Oral Abstracts

Rhett Morton¹, Marcelo Nascimento², Penny Mackenzie¹, Kathryn Middleton³, Shaun McGrath³, Anna Kuchel¹, Danica Cossio⁴, Victoria Donoghue⁴, Karen Sanday⁵, Neal Rawson⁴, Euan Walpole^4,6, Andrea Garrett¹

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

²Gold Coast University Hospital, Gold Coast, Queensland, Australia

³Mater Hospital Brisbane, Brisbane, Queensland, Australia

⁴Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

⁵Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia

⁶Princess Alexandra Hospital, Brisbane, Queensland, Australia

Aims: To understand the patterns of treatment for gynecological cancers (GC) across Queensland between 2012 and 2021 and look for areas of improvement.

Methods: The source of population data for this study is the Queensland Oncology Repository (QOR), which is a comprehensive clinical cancer database that links diagnostic information from the Queensland Cancer Register (QCR), with treatment data (radiation therapy, surgery, and intravenous systemic therapy), admissions data for both public and private hospitals, and patient outcome data.  Clinical data including FIGO stage and biomarkers was extracted from the Queensland Centre for Gynaecological Cancer database and linked to QOR.

Results:  A total of 11,909 Queensland women were diagnosed with GC between 2012 and 2021.  The most common diagnosis is endometrial (45%, n = 5378) followed by ovarian (29%, n = 3453) and then cervical (18%, n = 2127) with the three making up 92% of all GC.

Women with GC typically require a multidisciplinary approach to their care, including surgery, radiation therapy, and systemic therapy.  The overall treatment rate is high at 88% (n = 10,423/11,909).  73% of all GC diagnoses underwent resection with endometrial cancer having the highest resection rate of 84%. Radiation therapy treatment rates were highest for cervical cancer (47%), while systemic therapy rates were highest (70%) for ovarian cancer.

Small increases in the radiation therapy treatment rate between 2012 and 2016 and 2017 and 2021 were observed for endometrial (22%–26%) and vulval (29%–35%) cancers.

Survival for GC varies across the individual primary sites with endometrial cancer survival at 5 years 78% compared to ovarian at 44%.

Conclusion:  Accessing linked population-wide data enables active monitoring of care patterns for women with GC. This resource facilitates the extraction of valuable insights and evaluation of effective strategies and interventions to prevent, detect, diagnose, and treat GC. 

Tamara Butler¹, Andrea Garrett², Danica Cossio³, Karen Sanday⁴, Victoria Donoghue³, Nathan Dunn³, Kathryn Middleton⁵, Rhett Morton², Shaun McGrath⁵, Anna Kuchel², Marcelo Nascimento⁶

¹The University of Queensland, Brisbane, Queensland, Australia

²Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

³Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

⁴Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia

⁵Mater Hospital Brisbane, Brisbane, Queensland, Australia

⁶Gold Coast University Hospital, Gold Coast, Queensland, Australia

Aims: To review the prevalence of endometrial and cervical cancer in Queensland First Nations women.

Methods: The source of population data for this study is the Queensland Oncology Repository (QOR), which is a comprehensive clinical cancer database that links diagnostic information from the Queensland Cancer Register (QCR), with treatment data (radiation therapy, surgery, and intravenous systemic therapy), admissions data for both public and private hospitals, and patient outcome data.  Clinical data including FIGO stage and biomarkers was extracted from the Queensland Centre for Gynaecological Cancer (QCGC) database and linked to QOR.

Results: Incidence rates of both endometrial and cervical cancer in First Nations women were more than double those observed among Queensland non-First Nations women (endometrial: 37.9 per 100,000 cf. 18.1 per 100,000; cervical 19.4/100,000 cf. 8.4/100,000). Similar differences were present when examining mortality, with rates 2.5–3.5 times higher among the First Nations population (endometrial: 8.5/100,000 cf. 3.1/100,000; cervical 6.9/100,000 cf. 1.9/100,000).

