptive statistics was utilised to estimate consensus and a thematic analysis of participants’ comments was conducted.

Results: There was a consensus on testing men with a family history of a high-risk hereditary gene, men with PCa and a family history of Hereditary Breast and Ovarian Cancer syndrome or Lynch syndrome, and men with metastatic PCa. There was a consensus on testing BRCA2, BRCA1 and DNA MMR genes for men with metastatic PCa. P/Cs had consistently higher levels of consensus than HP/Rs across recommendations. There was a consensus across the HP/R and P/C panels that genetic counselling requires specialised training; however, P/Cs preferred face to face counselling while HP/Rs favoured counselling via telehealth. Thematic analysis of HP/R comments revealed three main recurring topics: the lack of information to make a decision, insufficient knowledge of genetic testing and capacity to provide genetic testing and counselling.

Conclusions: This is the first Australian study on genetic testing recommendations in PCa to inform who should be tested and how. While the need for genetic testing is widely accepted, our study showed apparent deficits in knowledge and implementation, exacerbated by workforce issues around the provision of genetic counselling and testing. Future work should focus on evaluating these recommendations for implementation in Australian practice.

Rebecca Luo¹, Sim Yee (Cindy) Tan^1,2, Haryana M Dhillon³, Janette L Vardy^1,2

¹University of Sydney, Concord, NSW, Australia

²Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia

³CeMPED, University of Sydney, Sydney, NSW, Australia

Aim: A Survivorship Care Plan (SCP) is prepared for all cancer survivors at the Sydney Cancer Survivorship Centre (SCSC). The SCP is a comprehensive, individualised document including a cancer treatment summary, surveillance plan and recommendations from all members of the multidisciplinary team. We aimed to evaluate how culturally and linguistically diverse (CALD) cancer survivors at the SCSC view and use their SCPs.

Methods: We used a qualitative study design and conducted semi-structured interviews with CALD survivors who attended their initial SCSC clinic from 3 months to 5 years ago. Data were analysed thematically with an inductive, interpretive approach and 15% of interviews were cross coded by two researchers to ensure rigor.

Results: Overall, 25 survivors were invited to participate and 20 interviews completed. Of participants, 15 were male and 5 were female, with a mean age 59 (range 41–76) years, from diverse cultural backgrounds (11 Chinese, 2 Korean, 2 Filipino, 1 Macedonian, 1 Sri Lankan, 1 Tongan, 1 Lebanese, 1 Greek). 40% of participants required an interpreter in clinic.

Qualitative interviews identified a meta-theme of ‘SCP as a tool’, supported by five distinct themes: (1) Delivery of SCP, (2) Comprehensibility of SCP, (3) SCP content, (4) Support for using SCP and (5) Perceived SCP usefulness.

CALD survivors’ use of the SCPs as a tool were influenced by a variety of factors: whether the SCP was received in a timely manner, whether they could comprehend it and whether they had support to use it. Many participants (60%) stated they did not receive their SCPs, suggesting its use as a tool was impeded by inconsistent delivery.

Conclusion: Effective use of the SCP in CALD populations can be encouraged by improving its timely delivery and ensuring CALD survivors have adequate support in comprehending its contents, and providing SCP in survivors’ preferred language(s).

Eleonora Feletto¹, Caitlin Latumahina¹, Amanda McAtamney², Megan Varlow², Jacob George³, Nicole Allard⁴

¹The Daffodil Centre, A Joint Venture between the University of Sydney and Cancer Council NSW, Sydney, Australia

²Cancer Council Australia, Haymarket, NSW, Australia

³Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia

⁴The Doherty Institute, Melbourne, Australia

Aim: The development of a strategic Roadmap to identify collective actions over the next 2, 5 and 10 years to reduce the burden of liver cancer in Australia.

Methods: Funded by the Department of Health and Aged Care in 2019, Cancer Council Australia utilised four processes to inform the development of priority actions to drive improvements in liver cancer outcomes: a scoping review of the literature on screening and surveillance for liver disease and hepatocellular carcinoma (HCC); an environmental scan of current models of care for HCC surveillance in Australia; iterative consultation with the Expert Advisory Group (EAG) and key stakeholders in liver cancer control; and a national Summit with key stakeholders to refine priorities.

This Roadmap presents a comprehensive and evidence-based plan to improve liver cancer outcomes in Australia.

Conclusions: The commonalities between liver cancer risk factors and modifiable risk factors for chronic diseases including alcohol consumption, and tobacco use, support clear calls for action and linking national policies to leverage the impact on liver cancer control. The Roadmap highlights the need to engage with policy makers, and clinicians to improve health literacy, awareness, understanding and utilisation of liver cancer control activities, across the life course to achieve better outcomes.

Acknowledgements: The authors acknowledge the contributions of the Expert Advisory Group and the Guidelines Working Party.

Laura N Woodings¹, Linda Nolte², Kris Ivanova¹, Luc te Marvelde¹, Fiona Kennett¹, Belinda Yeo³, Carla Read⁴, Kathryn Baxter⁵, Patsy Catterson⁶, Anupa Bhandari⁵, Colin Hornby⁷, Kerry Davidson⁸, Jane Auchettl⁷, Jodie Lydeker⁹, Vivian Yang¹, Sue Evans¹

¹Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia

²North Eastern Melbourne Integrated Cancer Service, Austin Health, Heidelberg, Victoria, Australia

³Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia

⁴Information Management and Standards, Victorian Agency of Health Information, Melbourne, Victoria, Australia

⁵Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁶Ballarat Health Services, Geelong West, Victoria, Australia

⁷Department of Health, Melbourne, Victoria, Australia

⁸Grampians Integrated Cancer Service, Ballarat, Victoria, Australia

⁹Consumer Representative, Melbourne, Victoria, Australia

Aims: Cancer stage at diagnosis is an important prognostic indicator and should be recorded in clinical records and multidisciplinary team meeting (MDM) software. Yet, cancer registrations submitted to the Victorian Cancer Registry (VCR) demonstrate this information is infrequently reported, despite being a mandated field. We sought to quantify (i) the level of compliance of cancer stage data submitted by Health Information Managers (HIM) and clinical coders and understand barriers to complying with this requirement, (ii) how well stage data was recorded in MDM software and barriers to recording.

Methodology: Cancer registrations for 2021 and 2022 calendar years for melanoma, colorectal, prostate, breast and lung cancer were analysed for compliance (complete and submitted in correct fields). Surveys were constructed in Qualtrics and distributed electronically to an HIM distribution list and to the Chairs of the five tumour MDMs in public hospitals.

Results: Compliance in reporting cancer stage was highest for lung cancer (11%) and lowest for prostate cancer (7%). Main barriers to registering cancer stage at diagnosis for HIMs and clinical coders (n = 156) were staging data not being available for the cancer registration (87% agree), being worried about incorrectly reporting stage and not feeling confident (46% and 42% agree, respectively). For MDM leads (n = 22), the most significant barriers were time restrictions to capture stage (50% agree) and information not being available at the time of the MDM (50% agree).

Conclusion: Increased compliance with legislated staging responsibility will require review of current data sources available and the timing of medical record processing to maximise the data available to clinical coders. Training is likely to increase compliance. MDM structure and processes should be examined to identify improved approaches ensuring data available at the time of the MDM is appropriately recorded as cancer stage.

Jianrong Zhang, Damien McCarthy, Sally Philip, Chris Kearney, Maarten IJzerman, Jon Emery

University of Melbourne, Melbourne, VIC, Australia

Aims: To comprehensively investigate treatment interval (TI) from pathological diagnosis to treatment initiation in patients with lung tumours, including its length, risk factors and prognostic impact.

Methods: This cohort study is part of a data-linkage project including the AURORA registry dataset based on the Peter MacCallum Cancer Centre and St. Vincent Hospital in Victoria. Multivariate Cox regressions were applied to identify risk factors for longer TI and evaluate TI's impact on overall survival (OS), both adjusted for sex, age, ethnicity, year, histopathology, stage, hospital site and treatment type.

Results: A total of 2805 patients diagnosed in 2012–2020 were included, with a median follow-up of 554 days. The median length of TI was 16 (95%CI: 15–18) days, demonstrating a decreasing tendency from 2012–2014 (hazard ratio [HR] = 0.75 [.62–.90]), 2015–2017 (HR = .91 [.75–1.10]) to 2020 (HR = 1.12 (.93–1.35]) (compared to 2018–2019). Identified risk factors were: South Asian (HR = .66 [.45–0.97]) versus White, neoplastic comorbidities (HR = .90 [.81–1.00]), stages I (HR = .47 [.40–.55]), II (HR = .56 [.46–.68]), III (HR = .63 [.55–.71]) versus stage IV, multi-disciplinary meeting (MDM) (HR = .78 [.69–.88]). Among the above characteristics, exploratory analyses indicated: years of 2012–2014 (HR = 1.46 [1.23–1.74]), 2015–2017 (HR = 1.35 [1.14–1.61]) and 2020 (HR = 1.55 [1.07–2.22]) associated with a worse OS; while MDM (HR = .83 [.71–.96]) with a better OS, in addition to stages I, II and III. The impact of TI on OS demonstrated as a U shape: TIs before and after week 8 were towards the risk of death, especially during week 1 (HR = 1.63 [1.15–2.30]), week 2 (HR = 1.42 [1.00–2.02]) and week 3 (HR = 1.50 [1.06–2.12]).

Conclusions: Informative results on the length and risk factors of the time to lung cancer treatment could provide valuable insights into policy-making and clinical practice regarding how to reduce the time interval for a better outcome. The observed ‘waiting time paradox’ in the prognostic impact suggests patients with more severe diseases were treated earlier.

Adilah Amil, Roslyn Jones, Kimberley Chan, Jennifer Doyle, Ru-Wen Teh

Royal Perth Hospital, Perth, WA, Australia

As we emerge out of the COVID-19 pandemic, many hospital services are assessing the changes made during this difficult period. Out of necessity, many services, especially those who treat immunocompromised patients, had to pivot quickly to minimise the spread of the SARS-CoV-2 virus. The Medical Oncology Department at Royal Perth Hospital, an inner-city outpatient-based service with limited space to allow social distancing, underwent a significant shift in patient care, utilising telephone consultations as its mainstay for patient appointments. In order to optimise our service in the post-pandemic era, we sought our patients’ opinion with regards to how they would like our service to run. We devised an online questionnaire for patients to complete. A total of 251 patients submitted a questionnaire. The majority of patients (83%) rated their telephone consult as good or very good. Almost three quarters of patients (72%) would like telephone consultations to continue. Patient reported benefits include time and money savings as well as convenience. A quarter of patients (24%) would prefer face to face appointments only. Patients did not report significant issues with telephone consultations with only 7% reporting concerns about quality of care and treatment received. Those who preferred face to face appointments report the reason to be being more comfortable talking in person. The median net promoter score was 58. As such, we aim to continue to delivery of our consultations according to patient preference. The next step would be to determine if there are any flow on effects from telephone consultations – has it improved DNA rates, improved compliance as it is easier for patients to access health care. Whilst many felt safe with their telephone consultation has this in fact lead to poorer health outcomes as patients are not examined as regularly. Further studies will need to be conducted to determine these important questions.

Kate Arkadieff, Maryanne Skarparis, Vanessa Hardy, Linda Saunders

Health Services, Leukaemia Foundation, Brisbane, Queensland, Australia

Talking Blood Cancer Podcast shares conversations that we have held with individuals who have faced blood cancer and their carers. With over 7843 downloads since December 2021, these conversations have provided insight, given information and support through relevant peer experiences. Our conversations have provided great insight that then influence our themes and topics for our Education and Support Webinars and clinical content. Our podcast reach has extended to our rural and regional communities and has been listened to internationally as well. This Podcast has received a finalist award with the Central Patient Award from Servier. A brilliant way of providing connection and support, our aim is to continue to connect and communicate with our people living with blood cancer and their loved ones to share stories and sentiments of hope, meaning and connection through shared peer lived experiences.

Kim KP Pattinson, Kimberley KB Bury

Queensland Regional Clinical Trials Coordinating Centre (QRCCC), Douglas, Queensland, Australia

The Australian Teletrial Model (ATM) delivers clinical trials via teletrials to patients across the nation. the Townsville University Hospital in Queensland in collaboration with Clinical Oncology Society of Australia (COSA) piloted the model in 2017. The success of the Pilot program led to a significant Commonwealth funding grant and the establishment of the Australian Teletrial Program (ATP).

Under the ATP, the Queensland Regional Clinical Trial Coordinating Centre (QRCCC) was established in Townsville, North Queensland in 2022. The role of the QRCCC is to enable the expansion of the ATM within Queensland. The ATM facilitates patient access to clinical trials by linking smaller and larger hospital and health service centres via telehealth and teletrials clusters. A primary site with a Principal Investigator (PI) connects with Satellite site/s with Associate Investigator/s to form a clinical trial cluster.

Building from the pilot experience, our vision is that the ATP will improve access to, and participation in clinical trials for rural, regional and remote Australians.

Incorporating the ATM as normal business will improve access to, and participation in clinical trials.

Mary-Ann Carmichael¹, Raymond J Chan¹, Nicolas H Hart², Fiona Crawford-Williams¹

¹Flinders University, SA, Australia, Bedford Park, SA, Australia

²INSIGHT Research Institute, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

Background: As advancements in cancer treatment continue to improve survival rates of people with cancer, the focus on comprehensive survivorship care has gained significant importance. Radiation therapy is a pivotal component of cancer treatment, and the role of the radiation therapist (RT) extends beyond the treatment phase. This systematic review aims to elucidate the multifaceted contributions of radiation therapists in providing effective survivorship care to cancer patients.

Methods: Five Electronic databases were searched from inception until 20 April 2023 (CINAHL, MEDLINE, Scopus, Web of Science and Cochrane). Studies were included if they: described the involvement of RTs as providers of cancer survivorship care for people with cancer or caregivers; described or evaluated the effects of an intervention delivered by a RT; and specifically addressed one of the domains of the Quality Cancer Survivorship Framework. Studies that investigated radiation therapists’ attitudes or beliefs about their role in cancer survivorship care were also included. This review was conducted in accordance with the PRISMA 2020 Statement.

Results: After screening and removal of duplicates, 31 articles were included. Twelve radiation-therapist led interventions were identified in the domains of management of physical effects and management of psychosocial effects, with seven reported studies related to health promotion and disease prevention. Of the intervention studies four examined the RT's role in follow up care; four described the introduction of specialist roles in palliative radiation therapy, supportive care and late effects; four investigated supportive care interventions.

Conclusion: Radiation therapists play a role in the provision of survivorship care for cancer survivors. However, there remains a paucity of research reporting this. Barriers to radiation therapists providing this care include lack of training and lack of confidence. The evolving landscape of survivorship care means that alternative models of care are required, and radiation therapists are well placed in the workforce to contribute to the delivery of quality survivorship care.

Duncan Colyer¹, Kathleen Wilkins², Jacqui Waterkeyn³, Anne Woollett⁴, Carolyn Stewart⁵, Christie Allan⁶, Jhodie Duncan⁷, Carole Mott⁸, Marian Lieschke⁹

¹VCCC Alliance, Melbourne, VIC, Australia

²VCCC Alliance Consumer, Melbourne, VIC, Australia

³Royal Melbourne Hospital, Melbourne, VIC, Australia

⁴TrialHub, Alfred Health, Melbourne, VIC, Australia

⁵Murdoch Children's Research Institute, Melbourne, VIC, Australia

⁶Cancer Council Victoria, Melbourne, VIC, Australia

⁷Latrobe Regional Health, Traralgon, VIC, Australia

⁸Goulburn Valley Health, Shepparton, VIC, Australia

⁹Parkville Cancer Clinical Trials Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Clinical trials provide significant value to Australia's healthcare system nationally, at an institutional level and at the level of private practice. This value is not just financial but can also be observed in key areas such as equity of access to treatment, improved quality of life (for both participants and patients), collaboration and partnerships, improving workforce education, and defining best practice healthcare. Despite these advantages, the wider and truer value of clinical trials remains underrealised and communication of these values needs to be better appreciated.

As part of their Business Capabilities project within the Clinical Trials Innovation program, the VCCC Alliance undertook a proposal to ascertain how the value of clinical trials could be better understood within a Health Service Organisation (HSO). Working with the knowledge that HSO strategic plans are designed to encapsulate their desired quality of healthcare provision, these were chosen as a focus for analysis. Thematic areas were identified from 12 strategic plans across Victoria and grouped together, along with explanations and references, that demonstrate alignment to clinical trials. The resulting ‘one pager’ document is freely available and offered to assist to communicate, support and justify business cases.

The poster here will reflect the scoping process outlined above and the key findings.

Cassandra Dickens¹, Manohan Sinnadurai¹, Martina O'Neill¹, Greg Cadigan², Natalie Bradford³, Bryan A Chan^1,4

¹Adem Crosby Centre, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

²Healthcare Improvement Unit, Queensland Health, Brisbane, Queensland, Australia

³Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia

⁴Griffith University, Nathan, Queensland, Australia

Background: Patients with cancer often require urgent assessment and intervention for complications related to their disease or treatment. Increasing numbers of patients and treatment complexity has added pressure to already strained hospital and primary care systems. To better assist our patients and prevent avoidable Emergency Department (ED) presentations, we implemented an Oncology Nurse-Practitioner (NP)-led, Rapid Access Clinic Expansion (RACE) service for telephone triage and streamlined outpatient management.

Aims: To evaluate and describe pragmatic models and pitfalls to inform future models and service expansion.

Methods: The RACE service was established in January 2023, as a NP-led service (Monday to Friday; 0830–1600 h). Calls and referrals were assessed for service eligibility and triaged by a dedicated Clinical Nurse (CN), using the United Kingdom Oncology Nurses Society Oncology/Haematology Telephone Triage Tool. Escalation pathways enabled the CN to seek advice or support from the NP, including urgent outpatient review. The implementation evaluation of RACE was informed by the ‘Reach, Effectiveness, Adoption, Implementation and Maintenance’ framework.

Results: From January to June 2023, 157 patients/carers utilised RACE. ED presentation was avoided in 134 (85%) patients, of these 127 (95%) were managed entirely as outpatients.

Education and awareness of the RACE service and eligibility criteria was imperative for successful implementation. Service establishment challenges were related to sustainable workforce support. Staffing challenges arose in relation to recruitment into essential service roles and backfill. Despite these challenges RACE was able to manage clinical concerns and assist in the mitigation of ED and hospital presentations efficiently and safely, with 100% of patients expressing satisfaction.

Conclusions: Our RACE service demonstrates the importance of appropriate resourcing, training and support for the successful implementation of a new service model. Specialist oncology NP-led services can reduce avoidable emergency presentations and admissions, whilst meeting the unplanned clinical needs of oncology patients.

Benjamin Newham¹, Bridgitte Evans¹, Hayden Sheehan¹, Denise Andree-Evarts², Ajeet Mishra¹, Wen-Long Hsieh², Joshua Hiatt¹, Matthew Fuller¹

¹Radiation Oncology, WNSWLHD, Orange, New South Wales, Australia

²Radiation Oncology, WNSWLHD, Dubbo, New South Wales, Australia

Introduction: Radiotherapy has been available in the Western NSW Local Health District (WNSWLHD) since the Central West Cancer Care Centre (CWCCC) opened in Orange in 2011, with the Western Cancer Centre Dubbo (WCCD) opening in 2021. Over this time, many complex techniques have been implemented to provide the rural patients with a level of service equivalent to that found in metropolitan centres. However, some types of treatment such as Stereotactic RadioSurgery (SRS) have been confined to larger centres.

In late November 2022 the Varian HyperArc Stereotactic RadioSurgery (SRS) system was implemented in WNSWLHD.

The implementation of HyperArc in WNSWLHD has already provided many benefits to patients and carers. There was a higher uptake of the technique in the first months of clinical use than initial estimates suggested. Ultimately this innovation will help improve cancer outcomes in our rural population.

William Evans¹, Anne Woollett¹, Nadine Herren², Katrina Brosnan³

¹TrialHub, Alfred Health, Melbourne, VIC, Australia

²Innovation and Development, Teletrials WA Country Health Service, Perth, WA, Australia

³Australian Teletrial Program, Office of Research and Innovation, Clinical Planning and Service Strategy Division, Queensland Health, Brisbane, QLD, Australia

Teletrials expand the model of care in clinical trials in order to provide patients with resources closer to their home and social supports. Patients can access optimal treatment in their local community rather than regularly having to travel long distances, especially if unwell or frail.

This emerging specialty offers a new professional development opportunity for clinical trial nurses and coordinators. In practice, long term, sustained logistical and project management is required by a dedicated teletrial manager to maintain connections between sites. They are also able to provide advice on the modifications required in the processes of feasibility, site initiation, maintenance and close out of a study.

The role of the teletrial manager is broad and varied depending on the nature of the sites, protocols, patients and jurisdictional requirements.

This poster will showcase the key roles and responsibilities that would inform a national teletrial coordinator position description.

Yae Joo Jun¹, Zoe Clarke², Catherine Osborne², Iliana Peters², Denise Andree-Evarts², Tamara Molloy¹, Eugene Tan¹, Madison Wong¹, Caitlin Allen¹, Matthew Fuller¹

¹Radiation Oncology, WNSWLHD, Orange, New South Wales, Australia

²Radiation Oncology, WNSWLHD, Dubbo, New South Wales, Australia

Background and aims: WNSWLHD covers a vast 247,000 square kilometres. However, radiation oncology is only available in two relatively south eastern sites: Western Cancer Centre Dubbo, and Central West Cancer Care Centre in Orange. These distances mean that a significant number of patients need to travel not only for the actual radiation treatment, but also for a separate preceding CT planning appointment. Particularly for patients with palliative intent, significant issues such as travel and transport and associated emissions, pain management and accommodation are barriers for receiving this essential treatment. A Medical Imaging Simulated Radiation Therapy (MISRT) pathway was implemented to alleviate this issue and expedite the process through the use of diagnostic images which the patient has already undergone. This quality assurance (QA) study will help give confidence in the accuracy of the different datasets from the many CT machines throughout the district.

Methods: A list of private and public medical imaging departments in the district was developed. Each department was contacted, and a remote or on-site visit was organised. An education session on the new pathway requirements was delivered and a QA phantom (GAMMEX Tissue Characterisation Phantom) was scanned. Radiotherapy dose distributions were calculated for these different scans, as well as different treatment situations.

Results: The engagement and education was well received by the different medical imaging centres. Slight differences in CT to ED data were noted due to the nature of differing CT brands and series. However, these differences were within clinically acceptable ranges.

Implications or conclusion: With existing data and protocols we feel confident any small variances are clinically insignificant and are far outweighed by the benefits this innovative pathway brings to both our rural patients and health system.

Lisa Gomes^1,2, Skye Dong^1,2, Claire Gore^1,2, Iris Bartula^1,2, Jake Thompson^1,2

¹Melanoma Institute Australia, Wollstonecraft, NSW, Australia

²The University of Sydney, Sydney, Australia

Background: Australia is the melanoma capital of the world, with an age-standardised incidence rate over 10 times that of the global average. In February 2022, the State of the Nation in Melanoma report¹ identified supportive care and survivorship to be one of five priority areas requiring immediate action, with psychological support being a significant unmet need.

Aim: To provide integrated, melanoma-specific clinical psychology services to patients attending outpatient clinics at Melanoma Institute Australia (MIA).

Method: The Clinical Psychology Service (CPS) was established in August 2021 to provide psychological support for MIA patients undergoing melanoma diagnosis, treatment and monitoring. This philanthropically funded service provides short-term and free-of-charge psychology support to patients diagnosed with melanoma (any stage) and their family.

In addition to providing direct psychotherapeutic support to patients and their family, the CPS participates in weekly MDT meetings, presents community and professional educational seminars, and conducts research activities.

Results: Since its establishment, there have been 299 referrals to the CPS. Referrals to the CPS are received from specialists across MIA outpatient clinics and satellite sites. Patients are offered face-to-face or telehealth appointments, with an average of three appointments attended by each patient. Patients and their family commonly presented for support managing their adjustment to melanoma, anxiety, mood disturbance, stress, and grief and loss issues. Psychologists primarily utilise Cognitive-Behavioural Therapy and Acceptance and Commitment Therapy approaches to treat presenting problems. At the conclusion of engagement with the CPS, patients were discharged as their goals were met or were assisted to connect with a community-based psychologist for ongoing therapy.

Ellen Heywood, Daniella Chiappetta

Alfred Health, Melbourne, VIC, Australia

With the shift of traditional cancer care from the hospital to home, Alfred Cancer has implemented innovative services to meet service demands in the ambulatory space. In 2021, Alfred Cancer embarked on a Cancer@Home model of care, with the objective of developing capabilities and care pathways to enable the provision of timely quality care. The aim is to improve patient experience and care for patients beyond the walls of the hospital. Cancer@Home focusses not only on delivering cancer treatments in the home but also ensuring appropriate resources are available in the ambulatory same-day setting. The intention is to provide preventative outpatient interventions, to avoid acute deterioration requiring hospitalisation. This model had the hypothesis of reducing all hospital admissions by providing cancer treatments in the home and early interventions in the outpatient/community setting.

Mahesh Iddawela^1,2, Kashif Sheikh¹, Stewart Harper¹, Caroline Lasry¹

¹Gippsland Regional Integrated Cancer Services, Traralgon, VIC, Australia

²La Trobe Regional Health Service, Traralgon, VIC, Australia

Background: Care Closer to home is one of the priorities of the Victoria Cancer Plan and important for a quality public health system. Integrated primary care data and hospital information on patient care is essential for developing efficient pathways. We developed a collaborative partnership with the Gippsland Primary Health Network (Gippsland PHN) and Gippsland Regional Integrated Cancer Service (GRICS) with the aim to investigate and compare patterns and trends in melanoma treatment for Gippsland residents between 2018 and 2020.

Results: The VCR reported 600 new incidences of melanoma in Gippsland between 2018 and 2020. Whereas the Gippsland PHN POLAR dataset indicated 991 new diagnoses of melanoma with 517 patients being billed for MBS items 31371 to 31376 by general practitioners (GPs) locally. Additionally, the VAED data indicated 782 Gippsland patients and 2836 admissions were assigned ICD-10 AM code ‘C43’ for the 2018–2020 period when calculated by calendar year.

The VAED also indicated 135 ‘biopsy of lymphatic structure’ being performed for Gippsland residents at state-wide health services during 2018–2020, where 17 were performed in Gippsland as opposed to 118 outside of Gippsland.

Conclusion: Integration and careful analysis of data from multiple sources is essential for service development and quality improvement. A larger research project is now planned to utilise this information to establish melanoma referral pathways, models of care and services to develop best pathways for diagnoses and procedures for Gippsland melanoma patients.

Pippa Labuc, Rachel Allan

Peter MacCallum Cancer Center, Melbourne, VIC, Australia

Aims: It is critical that cancer care clinicians have a strong knowledgebase regarding cancer, including evidence-based assessment and interventions. The COVID-19 pandemic necessitated a more generalised skill set, resulting in the dilution of specialist skills. The aim of this project was to evaluate the implementation of education and supervision strategies to improve clinical competency and patient care in occupational therapy.

Methods: Occupational therapists participated in evidence-based ‘Oncology Fundamentals’ package, developed by senior clinicians with over 10 years’ experience. This consisted of dual supervision models and 6x intensive 1-h face-to-face education modules targeting priority practice areas. This included cancer treatments, oncological emergencies and symptom management. Data was collected pre–post training including clinical record audits and participant program evaluation surveys to measure change in adherence to best practice guidelines, clinician competence and self-efficacy. Staff rated confidence post-intervention was self-rated from 1 = not confident at all to 5 extremely confident.

Results: Clinicians (n = 6, 3x Grade 1 and 3x Grade 2) had worked in cancer care for an average of 2.2 years. Education session attendance was 86%. Audit findings included improved frequency in documentation of fatigue (60.8%–77.8%), cognition (71.74%–75%) and pressure care (67.39%–75.00%). Confidence increased in all key areas including cancer treatments (30%) oncological emergencies (33%), metastatic spinal cord compression (27%), dyspnoea (23%) and pressure care (13%). Documentation of pain and positioning decreased (41.30%–25%). Areas to further target education based on the audit included documentation of clinical reasoning.

Conclusion: Implementing a dual supervision and intensive education model can improve clinician confidence and competence in delivering cancer care, in particular cancer symptom management, and enhancing service capacity to provide specialist cancer interventions to address patient needs. Further investigation is required on the sustainability of this model and translation across other clinical disciplines.

Arshya Pankaj, Wei-Sen WL Lam

Fiona Stanley Hospital, Perth, WA, Australia

Aim: Immune checkpoint inhibitors (ICIs) have significantly improved prognosis for patients with advanced malignancies. However, ICIs predispose to a spectrum of adverse effects known as immune-related adverse events (irAEs). We aimed to review prevalence of existing irAEs in the months prior to oncology admissions as well re-admission rates, management and outcomes.

Methods: Inpatient medical oncology admissions at Fiona Stanley Hospital (FSH) secondary to irAEs were audited for demographics, ICI treatment, irAE and severity, management, length of stay from January to June in 2022. We also reviewed mortality and readmissions. Outpatient correspondence was reviewed for pre-existing irAEs in the 3 months prior to admission.

Results: Twenty-nine patients were admitted for irAEs under FSH oncology. Approximately 41% of patients were on pembrolizumab, 28% on both ipilimumab and nivolumab, 21% on nivolumab and 10% on durvalumab. Colitis accounted for 34.5% of irAE admissions followed by pneumonitis and hepatotoxicity accounting of 21% and 17%, respectively. The mean length of stay was 8.3 days (median 7, range 2–34 days). Grade 3-4 IRAEs accounted for 72% of admissions while grade 2 irAEs accounted for 28%. Fifty-nine percent of patients received intravenous steroids, 41% received oral steroids and 17% of patients required additional immunomodulators. Approximately 69% of patients had grade 1–2 irAEs in the preceding admission. Forty-one percent of patients were readmitted within 6 months and 17% of these were for an irAE. One patient died during audited admission and one patient died during their readmission secondary to the irAE.

Conclusion: Admissions secondary to irAEs are growing. Over 40% of patients received oral steroids raising the possibility of avoiding admissions in the first instance. We found a majority of admitted patients had preceding IRAEs in the outpatient setting. Closer monitoring for these patients in the outpatient setting may suggest prompt diagnoses and treatment potentially preventing hospitalisations.

Melanie R Lovell^1,2, Sally Baksa², Phillip Siddall²

¹Sydney University, Sydney, Australia

²HammondCare, Greenwich, NSW, Australia

Aim: Pain is common in cancer and results in significant impact on quality of life and function. Approximately 25% of people attending ambulatory oncology services have pain ≥5/10 in severity. Non-pharmacological strategies are safe and effective although there is a nation-wide lack of access for patients to non-pharmacological treatments. There is therefore a need for scalable, cost-effective translation of evidence-based non-pharmacological interventions including exercise, mindfulness and relaxation to manage cancer pain. We aim to describe development of an app to deliver evidence-based interventions for self-management of cancer pain.

Method: Meditations including for breathing techniques; relaxation; guided imagery; desensitisation; body scan; sitting with sounds, thoughts, feelings and sensation; difficult thoughts and feelings; compassion, kindness and gratitude; and mindfulness meditations for intense pain based on evidence were written and recorded by Dr Skye Dong. Exercises including stretching, resistance based on Cancer Council resources and tai chi were demonstrated and filmed. The app was released.

Results: The free app was released in September 2022 and at the time of writing had been used over 5000 times. Patient feedback confirms feasibility, acceptability and effectiveness. A nurse said ‘I have a young patient (42 years) with mets in his sacral spine. He was really struggling with this pain and the side effects of the increasing doses of morphine. After downloading the (Cancer Pain) app last visit he called me today to say that he has been meditating, breathing through his incident pain… This has helped him to not need any BT medications all week. He was chuffed to be able to go to his nephew's birthday party this weekend and not feel groggy at all.’

Narelle McPhee¹, Michael Leach¹, Claire Nightingale², Samuel Harris³, Eva Segelov⁴, Eli Ristevski⁵

¹School of Rural Health, Monash University, Bendigo, Victoria, Australia

²Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia

³Bendigo Cancer Centre, Bendigo Health, Bendigo, Victoria, Australia

⁴Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia

⁵Monash University, Monash Rural Health, Warragul, Victoria, Australia

Background: Clinical trials are essential to cancer care as they test new ways of screening, treating and providing care to people with cancer. Improved survival may also be a benefit of participating in clinical trials. There are known patient populations that are underrepresented in clinical trial participation. Rural residents are one such population. While there are numerous studies on patient-related factors that influence clinical trial participation, there are limited studies on what factors influence whether healthcare professionals discuss clinical trial participation with some rural-residing people with cancer and not others. There is a lack of research on this topic, especially in the Australian context.

Methods: Straussian Grounded Theory methods will be utilised.¹ Semi-structured interviews will be conducted with cancer clinical trial investigators, healthcare professionals who refer rural residents to cancer clinical trials and clinical trial administrators. Purposive and theoretical sampling will guide recruitment of participants from rural and metropolitan health services and clinical trial units in Victoria, Australia. Semi-structured interviews will be conducted via telephone or video conferencing, recorded and transcribed verbatim. A three-step coding process (open, axial and selective coding) will be undertaken to analyse the data. Concurrent data collection and analysis and a continuous comparison approach will be undertaken. Interviews will be conducted until no new concepts have been identified from the data (i.e. theoretical saturation). Monash University Human Research Ethics Committee approved this project (31102).

Louise Moodie, Julie Pratt

Nutrition & Dietetics, Mackay Hospital and Health Service, Mackay, Queensland, Australia

Routine screening for cancer-related malnutrition is a key recommendation of the Clinical Oncology Society of Australia cancer-related malnutrition and sarcopenia position statement. Recent local audits of our service demonstrated lower than expected nurse-led malnutrition screening in the oncology day unit and no routine screening amongst those receiving oral therapies. This quality improvement activity gathered preferences for malnutrition screening from adults receiving cancer treatments in a chemotherapy day unit at a regional hospital. Twenty-eight patients volunteered to provide feedback on their ability to complete two validated malnutrition screening tools – the Malnutrition Screening Tool (MST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). These screening tools were developed to be completed by patients and health professionals. Forty-four percent of respondents preferred the PG-SGA SF, 40% preferred the MST, with the remainder having no preference. Respondents reported that both tools were easy to use, understood the questions and were generally able to complete the screening tools independently. Most respondents reported they could complete the screening tools in under 5 min (93% for the MST; 80% for the PG-SGA SF) with many reporting the ability to complete the tool in under 3 min. Most respondents stated they would prefer to answer the screening questions on their own. Respondents preferred to complete the screening on paper; however, this may have been biased as participants were only provided with paper tools to complete. Feedback generated from this quality activity will be used to inform future changes to improve malnutrition screening in our centre and may provide an avenue to implement malnutrition screening amongst those receiving oral therapies. Patients told us that they are willing and able to screen themselves for malnutrition. It is up to us to be inspired to innovate processes to improve cancer-related malnutrition care in the future.

Alexandra Nolte, Katherine Lane, Tamara Blackmore, Claire Evans, Danielle Chidlow, Richard Muntz, Cuong Lam, Paige Dore, Danielle Spence

Cancer Council Victoria, East Melbourne, VIC, Australia

Aims: With greater demands on health services during COVID-19, Cancer Council Victoria (CCV) aimed to increase awareness of our 13 11 20 cancer support line to take pressure off the acute and primary sectors and ensure people affected by cancer were well-supported.

Conclusions: A combined stakeholder engagement and strategic marketing approach, supported by additional staff has been a successful model for increasing awareness and uptake of our 13 11 20 service during and post COVID-19. Importantly this has helped relieve the pressure on health services and improve access to support for Victorians affected by cancer, particularly those in regional and rural areas.

Rayan Saleh Moussa¹, Maria Gonzalez¹, Sally Fielding¹, Tim Luckett¹, Charbel Bejjani², Ben Smith³, Slavica Kochovska⁴, Arwa Abousamra¹, Nadine El-Kabbout¹, Linda James¹, Linda Brown¹, Meera Agar^1,2

¹University of Technology Sydney, Ultimo, NSW, Australia

²South Western Sydney Local Health District, Sydney, Australia

³University of Sydney, Camperdown, Australia

⁴University of Wollongong, Wollongong, Australia

Background: Australia is growing in ethnic diversity, and Arabic is now the third most spoken language in the country.¹ Despite this, people from culturally and linguistically diverse (CALD) communities continue to experience poorer healthcare access and healthcare outcomes, with several contributing factors identified in the context of cancer care.² These inequities are compounded by the exclusion and underrepresentation of CALD communities in potentially life-saving cancer clinical research. To date, research has predominantly focussed on community-sided barriers, with a perceived lack of understanding of the health system and low English proficiency identified as key barriers to participation in clinical research.^3–5 However, it is critical to investigate the experiences of key stakeholders such as trial sponsors, researchers, healthcare professionals and site staff, to inform a more holistic approach to improving diversity and inclusion in the Australian clinical research landscape.

Aim: To unpack the barriers and enablers to CALD participation in clinical research, through the perspectives of researchers and healthcare professionals, with an initial focus on the Australian Arabic-speaking community.

Method: A qualitative study that uses focus group sessions with researchers and healthcare professionals working with adults with cancer from the Australian Arabic-speaking community. Each participant will be required to attend one focus group session (∼60 min). Participants who are unable to attend a focus group session will be invited to participate in a semi-structured interview (∼45 min). Recruitment will be guided by data saturation, with an initial target sample size of 30 participants.

Rayan Saleh Moussa¹, Jack Power¹, Vanessa Yenson¹, Belinda Fazekas¹, Celia Marston², Annmarie Hosie³, Domenica Disalvo¹, Linda Brown¹, Imelda Gilmore¹, John Stubbs¹, Andrea Cross¹, Sally Fielding¹, Meera Agar^1,4

¹University of Technology Sydney, Ultimo, NSW, Australia

²Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³University of Notre Dame, Chippendale, NSW, Australia

⁴South Western Sydney Local Health District, Sydney, Australia

Accurate capture and reporting of adverse events (AEs) in clinical trials is critical to understand the potential harms to individuals receiving prospective therapies. A series of collaborative discussions with consumers, interdisciplinary clinical trialists and case study analysis, identified that clinical trials investigating non-pharmacological interventions rarely incorporate systematic capture of AEs and often report no harms. This has the potential for under-reporting, which could impact the safety of such therapies when implemented in clinical practice. Current AE-reporting frameworks (e.g. International Council on Harmonisation of Technical Requirements for Pharmaceuticals for Human Use: Guideline for Good Clinical Practice and the National Cancer Institute's Common Terminology Criteria for Adverse Events) were developed to capture and report AEs that occur in pharmacological trials. Adaptation of pharmacological AE-reporting frameworks imparts a risk of excluding AEs unique to non-pharmacological interventions that have not yet been defined. For example, capturing a participants’ feeling of failure associated with an inability to complete a mindfulness-based intervention. Furthermore, there can be study setting-dependant AE-reporting disparities in non-pharmacological trials, with a risk of AEs not being captured when conducted in a community setting compared to a hospital clinic, due to rigid reporting frameworks and inadequate participant self-reporting. In addition, clinical trials focus primarily on the participant receiving the intervention, with current AE-reporting frameworks failing to recognise potential harms to participants’ families, carers, clinical and research staff. For example, the risk of harm to research nurses from participants presenting with unpredictable behaviour. This initiative aims to: (i) increase awareness for the potential under-reporting of AEs, particularly in non-pharmacological trials; and (ii) explore appropriate AE-reporting frameworks to aid the systematic capture and reporting of AEs experienced by all individuals, either directly or indirectly, participating in clinical trials. Addressing this gap will enable a comprehensive and accurate understanding of the potential harms of all types of prospective therapies.

Kate Saw^1,2, Oksana Zdanska^2,3, Gio Kalender¹, Emma-Kate Carson⁴, Antonia Gazal⁵, Nitesh Naidoo⁶, Elgene Lim^1,2

¹The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia

²The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

³Torrens University, Fortitude Valley, QLD, Australia

⁴Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia

⁵University of Notre Dame Australia, Sydney, NSW, Australia

⁶Vocus Group Limited, Sydney, NSW, Australia

Background: Clinical research is vital to the development of new anticancer treatments, yet only ∼5% of cancer patients in Australia participate in an oncology clinical trial.¹ In the context of increasing numbers of clinical trials in Australia, a shift towards precision medicine, and an improvement in objective response rates, there is now a unique opportunity to increase clinical trials enrolment and provide access to further treatment options for cancer patients. However, from a patient perspective, the complexity of the clinical trials landscape continues to provide a major barrier to participation.

The problem: The ability to consider, let alone participate in clinical trials throughout a person's cancer journey is hampered by multiple barriers from the patient, clinician and structural perspectives including awareness, accessibility, language, time and resources. Existing clinical trial navigation tools are either designed with a clinician-centric only approach, operate on a fee-for-service basis, do not allow for real-time updating of clinical trial information or are optimised for clinical trial locations outside of Australia. Hence, there is a need for a simple to use, up to date navigation tool that assists a cancer patient in identifying appropriate trials relevant for their condition and in their decision to join, and remain engaged, in a clinical trial.

Anthea Udovicich

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aim: A Melbourne tertiary cancer centre provides occupational therapy wellbeing sessions for patients on managing fatigue and cognitive changes. Sessions were developed and delivered by senior occupational therapy clinicians, using evidence-based literature alongside specialist clinical expertise. Aims of this project were to: (a) improve clinician skills and confidence in online group facilitation, (b) evaluate consumer feedback following the sessions to ensure they are fit for purpose.

Results: Clinicians (n = 6) ranged from grade 1 to grade 3 occupational therapists with clinical experience ranging 7 months to 14 years. Average confidence facilitating groups increased from 3.0 to 4.0 average knowledge in preparing for group facilitation increased from 3.0 to 4.0, average knowledge in group facilitation best practice increased from 2.8 to 4.0.

Themes from patient qualitative surveys (n = 28) and interviews (n = 2), July 2022 to July 2023, included increasing accessibility of the sign-up process and ensuring different methods of within and post-session communication to meet patient diverse needs and schedules. Consumer feedback reinforced the importance of an experienced therapist facilitating the sessions who could emphasise and provide strategies to support symptom management.

Conclusion: Education improved clinician knowledge and confidence facilitating groups. Feedback enabled targeted improvements to the session and facilitator skills. This project highlights the importance of continuous improvement, clinician education and consumer feedback when facilitating patient sessions.

Matthew P Wallen¹, Rohan Miegel^1,2, Nathan Chesterfield¹, Raymond J Chan¹, Claire Drummond³, Joyce S Ramos¹, Holly Evans¹

¹Caring Futures Institute, Flinders University, Adelaide, SA, Australia

²Flinders Medical Centre, Adelaide, SA, Australia

³College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

Background: Exercise is a powerful intervention shown to improve a myriad of physiological and psychosocial outcomes for people living with and beyond cancer. Given the increasing demand for exercise services, there is impetus to investigate alternative models of service delivery to maximise reach. Student-led exercise clinics may provide an opportunity to alleviate extended waitlist times for public exercise services, while simultaneously achieving clinical practicum requirements.

Aim: This abstract provides an overview of a student-led exercise oncology program hosted between Flinders University and Flinders Medical Centre.

Methods: The Cancer Exercise and Physical Activity (CEPA) service is a 12-week, group-based exercise program hosted at Flinders University. Patients are referred into the service following discharge from the Exercise Fatigue program at Flinders Medical Centre or can self-refer into the program. The service provides group-based exercise services two times per week under the guidance of student exercise physiologists undertaking a clinical placement block and are supervised by Accredited Exercise Physiologists with experience in exercise oncology. All patients are individually prescribed a combination of aerobic and resistance training and provided a home program to complete. Outcomes are modified based on patient conditioning, are assessed at baseline, 6- and 12-weeks, and include validated measurements of key physical qualities (cardiorespiratory fitness, muscular strength, balance, change of direction speed and mobility) and patient-reported outcomes (health-related quality of life, fatigue and motivation for exercise). Key implementation characteristics from patients and students are captured at the end of the 12-week program and placement block, respectively. Harms are evaluated using the Exercise Harms Reporting Method.

Progress: The CEPA service launched in July 2023 and is currently enrolling patients into the service.

Peta Wright, Ella Sexton, Cassandra Haynes, Geraldine McDonald

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: In 2021 a Patient Parliament consultation process with over 80 consumers at a comprehensive cancer centre identified carer and family support as a high priority and highlighted the need for more services for carers, and awareness early in treatment of services available for carers. Further consultations found that carers were unprepared for the impact of physical toll, managing carer emotions and impacts on everyday living. They were struggling to get the support they need, and support services were not being used to their greatest benefit. Objective 1 was to develop a Supporting Carers Strategy to address the priorities and gaps in current service provision as identified by consumers and in alignment with the Victorian Carer Strategy. Objective 2 was to develop an accessible, onsite dedicated service for carers.

Development: Stage 1. A Carers Strategy Advisory Committee was created to advise on the development of the strategy and to support and evaluate its implementation. Consumer consultation (n = 9) was conducted in September 2022. Key hospital staff reviewed the strategy and provided feedback via an online survey between August and September 2022. Stage 2. A Carer Support Program was established to provide dedicated onsite services for carers. This included a Carer Support Officer, Clinical Psychologist and Carer's Circle peer support group.

Implementation: Stage 1. The Supporting Carers Strategy 2022–2026 was launched in December 2022 and outlines five priorities to establish a coordinated approach to the way we care for carers. Stage 2. The Carer Support Officer role was established in January 2022 and provides supportive conversations to understand carer needs, establish wellbeing goals and connect carers with appropriate support services. The Clinical Psychologist commenced service delivery in February 2023 and provides accessible and timely psychological services. The program has supported 157 carers to date.

Vanessa Yenson^1,2,3, Sonia Dixon¹, Garth Hungerford¹, Brian Dalton¹, Janelle Bowden⁴, Carrie Hayter⁵, Alexandre Stephens⁶, Angela Todd⁷, on behalf of Consumer Voices in Clinical Trials in NSW¹

¹ConViCTioN, Sydney, NSW, Australia

²University of Technology Sydney, Ultimo, NSW, Australia

³Cancer Symptom Trials (CST), Ultimo, NSW, Australia

⁴AccessCR, Sydney, NSW, Australia

⁵Health Consumers NSW, Sydney, NSW, Australia

⁶Northern NSW Local Health District, Lismore, NSW, Australia

⁷Sydney Health Partners, Sydney, NSW, Australia

Aim: To engage and support a group of consumers with diverse experiences to develop targeted resources that increase awareness and participation in clinical trials among the wider community.

Method: An Expression of Interest (EOI) process invited people in NSW to join a consumer group supported by: Sydney Health Partners, Health Consumers NSW, AccessCR and Northern NSW Local Health District.

Results: This consumer-led project received funding for 15 online consumer members, selected from 42 EOI submissions representing people from culturally and linguistically diverse and Indigenous backgrounds, with diversity in health conditions (including cancer), age, gender, NSW location, and clinical trial and lived experience. Initial meetings established two co-chairs, terms of reference, reimbursement plan, project methodology and agreed on the group name: Consumer Voices In Clinical Trials NSW (ConVICTioN). Members completed fact-finding exercises to identify what was missing from current awareness resources and brainstormed solutions to fill the gaps. Since its inception in 2022, ConVICTioN has developed: four resources for consumers by consumers (a webinar, a 7-min video, infographic and checklist for others interested in clinical trials). All resources are freely available on the ConViCTioN website¹ and have been disseminated at a number of conferences and events.

Monique Bareham

¹Lymphoedema Advocate, Adelaide, South Australia, Australia

This presentation will outline the progress in lymphoedema (LO) advocacy in Australia over the past 10 years. This presentation highlights the key achievements, including state-wide access to the LO garment reimbursement scheme in South Australia which has led to a National Patient Advocacy movement. Subsequently the accumulation of work in the lymphoedema advocacy space has led to the recent release of the seminal AIHW report on the burden of LO in Australia.

The presentation will also consider the existing challenges in LO care that advocacy could address and potential opportunities for leveraging consumer led advocacy at state and national levels to address them.

*Part of a symposium with Prof. Bogda Koczwara

Shae Beaton, Peta Wright, Geraldine McDonald

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aims: This study aims to evaluate the benefits of the Head and Neck (H&N) and Lung Cancer Peer Support Groups for patients and carers at a comprehensive cancer centre, and to identify any potential areas for improvement.

Methods: Convenience sampling was utilised to invite all eligible participants to partake in the evaluation. Eligible participants included any patient or carer who had attended at least one H&N or Lung Cancer Peer Support Group meeting. Participants completed a survey (including demographic and evaluation questions) and/or took part in a focus group. A total of 21 participants completed the survey, and 10 participants took part in a focus group session. A survey of H&N and lung cancer staff was undertaken to gain an understanding of staff awareness of the peer support groups, and to determine their opinions on the appropriateness of one-on-one peer navigation for H&N and lung cancer patients.

Results: Thematic analysis of preliminary results of both the survey and focus group data identified several benefits of group peer support including mutual sharing/identification, knowledge, connection, belonging, confidence and self-efficacy. Participants identified the need to increase awareness of the H&N Peer Support Group amongst the H&N community. Participants from both peer support groups identified the need for support earlier in the patient's cancer journey, ideally from time of diagnosis. Participants from the H&N peer support group also expressed a need for additional support in the form of one-on-one peer navigation. Final results will be presented at the meeting.

Conclusion: Preliminary results indicate that peer support groups benefit participants in numerous ways and indicate a need for additional peer support in the form of one-on-one peer navigation for patients with H&N cancer, ideally to be implemented at time of diagnosis.

Shae S Beaton, Ronna R Moore, Peta P Wright, Geraldine G McDonald

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aim: This study aims to examine the effects of a single oncology massage (OM) session on participants’ self-reported symptoms and wellbeing.

Methods: Convenience sampling was used to recruit eligible participants which included any patient who attended an oncology massage session as an outpatient in a comprehensive cancer centre. Sixteen participants were recruited in total. Participants completed pre- and post-intervention surveys, including demographic questions and validated tools in the form of the ESAS-r and MyCAW which were used to collect data relating to participants’ self-reported symptoms and well-being. Quantitative data were analysed to understand if there was any meaningful change between pre- and post-intervention scores. Due to a small sample size, statistical tests were not performed. Qualitative data was analysed using thematic analysis.