Differentials in cervical cancer mortality may be linked to later presentation at diagnosis, with the proportion of First Nations women presenting with stage IV disease at diagnosis being around 50% higher than in non-First Nations women (10% vs. 6.8%).

Conclusion: Extensive interrogation of Queensland cancer data has allowed for the discovery and monitoring of key specific cancer indicators relevant to First Nations women. A targeted approach allows the use of additional curated data within these subpopulations to identify disparities across the cancer care continuum and priority areas for ensuring equity in health outcomes for First Nations women.

Penny Mackenzie¹, Tracey Guan², Victoria Donoghue², John Harrington², Bryan Burmeister³

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

²Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

³GenesisCare, Fraser Coast, Queensland, Australia

Aims: To determine the trends in brachytherapy (BT) use in cervical cancer in Queensland, identify factors associated with treatment, and to compare BT utilization with optimal utilization guidelines.

Methods: This retrospective population-based study used clinical and treatment data from linked data sources of Queensland Oncology Repository and the Qld Centre of Gynaecological Cancer Research data. The study population included Queensland (Qld) women with cervical cancer diagnosed between 2012 and 2021 (n = 2121) and the radiation therapy treatment patterns received, with a focus on brachytherapy treatment.

Results: Thirty five percent (n = 736) of Qlders with cervical cancer received external beam radiation therapy (EBRT) and brachytherapy within 365 days of diagnosis, and 12% (260) women received EBRT only. Trends in EBRT and/or BT over the 10-year period have remained steady. Characteristics of women receiving BT include median age 55 years (range 22–87), more likely to reside in rural areas and have a disadvantaged socioeconomic status. FIGO stage was available for 78% of records and the distribution of stage for rural and urban women was similar with the majority of women (80%) presenting at an early stage (Stage I, II). For women with FIGO stage IB–IIA, 39% (213) received BT and for those with Stage IIB–IVA, 79% (377) received BT. The state-wide BT rate of 35% is less than the recommended optimal BT utilization rate for cervical cancer of 49% (range 42%–50%).

Conclusion: While the Qld BT utilization rate is lower than the optimal BT rate, it is reassuring to find the trends in Qld remain steady. Reporting these outcomes allows comparisons with other jurisdictions and sets a baseline to enable prospective monitoring of BT utilization for cervical cancer in Qld.

Rhett Morton¹, Marcelo Nascimento², Kathryn Middleton³, Shaun McGrath³, Anna Kuchel¹, Danica Cossio⁴, Victoria Donoghue⁴, Karen Sanday⁵, Nathan Dunn⁴, Neal Rawson⁴, Andrea Garrett¹

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

²Gold Coast University Hospital, Gold Coast, Queensland, Australia

³Mater Hospital Brisbane, Brisbane, Queensland, Australia

⁴Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

⁵Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia

Aims: Many studies have observed the relationship between obesity and endometrial cancer. This population-based analysis will examine the overall trends in BMI among Queensland women with endometrial cancer.

Methods: The source of population data for this study is the Queensland Oncology Repository (QOR), a comprehensive clinical cancer database linking diagnostic information from the Queensland Cancer Register (QCR), with treatment data (radiation therapy, surgery, and intravenous systemic therapy), admissions data for both public and private hospitals, and patient outcome data.  Relevant clinical data including FIGO stage and biomarkers was extracted from the Queensland Centre for Gynaecological Cancer database and linked to QOR.

BMI data for analysis was obtained from oncology information systems and augmented with obesity codes from hospital admitted patient data. Study population includes Queenslanders diagnosed with endometrial cancer (n = 2925) between 2017 and 2021.

Population estimates of the proportion of Queensland women who are overweight/obese are from the Queensland Survey Analytic System.