Results: Analysis of the pre- and post-intervention ESAS-r scores showed that a single oncology massage session can decrease pain, tiredness, drowsiness and lack of appetite. Pain and tiredness displayed the greatest decrease in frequency, with a mean decrease in ESAS-r scores of 2.31 and 2.25, respectively. Depression and anxiety mean scores decreased by 1.62 and 1.75, respectively. Results of the MyCAW surveys showed wellbeing improved by a mean improvement of 1.56. Thematic analysis of qualitative data showed the following themes emerge relating to participants self-perceived benefits of OM: providing a safe space, communication, opening up, relaxation, healing, connection, physical relief and happiness.

Conclusion: OM may be associated with a decrease in pain, tiredness, drowsiness, nausea, lack of appetite, depression and anxiety. Results also indicated that OM may be associated with an increase in wellbeing and may have a greater benefit for patients currently undergoing chemotherapy and/or radiotherapy compared to patients on other forms of treatment/no active treatment.

Katarzyna Bochynska, Pareoranga Luiten-Apirana

Cancer Council NSW, Woolloomooloo, NSW, Australia

Aims: Timely identification and referral of individuals with unmet supportive care needs can improve quality of life, adherence to cancer treatment and reduce the adverse effects of cancer and its treatment. To improve access to information and support services, Cancer Council NSW established the Cancer Council Liaison (CCL) service. CCLs are based in treatment facilities and work alongside treatment team to support people affected by cancer. The aim of this study was to assess the quality of clients’ experiences with the CCL service and satisfaction with the support received.

Methods: The research presented here, results from client experience survey was one part of a broader mixed methods evaluation. Clients who received support from a CCL were invited to participate in an anonymous survey, which included questions about cancer type, length of diagnosis, support received and feedback on the CCL role. Quantitative data were analysed descriptively while free-text comments were coded and analysed qualitatively.

Results: Forty-seven clients completed the survey, of whom 66% (n = 31) had a current or previous cancer diagnosis and 34% (n = 16) were a family member/carer. After interacting with the CCL, 94% of survey respondents reported that they were more aware of the support available and how to access it, 91% reported to be less stressed about their current situation and 83% reported that their individual needs were met. Respondents reported a mean rating of 4.9 out of 5 stars regarding their experience with the CCL.

Conclusions: The findings demonstrate the high quality of clients’ experiences with the CCL service and highlight the value of the CCL service in treatment centres. It should be noted that the representativeness of the findings may be limited due a small sample size. Further research is required to determine the impact of the CCL service on client quality of life and health outcomes.

Katarzyna Bochynska, Annie Miller, Rhiannon Edge, Lauren McAlister

Cancer Council NSW, Woolloomooloo, NSW, Australia

Aims: Timely identification and referral of individuals with unmet supportive care needs can improve cancer outcomes. To improve access to information and supportive care services, Cancer Council NSW established the Cancer Council Liaison (CCL) service. CCLs are based in treatment facilities, work alongside cancer treatment team and support people affected by cancer across the cancer continuum. The aim of this study was to explore the perceptions of the service amongst healthcare professionals (HCPs) and assess the feasibility of integration of the CCL service in their cancer centre.

Methods: The research presented here, results from semi-structured interviews with healthcare professionals (HCPs; n = 20) from four cancer centres, was one part of a broader mixed methods evaluation. Interview transcripts were transcribed, coded and analysed thematically using NVivo.

Results: HCPs reported improved access to supportive care for patients and families and that a CCL enabled timely detection of unmet needs at any point in the patient or carer's cancer experience. CCLs approach to assessing needs helped reduce the risk of patients’ unmet needs and adverse impacts on their psychosocial wellbeing. Considered by HCPs as an ‘extended part of the cancer care team’, engaging with the CCL increased HCPs own awareness of available support services. Described by HCPs as unique and innovative, all of the participants stated that they would recommend the CCL role to other cancer centres. HCPs identified several facilitators to successfully embed the role within the cancer centres.

Conclusions: Healthcare professionals value the Cancer Council Liaison role and believe the role improves patients access to supportive care services and improves patient outcomes.

Elizabeta Brkic, Lisa Beatty, Ivanka Prichard

Flinders University, Adelaide, South Australia, Australia

Aim: Body image interventions can promote positive body image in cancer populations; however, in-person interventions pose accessibility barriers, and low adherence is common with intensive online interventions. Therefore, this study investigated whether positive body image could be enhanced, and cancer-related distress reduced, through a brief single-session online writing intervention, entitled Expand Your Horizon (EYH).

Methods: A total of 130 participants were required for a sufficiently powered study. Female cancer survivors aged 18 and over were randomised to either EYH (where they described the functionality of their body), or active control (described activities of the day prior). Outcomes included appreciation of body functionality (primary outcome), body appreciation, body dissatisfaction and distress. Transient body image was assessed at baseline and immediately post-intervention; enduring body image was assessed at baseline and one-week follow-up.

Results: Both EYH (n = 24) and control (n = 24) experienced significant improvements in transient body image and distress from baseline to immediately post-intervention. However, no significant differences emerged between groups on appreciation of body functionality [EYH = 72.81(23.35); 95% CI: 62.41–83.22; control = 64.71(25.31); 95% CI: 54.30–75.11; p = 0.61], body appreciation [EYH = 59.83(30.05); 95% CI: 48.26–71.41; control = 52.71(26.15); 95% CI: 41.14–64.28; p = 0.10], body dissatisfaction [EYH = 47.61(29.03); 95% CI: 35.91–59.31; control = 54.71(27.90); 95% CI: 43.01–66.41; p = 0.42] or distress [EYH = 2.42(3.09); 95% CI: 1.28–3.55; control = 1.92(2.38); 95% CI: .78–.31; p = 1.00]. Similarly, at 1-week follow-up, no significant differences emerged between groups on any outcome measure.

Conclusion: While both writing conditions lead to improvements in transient body image and distress, this study failed to provide evidence for the efficacy of Expand Your Horizon over the control in female cancer survivors. Reasons for this and directions for future research will be discussed.

Jenni Bruce¹, Jenny Mothoneos¹, Ruth Sheard¹, Jane Ussher², Rosalie Power², Janette Perz²

¹Cancer Council NSW, Woolloomooloo, NSW, Australia

²Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia

Background: LGBTQI+ people face a disproportionate cancer burden, with high rates of distress and unmet needs including invisibility in cancer information and care.^1–3 An audit of Australian cancer websites found the vast majority (87%) did not mention LGBTQI+ people and few resources were tailored for LGBTQI+ people.⁴

Aims: Evidence shows that access to reliable, easy-to-read information after a cancer diagnosis can reduce distress, help with treatment decisions and managing side effects, and facilitate conversations with health professionals.^5–8 As a partner in the Out with Cancer Study Team, Cancer Council NSW produced a tailored information booklet as a translational outcome of the research. The aim of the booklet was to fill the information gap, answer the common questions that LGBTQI+ people have after a cancer diagnosis, and improve the cancer experience of LGBTQI+ people.

Method: Working closely with the Out with Cancer Study Team, Cancer Council NSW prepared an evidence-based draft to address unique experiences and concerns identified in the research. The draft was reviewed by over 30 expert stakeholders, including researchers, health professionals, LGBTQI+ organisations and LGBTQI+ people with a cancer experience.

The draft was then extensively revised and expanded to 80 pages. Topics covered include coping with cancer when you are LGBTQI+, disclosure to health professionals, dealing with discrimination, body image and gender, sexual intimacy, fertility, survivorship issues and advanced cancer, with chapters for trans and/or gender-diverse people, intersex people and carers.

Results: Launched in February 2023 with a national print run of 5000 copies, LGBTQI+ people and cancer⁹ is a world-first resource. The booklet has been distributed to cancer treatment centres and to individuals on request. It is also available on the Cancer Council NSW website, with 10,959 page visits in the first 4 months.

Raymond J Chan¹, Reegan Knowles¹, Joanne Bowen², Alexandre Chan³, Melissa Chin⁴, Ian Olver⁵, Carolyn Taylor⁶, Stacey Tinianov⁷, Maryam Lustberg⁸, Florian Scotte⁹

¹Caring Futures Institute, Flinders University, Adelaide, SA, Australia

²Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

³Department of Clinical Pharmacy Practice, University of California, Irvine, California, USA

⁴Multinational Association of Supportive Care in Cancer, Aurora, Ontario, Canada

⁵School of Psychology, University of Adelaide, Adelaide, SA, Australia

⁶Global Focus on Cancer, South Salem, New York, USA

⁷Advocates for Collaborative Education, Santa Clara, California, USA

⁸Yale Medical School, Yale University, New Haven, Connecticut, USA

⁹Interdisciplinary Department for the Organization of Patient Pathways, Gustave Roussy Cancer Campus, Villejuif, Paris, France

Background and aim: Quality supportive care is critical to optimising patient outcomes and experiences for people with cancer. MASCC, as the pre-eminent organisation in supportive care in cancer, is committed to a coordinated approach to supportive care. We aimed to develop a set of ambition statements as a shared-vision for the future state of supportive care by year 2030.

Methods: A Delphi methodology involving three rounds of consultation was used to reach consensus on a list of supportive care ambition statements. Prior to the Delphi, leaders of MASCC study groups (expert panel) suggested potential statements. The expert panel then completed online surveys in Round 1 and 2 to rate and provide qualitative feedback on appropriateness and clarity of statements. Consensus was reached when >80% of participants agreed/strongly agreed with the appropriateness of statements. In Round 3, patient advocates discussed clarity and appropriateness of inclusion of statements. Throughout the Delphi study, the project team revised statements according to feedback.

Results: The expert panel (n = 25) suggested 99 potential statements, which were collapsed into 23 for Delphi round 1. Twelve statements reached consensus in round 1. One of the 11 not reaching consensus was removed. In Round 2 (n = 18) expert panel rated the revised statements that had not reached consensus, with four reaching consensus. In Round 3, 11 patient advocates discussed 16 statements that reached consensus and six that did not. A final list of 15 statements was developed, addressing guidelines, education, research and clinical supportive care.

Conclusions: This study is the first to develop unifying and futuristic ambition statements for supportive care in cancer, informed by clinical and academic experts and patient advocates. This shared vision for supportive care can inform a roadmap to guide efforts and facilitate collaboration at a global level.

Udari N Colombage^1,2, Sze-Ee Soh², Robyn Brennen¹, Kuan-Yin Lin³, Helena C Frawley¹

¹Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia

²Physiotherapy, Monash University, Frankston, Victoria, Australia

³Physical Therapy, National Taiwan University, Taiwan

Aim: This qualitative study aimed to explore the experiences of pelvic floor (PF) dysfunction, and the perceived barriers and enablers to the uptake of its treatment in women with breast cancer.

Method: Purposive sampling was used to recruit 30 women with breast cancer who self-identified as experiencing PF dysfunction. Semi-structured interviews were conducted over videoconferencing and data were analysed inductively to identify emerging themes, and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework.

Results: Women were aged between 31 and 88 years with stage I–IV breast cancer. Participants experienced urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) and/or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction. Participants who were resigned felt their PF dysfunction was a low priority. Bother was driven by embarrassment of experiencing PF symptoms when in public. A barrier to accessing treatment for PF dysfunction was the lack of awareness about PF dysfunction as a side-effect of breast cancer treatments, and the lack of information available about accessing treatment for PF dysfunction. An enabler was their motivation to resuming their normal pre-cancer lives.

Conclusion: Women in this study who were bothered by PF dysfunction would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment.

Jack Dalla Via¹, Francesca Cehic², Carolyn J McIntyre³, Chris Andrew¹, David Mizrahi^4,5, Yvonne Zissiadis⁶, Rob U Newton^3,7, Mary A Kennedy¹

¹Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia

²Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

³Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

⁴The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

⁵Discipline of Exercise and Sports Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

⁶Radiation Oncology, GenesisCare, Perth, WA, Australia

⁷School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia

Aim: The COSA position statement on exercise in cancer care encourages health professionals to discuss, recommend and refer patients for exercise. We performed a national cross-sectional survey to understand the reach and barriers to use of this guidance in cancer care.

Methods: Oncology healthcare professionals (other than exercise physiologists or physiotherapists) were invited to complete an online survey that assessed contextual factors that influence implementation of COSA exercise guidance in cancer care, based on the Consolidated Framework for Implementation Research.

Results: Seventy-eight participants were eligible with complete responses. Most were women (73%), involved in cancer care for >10 years (63%), and in a public hospital setting (65%). Common occupations included oncologists (28%), nurses (28%) and dietitians (10%). Most participants agreed there is strong evidence that exercise is beneficial for cancer patients (92%) and the COSA recommendations would positively influence patients’ exercise behaviours (94%). However, only 32% reported routinely applying COSA recommendations in practice, with a minority (28%) indicating they were the best person to provide support. Patient-level barriers included a need for additional support to access exercise (92%), most commonly financial (71%), transportation (57%), education (54%) and then social/emotional (50%). Organisational-level barriers included a lack of dedicated resources to support delivery of exercise guidance (69%), and not believing provision of exercise guidance as an important part of their role (58%). Only 22% agreed their organisation revised practice based on the COSA recommendations.

Conclusions: Despite high agreement that exercise is beneficial in cancer care and application of COSA recommendations being useful for patients, only a minority of oncology health care professionals routinely apply exercise recommendations in clinical practice. Targeted efforts to overcome barriers that impact implementation of guidelines into practice aimed primarily at the patient and organisation levels are needed to improve incorporation of COSA exercise recommendations into standard cancer care.

Domenica Disalvo¹, Erin Moth^2,3,4, Wee-Kheng Soo^5,6,7, Maja V Garcia¹, Prunella Blinman^2,8, Christopher Steer^9,10, Ingrid Amgarth-Duff¹, Jack Power¹, Jane Phillips¹¹, Meera Agar¹

¹IMPACCT – Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia

²Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

³Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia

⁴Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia

⁵Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

⁶Cancer Services, Eastern Health, Melbourne, Victoria, Australia

⁷Department of Aged Medicine, Eastern Health, Melbourne, Victoria, Australia

⁸Concord Repatriation General Hospital, Sydney, New South Wales, Australia

⁹School of Clinical Medicine, University of New South Wales, Rural Clinical Campus, Albury, NSW, Australia

¹⁰Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia

¹¹School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia

Introduction: This systematic review aims to summarise the available literature on the effect of geriatric assessment (multidimensional health assessment across medical, social and functional domains; ‘GA’) or comprehensive geriatric assessment (geriatric assessment with intervention or management recommendations; ‘CGA’) compared to usual care for older adults with cancer on care received, treatment completion, adverse treatment effects, survival and health-related quality of life.

Materials and methods: A systematic search of MEDLINE, EMBASE, CINAHL and PubMed was conducted to identify randomised controlled trials or prospective cohort comparison studies on the effect of GA/CGA on care received, treatment, as well as cancer- and geriatric-domain outcomes for older adults with cancer.

Results: Ten studies were included, seven randomised controlled trials (RCTs), two phase II randomised pilot studies and one prospective cohort comparison study. All studies included older adults receiving systemic anticancer therapy, mostly chemotherapy, for mixed cancer types (eight studies), colorectal cancer (one study) and non-small cell lung cancer (one study). Integrating GA/CGA into oncological care increased treatment completion (three of nine studies), reduced grade 3+ chemotherapy toxicity (two of five studies) and improved quality of life scores (four of five studies). No studies found significant differences in survival between GA/CGA and usual care. GA/CGA incorporated into care decisions prompted less intensive treatment approaches and greater use of non-oncological interventions, including supportive care strategies.

Discussion: GA/CGA integrated into the care of an older adult with cancer has the potential to optimise care decisions, which may lead to reduced treatment toxicity, increased treatment completion and improved health-related quality of life.

Maja V Garcia¹, Domenica Disalvo¹, Christopher Steer^2,3, Bianca Devitt⁴, Tim To^5,6, Penny Mackenzie⁷, Lucinda Morris^8,9, Jane Phillips¹⁰, Meera Agar¹

¹IMPACCT – Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia

²Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia

³School of Clinical Medicine, University of New South Wales, Rural Clinical Campus, Albury, NSW, Australia

⁴Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

⁵Division Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, SA, Australia

⁶College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia

⁷Icon Cancer Centre, St Andrew's Hospital, Toowoomba, QLD, Australia

⁸GenesisCare, Waratah Private Hospital, Hurstville, NSW, Australia

⁹St George & The Sutherland Hospitals, Sydney, NSW, Australia

¹⁰School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia

Background: Given population ageing understanding the impact of geriatric assessment on radiotherapy referrals for older people with newly diagnosed or recurrent cancers. This systematic review aims to assess the effect of geriatric assessment (GA) with tailored interventions or comprehensive geriatric assessment (CGA) compared to usual care for older adults with cancer receiving radiotherapy, and the impact on treatment decisions, care received, cancer-related and geriatric assessment outcomes.

Method: MEDLINE, EMBASE, CINAHL and PubMed were systematically searched for randomised control trials and prospective cohort studies with comparison groups from January 2000 to November 2022, focussed on assessing the effect of GA/CGA compared to usual care on treatment decision-making, supportive care received, and cancer-related and geriatric assessment outcomes for older adults with cancer receiving radiotherapy.

Results: The search yielded 10,438 citations, with 119 flagged for full-text review. Only one randomised controlled trial was included, with older adults receiving radiotherapy for non-small cell lung cancer. Medical or non-medical interventions were implemented after CGA in 86% of patients. No statistically significant difference was reported between CGA and usual care at 12 months, for health-related quality of life [EuroQoL Group 5D health index, .77 vs. .71; Visual Analogue Scale, 69 vs. 66], overall survival [92% vs. 72%, p = 0.32], unplanned admission [46% vs. 52%] or median length of stay [5.5 vs. 5, p = 0.62].

Conclusion: Larger comparative studies are required to determine whether integrating GA/CGA into care of older adults receiving radiotherapy can optimise treatment decisions and supportive care, thereby improving health-related quality of life, survival and adverse effects.

Domenica Disalvo¹, Maja Garcia¹, Heather Lane², Wee-Kheng Soo^3,4,5, Elise Treleaven⁶, Gordon McKenzie⁷, Tim To^8,9, Jack Power¹, Jane Phillips¹⁰, Meera Agar¹

¹IMPACCT – Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia

²Rockingham General Hospital, Fremantle, WA, Australia

³Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

⁴Cancer Services, Eastern Health, Melbourne, Victoria, Australia

⁵Department of Aged Medicine, Eastern Health, Melbourne, Victoria, Australia

⁶Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

⁷Hull York Medical School, University of Hull, Hull, UK

⁸Division Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, SA, Australia

⁹College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia

¹⁰School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia

Introduction: Surgery is an essential part of multimodal treatment of solid tumours, but frail older patients are at increased risk of postoperative complications. Geriatric assessments (GA) with tailored interventions or comprehensive geriatric assessments (CGA) can identify the frailty factors and needs of older adults with cancer intended for surgery, thereby assisting with treatment decision-making and implementation of supportive care strategies to reduce postoperative complications and enhance recovery after surgery.

Aim: This systematic review aims to summarise the effects of GA/CGA compared to usual care for older adults with cancer intended for surgery, and its impact on treatment decisions, supportive care interventions, postoperative complications, survival and health-related quality of life (HRQOL).

Method: A systematic search of MEDLINE, EMBASE, CINAHL and PubMed was conducted to include studies from January 2017 to October 2022, to identify randomised controlled trials or prospective cohort comparison studies on the effects of GA/CGA of older adults with cancer intended for surgery, and its impact on outcomes of interest.

Results: Eleven studies reporting on 10 trials were included for analysis. Two randomised trials found preoperative GA/CGA did not significantly reduce the incidence of postoperative delirium, Clavien–Dindo grade II–V complications, hospital length of stay, readmissions, reoperations, mortality or most geriatric domains, nor reduce or stabilise care dependency postoperatively compared to usual care. There was marginal benefit in some domains of HRQOL, such as total pain, but the clinical implications are unclear. There was a statistically significant difference in favour of the intervention for reducing the total number of Grade I–V complications, due to fewer Grade I–II complications, which were primarily medical rather than geriatric-focussed.

Conclusion: Future research to endeavour to develop well powered high-quality trials to determine the impact of CGA on treatment decision-making, the supportive care pathway and postoperative surgical outcomes in older adults with cancer.

Genevieve Douglas¹, Alicia Orr¹, Zosha Jarecki-Warke², Eric Wong¹, Ashley Bigaran^2,3

¹Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia

²Wellness and Supportive Care, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia

³Department of Surgery, Austin Precinct, The University of Melbourne, Melbourne, VIC, Australia

Background: Allogeneic haematopoietic stem cell transplantation (AlloHSCT) is a critical therapy providing long-term control of haematologic cancers; however long-lasting, debilitating fatigue is common, associated with reduced quality-of-life (QoL) and cardiorespiratory fitness. Exercise interventions have been shown to improve fatigue, QoL and cardiorespiratory fitness, however, few studies have examined feasibility or efficacy >6 months after alloHSCT. We aimed to determine feasibility of an 8-week, tailored exercise training program for patients with persistent fatigue >6 months after alloHSCT.

Methods: Prospective, single-site, single-arm pilot, recruited participants >6 months after alloHSCT (transplanted November 2018–July 2022) with fatigue symptoms. Participants performed a twice-weekly combined aerobic exercise and resistance training program (EXT) for 8 weeks. Prior to and following the EXT, patient-reported fatigue (FACIT-F), quality of life (FACT-BMT), cardiorespiratory fitness [peak oxygen uptake (VO_2peak), peak power output (watts)] were assessed. Patient satisfaction was also assessed at 8 weeks.

Results: Of 13 patients recruited, 9/11 participants have completed the study. Attendance to the EXT was >80%. Compared with baseline values, EXT significantly improved fatigue (FACIT-F absolute change +16.8 points, p = 0.03, Cohen's d = .89), QoL (FACT-BMT absolute change +12 points, p = 0.03, d = .83) and peak power output (absolute change, +13.12 watts, p = 0.04, d = .85). Despite no differences detected for VO_2peak mL/kg/min, medium effect estimates were observed between baseline and 8 weeks (d = .67–.76). Satisfaction was high, 9/9 (100%) reported they would recommend the program to others and reported further benefits including mood improvement, and improved capacity for daily activities. There were no adverse events.

Conclusions: In a small sample of participants with fatigue >6 months after alloHSCT, EXT improved fatigue and QoL after 8-weeks. While these pilot results appear promising, future randomised controlled trials are required to better understand the impact of EXT on participants with fatigue 6 months after alloHSCT.

Holly EL Evans¹, Daniel A Galvão², Cynthia Forbes³, Danielle Girard⁴, Corneel Vandelanotte⁵, Rob U Newton², Andrew D Vincent⁶, Gary Wittert⁶, Suzanne Chambers⁷, Nicholas Brook⁸, Ganessan Kichenadasse⁹, Maddison Shaw¹, Camille E Short¹⁰

¹College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia

²Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia

³Wolfson Palliative Care Research Centre, University of Hull, Hull, UK

⁴Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

⁵Physical Activity Research Group, Central Queensland University, North Rockhampton, QLD, Australia

⁶Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, SA, Australia

⁷Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia

⁸Department of Surgery, University of Adelaide, Adelaide, SA, Australia

⁹Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia

¹⁰Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, VIC, Australia

Aims: Research has shown the effectiveness of supervised exercise-based interventions in alleviating sequela resulting from metastatic prostate cancer. Technology-enabled interventions such as the ExerciseGuide web-based exercise program offer a distance-based alternative. Despite preliminary evidence demonstrating that the ExerciseGuide program is safe and efficacious among individuals with metastatic prostate cancer, participant perceptions of the program have not been explored. This study aimed to investigate participant perceptions of the strengths and limitations of the ExerciseGuide program to inform future practice.

Methods: A qualitative methodology was undertaken using one-on-one semi-structured interviews with participants who completed the ExerciseGuide randomised controlled trial. Thematic analysis was used to analyse the data.

Results: Interviews were conducted with 18 of the 20 Australians (59–83 years; M = 69.1, SD = 6.8) living with metastatic prostate cancer who had completed the exercise arm of the ExerciseGuide study. Three themes emerged related to strengths/limitations: personalised support (sub-themes: beneficial, greater accountability, peer support, self-management strategies), website (sub-themes: education, usability) and exercise prescription (sub-themes: aerobic easy/resistance hard, modality variety, increased tailoring, benchmarking and monitoring). Overall, the participants found the intervention beneficial. Receiving individualised support from the Exercise Physiologist was invaluable, but increased contact was desired for accountability and troubleshooting. Website usage was mixed, with information-technology literacy key to positive perception. Participants had more barriers to resistance training than aerobic training and sought increased tailoring with regards to exercise modality, treatment stage and symptoms.

Conclusions: Individuals with metastatic prostate cancer had mostly positive experiences with the ExerciseGuide program. Future programs need to provide personalised support and education tailored to the need of the individual rather than one-size-fits-all. A focus on tools that aid resistance training adherence are required. Finally, further refinement of websites is needed for the simplicity of use.

Miriam Ferres¹, Lisa Mounsey¹, Peter Eastman¹, David Campbell², Brian Le³, Jennifer Philip^3,4, Joyce Chua⁵, Ian Collins⁶

¹Palliative Care, Barwon Health, North Geelong, VIC, Australia

²Oncology, Barwon Health, Geelong, VIC, Australia

³Palliative Care, Melbourne Health, Parkville, VIC, Australia

⁴Palliative Medicine, University of Melbourne, Parkville, VIC, Australia

⁵Palliative Care, Peter MacCallum Cancer Centre, Parkville, VIC, Australia

⁶Oncology, South West Healthcare, Warrnambool, VIC, Australia

Background: Clinical trials are important for the continued development of quality evidence-based interventions in palliative medicine. Barriers exist for patients accessing palliative care clinical trials, including factors related to clinical conditions, geography and trial availability and even more so in regional areas.

Methods: To inform development and expansion of Palliative Care regional clinical trials capacity, a baseline census of clinical trials activity in eight regional Victorian Palliative Care services was undertaken.

A brief survey was electronically distributed to the clinical director of Palliative Care services at each service to assess current involvement in clinical trials prior to planning increased service support and targeted trial development initiatives.

Results: Overall while responses indicated interest for involvement in palliative/supportive care research, they also highlighted that actual engagement with clinical research was minimal or absent in the regional centres surveyed. For those services engaged with clinical trials, no patients had been recruited in the previous 12 months.

Conclusion: This census demonstrated opportunities across regional palliative care service providers for engagement with palliative/supportive care research.

While there is evidence to support patient interest in engagement with palliative and supportive care clinical trials, there are currently limited resources in place accessing such trials for patients receiving care in regional Victoria. The ReViTALISE palliative and supportive care project stream aims to facilitate improved access to address the discrepancy in clinical trials opportunities for regional Palliative Care patients.

Cynthia Forbes¹, Alex Bullock¹, Jordan Curry¹, Flavia Swan¹, Angela Darby², Mike Lind¹, Miriam Johnson¹

¹University of Hull, Hull, East Yorkshire, UK

²York Teaching Hosital, York, UK

Purpose: Older adults with lung cancers are often frail and unfit, negatively affecting treatment tolerance and quality of life (QoL). Lifestyle behaviours, like physical activity (PA) and healthy nutrition, significantly improve QoL among people with cancer. They may also positively impact treatment completion rates, potentially improving survival. However, older, frailer lung cancer populations are typically excluded from research as, assumed to be too high risk. Our aim was to investigate the feasibility and acceptability of a tailored wellbeing programme for older adults with lung cancers.

Methods: Clinicians identified older adults (≥60 years) with stage III/IV lung cancer or mesothelioma who were deemed fit for systemic anti-cancer treatment (chemotherapy, radiotherapy and/or immunotherapy). Feasibility was assessed by recruitment/retention rates, data collection/quality and programme adherence/acceptability. Secondary measures included PA, frailty, performance status, physical function, body composition, grip strength, nutritional status, symptom burden, treatment tolerance, QoL and health service usage. Participants received a tailored home-based PA and nutrition programme (resistance bands, Fitbit, handheld fan and tailored educational materials) with initial consultation sessions with a physiotherapist and a dietitian. Participants were followed over 12 weeks with check-in calls. Measures were collected at mid-point (6 weeks), post-study (12 weeks) and at 24 weeks. At 12 weeks, in-depth interviews were conducted with participants to explore acceptability further.

Results: Recruitment rate was ∼27% (11 consented). One participant has yet to complete 24-week measures; 90% of all check-in appointments have been completed. Changes in secondary measures will be reported, but so far, interviews show increased confidence for other activities (e.g. going out, walking more, visiting family more), feeling stronger overall, and positive views about the tailored, adaptable programme.

Conclusions: Though a challenging time for clinic-based recruitment, those recruited felt it helpful and worthwhile. We will use the interviews and feasibility data to understand how best to further evaluate this potentially beneficial programme for this overlooked group of people with cancer.

Grace Nguyen¹, Daniel Croagh^2,3, Terry Haines⁴, Catherine E Huggins⁵, Lauren Hanna⁶, Kate Furness⁷

¹Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia

²Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia

³Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia

⁴School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia

⁵Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia

⁶Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia

⁷Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia

Aims: Malnutrition is highly prevalent in pancreatic cancer (PC), and is associated with poor quality of life (QOL). A planned randomised controlled trial (RCT), ‘Supplemental Enteral Nutrition to Improve Quality of Life (SuperQoL)’ in advanced PC patients, will investigate the effect of delivering top-up nutrition via percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). This will be supported by intensive dietetic counselling delivered via telehealth. The present study aims to determine the acceptability of this intervention to elucidate appropriateness, anticipated barriers to uptake, and facilitate informed co-design with patients.

Methods: Patients with PC who consented to future research with the Pancreatic Cancer Biobank were recruited for semi-structured interviews using random sampling. Information power was used to assist with sample size determination, where lower numbers of participants are required when more relevant information is held by the sample. The Theoretical Framework of Acceptability was used as the analytical framework.

Results: Ten PC participants were recruited to the study. Five overarching themes were developed from interviews: (1) debilitating nutrition impact symptoms are a barrier to maintaining adequate nutrition; (2) willingness to participate depends upon an individual threshold for nutritional deterioration; (3) supplementary enteral feeding is anticipated to be effective and beneficial; (4) predicted perceived effectiveness outweighs financial burden and (5) adequate dietetic support is needed for maintaining a PEG-J at home with confidence.

Suzanne Grant^1,2, Susannah Graham³, Sanjeev Kumar⁴, Shelley Kay², Kim Kerin-Ayres², Justine Stehn², Maria Gonzalez², Jane Cockburn⁵, Sandy Templeton², Gillian Heller⁶, Ash Malalasakera², Sara Wahlroos⁴, Judith Lacey²

¹Western Sydney University, Sydney, NSW, Australia

²Chris O'Brien Lifehouse, Sydney, NSW, Australia

³Surgical Oncology Department, Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁴Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁵Patient Advocate, Sydney, NSW, Australia

⁶NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

Background: Neoadjuvant therapy has become standard treatment for patients with patients with Stage II/III HER2 positive and triple negative breast cancer, and in well selected patients with locally advanced and borderline resectable high risk, luminal B breast cancer. Long term outcomes can be significantly impacted by side effects including fatigue, cardiotoxicity, neurotoxicity, gastrointestinal disturbance, insomnia, weight gain as well as immune-related adverse events. Providing early supportive care and prehabilitation may mitigate these side effects and improve quality of life.

Methods: We conducted focus groups and interviews to co-design a multi-modal prehabilitation program with consumers and healthcare professionals to support women during neoadjuvant therapy. The program comprises periodised exercise, education, nursing and specialist support appointments and supportive care therapies such as acupuncture and massage. We conducted a feasibility study to assess the acceptability and explore the effectiveness of the program to maximise functioning and wellbeing during treatment, prior to surgery and at follow-up (6 months).

Results: We report on the results of the co-design phase and provide an interim analysis of the feasibility study. Eleven women with breast cancer and 11 healthcare professionals participated in focus groups and interviews. Key themes for consumers included: the need for a single point of contact (navigation), preference for a ‘package’ of individualised and organised interventions, along with engagement of the oncologist.

We recruited 23 participants recruited over a 9–10 month period. Of these, there were two withdrawals; 16 completions of the intervention phase; five still participating. No drop-outs to date. Exit interviews were completed with five participants. Interim analysis will be presented at the conference.

Conclusions: The integration of personalised exercise and supportive care programs for women with breast cancer receiving NACT is an important component of holistic cancer care. Results of the PROactive B study will provide insight into the appropriateness and acceptability of a multi-modal prehabilitation program for women receiving NACT for breast cancer.

Catherine Grigg¹, Hattie Wright^1,2, Corey Linton¹, Jacob Keech³, Suzanne Broadbent⁴, Karina Rune⁴, Michelle Morris⁵, Anao Zhang⁶, Cindy Davis⁷

¹School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia

²Sunshine Coast Health Institute, Britinya, QLD, Australia

³School of Applied Psychology, Griffith University, Brisbane, QLD, Australia

⁴University of the Sunshine Coast, Sippy Downs, QLD, Australia

⁵Medical Oncology, Sunshine Coast Private Hospital, Britinya, QLD, Australia

⁶School of Social Work, University of Michigan, Michigan, USA

⁷School of Law and Social Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia

Aim: To investigate the effectiveness of diet-and-exercise interventions to facilitate and sustain diet and exercise behaviours of prostate cancer (PCa) survivors.

Methods: Five databases were systematically searched using PRISMA guidelines between January 2012 and December 2022. Studies including PCa cancer survivors of any stage and treatment with a diet-and-exercise (D&E) intervention intended to change diet and exercise behaviour were eligible. Primary outcome measures of dietary behaviour included energy, nutrient and a priori dietary indices; direct exercise behaviour was physical activity and indirect measures included fitness, mobility and strength.

Results: Eighteen publications reporting on 14 trials (n = 1024) were included. Average intervention duration was 14.1 weeks (range: 12–28), with eight dietary sessions (range 1–18) of 34.6 min duration (range 20–60), and 10.8 exercise sessions (range 1–24) of 35.9 min duration (range 20–60). Three trials had 3-month, two 6-month and one 12-month follow-up measures of D&E behaviour. Eight trials were informed by behaviour change theory and a total of 35 behaviour change techniques (BCTs) were identified across all trials. D&E behaviour change was mixed with 10 publications reporting dietary behaviour change and 11 exercise behaviour change. Only two out of six publications reported sustained behaviour change at follow-up for diet and exercise, respectively. Four trials facilitated both D&E behaviour change, common BCTs in these trials were goal setting (behaviour), action planning, instruction to perform a behaviour and credible source. Problem solving and social support (unspecified) also supported D&E behaviour change in trials that included these BCTs. In addition, exercise behaviour change was facilitated through self-monitoring and having supervised sessions.

Conclusions: D&E behaviour change was facilitated through specific BCTs which may inform more effective D&E interventions for PCa survivors. Long-term maintenance of D&E behaviour change post-intervention warrants further investigation to enable sustained health benefits into survivorship.

Oliver Hodge¹, Tshepo Rasekaba², Irene Blackberry^2,3, Stacey Rich^2,3, Nicole Webb^2,4, Christopher Steer^1,2,4

¹School of Clinical Medicine, Rural Clinical Campus, University of New South Wales, Albury, Australia

²John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Australia

³Care Economy Research Institute, La Trobe University, Albury-Wodonga, Australia

⁴Border Medical Oncology and Haematology, Albury-Wodonga, Australia

Aim: Building on previous PhotoVoice study findings, this study explored the feasibility of adding the novel combination of PhotoVoice and TiM to a geriatric assessment (using eRFA) to inform enhanced supportive care decisions.

Methods: A cross-sectional mixed-methods study; new patients who were diagnosed with cancer, attended the Albury-Wodonga Regional Cancer Centre, were ≥70 years of age, and scored ≤14 on the G8 were eligible to participate. A convenience sample n = 17 patients completed the Photo-eRFA-TiM assessment. PhotoVoice involved the collection of two patient supplied photos; one of the patient's identity and the other of someone or something important to them. The combined Photos, eRFA and TiM assessments were used to prompt discussions at the weekly ‘Enhanced Supportive Care’ multidisciplinary team (MDT) case meeting to drive supportive care discussion. n = 8 patients and n = 3 MDT members completed semi-structured interviews focussed on their experience of the Photo-eRFA-TiM approach to geriatric assessment and its utility for informing cancer care decisions.

Results: All patients completed the eRFA and 14 patients completed the TiM and PhotoVoice components; some patients required assistance to complete one or more assessment components. Supplying the photos occurred via a variety of means – digital, electronic transmission and in-person. Preliminary findings suggested that implementing the Photo-eRFA-TiM was feasible, assessments were easy to complete, would be best timed to early in the care journey and enabled clinicians to gain a deeper understanding of the patient and see them beyond the disease.

Conclusion: Based on preliminary findings, the Photo-eRFA-TiM assessment appears feasible and acceptable to older adult patients undergoing cancer care. Incorporation of photos and questions about what matters to individuals through PhotoVoice and TiM may guide person centred enhanced supportive care.

Kristin Hsu¹, Tiffany Foo², Monique Swan¹, David Gordon¹, Anna Rachelle Mislang¹

¹Flinders Medical Centre, Adelaide, South Australia, Australia

²The Queen Elizabeth Hospital, Adelaide, SA, Australia

Introduction: During the coronavirus SARS-CoV-2 (COVID-19) pandemic, the high rates of infection, hospitalisation and mortality prompted an urgent development of an effective vaccine. The first two vaccines that were developed were the BNT162b2 (Pfizer/BioNTech vaccine) and the ChAdOx1-S (Oxford/AstraZeneca COVID-19) vaccine.

In this study, we assessed the efficacy of the COVID-19 vaccine in patients with solid cancers on active anti-cancer therapy; and measured their antibody responses following a minimum of two doses of the two available COVID-19 vaccines in Australia at time of study.

Study design and methods: This study was a prospective study of patients with solid organ cancers who were on active systemic anti-cancer treatment and who received the COVID-19 vaccine. Enrolled patients would undergo blood collections: Baseline pre-1st vaccination, day 21 pre-2nd dose, 3–4 weeks post-2nd dose, 3 months post-2nd dose and 6 months post-2nd dose. Bloods were tested for SARS-CoV-2 specific spike protein and spike protein receptor binding domain (RBD) antibody responses by ELISA and flow cytometry assays (Elecsys Anti-SARS-CoV-2 S). Marked elevation of antibody titres observed post-vaccination would suggest a strong humoral immune response to vaccination.

Results: We recruited 23 patients from Flinders Medical Centre – 16 participants had Astra Zeneca, six had Pfizer, one had Moderna vaccine. Eleven participants completed the five required blood tests for the study. None of the 23 patients had past covid infection. Seroconversion rate after 1st dose of vaccine was 60% and antibody titres exponentially increased over time and after 2nd dose of vaccination. 100% seroconversion was achieved after dose 2 and maintained up to 6 months.

Samira Imran, Kiarash Khosrotehrani, Victoria Mar, Chris McCormack, Gerald Fogarty, Rahul Ladwa, Peggy Chan, Gurpreet Grewal, Delphine Kerob

L'Oreal Australia and New Zealand, Melbourne, VIC, Australia

Patients undergoing oncology treatments often experience a number of side-effects, with up to 60% of patients experiencing skin toxicities from these treatments. Such skin toxicities may range from alopecia to photosensitivity and xerosis. Experiencing these side effects may exacerbate the burden of oncology treatments for the patients, and there are currently no set guidelines for appropriate management of these treatment side effects.

In order to identify key patient needs, each stage of the patient oncology treatment journey must be taken into account, including the advice of the oncologists and dermatologists, as well as oncology nurses who are often the most frequent point of contact for the patient. Limited numbers and access to dermatologists in New Zealand often means that treatments are ceased due to severity of their side effects. To address these patient needs, taking quality of life into account, experts emphasise the relevance of patient education around skincare, including the stage of treatment, and healthcare professional responsible for delivery of this knowledge. A panel of key healthcare professionals, comprising dermatologists, oncologists and an oncology nurse, developed a consensus for effective management of these common skin conditions.

This consensus sets forth specialised recommendations for both preventative measures as well as reactive measures for appropriate care of skin conditions such as radiation dermatitis (both acute and chronic), alopecia (from hormonal therapy and/or chemotherapy), xerosis/pruritus, maculopapular rash, acneiform rash, photosensitivity, pigmentation changes, and inflammatory and hyperkeratotic hand-foot syndrome.

These guidelines, among other suggestions, recommend the use of a sunscreen with UV-broad spectrum UVA/UVB filters was emphasised for proactive prevention of side effects for all treatments. The roles of pH-balanced moisturisers and cleansers, along with skin barrier restoring creams formulated with microbiome rebalancing ingredients (panthenol) were also highlighted.

This will form an educational document for healthcare professionals all across the field, including experienced specialists, as well as pharmacists and registrars training in oncology.

Brett Janson¹, Catherine Ashwell¹, Safeera Hussainy^1,2,3, Jeremy Lewin^2,4,5

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

³Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

⁴ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁵ Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Melbourne, Victoria, Australia

Introduction: Systemic chemotherapy, incorporating high-dose methotrexate (HD MTX), is an important component of care for patients under the age of 40 with osteosarcoma. Delivery of methotrexate requires inpatient admission to facilitate monitoring of MTX clearance, provide hydration, urinary alkalinisation and folinic acid administration. Standard practice is to measure MTX levels every 24 h until below .10 μmol/L, in order to be cleared for discharge.

Aim: To assess the impact of an earlier standardised MTX level at 60 h on overall length of stay (LOS) compared to the standard 24-h level.

Methods: A retrospective cohort study at a tertiary sarcoma centre between 21 May 2019 and 18 November 2021 was designed to identify the difference in LOS following the institution's implementation of a 60-h MTX level. A two-sample t-test was conducted between pre- and post-implementation of the 60-h MTX level LOS.

Results: Fifteen patients with a total of 112 admissions were eligible for analysis. The average LOS in the pre-60-h MTX level LOS group was 83.5 h (n = 45), with the post-implementation average LOS being 76.5 h (n = 67). The majority (85%, 57/67) of the post-implementation group were eligible for 60-h testing, of which 84% (48/57) had reached the required level of .10 μmol/L and were able to be discharged (average LOS 70.9 h). A two-sample t-test showed that there was a statistically significant difference (p-value < 0.0001) between the pre-implementation group, and post-implementation group who had cleared their methotrexate.

Conclusion: The introduction of a 60-h MTX level demonstrated a statistically significant decrease in the LOS by more than 12 h in eligible patients, with the majority of patients (71%, 48/67) able to be discharged after the 60-h MTX level.

Lizzy Johnston^1,2,3, Katelyn Collins⁴, Jazmin Vicario¹, Chris Sibthorpe¹, Michael Ireland^4,5, Belinda Goodwin^1,5,6

¹Cancer Council Queensland, Fortitude Valley, QLD, Australia

²School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

³Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

⁴School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia

⁵Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia

⁶School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

Aims: Caring for someone with cancer can disrupt usual routines, including caregivers’ ability to maintain their own health and wellbeing. Little is known about how caregiving affects the health behaviours of rural caregivers who face additional challenges in their support role. Therefore, this study examined changes in rural caregivers’ health behaviours whilst caring for someone with cancer and the factors underlying these changes.

Methods: Through semi-structured interviews, 20 caregivers living outside of a major city were asked about changes in health behaviours since caring for their family member or friend with cancer. Specific prompts were provided for diet, physical activity, alcohol, smoking, sleep, social connection and leisure, and accessing health care when needed. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to identify changes in health behaviours and the factors underlying these changes. The underlying factors were then mapped to the socioecological framework, identifying areas for intervention across multiple levels. Recruitment ceased when concurrent data analysis generated consistent findings for changes in health behaviours and factors underlying these changes.

Results: All rural caregivers reported changes in more than one health behaviour whilst caring for someone with cancer. Rural caregivers reported both positive and negative changes to their diet, physical activity, alcohol and smoking. Sleep, social connection and leisure, and accessing health care when needed were negatively impacted since becoming a caregiver. Factors underlying these changes mapped across the five levels of the socioecological framework (individual, interpersonal, organisational, community and policy). The factors included caregivers’ coping strategies, carer burden and fatigue, access to cooking and exercise facilities and social support while away from home, the need to travel for treatment, and the financial support available.

Conclusions: Designing interventions to address the factors underlying changes in rural caregivers’ health behaviours could yield widespread benefits for supporting the health and wellbeing of rural caregivers.

Tamara Jones^1,2, Riley Dunn³, Carolina Sandler^2,6,4,5, Camille Short^1,7, Sandi Hayes^2,4, Rosalind Spence^2,4

¹Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia

²Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia

³School of Pharmacy and Medical Sciences, Griffith University, Brisbane, QLD, Australia

⁴School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia

⁵School of Health Sciences, Western Sydney University, Sydney, NSW, Australia

⁶The Kirby Institute, University of New South Wales, Sydney, NSW, Australia

⁷Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia

Aims: The strength of exercise oncology evidence was considered sufficiently strong for the American College of Sports Medicine (ACSM) to support a specific exercise prescription of aerobic and/or resistance training for improvements in health-related quality-of-life, physical function, anxiety, depressive symptoms and fatigue following cancer. The aim of this review was to evaluate and describe the characteristics of participants who contributed to the studies that support these exercise recommendations and to determine the representativeness of the sample to the wider cancer population.

Methods: All exercise oncology trials (directly cited or cited within systematic reviews and meta-analyses) that informed the 2019 ACSM exercise prescription recommendations were included in the current review. Individual participant characteristics of the included trials (gender, cancer type and disease stage) were extracted and summarised descriptively.

Results: Data from 18,419 participants (from 231 trials) contributed to the 2019 recommendations, with the majority (n = 14,635, 79%) being female. Breast cancer was the most included cancer type (n = 12,827, 70%), followed by prostate (n = 1747, 9%) and haematological cancers (n = 1357, 7%). Less than 14% of participants (n = 2488) represented at least 20 other cancer types. Approximately one in four participants were specifically described as having early-stage disease at diagnosis (n = 5201, 28%) and 7% were described as having late-stage (n = 1307), while stage of disease at diagnosis was unclear for 43% (described as ‘mixed’; n = 7895) and unknown for 22% (n = 4016) of the sample.

Conclusions: Findings demonstrate the over-representation of women with breast cancer in exercise oncology research and the lack of clarity regarding the disease stage of those participating in exercise oncology trials. Effective, feasible and safe integration of exercise into cancer care for all will require future research to evaluate the safety, feasibility and effect of exercise on representative samples of people within and across cancer types.

Hannah Jongebloed¹, Eileen Cole², Emma Dean², Anna Ugalde¹

¹Institute for Health Transformation, Deakin University, Burwood, VIC, Australia

²Quit Victoria, Cancer Council Victoria, Melbourne, VIC, Australia

Aims: Despite improvements in global smoking rates,¹ patients who continue to smoke after a cancer diagnosis experience high mortality and morbidity.² This study aimed to understand nurses’ current knowledge and practices in providing smoking cessation care in general practice settings.

Methods: Participants were registered nurses currently working in a general practice setting in Australia. Interviews were conducted over Zoom and focussed on current practice and opportunities to improve delivery of smoking cessation care. Interviews were recorded and a thematic analysis was conducted.

Results: Fourteen general practice nurses participated of which 13 (93%) were female. Nurses varied in age and experience and were recruited across most states and territories, with representation from metropolitan, regional and rural Australia.

Three themes were evident in the data. The first theme: Nurses’ current practices in supporting people to quit smoking focusses on the strategies currently employed by nurses to deliver cessation care. The second theme: The influence of the general practice setting on smoking cessation discussions explores the impact of diversity in the systems, processes and structures across Australian general practice settings on the support offered by nurses. The third theme: the challenges experienced by nurses in providing optimal smoking cessation care focusses on ambiguity in nurses’ roles within the practice setting, the potential for engaging quitlines and vaping as an emerging issue.

Emma Kemp¹, Sara Zangari², Bogda Koczwara^1,3, Lisa Beatty⁴

¹College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

²Cancer Council SA, Adelaide, South Australia, Australia

³Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia

⁴College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia

Introduction: Digital health approaches in cancer care can assist in coordinating care and supporting self-management. However, people living with socioeconomic disadvantage, and those living rurally, who already face increased barriers to cancer care, can face challenges with accessibility, usability and relevance of digital technologies resulting in risk of digital exclusion and widening of disparities in cancer outcomes. This research aimed to examine perspectives of people living with cancer in socioeconomically and/or geographically disadvantaged circumstances on how they can be better supported in accessing digital health for cancer care.

Methods: Qualitative interviews were conducted with individuals living with cancer in socioeconomically and/or geographically disadvantaged circumstances. Participants were approached via promotion (flyers and social work staff approach) at Cancer Council SA lodge and/or by Cancer Council SA support staff (outreach nurse). Interviews were conducted by the researcher in person or by telephone, using a semi-structured topic guide, and were audio recorded, transcribed and thematically analysed.

Results: Interim data from nine participants (seven women, seven rural) indicated that for people living rurally, digital health resources could be accessible; however, some participants experienced an overall lack of resources/guidance at rural treatment centres compared with metropolitan treatment centres. People living with socioeconomic disadvantage more frequently discussed limited/lack of internet connection as a barrier, with smartphone access improving resource access for some. Engagement with digital resources was influenced by personal preferences, even for participants with reliable internet access.

Conclusion: People with cancer who experience socioeconomic/geographic disadvantage can be better supported in accessing cancer care resources by ensuring availability of print and smartphone-compatible digital resources, and by addressing limited resource availability in rural areas, potentially by linking with large centres and organisations. Future development of cancer care resources should consider providing diversity of formats to optimise accessibility and meet diverse consumer preferences.

Deborah Kirk¹, Istvan Kabdebo², Lisa Whitehead²

¹School of Nursing and Midwifery, Edith Cowan University – SW Campus, Bunbury, WA, Australia

²School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia

Aims and objectives: In this presentation data from a completed study on caregiver distress will be presented. This study aimed to (i) determine prevalence of distress among caregivers of people living with cancer, (ii) describe caregivers’ most commonly reported problems and (iii) investigate which factors were associated with caregivers’ distress.