Results: The incidence of endometrial cancer among Queensland women has increased by almost 40% over the 20 years from 2001 to 2020 (16.9 per 100,000 to 23.3 per 100,000). Over a similar period, the estimated proportion of Qld women aged 18+ who are overweight/obese has risen from 43% to 56%.

The proportion of women with endometrial cancer who were overweight/obese was 68%, higher than the estimated proportion in Queensland (52%−57%). The proportion was highest among women aged under 40 and decreased with increasing age.

Conclusion: Contemporaneous increases in both the incidence of endometrial cancer and obesity levels in Queensland reflect patterns reported elsewhere in the literature. Links between obesity and increased endometrial cancer risk are highest among younger women. General health measures, including dietician referral and obesity prevention programs, may help address the rising incidence of endometrial cancer and other cancers with links to obesity such as breast, colon, and pancreatic cancer.

Michael Friedlander

Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia

The 50th anniversary of COSA is both cause for celebration as well as a time to reflect on the extraordinary progress in the science and practice of oncology and the lessons learned. My interest in oncology was sparked in 1978 as a rotating registrar in the new field of medical oncology. I rapidly enrolled in the nascent specialist training program and attended my 1st COSA conference in 1979. My clinical and research focus on breast and gynecological cancers began early during my training and encouraged by excellent mentors. I will focus on how things have changed in the management of ovarian cancer as there are parallels with most other cancers. I believe that it is worthwhile looking back not simply to reminisce but rather to learn from what we got right and what we got wrong, as the past can and should inform how to plan for future success. I will briefly review the “bad old days” which is an apt description of treatment in the 1970s due to our limited understanding of the biology of ovarian cancer and inadequate management that was not underpinned by strong evidence or a multidisciplinary approach that we now take for granted. I will illustrate the steady improvements that occurred over the next three decades and the key drivers for progress and the secret sauce will be revealed. I will end with the transformational events that have occurred over the last decade and use the experiences of the past to project on what is ahead in the next decade. There have been many missed opportunities along the way and mistakes made which we should learn from. Despite the undisputable progress, it is sobering that some things have not changed including the inequities in access to optimal management which remains a universal problem which science will not fix and requires political solutions.

Meinir Krishnasamy

Peter MacCallum Cancer Centre, Surrey Hills, VIC, Australia

Content not available at time of publishing.

Bruce Mann

Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia

Content not available at time of publishing.

Darren Brenner

University of Calgary, Calgary, Canada

Our collaborative research team is focused on generating impact in cancer control for Canadians using novel data approaches and analytics. This presentation will highlight several of the data-driven research initiatives underway to advance cancer control efforts in Canada. Over the past several years, we have been developing the Canadian Cancer Statistics publications and data dashboard. This work has highlighted emerging trends in early-onset cancers in Canada. Our team has been using various data platforms to model and examine the impacts of these trends for breast and colorectal cancer. To evaluate the impact of early detection, we have been using microsimulation approaches to model these trends at the population-level and examine whether screening guideline modifications should be considered. This modeling work is being utilized by the provincial screening programs to make evidence-based decisions. Given that these trends have resulted in higher numbers of patients being diagnosed, our team has also been using machine learning approaches with large administrative health data to model the uncertainty around clinical management in these patient populations. We have been applying causal inference approaches to identify optimal treatment strategies in real-world clinical populations where these populations have been under-represented in classic randomized controlled trials. To transform these analytical approaches to impact, we are developing provider and patient-facing tools based on efforts to reduce uncertainty and improve outcomes and experiences. These tools are being developed in collaboration with patients and family members as well as clinicians. Results of these analyses will be presented in the context of national efforts to guide cancer control strategies using data for these emerging populations in Canada. Despite progress, the myriad challenges to and opportunities for implementation to increase impact will be discussed.