Background: The psychological distress associated with a cancer diagnosis jointly impacts those living with cancer and their caregivers(s). As the provision of clinical support moves towards a dyadic model, understanding the factors associated with caregivers’ distress is increasingly important.

Design: Cross-sectional study.

Methods: Distress screening data were analysed for 956 caregivers (family and friends) of cancer patients accessing the Cancer Council Western Australia information and support line between 1 January 2016 and 31 December 2018. These data included caregivers’ demographics and reported problems and their level of distress. Information related to their care recipient's cancer diagnosis was also captured. Caregivers’ reported problems and levels of distress were measured using the distress thermometer and accompanying problem list (PL) developed by the National Comprehensive Cancer Network. A partial-proportional logistic regression model was used to investigate which demographic factors and PL items were associated with increasing levels of caregiver distress. Pearlin's model of caregiving and stress process was used as a framework for discussion. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed.

Results: Nearly all caregivers (96.24%) recorded a clinically significant level of distress (≥4/10) and two thirds (66.74%) as severely distressed (≥7/10). Being female, self-reporting sadness, a loss of interest in usual activities, sleep problems or problems with a partner or children were all significantly associated with increased levels of distress.

*Published paper

*Presented at COSA Survivorship 2023

Deborah Kirk¹, Istvan Kabdebo², Lisa Whitehead²

¹School of Nursing and Midwifery, Edith Cowan University – SW Campus, Bunbury, WA, Australia

²School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia

Aims and objectives: To (i) characterise prevalence of distress amongst people diagnosed with cancer, (ii) determine factors associated with increasing distress, (iii) describe reported problems for those with clinically significant distress and (iv) investigate the factors associated with referral to support services.

Background: International studies report a high prevalence of clinically significant distress in people with cancer. Australian studies are notably lacking. Additionally, clinicians still do not fully understand the factors associated with cancer-related distress.

Design: Period prevalence study.

Methods: Distress screening data were analysed for 1071 people accessing the Cancer Council Western Australia information and support line between 1 January 2016 and 31 December 2018. These data included people's demographics, cancer diagnoses, level of distress, reported problems and the service to which they were referred. Distress and reported problems were measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List. A partial proportional logistic regression model was constructed to determine which factors were associated with increasing levels of distress. Standard binary logistic regression models were used to investigate factors associated with referral to support services. The STROBE checklist was followed.

Results: Prevalence of clinically significant distress was high. Self-reported depression, sadness, worry and a lack of control over treatment decisions were significantly associated with increasing distress. Emotional problems were the most prevalent problems for people with clinically significant distress. Most people were referred to emotional health services, with depression, fatigue, living regionally and higher socioeconomic status associated with referral.

Conclusions: Emotional problems such as depression, sadness and worry are associated with increasing levels of distress.

Relevance to clinical practice: Not all factors associated with referral to support services were those associated with increasing levels of distress. This suggests that other factors may be more influential to referral decisions.

*Published paper

Vanessa Knibbs, Stephen Manley

North Coast Cancer Institute, Lismore Base Hospital, Lismore, NSW, Australia

Introduction: Supportive Care Needs (SCN) refers to support required by patients and their families to better cope with cancer. Many rural radiation therapy (RT) patients stay away from home for significant periods of time for treatment.¹ They have reported concern over travelling for RT, which can lead to the negative effects of both social isolation^2,3 and cultural disparity.⁴ Patients often have a range of complex SCN and there is a lack of in-depth study of rural patient perspectives going through RT. The study aimed to explore and understand experiences of being away from home, consider patient perspectives of their own SCN and identify recurring themes. Giving health professionals a deeper understanding of how patients think and feel and provide a foundation of patient-centred insights for further research.

Methods: Thirteen patients participated in face-to-face unstructured interviews. All stayed away from home for RT for more than 3 days-a-week for more than three weeks. Data saturation was reached with 13 patients. The data was subject to interpretive phenomenological analysis: a process of naive understanding and structural analysis was followed by comprehensive understanding and reflection.⁵

Results: Two themes emerged which influenced patient experiences of their care; values and identity, and expectations. Patients discussed the value that they place on rural-life, community connections, family and healthcare. They referred to experiences of health service continuity and information which helps manage expectations. SCN discussed fell into three categories; practical, physical and psycho-social.

Mahima Kalla^1,2, Ashleigh Bradford³, Verena Schadewaldt⁴, Kara Burns^1,2, Sarah Bray⁴, Sarah Cain⁴, Heidi McAlpine⁴, Rana Dhillon^5,6, Wendy Chapman², James R Whittle^7,8,9, Katharine J Drummond¹⁰, Mei Krishnasamy^3,11,12

¹Uni of Melbourne, Carlton, VIC, Australia

²Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia

³Peter MacCallum Cancer Centre, Melbourne, Australia

⁴Royal Melbourne Hospital, Melbourne, Australia

⁵Barwon Health, Geelong, Australia

⁶St Vincent's Hospital, Melbourne, Australia

⁷Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

⁸Personalised Oncology Division, WEHI, Melbourne, Australia

⁹Department of Medical Biology, University of Melbourne, Melbourne, Australia

¹⁰Department of Neurosurgery, University of Melbourne, Melbourne, Australia

¹¹Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia

¹²VCCC Alliance, Melbourne, Australia

Typically, people who have brain tumours will experience persistent, distressing and disabling physical, psychosocial, cognitive and financial challenges. These challenges are compounded by the difficulties in connecting and communicating with their treating team, establishing peer support networks, managing their symptoms, and accessing personalised supportive care, especially for rural patients. Digital health interventions can address access and equity barriers to cancer services by overcoming geographic, physical and psychological barriers, facilitating access to treatment, support and education for patients within convenient timeframes and their own environments. Our team set out to co-design a supportive care digital resource to mitigate the unmet needs of Australians affected by brain tumours, no matter where they live. Using an evidence informed framework and data from studies previously undertaken by members of our team, we developed Brain Tumours Online, a novel Australian digital health solution. This paper focusses specifically on one step in the co-design process – a qualitative interview study with consumers and multidisciplinary health care professionals to generate an in-depth understanding of needs and preferences for a digital health solution, to address needs currently unmet by face to face care delivery approaches. True to consumers’ preferences expressed in our co-design activities, our platform provides supportive psychosocial care for patients and their carers, via three key pillars: (a) Learn: a curated repository of vetted evidence-based information about symptoms, treatment options, available psychosocial/allied health supports and other practical information (e.g. preparing for return to work/study, navigating welfare support, etc.); (b) Connect: an online peer support community that allows patients and their informal caregivers to connect with each other and healthcare professionals in a variety of formats and (c) Toolbox: a selection of validated self-management digital health tools to support symptom management and self-care for other psychosocial needs.

Meinir Krishnasamy^1,2,3, Amelia Hyatt^1,2, Holly Chung¹, Karla Gough^1,2, Margaret Fitch⁴

¹Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²University of Melbourne, Melbourne, VIC, Australia

³Nursing, VCCC Alliance, Melbourne, VIC, Australia

⁴Bloomberg Faculty of Nurisng, University of Toronto, Toronto, Canada

Aims: This study set out to examine contemporary views of cancer supportive care among national and international experts to examine requirement for refreshed definitions of, and a conceptual framework for supportive care, relevant to present-day cancer care.

Methods: A two-round online modified reactive Delphi survey was undertaken. Recruitment was via direct and snowball email invitation. Relevant cancer supportive care terms were identified through a scoping review and presented for assessment by experts (round 1). Terms that achieved ≥ 75% expert agreement as ‘necessary’ were then assessed using Theory of Change (ToC) to develop consensus statements and a conceptual framework. These were presented to participants for agreement in round 2.

Results: In the round 1 Delphi, 55 experts in cancer control and experience of supportive care in cancer took part. Expert consensus assessed current supportive care terminology with 124 terms deemed relevant and ‘necessary’ according to pre-specified criteria. Theory of Change was applied to consensus terms to develop three key definition statements and a refreshed conceptual framework for supportive care. These were presented for expert consensus review in Delphi round 2 (n = 37). Thirty-six (97%) respondents felt that the definition statements are effective in conveying what cancer supportive care entails; 34 (92%) agreed that the framework contained all components of supportive care and 36 (97%) agreed that they could help inform health system planning. This paper will present the definitional statements and the refreshed conceptual framework for contemporary, integrated supportive care.

Conclusions: Our work contributes new perspectives to the literature on supportive care. It offers health service administrators, policy makers, health services researchers and multidisciplinary clinicians an opportunity to re-envision supportive care as a conceptual framework to deliver quality cancer care, and importantly orients supportive care as the fundamental lens through which all other aspects of cancer care are delivered.

Rebekah Laidsaar-Powell¹, Sarah Giunta¹, Iona Gurney², Claire Hudson², Lisa Beatty³, Joanne Shaw¹

¹Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia

²School of Psychology, The University of Sydney, Sydney, NSW, Australia

³Flinders University, Adelaide, SA, Australia

Aims: Cancer carers report high levels of anxiety, depression and unmet emotional needs; however, limited targeted support is available. We aimed to adapt an iCBT program with demonstrated efficacy among cancer patients (iCanADAPT) to target the unique psychological needs of carers.

Methods: To ensure iCBT content and design aligned with evidence-based psycho-oncology approaches and grounded in end-user experiences and needs, we applied Yardley et al.’s (2015) Person-Based Co-design Approach. Psycho-oncology clinicians (psychologists, social workers) and cancer carers participated in individual cognitive interviews to discuss carer-relevant adaptations needed for the iCanADAPT program. Carers completed a follow-up interview to provide feedback on iteratively adapted content. Qualitative data was analysed using interpretive description.

Results: Fifteen carers, nine psychologists and eight social workers completed cognitive interviews. All participants discussed the need for widely available and targeted psychological support for carers. Participants stressed that iCBT content should address unique carer challenges such as juggling multiple roles, relationship changes, caregiving responsibility and overwhelm, and carer guilt.

Carers engaged with CBT components of the existing module such as thought challenging, activity planning and mindfulness and suggested revisions to make content more relatable. Carers proposed technical and practical revisions to facilitate more widespread uptake, completion and implementation.

Psycho-oncology clinicians endorsed existing CBT strategies, and many suggested incorporating Acceptance and Commitment Therapy approaches such as cognitive defusion and values clarification. Clinicians noted key barriers/facilitators to carer uptake and discussed implementation factors of scope, delivery and target audience. Eight carers completed a follow-up interview and reported high acceptability of the carer-relevant content.

Conclusions: Development of a carer-specific anxiety and depression program, CarersCanADAPT will improve carer psychological wellbeing. Co-design methodology will ensure it meets the unique needs of carers. Future research to evaluate the efficacy of CarersCanADAPT is planned.

Erin Laing¹, Nicole Kiss^1,2, Jenelle Loeliger^1,2, Belinda Steer^1,2, Michael Michael^3,4, Nick Pavlakis⁵, Meredith Cummins⁶, Simone Leyden⁶, David Chan⁵, Megan Rogers³, Grace Kong^3,7, Lara Edbrooke^8,9, Lynda Dunstone⁶, Meinir Krishnasamy^10,11

¹Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²School of Exercise & Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

³Upper Gastrointestinal & NET Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁵Medical Oncology Department & NET Unit, Royal North Shore Hospital, Sydney, VIC, Australia

⁶NeuroEndocrine Cancer Australia, Australia

⁷Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁸Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁹Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia

¹⁰Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

¹¹Department of Nursing, University of Melbourne, Melbourne, VIC, Australia

Aim: Patients with neuroendocrine tumours (NET) are at risk of malnutrition, malabsorption and dietary change, but existing validated nutrition screening tools are not designed to capture complex NET symptoms and nutrition issues. This study aimed to develop a novel nutrition risk screening tool to improve early identification of patients with NETs requiring nutrition intervention.

Methods: Virtual focus groups and a two-round, online modified Delphi survey, involving international multidisciplinary NET health professionals (HP), informed the tool content and structure. The Delphi survey established consensus on the importance, wording and response options for proposed tool items. Acceptance criteria for inclusion of items between rounds was set at 75% (of rating > 7 on the 9-point Likert scales). Patients with NETs attending clinics at an ENETS Centre of Excellence in Melbourne were recruited to test the tool utility against key domains (ease of use, format, acceptability), assessed using a 5-item survey (with 7-point Likert scales) and test–retest study of item reliability.

Results: Twenty-two multidisciplinary HPs, from five countries/regions, participated in focus groups developing essential content for the initial 7-item tool (NET-NS). In Delphi round one, 46 HPs (including medical oncologist n = 14, surgeon n = 8, nurse n = 7, dietitian n = 6) from across six countries/regions (Aus = 21, Canada = 6, Europe = 11, NZ = 5, US = 3) revised the tool. After round one, all questions were retained (100% rated >4, 60% rated >7) with wording changes. Twenty-four (52%) participants completed Delphi round two, after which 6/7 questions (relating to NET-symptoms and diet change) met acceptance criteria, resulting in a 6-item tool. Consumer testing results were positive, with mean survey responses of 6.3–6.9 (SD .3–.7, n = 15), and 9/11 sub-items scoring >.833 on the test–retest study (n = 24).

Conclusions: Using NET HP expertise and consumer-informed utility testing, a novel NET-nutrition risk screening tool has been developed. Planning for a multi-site validation study and international implementation is underway.

Han Yang Lau

Flinders Medical Centre (Australia), Bedford Park, SA, Australia

Background: Use of patient reported outcomes (PROs) to guide routine cancer care is associated with improved outcomes but their implementation into routine practice is limited. This study reviewed current Australian national, state and territory cancer plans to assess how they addressed the use of PROs.

Methods: We identified publicly available current cancer plans, and associated publications, issued by Australian national, state and territory governing bodies. This search was conducted through Google in July 2023. Identified publications were reviewed to discern if PROs were mentioned. If so, they were further analysed for reasons, timeframe, methods and responsibility for PROs collection.

Results: Ten pertinent publications dating from 2010 to 2023 were identified as relevant to the study. These publications were titled cancer plans and strategy implementations plans which were represented by seven states and the Australian national cancer plan. Eight of the reviewed plans underscored the utility of PROs in cancer care. The reasons for PROs collection were to advance clinical care (n = 8), improve access to cancer and associated services (n = 5) and better quality of life for cancer survivors (n = 7). There was no consensus on the method for PRO collection, with three publications suggesting three different measures. Four publications acknowledged that PROs collection was a multi-organisational undertaking.

Conclusion: There is general acknowledgement and plans to assess PROs in the Australian cancer care system. This is agreed to be done across the patient's journey. However, there is no standardised method to do so. The lack of standardisation can be attributed to the segmented structure of the Australian health system. Addressing this absence of uniformity necessitates the establishment of a nationally consistent benchmark and reporting approach to spur future developments in this field.

Jane Lee¹, Neil Piller¹, Raymond Chan¹, Monique Bareham², Bogda Koczwara¹

¹Flinders University, Bedford Park, SA, Australia

²Lymphoedema Advocate, Adelaide, Australia

Background: Australian cancer survivors identify lymphoedema (LO) as a significant unmet care need. Many barriers to care delivery have been identified but there is limited data on priorities and preferences for improving outcomes from the perspective of diverse stakeholders involved in LO care including health care providers, researchers and consumers. This presentation will report on the findings of stakeholder consultations conducted in person and online exploring stakeholder views on key priorities for improving LO care in Australia.

Methods: Cancer survivors with lived experience of LO in diverse cancer types (e.g. breast, melanoma, head and neck cancer, gynaecological cancer; n = 19), and health care professionals and researchers representing diverse disciplines (i.e. oncology, nursing, general practice, physiotherapy, exercise physiology, lymphoedema therapy, dermal scientist; n = 36) participated in a face-to-face workshop (n = 24) and an online workshop (n = 31). All Australian state and territories were represented with 17 participants coming from or working within rural or regional settings. Furthermore, nine participants represented organisations or provide LO advocacy and care at the state or national level.

Results: Participants identified a number of priorities for improvement of LO care including improvement of patient and professional education, care navigation, workforce capacity, equity of access and cost. A unique challenge and an opportunity for better LO care was greater recognition of LO as a chronic, complex condition rather than an acute skin toxicity with resulting implications on the most appropriate models of care.

Conclusion: These multidisciplinary stakeholder workshops identified a range of priorities for improvement of LO care than can inform care delivery, policy and research priorities.

Grace Mackie¹, Jasmine Ekaterina Persson¹, Sophie Lewis², Frances Boyle^1,3, Andrea Smith⁴

¹Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

²Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia

³Mater Hospital, North Sydney, NSW, Australia

⁴Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

Background: Research shows that support groups can help people living with breast cancer to cope better with the psychosocial impacts of their diagnosis and treatment. Yet, there remains relatively limited exploration of the value of support groups for those living with metastatic breast cancer (MBC). To address this gap, this study aimed to explore the perspectives of people living with MBC on the value of support groups, and key factors that encourage or hinder group attendance.

Methods: Participants were recruited via promotional material distributed by cancer and breast cancer organisations, and direct recruitment through clinicians and support group facilitators. Recruitment ceased once thematic saturation was reached. Semi-structured interviews were conducted with 28 women living with MBC. Data were analysed using an inductive approach to thematic analysis.

Results: Three themes were identified: (1) the value of shared experiential knowledge; (2) a safe space for open and honest discussions and (3) finding connection and community. Women who attended stage-specific MBC support groups highlighted the importance of their group as an avenue of much-needed connection to others with MBC, thereby reducing isolation and normalising their diagnosis. Other valued aspects of a support group included information sharing and relief of emotional burden on family and friends. Participants reported that support groups were particularly beneficial in sharing feelings or experiences that were difficult to discuss with loved ones. Reasons for not attending groups included a negative perception of support groups, concern about dealing with the inevitable death of other group members, and satisfaction with existing support networks. Stage-specificity and professional facilitation were identified as important aspects of group structure.

Conclusions: People living with MBC in Australia have little opportunity to connect to others with the same diagnosis. For some, stage-specific support groups address this critical supportive care gap. However, others may prefer to connect online or one-on-one, or else feel sufficiently supported by family and friends.

Rebecca McLean¹, Anne Woollett¹, Taylah Wynen², Kaye Hewson³, Amy Shelly²

¹Alfred Health, Melbourne, VIC, Australia

²Cancer Council Victoria, Melbourne, Victoria, Australia

³Australian Teletrial Program, Brisbane, QLD, Australia

Overview: A teletrial is a new model of care that aims to improve access and participation in clinical trials for people who live in regional and rural areas. With all new models of care, simple communication is vital so that patients clearly understand the language so they feel well-informed.

TrialHub, the Australian Teletrial Program (ATP) and Cancer Council Victoria partnered with consumers to revise and review the current teletrial language to inform a brochure that would resonate with future clinical trial participants.

Distribution: Regional, metro and rural health service websites, and in waiting rooms, Cancer Council Victoria's website, and Australian Teletrial Program website.

Results: Provides a single reference point of information for all Australian patients considering a teletrial.

Conclusions: Using language derived from the community ensures the explanation of a teletrial is the best it can be. This brochure's success can be measured by printed volume, and web downloads, and contributes to improving health literacy and participation of clinical trials in Australia.

Claire Munsie^1,2,3, Jo Collins^1,3, Meg Plaster^1,3

¹WA Youth Cancer Service, Nedlands, WA, Australia

²School of Human Science, The University of Western Australia, Perth, Western Australia, Australia

³Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Background/aims: Adolescent and young adult (AYA) cancer survivors often experience a myriad of acute and chronic toxicities which can significantly impact their physical and psychosocial functioning and quality of life (QOL). This presentation will share patient insights into the vast impacts a cancer diagnosis and its treatment has on this population. It will report both the objective results alongside the patient voice to demonstrate the physical and psychosocial benefits of group-based exercise in AYA cancer survivors.

Methodology: A total of 110 AYAs enrolled in a 12-week group-based exercise programs that were delivered in a community setting. Participants completed pre- and post-intervention assessments of physical (1RM strength, grip strength, VO_2peak, push ups and sit ups) and psychosocial measures. Following the intervention, participants were invited to share their experience of the program via video or audio recording.

Results: Ninety-one participants have completed the program over a 6-year period. Significant improvements were reported in all 1RM strength measures, push ups and sit ups (p ≤ 0.01). Subjectively reported fatigue, pain, social, emotional, role and physical functioning quality of life variables also improved over time (p ≤ 0.05). No detectable change was evident in VO_2peak. Participant interviews revealed the greatest impacts were on psychosocial functioning and group connectedness in this cohort.

Andrew Murnane^1,2, Jakub Mesinovic^2,3, Jeremy Lewin^1,4, Nicole Kiss², Steve Fraser²

¹ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences, Faculty of Health Deakin University, Burwood, VIC, Australia

³Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia

⁴Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Introduction: Adolescent and young adult (AYA) cancer survivors may be at risk of impaired functional capacity and unfavourable body composition due to their cancer therapy or current health behaviours. Impaired functional capacity and unfavourable body composition contribute to the increased risk of chronic disease development, in particular cardiovascular disease. The purpose of this study was to investigate the cardiorespiratory fitness (CRF), body composition and health-related quality of life (HRQoL) of long-term AYA cancer survivors and compare their current health and well-being to age-matched normative data.

Method: This explorative cross-sectional study recruited participants aged 15–25 years at time of cancer diagnosis and ≥5 year's post-treatment completion. Study participants completed a range of assessments including cardiopulmonary exercise testing, dual x-ray absorptiometry, and questionnaires to measure fatigue (FACIT-F) and HRQoL (AQoL-6D). T-tests were used to compare means to normative data and Z-score within 1 SD indicated normal bone mineral density.

Results: Twenty-two participants were recruited with the following demographics: median age 27.9 (SD 3.3), 54.5% women, 7.2 years post-treatment completion (SD 2.2) and predominantly had Hodgkin lymphoma (40.1%). CRF was 13.9% below predicted (V0₂peak 32.9 mL/kg/min vs. predicted 38.2 mL/kg/min, p = 0.05). Bone mineral density Z-scores (.17) were within normal ranges; however, both women and men had higher body fat percentage (AYA women: 32.2% vs. 28.6%; AYA men: 27.1% vs. 18.9%) and lower lean mass (AYA women: 40.4 vs. 45.3 kg; AYA men: 55 vs. 65.5 kg) compared to age-matched counterparts. AYA cancer survivors also had lower HRQoL (t[df = 465] = −3.6, p < 0.0001) and similar fatigue levels (t[df = 325] = −.8, p = 0.5) compared to age-matched counterparts.

Conclusion: AYA survivors exhibit lower CRF, higher fat mass, lower lean mass and poorer HRQoL compared to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase risk of chronic disease development. Interventions that address these issues early in survivorship may promote better long-term health outcomes in this population group.

Sandra Picken, Angela Mellerick, Michael Barton

Peter MacCallum Cancer Centre, Parkville, Victoria, Australia

Aims: The Victorian Integrated Cancer Services (VICS) aim to use available data sources to monitor and communicate Victorian health services’ alignment with the Optimal Care Pathways (OCPs) by defining a standardised suite of performance and quality indicators and a standardised monitoring process.

Cancer quality and performance indicator results will be used to identify aspects of cancer care in need of further analysis, investigation and quality intervention. The monitoring data will be routinely accessed and reported on by each of the VICS to drive improvements within their network, and across the state.

Methods: Indicator selection, testing and development was a staged process drawing on both evidence-based literature and advice gathered through clinician engagement, stakeholder input and expert opinion. Criteria were established to guide the comparison, ranking and assessment of candidate indicator areas for selection. Indicators were derived from recommended timeframes and actions from the 24-adult cancer OCPs.

Results: Using a modified-Delphi method, the longlist of 36 indicators were assessed by a clinical reference group for their value in monitoring the quality of cancer care and potential to inform impactful improvement activities. Each was scored on a scale of 0–10. Results were collated and then ranked indicators grouped by ease of data collection.

Conclusions: A recommended suite of indicators covering all aspects of the patient journey and key components of service delivery as defined by the OCPs will be incorporated into a process to monitor OCP alignment. This will provide a mechanism for the VICS to produce, for Victorian health services, regular data reports against these indicators to inform service improvement opportunities and drive changes in clinical practice to improve outcomes.

Poorva Pradhan^1,2, Helen Hughes², Ashleigh Sharman^1,2, Judith Lacey³, Jonathan Clark^1,2,4,5, Patrick Dwyer⁶, Jacques Hill⁷, Kimberley Davis⁸, Steven Craig⁹, Raymond Wu^1,2,10, Bruce Ashford¹¹, Rebecca Venchiarutti^1,12

¹Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia

²Chris O'Brien Lifehouse, Sydney, NSW, Australia

³Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia

⁴Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia

⁵Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia

⁶Department of Radiation Oncology, North Coast Cancer Institute, Lismore, NSW, Australia

⁷Department of Radiation Oncology, The Mid North Coast Cancer Institute, Port Macquarie, NSW, Australia

⁸Department of Research, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia

⁹Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia

¹⁰Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia

¹¹Department of Surgery, Wollongong Hospital and Wollongong Private Hospital, Wollongong, NSW, Australia

¹²Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

Aims: As a result of high survival rates in patients with head and neck cancer (HNC), there has now been a recognition of survivorship issues in such patients. Survivors of HNC have among the most unique and complex needs as compared to other types of cancers due to anatomical complexity of the head and neck region. That is, the effects of HNC treatment are often wide ranging and serious, encompassing physical and psychological conditions that are critical to day-to-day functioning. However, much of the research in this area has been focussed on patients residing in urban/metropolitan areas. Much less is known for HNC survivors residing in regional/remote areas, where survivorship issues are even more complex. Hence, the current study aims to explore the survivorship needs of patients residing in regional or remote NSW with HNC.

Methods: Patients with HNC who resided across regional/remote areas of New South Wales were recruited for this study. Semi-structured interviews were conducted with these patients to explore such needs in-depth. The Quality of Cancer Survivorship Care Framework was used to guide the interviews. These interview sessions were audio-recorded and were then transcribed verbatim and analysed using a thematic analysis approach.

Results: As of 7 August 2023, four patients have been interviewed, with mean age of 68.25 years having laryngeal and oropharyngeal cancer. Preliminary findings suggest that HNC survivors have long lasting physical symptoms affecting their day-to-day functioning and impairing the overall quality of life. Detailed results along with themes will be presented in the 2023 COSA Annual Scientific Meeting.

Conclusions: This study will provide new insight into the survivorship needs of patients residing in regional parts of New South Wales and the impact of such needs on their wellbeing. These results may offer directions to future survivorship care service development and potentially critical insights to develop tailored interventions or models of care that address such prominent needs.

Ursula M Sansom-Daly^1,2,3, Sarah Ellis^1,2, Kate Hetherington^1,2, Brittany C McGill^1,2, Holly E Evans^1,2, Clarissa E Schilstra^1,2, Mark W Donoghoe^1,2, Richard J Cohn^1,2, Antoinette Anazodo^2,4, Claire E Wakefield^1,2

¹Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

²School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia

³Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospitals, Randwick, NSW, Australia

⁴Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

Background: Cancer significantly impacts adolescents’ and young adults’ (AYAs’) identity.¹ Little is known about whether AYAs adopt a ‘cancer survivor’ identity, and whether a ‘survivor-centric’ identity is linked with psychological outcomes into survivorship.^1,2

Objective: To explore prevalence and predictors of AYAs’ cancer-related identity preferences in survivorship, and examine associations with their psychological adjustment.

Method: Across two studies, two items explored AYAs’ cancer-related identity preferences: firstly, using a 10-point sliding-scale, and then with seven categorical label-options (e.g. ‘cancer survivor’, ‘victim of cancer’), alongside psychological measures (Depression and Anxiety Scale-Short,³ Centrality of Events,⁴ Impact of Cancer⁵). Study 1's cross-sectional questionnaire-design compared AYAs in survivorship, with controls (who appraised non-cancer illness experiences). Study 2 enabled observation of AYAs’ cancer-identity preferences over a 12-month period following treatment-completion, within the Recapture Life intervention randomised-trial.^6,7

Results: Study 1: AYAs with a cancer history endorsed more ‘survivor-centric’ identity than controls (p < 0.001). Greater perceived cancer-centrality, and lower depression, predicted greater survivor-identity (p = 0.001). Study 2: At baseline, AYAs preferred the term ‘cancer survivor’ (mean = 7.4, SD = 1.9), with ‘cancer survivor’ chosen most frequently (35%), followed by ‘had cancer once, but is fine now’ (20%). Twelve months later, ‘survivor’ was still most endorsed, but only by 25% of AYAs. Most AYAs (60%) identified with more than one identity-label – at times simultaneously. No significant relationships between survivor-identity, anxiety or depression emerged. A positive linear relationship indicated that more survivor-centric identity was correlated with AYAs perceiving more positive impacts of cancer, over time (r = .27, p = 0.009).

Linda Saunders, Jenni Bourke

¹Health Services, Leukaemia Foundation, Melbourne, Victoria, Australia

Background: The systemic nature of blood cancer can lead to a complex diagnostic and treatment pathway. Many blood cancers are considered chronic and/or incurable. People face life-long impact on their physical, psychological, and social health and wellbeing. They experience constant adjustment to remission/relapse/progression with multiple lines of treatment. Therefore, the term ‘survivor’ does not accurately reflect the lived experience of this community. Data indicates a high level of unmet supportive care needs, particularly when disease management is community based.

The original face-to-face support groups transitioned to regular online groups in response to the need for consistent, accessible and high-quality support. Implementation was hastened due to Covid-19 and the need to provide continuity of support to a highly vulnerable community.

Discussion: The focus of the program to address the specific health and wellbeing needs of the blood cancer community. This is in recognition that some issues are common across diagnoses yet remain specific to the unique nature of blood cancer. Stakeholder feedback indicates the program provides valued, relevant information and support anywhere in Australia. Program planning and design enables a flexible response to the current health environment and lived experience of the blood cancer community.

Catherine Seet-Lee^1,2, Jill Clarke¹, Kate Edwards^1,2

¹Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia

²Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia

Aim: Effective cancer treatment relies on intravenous chemotherapy penetrating the entire tumour in sufficient concentrations, which is largely reliant on effective blood supply into and within the tumour. However, tumours contain abnormal vasculature with inefficient blood perfusion leading to the inability for chemotherapy to reach the target tumour.¹ Pre-clinical evidence suggests acute exercise may increase blood flow by 200%.² However, most pre-clinical studies investigate the effects of light-to-moderate intensity exercise and subsequently there is little evidence regarding the most effective exercise intensity for improved tumour vasculature. Therefore, the aim of this ongoing case series is to determine whether exercise changes tumour blood flow in a clinical model using non-invasive techniques, and how exercise intensity effects degree of change in blood flow to tumours in patients with liver metastases.

Methods: Participants were eligible if they were aged over 18 years, had stage IV cancer with liver metastasis and ECOG 0-2. The study visit consisted of an aerobic fitness test (YMCA) to determine cardiorespiratory fitness and three 5-min bouts of exercise at low, moderate and high intensities. After each exercise bout, Doppler ultrasound was used to measure a liver tumour vessel and the hepatic artery (as a control) to determine blood flow parameters.

Results: Exercise increased peak systolic velocities (PSV) to liver tumours at all intensities compared to rest. Moderate and high exercise intensities showed a marked increase in PSV within the first 2 min after exercise. The hepatic artery showed less variability in PSV with time compared to the liver tumour. Cardiorespiratory fitness did not affect tumour PSV.

Anna C Singleton^1,2, Nashid Hafiz², Raymond Chan³, Amy Von Huben², Rodney Ritchie⁴, Nikki Davis⁵, Kirsty Stuart^6,7, Aaron Sverdlov^8,9, Rebecca Raeside², Karice K Hyun^2,10, Stephanie R Partridge², Elisabeth Elder^2,6, Julie Redfern^2,11

¹Engagement and Co-design Research Hub, The University of Sydney, Sydney, NSW, Australia

²The University of Sydney, Sydney, NSW, Australia

³Flinders University, Adelaide, South Australia, Australia

⁴Male Breast Cancer Global Alliance, Sydney, NSW, Australia

⁵Primary Care Collaborative Cancer Clinical Trials Group Consumer Advisory Group, Melbourne, Victoria, Australia

⁶Westmead Breast Cancer Institute, Sydney, NSW, Australia

⁷Crown Princess Mary Cancer Centre, Sydney, NSW, Australia

⁸University of Newcastle, Newcastle, NSW, Australia

⁹John Hunter Hospital, Newcastle, NSW, Australia

¹⁰Concord Repatriation General Hospital, Sydney, NSW, Australia

¹¹University of New South Wales, Sydney, NSW, Australia

Background: Over 1.5 million Australians are living with/beyond cancer and over half of them with breast, colorectal, lung, ovarian or prostate cancer. The majority have unmet information or psychosocial needs.

Aim: To evaluate variations in supportive care needs during and after treatment between cancer types.

Methods: Australian adults with a history of breast, colorectal, lung, ovarian or prostate cancer recruited through Facebook advertisements and stakeholder e-newsletters. Participants completed a purpose-built, cross-sectional, consumer/researcher co-designed online survey (34-items). Quantitative data were summarised using summary statistics; mean ± standard deviation and frequencies/percentages and compared using chi-square and Bonferroni adjustment. Free-text responses were analysed thematically.

Results: Participants (N = 457) had a mean age 59 ± 11 years (range 26–83 years) and were diagnosed with breast (23%), colorectal (20%), lung (18%), ovarian (18%), prostate (19%) or multiple cancers (2%). Most were female (71%), born in Australia (77%) and one-third were from regional/rural/remote areas. Participants reported receiving ‘some-’ or ‘little to no information’ during versus post-treatment (33% vs. 53%). During treatment, there was variability between cancer types in desiring information about free health programs (X²[5] = 20.70, p < 0.001; e.g. 63% colorectal, 31% prostate), financial support (X²[5] = 11.313, p = 0.046; e.g. 32% breast, 24% ovarian) and sexual health (X²[5] = 47.725, p < 0.001; e.g. 45% prostate, 6% lung). Between cancer types, participants equally desired information regarding diet, exercise or mental health/self-care. After active treatment, there was variability in desire for information about diet (X²[5] = 16.25, p = 0.012; e.g. 39% colorectal, 13% lung) and sexual health (X²[5] = 24.01, p < 0.01; e.g. 33% prostate, 5% lung) but participants equally desired information about exercise, mental health, fear of recurrence, side effects and financial assistance. Qualitative results found ‘seeking support immediately’, ‘being prepared’ and ‘leading a healthy lifestyle’ were important for managing mental and physical health during and after treatment.

Conclusions: Participants had shared and cancer-specific supportive care needs during and after treatment, which could inform development of future interventions. Early and accessible intervention were key themes across cancer types.

Malini Sivasaththivel¹, Anousha Yazdabadi¹, Arlene Chan², John Su¹

¹Eastern Health, Box Hill, Victoria, Australia

²Oncology, Perth Breast Cancer Institute, Western Australia, Victoria, Australia

Background: PD-1-inhibitors play a key role in the treatment of melanoma and other cancers. However, a number of cutaneous adverse events have been reported.

Objective: We reviewed the literature on clinical and histological characteristics of PD-1 inhibitor-induced skin reactions, their potential pathogenesis and treatment.

Materials and methods: The literature was searched for publications on PD-1 inhibitor induced skin reactions using the MEDLINE and SCOPUS databases.

Discussion: Morbilliform, lichenoid, psoriasiform and eczematous skin reactions have been documented to have occurred in the context of PD-1 inhibitor usage. The skin reactions are thought to result from altered immunological tolerance. This response may be heightened in the presence of other immunomodulating agents. Although these skin reactions present diversely, there are shared principles of treatment. Emollients and topical agents are first line therapies; prednisolone, other systemic agents and biological agents may be effective in refractory cases.

Conclusion: Clinical awareness of these skin reactions will enable early diagnosis, treatment and improved outcomes.

Belinda Steer^1,2, Kate Graham¹, Nicole Kiss³, Jenelle Loeliger^1,2

¹Nutrition and Speech Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia

³Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia

Aim: The presence of malnutrition and sarcopenia can lead to significant impacts on cancer patients, including reduced quality of life and increased mortality. Cancer-related malnutrition prevalence in Victorian health services is well documented, but the prevalence of sarcopenia is less well known. The aim of this study was to determine the prevalence of malnutrition and sarcopenia risk within the Victorian adult cancer population.

Methods: A multi-site point prevalence study was conducted across Victorian acute health services in July 2022. Adults with cancer receiving ambulatory treatment, and multi-day stay inpatients were included. Malnutrition was assessed using GLIM criteria and sarcopenia risk assessed using the SARC-F and calf circumference.

Results: Twenty-one health services recruited 1705 adult oncology patients (n = 292 inpatients, 17%). Malnutrition risk was present in 44% (n = 754) of all patients, and 32% were malnourished according to GLIM criteria. There was a significant difference between inpatient and ambulatory malnutrition prevalence (53% and 28%, respectively, p < 0.005). Sarcopenia risk was identified in 21% (n = 352) of all patients, with inpatients having a significantly higher risk than ambulatory patients (35% and 18%, respectively, p < 0.0005). Four of the five top tumour streams most at risk of sarcopenia (lung 34%, gynaecological 31%, upper GI 30% and colorectal 24%) also had the highest malnutrition prevalence. Malnutrition and sarcopenia risk was present in 14% of all patients, and of those not at risk of malnutrition, 13% were at risk of sarcopenia.

Conclusion: This study found that malnutrition continues to be highly prevalent in adult oncology patients, and sarcopenia risk is also a significant issue, particularly in the inpatient setting. To ensure cancer-related malnutrition and sarcopenia are identified early and subsequent multi-modal interventions can be put in place to prevent poor patient outcomes, a systematised process that incorporates both malnutrition and sarcopenia risk screening is recommended in clinical practice.

Christopher B Steer^1,2,3,4, Nicole Webb⁴, Stacey Rich³, Tshepo Rasekaba³, Ben Engel⁴, Craig Underhill^1,2,4, Sian Wright⁵, Irene Blackberry³

¹Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia

²Rural Clinical Campus, Albury, UNSW School of Clinical Medicine, Albury, NSW, Australia

³John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, VIC, Australia

⁴Albury Wodonga Health, Albury, NSW, Australia

⁵Hume Regional Integrated Cancer Service, Shepparton, VIC, Australia

Introduction: The evidenced based care of older adults with cancer includes geriatric assessment (GA) to enable treatment decisions and guide supportive care (SC). Clinical implementation of GA is a complex change management process. Electronic GA is feasible and acceptable in the regional cancer centre setting as part of supportive care.

Objectives: To establish an electronic GA-guided enhanced supportive care (ESC) service for older adults with cancer.

Methods: As a quality improvement process, a project officer was employed and steering committee established. Iterative implementation plan developed using Kotter's Eight Step Model of Change including creating a sense of urgency, a coalition with local champions and generating short term wins. Existing SC services and GA tools leveraged with focus on sustainability.

ESC model used: G8 screening in new patients aged >70 years then (if G8 score <14 or age >85 years) a GA with electronic Rapid Fitness Assessment (eRFA) + mini-COG/clock draw + Timed Up and Go. Questions added: Known to My Aged care? and Presence of Advanced Care Directive?. Results presented at a weekly virtual ESC multidisciplinary meeting (MDM) and appropriate SC referrals made.

Results: Project officer employed July 2021 to June 2022. Key implementation steps: (1) multistakeholder GA education programme, (2) moved eRFA to local platform (snapforms.com.au), (3) empowered all ESC MDM team to conduct eRFA and (4) admin support for ESC MDM.

During the pilot phase (November 2021 to June 2022) 38 patients underwent eRFA GA and were presented at ESC MDM. Sustainability then proven as ESC MDM continues with a further 102 patients [median age 80 years (70–97)] presented in the 13 months after project completion. The ESC MDM enables focussed and streamlined referrals for supportive care services.

Conclusion: A two step model with G8 screening then an electronic GA is feasible, acceptable and sustainable in patients aged >70 years. An electronic GA-guided enhanced supportive care service can be created and sustained at a regional cancer centre.

Lara Stoll¹, Gail Garvey¹, Nienke Zomerdijk¹, Haryana Dhillon², Joan Cunningham³, Sabe Sabesan⁴, Georgia Halkett⁵, Siddhartha Baxi⁶, Kar Giam⁷, Joanne Shaw⁸, Michael Penniment⁹, Adam Stoneley¹⁰, Luke McGhee¹⁰, Jim Frantzis¹⁰

¹University of Queensland, Brisbane, Queensland, Australia

²The University of Sydney, Sydney, Australia

³Menzies School of Health Research, Melbourne, Australia

⁴Townsville Hospital and Health Service, Townsville, Australia

⁵Curtin University, Perth, Australia

⁶GenesisCare, Gold Coast, Australia

⁷Alan Walker Cancer Care Centre, Darwin, Australia

⁸The University of New South Wales, Sydney, Australia

⁹Royal Adelaide Hospital, Adelaide, Australia

¹⁰ICON Cancer Care, Cairns, Australia

Objectives/purpose: Aboriginal and Torres Strait Islander (hereafter respectfully referred to as First Nations) people experience poorer cancer outcomes than other Australians. Health communication is an integral part of delivering patient-centred care and improving health literacy. Culturally appropriate resources can improve clinician–patient communication. The 4Cs project (Collaboration and Communication in Cancer Care) aims to develop resources to improve clinician–patient communication during radiation therapy; here, we report on the development and implementation of a Radiation Therapy talking book (RTB) for First Nations cancer patients.

Methods: The content and design of an existing RTB for cancer patients with low health literacy was adapted for First Nations cancer patients using an iterative process. The iterative adaption process included Yarning circles/interviews with First Nations cancer patients, health professionals, Indigenous interpreters and Indigenous graphic designers. First Nations actors provided voice over for the RTB in simple English and an Indigenous language (Yolngu Matha). The content and audio were then combined into an eBook accessible on electronic tablets.

Results: Twenty-two participants completed Yarning circles/interviews and provided feedback on the RTB content, design, language and cultural aspects. The RTB is currently being implemented and evaluated by First Nations cancer patients in three cancer centres across Queensland and the Northern Territory (accrual target, N = 40). Preliminary findings will be presented during the session.

Conclusion and clinical implications: Cultural adaptation of existing high-quality information resources is feasible. Further work evaluating the impact of RTB on improving patient centred care for First Nations cancer patients is required to support sustainable implementation of these resources.

Megumi Uchida^1,2, Tatsuo Akechi^1,2, Tatsuya Morita³, Naoko Igarashi⁴, Yasuo Shima⁵, Mitsunori Miyashita⁴

¹Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Aichi, Japan

²Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan

³Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan

⁴Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

⁵Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaragi, Japan

Aim: This study aimed to investigate the association between terminal delirium related distress assessed by bereaved family and bereaved family's depression and prolonged grief disorder.

Methods: A self-administered questionnaire was mailed to the bereaved families of cancer patients who were admitted to a hospice/palliative care ward. The questionnaire asked about age, relationship with the patient, education, physical and mental health status during the patient's last hospitalisation, depression (PHQ-9), prolonged grief disorder (BGQ), terminal delirium related distress (Terminal Delirium related Distress Scale: TDDS), whether they had accompanied the patient in the week before death, whether there was a substitute attendant, whether there was someone who listened to them, whether there was someone who care them, whether they had religion and whether the patient became delirium.

Results: A total of 513 bereaved returned their questionnaire (response rate: 65%). Of these, 281 bereaved (55%) reported their family member had terminal delirium. The mean (±SD) and median age of the respondent was 59(±12) and 59 years, respectively. Chi-square test indicated that (1) age (59/60), relationship (spouse or child), physical and mental health status during the patient's last hospitalisation were significantly associated with bereaved depression (PHQ-9:11/10) and (2) relationship (spouse or child), physical and mental health status during the patient's last hospitalisation and terminal delirium related distress (TDDS:75/76) were significantly associated with bereaved prolonged grief disorder (BGQ:9/8). A logistic regression analysis revealed that (1) relationship (spouse) and physical health state during the patient's last hospitalisation were significantly associated with bereaved depression and (2) relationship (spouse or child) and terminal delirium related distress were significantly associated with bereaved prolonged grief disorder.

Conclusion: Assessing and improving the quality of treatment and care for terminal delirium may reduce prolonged grief disorder of bereaved family.

Rebecca L Venchiarutti^1,2, Haryana M Dhillon², Carolyn Ee^1,3,4, Nicolas H Hart^4,5,6, Michael Jefford^7,8,9, Bogda Koczwara^4,5

¹Chris O'Brien Lifehouse, Missenden Road, NSW, Australia

²The University of Sydney, Camperdown, NSW, Australia

³Western Sydney University, Penrith, NSW, Australia

⁴Flinders University, Adelaide, SA, Australia

⁵Flinders Medical Centre, Adelaide, SA, Australia

⁶University of Technology Sydney, Moore Park, NSW, Australia

⁷Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁸Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁹Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

Aims: Multimorbidity (≥2 coexisting conditions) in cancer survivors is common and associated with increased symptoms, greater complexity of care, higher healthcare costs and mortality. The aim of this study is to identify priority elements of care delivery and research for Australian cancer survivors with multimorbidity.

Methods: A Delphi study, administered over at least two rounds, is being conducted. Included elements of care and research are based on the National Strategic Framework for Chronic Conditions and review of evidence. In Round 1, health professionals (GPs, allied health, oncologists, nurses, care coordinators), consumers and researchers were invited to rate the importance of the elements [18 principles (e.g. equity, access, whole-person care), nine enablers (e.g. skilled workforce, health literacy, technology) and four objectives (e.g. prevention, quality of life, prolonged survival, priority populations)] on a 5-point Likert scale. Participants could suggest additional elements of care delivery and research priorities. Consensus was defined as ≥70% of respondents rating an element as important (score of 4) or very important (score of 5).

Results: As of 11 August 2023, 23 participants had completed Round 1 (closed 17 August 2023). Participants (82% female) from five Australian states included six people with lived experience of diverse cancers, 13 health professionals and three researchers. All elements had a mean score ≥4 (important/very important) for care delivery. Two principles and two enablers did not achieve this threshold (mean score <4) for research priorities. Four elements (three principles, one enabler) did not achieve consensus ratings. Participants provided feedback on wording and suggested additional elements, which will be assessed in Round 2 (14 September 2023–5 October 2023). Data from the completed study will be available at the time of presentation.

Conclusions: This study will establish clinical and research priorities to inform a national framework for the management of multimorbidity in cancer survivors and priorities for future research.

Kyra Webb^1,2, Louise Sharpe¹, Phyllis Butow^1,2, Haryana Dhillon^1,2,3, Robert Zachariae^4,5, Nina Møller Tauber⁴, Mia Skytte O'Toole⁴, Joanne Shaw^1,2

¹School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

²The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

³Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

⁴Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark

⁵Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

Aims: Substantial research has explored survivor fear of cancer recurrence (FCR); however, less is known about caregiver FCR. This study aimed to conduct a meta-analysis to (a) quantify the severity of FCR among caregivers; (b) compare caregiver and survivor FCR levels; (c) examine the relationship between caregiver FCR and depression and anxiety and (d) evaluate the psychometric properties of measures used to quantify caregiver FCR.

Methods: Databases, CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research exploring caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR, published in English-language, peer-review journals between 1997 and November 2022. The COSMIN taxonomy was used to assess measure content and psychometric properties. The review was pre-registered (PROSPERO ID: CRD42020201906).

Results: Of 4297 records screened, 45 met criteria for inclusion. A meta-analysis confirmed that 48% of caregivers experience clinically significant FCR levels (k = 13). Caregiver FCR was as high as FCR amongst survivors. Large associations between caregiver FCR and anxiety (k = 12; r = .561, p < 0.001; 95% CI: .453–.653) and caregiver FCR and depression (k = 11; r = .533, p < 0.001, 95% CI: .447–.609) were found. Assessment using the COSMIN taxonomy found few instruments had undergone appropriate development and psychometric testing in caregiver populations. Only one instrument scored higher than 50% indicating substantial development and validation components were missing in most.

Conclusions: Results indicate that FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with increased levels of depression and anxiety. Measurement of caregiver FCR has predominately relied on survivor conceptualisations and unvalidated measures. There is an urgent need for more caregiver specific FCR research.

Kyra Webb^1,2, Louise Sharpe¹, Hayley Russell³, Joanne Shaw^1,2

¹School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

²The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

³Ovarian Cancer Australia, Melbourne, Victoria, Australia

Aims: Fear of cancer recurring or progressing (FCR) is a key concern for cancer caregivers, with 48% experiencing FCR at levels considered clinically significant among survivors. A recent systematic review investigating the utility of caregiver FCR measures found low adherence to measure development and psychometric validation best practice as outlined by the COSMIN taxonomy. This study aimed to develop and evaluate the psychometric properties of a caregiver specific measure of FCR (CARE-FCR).

Methods: Item generation was guided by results from a qualitative systematic review and qualitative interview study. A total of 438 caregivers (56% female, M_age= 50.53 years, SD = 17.38) were recruited through cancer organisations, Register4 an Australian online registry where people diagnosed with cancer and caregivers can indicate their interest in participating in research studies and Prolific paid study participation. An exploratory factor analysis, in a split sample of 220 resulted in a 24 item, three factor scale. We then performed confirmatory factor analysis on these 24 items in the remaining sample. Convergent validity was assessed using pre-existing measures of fear of recurrence and progression, depression, anxiety, death anxiety and meta-cognitions. The extraversion dimension of the Big Five Personality Trait questionnaire was used to assess divergent validity.

Results: The 24-item scale demonstrated good convergent, divergent validity internal consistency (overall Cronbach's α = .96, progression = .93, recurrence = .92 and behaviours = .78) and test–retest reliability (r (377) = .81, p ≤ 0.001).

Conclusions: The CARE-FCR is a theoretically informed and psychometrically robust measure of caregiver FCR. Further research to determine clinical cut-offs for the measure are required.

Hattie Wright^1,2, Jacob Keech³, Suzanne Broadbent⁴, Karina Rune⁴, Michelle Morris⁵, Anao Zhang⁶, Cindy Davis⁷

¹Sunshine Coast Health Institute, Britinya, QLD, Australia

²School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia

³School of Applied Psychology, Griffith University, Brisbane, QLD, Australia

⁴University of the Sunshine Coast, Sippy Downs, QLD, Australia

⁵Medical Oncology, Sunshine Coast University Private Hospital, Britinya, QLD, Australia

⁶School of Social Work, University of Michigan, Michigan, USA

⁷School of Law and Social Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia

Aim: This study explored the eating behaviour and diet quality of prostate cancer survivors (PCS).