Kate Stern

Melbourne IVF, East Melbourne, Victoria, Australia

Content not available at time of publishing

Michelle Peate^1,2, Y Jayasinghe^1,2,3,4, A Roman^3,5, L Song^2,6, Z Edib^1,2,3

¹Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia

²FoRECAsT Consortium, VIC, Australia

³Royal Women's Hospital, Parkville, VIC, Australia

⁴Australian Fertility Decision Aid Collaborative group, VIC, Australia

⁵Endometrial Decision Aid team, VIC, Australia

⁶School of Computing and Information Systems, Faculty of Engineering and IT, University of Melbourne, VIC, Australia

Background: Infertility is a common consequence of cancer and its treatment for reproductive aged patients, and is a key concern for many, with negative long-term outcome. Fertility preservation may be an option, but for optimal results, it should be discussed prior commencement of treatment. At this high stress time, the decision to undertake fertility preservation is complex, and patients need support. There are several ways we can provide this support.

Aims: To present the evidence on different tools to support informed oncofertility decision-making.

Methods: Multiple studies will be described, including data from qualitative, cross-sectional, clinical trial, and meta-analyses of an international databank.

Results: The team have been involved in the development of four different oncofertility decision aids, at different stages of development, for: women with breast cancer, women with endometrial cancer, and parents of children with cancer. Oncofertility decision aids are acceptable to patients, reduce decisional conflict and regret, and improve the quality of decision-making around fertility and fertility preservation and patient satisfaction. They also are well accepted by clinicians.

We are also in the process of developing a web-based tool (FoRECAsT: infertility after cancer predictor) to provide an individualized risk of developing ovarian function decline and likely fertility outcomes for young breast cancer patients. The risk prediction models have been developed based on a databank of 24,678 individual fertility records of pre-menopausal women across 19 clinical centers in Australia, the United Kingdom, the United States of America, Hong Kong, France, Belgium, Denmark, Italy, and International Trial Groups. The development of this tool will be described, as well as the original and imputed model prediction models.

Conclusions: Providing patients with tools to support decision-making can improve their experience and lead to better outcomes.

Christobel Saunders

Uni of Melbourne, Parkville, Victoria, Australia

Over 3000 women under 45 diagnosed with breast cancer each year in Australia and many will want to become pregnant. Retrospective evidence suggests pregnancy after BC does not worsen disease outcomes, but treatments including chemotherapy and 5–10 years of adjuvant endocrine therapy (ET) mean if women wait until the end of therapy their chances of conceiving are very low.

The POSITIVE trial asked “is it safe, from a BC relapse perspective, to temporarily interrupt ET to attempt pregnancy?” The results confirm temporary interruption of ET to attempt pregnancy among women who desire pregnancy does not impact short-term disease outcomes, nor birth outcomes. These findings are reassuring and stress the need to incorporate patient-centered reproductive healthcare in the treatment and follow-up of young women with breast cancer.

Wanda Cui^1,2

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

²Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

As advancements in anti-cancer treatments improve survival rates, understanding the potential long-term side effects of these treatments become increasingly important. Treatment related ovarian toxicity can potentially lead to infertility and early menopause, and is an important consideration for premenopausal women when making treatment decisions.

Although it is well established that alkylating chemotherapy can negatively impact ovarian function, little is known about the effects of other systemic anti-cancer agents on the human ovary. In recent years, many new classes of anti-cancer agents have received regulatory approval and are now routinely used in clinical practice, such as immunotherapy, targeted therapies, monoclonal antibodies, and antibody-drug conjugates. The targets of some of these drugs have fundamental roles in normal ovarian physiology, and preclinical studies have suggested that PARP inhibitors, PDL1 inhibitors, and CTLA4 inhibitors can significantly reduce primordial follicle counts (i.e., the ovarian reserve) in mice.

Yet, ovarian toxicity is currently inadequately assessed in cancer clinical trials. Indeed, only 24% of phase 3 breast cancer clinical trials which enrolled premenopausal women collected data regarding ovarian function measures. Interviews with clinical trialists found that the main barrier to ovarian toxicity assessment in clinical trials enrolling young women was that the issue was rarely considered during trial design.