Methods: PCS completed a mixed methods online survey to gather demographic information, diet quality (Mediterranean Diet Adherence Screener, MEDAS), physical activity (Godin Leisure Score Index), emotional state (Depression Anxiety Stress Scale 21) and dietary intention (7-point Likert scale).

Results: PCS (n = 119) were aged 71.9 ± 6.7, 8-years post-diagnosis, 79% were retired and on pension. Most had a prostatectomy (43%) or received androgen deprivation therapy (45%) as treatment. Over half (57%) were classed ‘overweight’ for their age, 38% had comorbidities and 70% had a low diet quality (MEDAS score = 4.6, range 3–9). Unhealthy food choices such as salt intake, high-energy baked goods, fried foods and alcohol were limited by 84%, 89%, 74% and 83%, respectively. Meeting healthy eating guidelines were low with 52% meeting fruit, 3% vegetable, 37% legume, 33% nuts and seeds and 40% fish guidelines. Those with high healthy eating behaviour intent had lower depression (p < 0.001), anxiety (p = 0.001) and stress scores (p = 0.048). BMI was associated with depression, anxiety and stress (p < 0.05). Only 42% have spoken to someone about food and nutrition during their cancer journey with their medical specialist (21%), dietitian (17.6%) and family or friends (13.4%) the main people spoken to. Six themes described eating behaviour namely (i) interrelatedness of personal factors to achieve healthy eating goals, (ii) beliefs on diet, health and quality of life, (iii) opinion of credible sources, (iv) social support, (v) an enabling food environment and (vi) cognitive load associated with healthy eating.

Conclusions: Despite efforts to limit unhealthy food choices, long-term prostate cancer survivors’ diet quality is low. Insights are gained into factors influencing eating behaviour and diet quality, highlighting the need for in-time tailored nutrition support delivered through reputable sources.

Vanessa M Yenson^1,2,3, Ingrid Amgarth-Duff^1,2,4, Linda Brown^1,2,3,5, Cristina Caperchione^1,6,7, Katherine Clark^1,8,9,10, Andrea Cross^11,12, Phillip Good^1,13,14,15, Amanda Landers^1,16, Tim Luckett^1,5,3,7, Jennifer Philip^7,17,18,19, Christopher Steer^7,20,21, Janette L Vardy^22,23,24, Aaron K Wong^12,17,18,19, Meera R Agar^1,5,2,3,7,12

¹University of Technology Sydney, Ultimo, NSW, Australia

²Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia

³Cancer Symptom Trials (CST), Ultimo, NSW, Australia

⁴Telethon Kids Institute, Perth, WA, Australia

⁵Palliative Care Clinical Studies Collaborative, Ultimo, NSW, Australia

⁶School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Ultimo, NSW, Australia

⁷Management Advisory Committee, Cancer Symptom Trials, Ultimo, NSW, Australia

⁸Supportive and Palliative Care Network, Northern Sydney Local Health District, St Leonards, NSW, Australia

⁹Northern Clinical School, The University of Sydney, Sydney, NSW, Australia

¹⁰Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia

¹¹Consumer Advocate, Cancer Symptom Trials, Ultimo, NSW, Australia

¹²Scientific Advisory Committee, Cancer Symptom Trials, Ultimo, NSW, Australia

¹³Palliative and Supportive Care, Mater Misericordiae, South Brisbane, QLD, Australia

¹⁴Department of Palliative Care, St Vincent's Private Hospital, Brisbane, QLD, Australia

¹⁵Mater Research, University of Queensland, South Brisbane, QLD, Australia

¹⁶Palliative Care, Department of Medicine, University of Otago, Christchurch, New Zealand

¹⁷Palliative Medicine, University of Melbourne, Melbourne, VIC, Australia

¹⁸Palliative Care, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

¹⁹Royal Melbourne Hospital, Melbourne, VIC, Australia

²⁰Rural Clinical Campus, University of New South Wales, Albury-Wodonga, NSW, Australia

²¹Border Medical Oncology, Albury-Wodonga, NSW, Australia

²²Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, Australia

²³Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia

²⁴Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

Background and aim: Cancer symptoms, from disease or treatment, are common. Our aim was to reach consensus on the most troublesome cancer symptoms in Australian/New Zealand adults, to inform the direction of future clinical research and improve quality of life.

Methods: We conducted a modified Delphi study comprising two online surveys and consensus-building meetings for participants who included consumers and healthcare professionals (HCPs). Consensus was defined a priori as ≥70% participant agreement. Responses were summarised descriptively.

Round 1: HCPs were asked about prevalence/severity/management of 31 cancer symptoms in their patients; consumers were asked whether they experienced these symptoms, and to rate their impact. Participants were asked to nominate interventions for future symptom management research.

Round 2: Participants were asked if there were symptoms missing from the list of the top 10 ranked symptoms from Round 1, and to rate the importance of researching each intervention nominated in Round 1 (4-point Likert scale).

Round 3: Consumer meetings aimed to reach consensus on symptoms that had previously been agreed on by HCPs. All participants voted on symptoms reinstated in Round 2, and interventions that had not previously reached consensus.

Results: Participation peaked in Round 1 (consumers = 332; HCPs = 51). Consumers reached consensus that fatigue, bowel/bladder problems were troublesome. HCPs reached consensus on these and agreed that depression/mood, memory, cachexia, drowsiness, anorexia, sensory neuropathy, neuropathic pain, breathlessness, anxiety and insomnia were also poorly managed.

Both groups agreed that medicinal cannabis, physical activity, psychological therapies, non-opioid interventions for pain and opioids for breathlessness were important foci for future research.

Eva Yuen^1,2,3,4, Megan Hale^2,3,4, Carlene Wilson^3,4,5

¹Deakin University, Burwood, VIC, Australia

²Monash Health, Clayton, VIC, Australia

³School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia

⁴Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia

⁵Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, VIC, Australia

Aims: Significant unmet emotional support needs have been identified among cancer caregivers from culturally and linguistically diverse (CALD) communities.^1–3 Social support and connection have been shown to improve psychological outcomes and reduce burden in caregivers.^4–6 This study aimed to explore, qualitatively, whether and how social support was used to manage emotional wellbeing among CALD cancer caregivers.

Methods: Chinese (n = 12) and Arabic (n = 12) speaking cancer caregivers residing in Australia participated in semi-structured interviews. Participants were, on average, 40.6 years, most were female (83%) and provided care to a parent (41.67%). Thematic analysis was used.⁷

Results: Five overarching themes emerged that described caregivers’ perspectives on the utilisation and importance of social support. Themes included: (1) receiving emotional support from social networks, (2) barriers to accessing emotional support from social networks (responsibility to protect others from burden; reliance on oneself and stoicism; avoiding discussions as a coping mechanism; cancer, death and illness as taboo topics), (3) isolation and loss of connection following a cancer diagnosis, (4) faith as a source of support and (5) utility of support groups and caregiver advocates.

Although some caregivers relied on social networks for emotional support, caregivers identified a number of cultural and generational barriers to seeking support from their social networks. These barriers prevented caregivers disclosing their emotions and caregiving situation to members of their social network. As a result, some caregivers felt isolated from their support systems, reporting difficulties disclosing their caregiving circumstances, and seeking emotional support.

Conclusions: Development and assessment of culturally appropriate strategies designed to improve social support seeking for caregivers from CALD communities to improve emotional wellbeing is warranted.

Sidney Davies¹, Carlene Wilson^1,2,3, Victoria White⁴, Trish Livingston^5,6, Eva Yuen^6,7

¹School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia

²Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, VIC, Australia

³Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia

⁴School of Psychology, Deakin University, Burwood, VIC, Australia

⁵Faculty of Health, Deakin University, Burwood, VIC, Australia

⁶School of Nursing and Midwifery, Quality and Patient Safety, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia

⁷Monash Health, Clayton, VIC, Australia

Aims: People with cancer from culturally and linguistically diverse (CALD) communities experience greater psychological morbidity than their native-born counterparts (1), however, understanding specific factors that influence psychological outcomes is limited. People from CALD communities have reported greater stigma relating to psychological help-seeking compared to non-CALD populations (2), which may hinder their interest in seeking psychological support. We investigated whether people with cancer from CALD communities have poor psychological outcomes compared to their English-speaking counterparts, and whether psychological help-seeking stigma mediates this relationship.

Methods: People diagnosed with cancer in the preceding five years (Arabic [n = 42], Chinese [n = 48], Greek [n = 29] and English-speaking [n = 50]) completed the Depression, Anxiety, and Stress Scale–21 (3), and Stigma Scale for Receiving Psychological Help (4). The influence of CALD status on depression, anxiety and stress was examined using ANOVA. Mediation models (n = 3) were conducted with CALD-status as the independent variable, psychological help-seeking stigma as the mediator variable, and depression, anxiety and stress, as the outcome variables, controlling for demographic characteristics.

Results: Participants were diagnosed with haematological (20.1%), lung (19.5%), breast (16%), prostate (13.6%), colorectal (8.9%), melanoma (7.1%) or other (14.8%) cancer, with a mean age of 51.80 (13.3) years. CALD participants had significantly higher depression (Arabic: M = 10.19 [SD = 3.39]; Chinese:11.83 [4.5]; Greek: 11.14 [3.65]), anxiety (Arabic: 10.83 [3.81]; Chinese: 12.54 [12.87]; Greek: 11.31 [3.66]), stress (Arabic: 11.12 [3.42]; Chinese: 13.46 [3.27]; Greek: 11.31 [3.16]) and psychological help-seeking stigma (Arabic: 8.1 [2.85]; Chinese: 8.08 [3.42]; Greek: 9.17 [2.70]) scores than English-speaking participants (Depression: 5.6 [4.84], Anxiety: 4.02 [4.00], Stress: 6.4 [4.42]; Stigma: 5.02 [3.17]). Psychological help-seeking stigma partially mediated the association between CALD-status and depression, anxiety and stress.

Conclusions: People with cancer from CALD communities experience higher levels of psychological morbidity compared to their English-speaking counterparts. Among CALD groups, stigma related to psychological help-seeking partly explained their psychological morbidity. Strategies to reduce help-seeking stigma have the potential to foster increased psychological service use and to reduce psychological sequelae in people with cancer from CALD communities.

Eva YN Yuen^1,2, Megan Hale^1,3,4, Carlene Wilson^3,4,5

¹Monash Health, Clayton, VIC, Australia

²School of Nursing and Midwifery, Quality and Patient Safety, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia

³School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia

⁴Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia

⁵Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, VIC, Australia

Background and aims: Informal caregivers play a critical role in providing support for people diagnosed with cancer (1), and adequate access to key cancer-related information has been associated with better health outcomes for care recipients and caregivers (2, 3). Despite this, caregivers often report high unmet information needs, and those from culturally and linguistically diverse (CALD) backgrounds have reported higher unmet needs compared to their English-speaking counterparts (4). Few studies have explored key determinants of information needs among cancer caregivers from CALD communities, and their satisfaction with information received. Consequently, we examined experiences with cancer-related information among CALD cancer caregivers.

Methods: Arabic and Chinese cancer caregivers (12 in each group) across Australia participated in semi-structured interviews. Data were analysed using thematic analysis.

Results: Participants had a mean age of 40.6 years, and the majority were female (83%). Five themes emerged: (a) lack of information to meet their needs; (b) challenges understanding cancer and care-related information; (c) proactivity to make sense of, and understand information; (d) interpreting information: the role formal and informal services and (e) engaging with health providers to access information.

Conclusions: Significant language and communication barriers were identified that impacted caregivers’ capacity to understand cancer-related information given by providers. Caregivers reported that they invested significant personal effort to understand information. Even for those with adequate English-proficiency, the importance of availability and access to formal interpreter services for caregivers and care recipients was highlighted. The importance of provider cultural sensitivity when having cancer-related discussions was also highlighted. Ensuring culturally tailored strategies are adopted to provide cancer-related information for CALD caregivers has the potential to improve the health outcomes of both caregivers and care recipients.

Leah Zajdlewicz¹, Belinda Goodwin^1,2,3, Larry Myers^1,4, Lizzy Johnston^1,5,6, Anna Stiller¹, Bianca Viljoen^1,2,7, Sarah Kelly¹, Nicole Perry¹, Fiona Crawford-Williams⁸, Raymond J Chan⁸, Jon Emery^9,10, Rebecca Bergin^9,11, Joanne F Aitken^1,12,13

¹Cancer Council Queensland, Brisbane, QLD, Australia

²Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia

³School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia

⁴School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia

⁵Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

⁶School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia

⁷School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia

⁸Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaie, South Australia, Australia

⁹Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia

¹⁰Centre for Cancer Research, University of Melbourn, Melbourne, Victoria, Australia

¹¹Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia

¹²School of Public Health, The University of Queensland, Brisbane, QLD, Australia

¹³School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia

Aims: Quality survivorship information is widely recognised as an essential component of cancer care, particularly for rural cancer survivors returning home after receiving treatment in a major urban centre. Despite this, there are no best practice guidelines for the delivery of survivorship care information during this transition. This program of research investigated the post-treatment information needs of rural cancer survivors in Australia and mechanisms for effective delivery of this information.

Methods: A systematic review of original studies in five academic databases and reports on websites of 118 cancer organisations was conducted to identify the post-treatment information needs of rural cancer survivors in Australia. A second review of original studies in six academic databases was conducted to identify mechanisms for effective delivery of survivorship care information in Australia. Using realist review methodology, context-mechanism-outcome theories were generated for how information should be transferred.

Results: From 37 studies and 15 reports, information on prognosis and recovery, managing treatment side-effects, healthy lifestyle choices and referrals to support services was needed by, yet often not provided to, rural cancer survivors. Forty-five studies reported on mechanisms for effective delivery of survivorship information. At the individual level, these mechanisms included tailoring the information to survivors’ social, cultural and linguistic backgrounds; reducing the burden on survivors to navigate their transition of care; and providing survivorship care information in multiple modalities. At the system level, clear roles and communication among care teams, dedicated staff and consultation time for survivorship care, and specialised training for staff providing this care, were identified as optimal strategies for effective information delivery.

Conclusions: Findings provide practical recommendations for improving delivery of survivorship care information to rural cancer survivors. In consultation with health professionals and survivors, these findings will inform the development of guidelines to facilitate the communication of survivorship care information to rural cancer survivors transitioning from hospital to home.

Eva M Zopf^1,2, Mark Trevaskis¹, Kelcey Bland^1,3, Ashley Bigaran^1,4, Niklas Joisten⁵, Lih-Ming Wong^6,7, Declan Murphy^7,8, Nathan Lawrentschuk^7,9, Mathis Grossmann^4,7, Sonia Strachan¹⁰, John Oliffe^7,11, Suzanne Chambers¹, Prue Cormie^7,8

¹Australian Catholic University, Melbourne, Victoria, Australia

²Cabrini Health, Melbourne, Victoria, Australia

³University of British Columbia, Vancouver, British Columbia, Canada

⁴Austin Health, Melbourne, Victoria, Australia

⁵Technical University Dortmund, Dortmund, North-Rhine Westphalia, Germany

⁶St Vincent's Health Melbourne, Melbourne, Victoria, Australia

⁷University of Melbourne, Melbourne, Victoria, Australia

⁸Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁹Melbourne Health, Melbourne, Victoria, Australia

¹⁰Goulburn Valley Health, Shepparton, Victoria, Australia

¹¹University of British Columbia, Vancouver, British Columbia, Canada

Introduction: Men with prostate cancer (PCa) experience increased rates of mental health concerns and current oncology services are needing to adjust to better meet the complex needs of men and their families. The primary aim of this randomised controlled trial (RCT) was to examine the efficacy of structured exercise to aid in the management of psychological distress in men with PCa.

Methods: Men with PCa reporting clinically significant distress (Distress thermometer score of ≥4) were randomised to either a 3-month, group-based, supervised exercise program undertaken 3x/week (IG) or usual care (UC). The primary outcome, psychological distress, was comprehensively assessed at baseline and 3 months using the Brief Symptom Inventory-18 (BSI), Hospital Anxiety and Depression Scale, Male Depression Risk Scale, Distress Thermometer and Kessler Psychological Distress Scale. Secondary outcomes included psychological supportive care needs, quality of life (QoL), fatigue, sleep quality, masculine self-esteem and objective measures of physical fitness and body composition.

Results: From October 2017 to January 2020, 53 men with PCa (age: 65.81 ± 5.86 years, body mass index: 28.69 ± 5.08 kg/m²) enrolled in the study (IG, n = 26 and UC, n = 27, planned recruitment target, n = 100). 84.6% ± 8.7% of exercise sessions were attended. Mixed-model repeated measure analysis showed significant between-group differences from baseline to post-intervention in all psychological distress measures in favour of the IG (e.g. BSI – Depression: mean difference −3.41, 95% CI: −5.77; −1.05, p = 0.006; BSI – Anxiety: mean difference −3.29, 95% CI: −4.85; −1.72, p < 0.001). Psychological supportive care needs, QoL, fatigue, physical function and body composition also improved significantly in favour of the IG (all p < 0.05).

Conclusions: To our knowledge, this is the first RCT to investigate the effects of a supervised exercise program specifically in men with PCa experiencing clinically significant distress. Our results suggest that structured exercise interventions may represent a well-tolerated and effective mental health care strategy for men with PCa experiencing distress.

Ana Baramidze¹, Miranda Gogishvili², Tamta Makharadze³, Mariam Zhvania⁴, Khatuna Vacharadze⁵, John Crown⁶, Tamar Melkadze¹, Omid Hamid⁷, Georgina V Long⁸, Caroline Robert⁹, Mario Sznol¹⁰, Héctor Martínez-Said¹¹, Giuseppe Gullo¹², Jayakumar Mani¹², Usman Chaudhry¹², Mark Salvati¹², Israel Lowy¹², Matthew G Fury¹², Karl D Lewis¹²

¹Todua Clinic, Tbilisi, Georgia

²High Technology Medical Centre, University Clinic Ltd, Tbilisi, Georgia

³LTD High Technology Hospital Med Center, Batumi, Georgia

⁴Consilium Medulla, Tbilisi, Georgia

⁵LTD TIM Tbilisi Institute of Medicine, Tbilisi, Georgia

⁶St Vincent's University Hospital, Dublin, Ireland

⁷The Angeles Clinical and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA

⁸Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia

⁹Gustave Roussy and Paris Saclay University, Villejuif, France

¹⁰Yale Cancer Center, New Haven, Connecticut, USA

¹¹Melanoma Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico

¹²Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA

Fianlimab (anti-LAG-3) and cemiplimab (anti-PD-1) are high-affinity, fully human, IgG4 monoclonal antibodies. Concurrent blockade of anti-LAG-3 and anti-PD-1 has shown enhanced efficacy (increase in PFS) in advanced melanoma. Data from a Phase 1 study of fianlimab plus cemiplimab from three separate cohorts with advanced metastatic melanoma, two of which were PD-(L)1 naïve and a third with prior treatment in the (neo)adjuvant setting (72% had received prior anti-PD-(L)1), showed an aggregate ORR of 61% with an acceptable risk–benefit profile. These observations provide a rationale for using fianlimab plus cemiplimab in high-risk adjuvant melanoma (Phase 3 study, NCT05608291) and 1L metastatic melanoma (presented in this abstract).

This is a randomised, double-blind, Phase 3 study to evaluate fianlimab plus cemiplimab compared with pembrolizumab in patients with previously untreated, unresectable locally advanced or metastatic melanoma (NCT05352672). This study will be conducted globally, at approximately 200 sites. Key inclusion criteria are: ≥12 years of age; histologically confirmed unresectable Stage III or Stage IV (metastatic) melanoma; no prior systemic therapy for advanced unresectable disease – prior (neo)adjuvant therapies are allowed with treatment/disease-free interval of 6 months; measurable disease per RECIST v1.1; valid LAG-3 results; ECOG PS of 0 or 1 (for adults), Karnofsky PS ≥70 (≥16 years) or Lansky PS ≥70 (<16 years); anticipated life expectancy ≥3 months.

The trial is expected to enroll approximately 1590 patients, who will be randomised to Arms A, A1, B or C and receive study treatment intravenously Q3W: A, cemiplimab + fianlimab dose 1; A1, cemiplimab + fianlimab dose 2; B, pembrolizumab + placebo; C, cemiplimab + placebo. The primary endpoint is PFS. Key secondary endpoints are OS and ORR. Additional secondary endpoints include DCR, DOR, safety, pharmacokinetics of cemiplimab and fianlimab, and immunogenicity (incidence and titre of anti-drug antibodies and neutralising antibodies). The study is currently open for enrollment.

Victoria Choi^1,2, Susanna Park¹, Judith Lacey^2,3, Sanjeev Kumar^2,4,5, Gillian Heller^2,6, Peter Grimison^2,6

¹Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

²Chris O'Brien Lifehouse, Camperdown, NSW, Australia

³Clinical School of Medicine, University of Sydney, Sydney, NSW, Australia

⁴School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia

⁵Garvan Institute of Medical Research, Sydney, NSW, Australia

⁶NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

Aims: CIPN is a frequent dose-limiting side effect of neurotoxic chemotherapy. Currently, there are no effective treatments, and the usual management relies on dose reduction/and or cessation. The primary aim of this pilot trial is to determine the feasibility and acceptability of electroacupuncture (EA) commencing at onset of CIPN during taxane treatment in a randomised controlled setting, with a secondary aim to compare deterioration of CIPN symptoms during and after taxane treatment amongst participants allocated to EA or sham-EA.

Methods: This is a single centre, randomised, sham-controlled, parallel group pilot phase II trial with two arms (EA and sham-EA), with a 1:1 allocation ratio. Sample size n = 40 (20 per arm) is proposed based on detection of a very large effect, assuming equal numbers in EA and sham-EA groups, with 80% power at a two-sided significance level of 5%. Participants will be screened weekly for CIPN symptoms using a validated patient reported outcome measure prior to their taxol infusion (up to cycle 6) and randomised to either treatment arm only if symptomatic. Participants in both groups will receive either EA or sham-EA for 10 consecutive weeks, with a follow-up period of 8 and 24 weeks. Primary outcome measure of CIPN will be assessed using the EORTC QLQ-CIPN20.

Statistical considerations: To evaluate the effect of EA compared to sham-EA, baseline measure of EORTC QLQ-CIPN20 overall scores at onset of CIPN will be compared to end of treatment scores using a nonparametric test (Mann–Whitney) on the change scores.

Study progress: At August 2023, 27 of 40 patients have been recruited and randomised to a treatment arm. This work is supported by the Chris O'Brien Lifehouse Surfebruary Cancer Research Fund.

Catherine Dunn, Peter Gibbs

Walter and Eliza Hall Research Institute, Melbourne, VIC, Australia

Background: As the management of cancer continues to rise in cost and complexity, there must be an attendant focus on its quality and consistency. There is a lack of validated quality indicators (QI) and challenges in collecting the comprehensive data with which to measure them. Clinical cancer registries, such as Treatment of recurrent and Advanced Colorectal Cancer (TRACC) collect data at multiple sites on the diagnosis, clinicopathological characteristics, treatment and outcomes for cancer patients. This data could be harnessed for the purposes of quality measurement.

Methods: We reviewed the literature examining QI for metastatic colorectal cancer (mCRC). We then explored the potential of existing TRACC data items as quality indicators, exploring any variation in practice (biomarker testing, drug therapy or surgery) across major sites. For any observed variation, we explored the association with clinical outcomes.

Results: In our literature review we found no well validated QI in the multidisciplinary care of mCRC. Analysis of TRACC found significant variability between sites in key biomarker testing, chemotherapeutic and biologic agent administration, and curative intent surgery. We engaged multiple Victorian sites to participate in a quality-focussed pilot trial called BEnchmarking and Tracking TrEatment and Response in Advanced Colon Cancer (BETTER-TRACC), using funding secured from the Victorian Cancer Agency. A modified Delphi study is in process to define a set of QI that can be extracted from TRACC data. Quality Appraisals then will be circulated to participating sites, with each site receiving summary data on their performance in comparison to other de-identified sites. Subsequent surveys will gauge the impact, strengths and limitations of the Quality Appraisals and inform the further evolution of the project.

Conclusion: Ensuring mCRC patients are accessing equitable, timely, evidenced-based high quality cancer care is an unaddressed need. Leveraging existing TRACC registry data, clinicians will gain insights into the quality of care provided at their institution and opportunities for improvement.

Priscilla Gates^1,2, Karla Gough^3,4, Heather J Green⁵, Haryana M Dhillon⁶, Janette L Vardy^7,8, Michael Dickinson⁹, Mei Krishnasamy^2,4, Trish M Livingston¹⁰, Victoria M White¹⁰, Anna Ugalde¹⁰, Jade Guarnera¹, Karen Caeyenberghs¹

¹Cognitive Neuroscience Lab, School of Psychology, Deakin University, Burwood, Victoria, Australia

²Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Department of Health Services Research, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

⁴Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

⁵Griffith University, Gold Coast, Queensland, Australia

⁶Faculty of Science, School of Psychology, Centre for Medical Psychology& Evidence-based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia

⁷The University of Sydney, Sydney, New South Wales, Australia

⁸Concord Cancer Centre, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia

⁹Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

¹⁰Deakin University, Burwood, Victoria, Australia

Introduction: Cancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be both distressing and disabling for affected individuals. While appropriate support, including better preparation and intervention are indicated, there is a paucity of research in this area. For example, most interventions have been trialled in people diagnosed with solid tumours, with little trial data available on people diagnosed with haematological malignancies. The main aim of this study is to test the feasibility and acceptability of methods and procedures intended for use in a large-scale trial of Responding to Cognitive Concerns (eReCog), a web-based cognitive rehabilitation program, in people diagnosed with aggressive lymphoma who have received chemotherapy.

Methods and analysis: This study is a single-site, parallel-group, pilot randomised controlled trial, with one baseline and one follow-up (or post-intervention) assessment. Thirty-eight people with perceived reduction in cognitive functioning, who have completed chemotherapy for aggressive lymphoma, will be recruited from a specialist cancer centre between July 2023 and June 2024. After baseline assessment, participants are randomised one-to-one to receive usual care only (a factsheet about changes in memory and thinking for people with cancer) or eReCog plus usual care. The 4-week eReCog intervention consists of four online modules offering psychoeducation on cognitive impairment associated with cancer and its treatment, skills training for improving memory and attention and relaxation training. Study outcomes include feasibility of recruitment; adherence to, usability of and intrinsic motivation to engage with eReCog; compliance with assessments; and retention of enrolled participants until the end of the trial. The potential efficacy of eReCog will also be evaluated. Findings from this study will inform a future, large multi-site RCT to test the effectiveness of a novel intervention to improve cognitive outcomes and quality of life.

Mandy M Goodyear

Fiveways Physiotherapy, Brisbane, Queensland, Australia

Aim: This research explores the potential of using the MMDC as a diagnostic instrument in early oedema detection in post-operative breast cancer, and the additional use of MMEpiD as a further diagnostic tool in the same subjects. The investigation will evaluate their efficacy in substantiating changes in tissue hydration and correlation with subjective reporting. Together the tools could register early indications of breast oedema, which can be an uncomfortable side-effect of post-operative radiation.

Methodology: Recruit a sample of local breast cancer patients following breast-conserving surgery, and then follow up visits as radiation treatment is undertaken. Data collection, at intervals during treatment and follow up visits, will track changes in hydration patterns using both tools. Statistical analysis will be performed to assess the correlation between the moisture meter readings, subjective reporting and clinical outcomes. This analysis will determine the best combination of moisture meter readings as diagnostic tools for breast oedema and early detection, allowing early management.

Results: MMDC tool has been used in the clinical environment for several years. The recent introduction of MMEpiD has provided early indications that it is a promising addition for timeous detection of tissue hydration changes, leading to improved recognition of breast tissue oedema. The close correlation between self-reported breast discomfort and sensory changes, and the objective data of tissue hydration provided by readings from MMEpiD and MMDC, supports a measurable relationship between patients’ perception and breast oedema.

Subhash Gupta¹, Richa Tripathy², Vittal Huddar², Haresh KP¹, Goura K Rath¹, Tanuja Nesari², Shivam Singh¹, Pranay Tanwar¹, Ashok Sharma¹, Omana Nair¹, Sandeep Mathur¹, Suman Bhasker¹, Ravi Mehrotra³

¹AIIMS New Delhi, New Delhi, India

²AIIA, Delhi, India

³ICMR, Delhi, India

Background: As per the National Cancer Registry program of the Indian Council of Medical Research (ICMR), Breast cancer (BC) is the leading cause of cancer-related deaths among women in India. There is a need to develop the integration therapy, due to the high tumour recurrence rate, regression and disease progression. Vardhamana Pippali Rasayana (VPR) is time tested medication by Ayurveda practitioners and is proven to be anti-cancerous, anti-proliferative, and inhibit the survival of cancer cells. However, its anti-cancer role in breast cancer is yet to be elucidated. The cytotoxic effects of Piper longum (Pippali) aqueous extract on human breast cancer cell line (MCF7) using various in-vitro assays have been discussed in our first abstract. The aim of the present study is to design a study for clinical validation of VPR in breast cancer patients.

Methods: In this exploratory study, 100 breast cancer patients (Stage-II–IVA) undergoing neo-adjuvant chemotherapy (NACT) will be randomly divided into two groups. Control group A (Observational Arm, n = 50) will receive only Neo-adjuvant chemotherapy (NACT) and Study group B (Trial Arm, n = 50), in which NACT + VPR will be administered. All the patients will be recruited from the IRCH, AIIMS, New Delhi, India. Approval will be taken by the research and ethics committee of IRCH, AIIMS, New Delhi, India and from AIIA, New Delhi. For clinical synergistic validation of VPR, the recruitment of patients with breast cancer has also been initiated (flow chart attached at the end).

Expected outcome: The expected primary outcome from the validation of the synergistic role of VPR Intervention with neo-adjuvant chemotherapy of BC is to evaluate the pathological complete response (PCR) rates, and the secondary outcome is progression-free survival (PFS) or recurrence-free survival (RFS) and overall survival benefits.

Novelty: VPR is considered to have strong anti-cancerous therapeutic potential and exploration of VPR interactions might be offering a novel opportunity for meaningful therapeutic interventions in BC.

Kate Furness¹, Lauren Hanna², Terry Haines³, Sharon Carey⁴, Catherine E Huggins⁵, Daniel Croagh^6,7

¹Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia

²Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia

³School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia

⁴Allied Health Research & Education, Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

⁵Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia

⁶Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia

⁷Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia

Aims: For people with advanced pancreatic cancer (PC), debilitating symptoms such as epigastric pain, bloating, loss of appetite and fat-malabsorptive diarrhoea cause poor oral intake and weight loss. These symptoms, and the resulting malnutrition, are associated with worse quality of life (QOL). Evidence suggests that interventions focussing on increasing oral nutrition intake through dietary counselling and/or oral nutrition supplements have limited effectiveness in preventing decline in nutrition status and QOL. Alternative, more intensive methods of nutrition support such as enteral tube feeding may have greater effectiveness; however, this approach is infrequently used during treatment for advanced PC. The aim of this study is to determine the effectiveness of supplemental jejunal feeding combined with intensive dietetic counselling delivered via telehealth for 6 months during chemotherapy, on QOL, compared with standard care, for people diagnosed with advanced PC. 

Methods: The study is a prospective randomised controlled trial, enrolling adults with newly diagnosed inoperable PC. The intervention group will receive ‘top-up’ enteral nutrition via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J). The study dietitian will conduct minimum weekly telehealth consults, providing nutrition counselling and facilitation of effective symptom control for the duration of chemotherapy treatment (up to 6 months). The control group will receive standard nutrition care as part of their cancer treatment. The primary outcome is QOL measured by the EORTC-QLQ C30 summary score. Secondary outcomes include overall survival, changes in chemotherapy dosing and markers of nutrition status. Outcomes will be measured at baseline, and 3- and 6-months follow-up.

Erin Laing¹, Andrew Murnane², Belinda Steer^1,3, Jeremy Lewin², Heather Gilbertson⁴, Elizabeth Mount⁵, Mary Anne Silvers⁶, Jenelle Loeliger^1,3, Jodie Bartle⁴, Kristin Mellett⁵, June Savva⁶, Pasquale Fedele⁷, Lisa Orme^2,8,9, Leanne Super¹⁰

¹Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Victorian Adolescent & Youth Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³School of Exercise & Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

⁴Nutrition & Food Services Department, Royal Children's Hospital, Melbourne, VIC, Australia

⁵Nutrition & Dietetics, Monash Children's Hospital, Melbourne, VIC, Australia

⁶Nutrition & Dietetics Department, Monash Health, Melbourne, VIC, Australia

⁷Department of Haematology, Monash Health, Melbourne, VIC, Australia

⁸Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC, Australia

⁹Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

¹⁰Children's Cancer Centre, Monash Health, Melbourne, VIC, Australia

Aims: Cancer treatment for adolescent and young adults (AYA) can be highly challenging and interfere with optimal nutrition, which is vital for healthy development, physical growth and well-being. Cancer malnutrition and associated negative outcomes are well-studied in adult and paediatric populations, but the distinct nutritional complications and requirements for AYA with cancer are poorly understood. This mixed methods study aims to explore and investigate the nutritional status, needs and outcomes of AYA after cancer diagnosis.

Methods: AYA (aged 15–25 years) diagnosed with cancer at three tertiary adult and paediatric health services will be recruited to a longitudinal observational study. Eligible patients will be within 6-weeks of cancer diagnosis or relapse and undergoing active cancer treatment. Study assessments will be undertaken at four time-points (recruitment, and 2-, 4- and 6-months post-recruitment) and include screening for nutrition risk (PNST or MST); assessment of nutritional status (PG-SGA, mid-upper arm circumference); assessment of muscle strength (hand-grip strength); frequency of dietitian referral, nutrition support and symptoms; and assessment of health-related quality of life (AQOL-6D). The statistical analysis will be primarily descriptive, and effect size estimates (Cohen's d) will be used to characterise any differences between nutritional status groups at follow-up assessments. During the study period, focus groups will be conducted with a cohort of AYA to explore in-depth their nutrition needs and experiences after a cancer diagnosis. Focus groups will also be conducted with AYA health professionals to explore their opinions regarding nutrition support requirements for AYA with cancer.

Results: The 6-month recruitment period commenced in July 2023, and preliminary results will be available in November 2023.

Conclusions: This multi-site longitudinal study will explore and describe the nutritional status, needs and nutrition-related outcomes of AYA after a cancer diagnosis. Results will inform future clinical practice guidelines, and interventional nutrition research targeting patients identified at greater risk of nutritional complications.

Andre van der Westhuizen¹, Megan Lyle², Nikola Bowden³

¹Calvary Mater Newcastle, Newcastle, Australia

²Cairns Hospital, Cairns, QLD, Australia

³Hunter Medical Research Institute, Newcastle, Australia

Aim: To investigate if azacitidine and carboplatin ‘prime’ metastatic melanoma for re-challenge with ipilimumab and nivolumab via stabilisation/decrease in disease burden and re-establishment of immune sensitivity.

Study Design: PRIME005 is an interventional non-randomised, single-arm, open-label phase Ib/II study to assess the feasibility of the multisite trial design and determine outcome measures required to calculate sample sizes and develop a statistical plan for a larger multi-centre Phase II study. The PRIME005 Phase Ib Stage 1 was a Bayesian Optimal Interval Design (BOIN) with three dose escalation steps to determine the recommended Phase 2 dose (RP2D) for azacitidine and timing of carboplatin administration.

Phase 1b recruited eight participants. The recommended Phase 2 Dose (RP2D) to move to Stage 2, Phase II was azacitidine 40 mg/m² IVI/day for 5 days (Day 1–Day 5) followed by Carboplatin AUC 4 IVI Day 8 of 21 day cycle.

PRIME005 consists of two cycles of azacitidine and carboplatin over 6 weeks followed by two cycles of azacitidine and carboplatin combined with ipilimumab and nivolumab for 6 weeks. Ipilimumab and nivolumab will be given in combination for another two cycles/21 days and then ipilimumab and nivolumab continue for 24 months or until disease progression by iRECIST.

Timothy J Panella¹, Sajeve S Thomas², Meredith McKean³, Kim Margolin⁴, Ryan Weight⁵, Giuseppe Gullo⁶, Jayakumar Mani⁶, Shraddha Patel⁶, Priya Desai⁶, Mark Salvati⁶, Israel Lowy⁶, Matthew G Fury⁶, Karl D Lewis⁶

¹University of Tennessee Medical Center, Knoxville, Tennessee, USA

²Orlando Health Cancer Institute, Lake Mary, Florida, USA

³Sarah Cannon Research Institute/Tennessee Oncology PLLC, Nashville, Tennessee, USA

⁴Saint John's Cancer Institute, Santa Monica, California, USA

⁵The Melanoma and Skin Cancer Institute, Denver, Colorado, USA

⁶Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA

Most patients with newly diagnosed melanoma have resectable disease and are potentially cured by surgery. However, regional nodal and/or distant relapses can occur after curative-intent resection. Postoperative adjuvant therapy with immune checkpoint inhibitors improves RFS and DMFS in patients at high risk of melanoma. Fianlimab (anti-LAG-3) and cemiplimab (anti-PD-1) are high-affinity, fully human monoclonal antibodies that, combined, have shown high clinical activity in patients with advanced melanoma. The combination of relatlimab (anti-LAG-3) and nivolumab (anti-PD-1) has also shown superiority over nivolumab in advanced melanoma. These observations provide a rationale for use of fianlimab plus cemiplimab for 1L metastatic melanoma (Phase 3 study, NCT05352672) and high-risk adjuvant melanoma (presented in this abstract).

This three-way, double-blind, Phase 3 international trial (NCT05608291) will compare fianlimab + cemiplimab with pembrolizumab as adjuvant therapy in high-risk, resected melanoma. Key eligibility criteria: aged ≥12 years; Stage IIc, III or IV (all M-stages) histologically confirmed melanoma resected ≤12 weeks before randomisation; no systemic anticancer or radiation adjuvant therapy for melanoma within 5 years; no evidence of metastatic disease; ECOG PS 0/1 (adults), Karnofsky PS >70 (≥16 years) or Lansky PS >70 (<16 years).

About 1530 patients will be randomised 1:1:1 to Arms A, B or C and receive study treatment Q3W intravenously for 1 year: Arm A, cemiplimab + fianlimab dose 1; Arm B, cemiplimab + fianlimab dose 2; Arm C, pembrolizumab + placebo. The trial will be stratified by disease stage (IIIA vs. IIC–IIIB–IIIC vs. IIID–IV [M1a/b] vs. IV [M1c/d]), and geographical location (North America vs. Europe vs. Rest of World). The primary endpoint is investigator-assessed RFS. Secondary endpoints include efficacy (OS, DMFS, melanoma-specific survival), safety (TEAEs, interruption or discontinuation of drugs due to TEAEs), pharmacokinetics, immunogenicity and patient-reported outcomes. First analysis will be performed when 242 RFS events have been observed.

Janine Porter-Steele^1,2,3, Katrina Sharples^4,5, Dorothy Chan⁶, Sarah Benge^4,7, Bobbi Laing^4,7, Sarah Balaam², Debra Anderson⁸, Alexandra McCarthy²

¹The Wesley Choices Cancer Support Centre, Auchenflower, QLD, Australia

²The University of Queensland, St Lucia, QLD, Australia

³Wesley Research Institute, Auchenflower, QLD, Australia

⁴Cancer Trials New Zealand, Auckland, Aotearoa/New Zealand

⁵University of Otago, Dunedin, Aotearoa/New Zealand

⁶The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China

⁷The University of Auckland, Auckland, Aotearoa/New Zealand

⁸University of Technology Sydney, Sydney, NSW, Australia

Background: Younger women (i.e. <50 years and likely pre-menopausal at diagnosis) treated for breast cancer often experience persistent treatment-related side effects that adversely affect their physical and psychological wellbeing. The Younger Women's Wellness After Cancer Program (YWWACP) was developed to address these outcomes.

Two of the three studies are complete, with the Australian study due to finish at the end of this year.

Methods: This longitudinal, randomised, single-blinded controlled trial involves three study sites in Aotearoa/New Zealand (‘KOWHAI’), Australia (‘EMERALD’) and Hong Kong (‘YWWACPHK’ – Cantonese version).

Eligibility: Women 18–50 years; completed intensive treatment (surgery, chemotherapy and/or radiotherapy) for Stage I–II breast cancer in previous 24 months, internet access, minimum year 8 schooling-level.

Sample size: Target of 60 participants in each country (total N = 180) achieved.

Discussion: The analysis will provide important data on the feasibility of the YWWACP method and intervention in each country. Combined, these three feasibility studies will harmonise cross-country differences to ensure the success of a proposed international grant application for a Phase III randomised controlled trial of this program to improve outcomes in younger women living with breast cancer in three countries.

Rayan Saleh Moussa¹, Vanessa Yenson¹, Annmarie Hosie², Joshua Wiley³, Imelda Gilmore¹, Angela Rao^1,4, Ingrid Amgarth-Duff⁵, Sungwon Chang¹, Irina Kinchin⁶, Linda Brown¹, Gideon Caplan⁷, Meera Agar^1,8

¹University of Technology Sydney, Ultimo, NSW, Australia

²University of Notre Dame, Chippendale, NSW, Australia

³Monash University, Melbourne, VIC, Australia

⁴South Eastern Sydney Local Health District, Sydney, Australia

⁵Telethon Kids Institute, Perth, WA, Australia

⁶Trinity College Dublin, University of Dublin, Dublin, Ireland

⁷University of New South Wales, Kensington, NSW, Australia

⁸South Western Sydney Local Health District, Sydney, Australia

Background: Two-thirds of people with advanced cancer experience delirium during hospitalisation.¹ Failure to improve delirium is associated with high mortality.^2,3 Commonly used antipsychotics lack evidence of effectiveness once delirium develops and may cause harm,^4,5 making delirium prevention a priority. Currently, multi-component non-pharmacological strategies are the most effective for reducing delirium.⁶ However, inclusion of cognitive and exercise components poses adherence challenges, especially in people with advanced cancer. Delirium is associated with sleep disturbances,⁷ providing a potential therapeutic target. Bright light therapy (BLT) is a non-pharmacological intervention with demonstrated therapeutic benefits that regulate and improve sleep quantity and quality in people with sleep disorders. Recently, BLT has been adopted into the context of delirium, demonstrating some benefit in various hospitalised patient cohorts.⁸ Further evaluation is warranted, particularly in advanced cancer where little data exists.

Aim: To determine the feasibility and tolerability of BLT in hospitalised adults with advanced cancer.

Method: BLT will be administered for 1 h every morning for 7 days. The study will collect clinical outcomes data and determine feasibility of collection of correlative endpoints, including sleep quality and duration and salivary melatonin levels, which will underpin mechanistic exploration in future trials. As a pilot feasibility study, an initial target of 10 participants has been set, to inform any study design modifications for a larger Phase II/III study.

Tharani Sivakumaran^1,2, Tim Akhurst³, Grace Kong³, Anthony Cardin^1,3, Su-Faye Lee³, Prasangi Pelpola³, Peter Roselt³, Ian M Collins⁴, Mark Warren⁵, Hui Li Wong^1,2, David Bowtell^1,6, Penelope Schofield^6,7, Richard Tothill^8,9, Rodney Hicks^10,11, Linda Mileshkin^1,2

¹Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

²Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴South West Healthcare, Warrnambool, VIC, Australia

⁵Department of Medical Oncology, Bendigo Health, Melbourne, VIC, Australia

⁶Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁷Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia

⁸University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia

⁹Department of Clinical Pathology, University of Melbourne, Melbourne, VIC, Australia

¹⁰Melbourne Theranostic Innovation Centre, Melbourne, VIC, Australia

¹¹The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia

Background: Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic tumours for which standardised diagnostic work-up fails to identify the tissue of origin at diagnosis. Despite improvement in conventional diagnostic processes the primary site is only identified ante mortem in <30% of CUP patients. ¹⁸F-FDG-PET/CT aids in CUP patient management and identification of putative primary site however has limited sensitivity for detecting cancers with high stromal content, as in CUP. Fibroblast activation protein (FAP) is a type II transmembrane serine protease and highly expressed by cancer-associated fibroblasts abundant in desmoplastic tumours, such as CUP. ⁶⁸Ga-FAPI-46 is a promising FAP-targeting PET tracer in multiple solid cancers but has not been directly compared to FDG-PET in CUP.

Aims: We aim to determine if the novel PET tracer (⁶⁸Ga-FAPI-46) detects more primary sites compared with ¹⁸F-FDG-PET/CT and CT scans in CUP patients and if there is an association with FAPI avidity and response to treatment.

Methods: The FAPI-CUP study is a prospective cohort study currently recruiting CUP patients across three sites in Victoria. Key inclusion criteria are (1) patients considered CUP after preliminary diagnostic work-up, pathological review and gender appropriate tests; (2) adequate haematologic and organ function to commence systemic treatment; (3) not commenced current line of systemic treatment (exception palliative radiotherapy for symptom control); (4) ECOG 0-2 and life expectancy >3months. (5) Up to 1 prior line of systemic treatment. Patients undergo imaging with CT chest/abdomen/pelvis, ¹⁸F-FDG-PET/CT and ⁶⁸Ga-FAPI-PET/CT scan which are reviewed at a multidisciplinary meeting and results are relayed back to the treating clinician. Patients start systemic treatment and have follow-up as part of standard of care with information regarding survival outcome and further lines of treatment collected at 3 monthly intervals for a total of 12 months. Clinical trial information: NCT05263700.

Amelia K Smit^1,2, Philip Ly², David Espinosa³, Noushin Nasiri⁴, Linda Martin^1,5, Pascale Guitera¹, Robyn Saw^1,6, Diona Damian^6,7, Caroline Watts², Martin Allen⁸, Anne E Cust^1,2

¹Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

²The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia

³NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia

⁴Faculty of Science and Engineering, Macquarie University, Sydney, Australia

⁵Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

⁶Royal Prince Alfred Hospital, Sydney, NSW, Australia

⁷Faculty of Medicine and Health, University of Sydney, Sydney, Australia

⁸University of Canterbury, Canterbury, New Zealand

Aims: To evaluate the impact of a personalised skin cancer prevention strategy (individual sun exposure alerts delivered via a Sun Watch and personalised SMS prevention reminders) on primary prevention behaviours, including objectively measured sun exposure, sun protection behaviours and psychosocial outcomes.

Methods: Eligible patients are aged >18 years, previously diagnosed with skin cancer and own a mobile phone to receive SMS. Patients will be recruited via clinics at the Melanoma Institute Australia and Royal Prince Alfred Hospital. After completion of the baseline measures [online survey, 7-days wear of a UV dosimeter (objective measure of sun exposure) and an activity diary] participants will be randomised 1:1 to the intervention or control arm. The intervention comprises 7-days wear of a Sun Watch, which issues sun exposure alerts to the wearer via an LED light alongside receiving personalised SMS sun protection reminders, and educational information on skin cancer prevention, early detection and treatment. The control arm will receive the educational information only. All participants will be asked to wear a UV dosimeter and complete an activity diary over the 7-day follow-up period. The primary outcome is total daily Standard Erythemal Doses (SEDs) at follow-up. Secondary outcomes include objectively measured UV exposure for specific time periods (e.g. midday hours), self-reported sun protection and skin-examination behaviours and psychosocial outcomes. The target sample size is 446 people (223 per arm) based on detecting 20% difference in total daily SEDs between groups, calculated using a t-test with a geometric mean ratio of .8, coefficient of variation .9, 80% power and α of .05, and assuming 15% loss to follow-up. A within-trial evaluation will assess the intervention costs.

Discussion: The findings from this trial will improve our understanding of how to support safe sun exposure and improve survival outcomes in the growing population of people with a history of skin cancer.

Po-Jun Su¹, Se Hoon Park², Yu Chieh Tsai³, Miso Kim⁴, Wen-Jen Wu⁵, Seasea Gao⁶, Annalisa Varrasso⁷, Sang Joon Shin⁸

¹Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan

²Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

³National Taiwan University Hospital, Taipei, Taiwan

⁴Seoul National University Hospital, Seoul, South Korea

⁵Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

⁶Merck Pte. Ltd., an affiliate of Merck KGaA, Singapore

⁷Merck Healthcare Pty. Ltd., Macquarie Park, Australia, An Affiliate of Merck KGaA, Sydney, Australia

⁸Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea

Introduction and objectives: UC is a common cancer, with >200,000 new cases reported in 2020 in the APAC region. In the global Phase III JAVELIN Bladder 100 trial, avelumab 1LM + best supportive care (BSC) significantly prolonged overall survival (OS) and progression-free survival (PFS) versus BSC alone in patients with advanced UC who had not progressed with 1L platinum-containing chemotherapy [median OS, 23.8 vs. 15.0 months (p = 0.0036); median PFS, 5.5 vs. 2.1 months (p < 0.0001)], leading to regulatory approvals worldwide, and incorporation into international treatment guidelines with Level 1 evidence. Here, we describe the design of SPADE, an ongoing, real-world, non-interventional study of avelumab 1LM in patients with advanced UC in the APAC region.

Methods: SPADE is a multicentre, prospective, observational study ongoing in Australia, Hong Kong, India, Malaysia, Republic of Korea, Singapore and Taiwan. Overall, 286 patients with unresectable locally advanced or metastatic (stage IV) measurable UC of any histology that has not progressed with 1L platinum-containing chemotherapy, for whom avelumab 1LM therapy is planned per local clinical practice, will be enrolled. All patients will receive avelumab 800 mg intravenously every 2 weeks (or per local marketing authorisation) and will be followed up for 12 months or until avelumab discontinuation. Data collected will include patient demographics, treatment details for 1L platinum-based chemotherapy (regimen, cycles and response per RECIST), treatment details for avelumab 1LM, and treatment outcomes with avelumab 1LM [6- and 12-month OS and health-related quality of life (HRQoL)]. OS will be analysed using the Kaplan–Meier method. HRQoL will be measured using the EQ-5D-5L and National Comprehensive Cancer Network (NCCN)/FACT FBISI-18 questionnaires. An interim analysis is planned after ∼30% of patients have been enrolled.

©2023 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2023 ASCO Genitourinary Cancers Symposium. All rights reserved.