Information regarding the impact of anti-cancer agents on ovarian function is urgently needed to facilitate fully informed decision-making regarding cancer treatment and family planning. This is a major gap in knowledge that needs to be addressed.

Faye Coe

Leeds Teaching Hospitals NHS Trust (LTHT), Clifford, West Yorkshire, England, UK

Content not available at time of publishing

Jordan Casey

Western Health, St. Albans, Victoria, Australia

When we look at a patient and their condition or diagnosis it can be easy to have tunnel vision and simply treating the condition and moving on. When it comes to Aboriginal and/or Torres Strait Islander healthcare, we must always look at the broader picture of what is happening in this person's life.

Multidisciplinary Care is extremely important to anyone receiving care and in particular our First Nations community. It is the holistic wrap around approach that makes a difference; however, we cannot simply put additional resources into a patient's treatment circle and hope for the best. We need to try and develop the workforce to ensure that we are all providing culturally safe care that suits the needs of our First Nations community.

Cultural safety comes in many forms such as the way we talk, the way we look, the way we act, the environment we are in, and the environment we create. Cultural safety is a serious topic, we need to do better than asking a question and ticking a box, then moving on.

Michael Jefford

Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Follow up is recommended for almost all patients after completion of treatment for cancer. Traditionally, follow-up has been specialist-led (by an oncologist, hematologist, or surgeon), hospital-based, and face-to-face. This model is becoming increasingly unsustainable given the large and growing number of survivors, and the limited health workforce. Traditional follow-up has tended to have a limited focus, mostly on detection of possible cancer recurrence, rather than considering the breadth of issues and needs that survivors can experience.

Australian cancer survivorship research priorities, as well as numerous international groups, emphasize the need to develop and implement alternative models of post-treatment survivorship care. One proposed model is shared care, wherein care is shared between the patient's hospital-based specialists and their general practitioner (GP). Such a model combines cancer-specific follow-up, with optimal management of comorbid illness, and general preventive care. Cancer Australia recommends shared follow-up care for survivors of several cancer types.

Two Australian randomized controlled trials, for survivors who had completed potentially curative treatment for either prostate or colorectal cancer, have shown quite similar findings. Compared to patients who had usual hospital-based follow-up, those exposed to shared care had similar quality of life outcomes and no apparent difference in cancer recurrence. Compared to hospital providers, GPs were more adherent to recommend follow-up testing. Patients exposed to shared care strongly prefer this model of care and shared care is cheaper than hospital-based follow-up. Few GPs declined participation in shared care in either of these studies. Several other studies of shared care are continuing in Australia.

Qualitative research with patients, GPs and oncologists, and a systematic review of barriers, and facilitators to shared care provide recommendations for practice and policy to support broader implementation of shared cancer care. Shared follow-up care is an appropriate model of care for many cancer survivors.

Vivienne Interrigi

Invited Speaker, Cheltenham, Victoria, Australia

Vivienne Interrigi is a cancer survivor. Going through breast cancer in 2018, she has learnt how to use a multidisciplinary approach to support her experience as she went from acute to chronic care. Cancer remains one of the most complex and challenging diseases worldwide. In recent years, the paradigm of cancer care has shifted toward personalized treatment approaches, acknowledging the unique characteristics of each patient and their tumor. In this context, the use of a multidisciplinary approach has emerged as a promising strategy to develop customized models of cancer care.

Recognizing the holistic nature of cancer care, Viv's experience in navigating this highlights the importance of psychosocial support and patient empowerment. Allied Health connections, support groups, and patient education were integral components of her personalized care plans, enhancing the overall well-being and patient experience for Viv. Regular assessments and adjustments to treatment plans were made to optimize outcomes and address emerging challenges effectively.

As an advocate for research and innovation, Viv emphasizes the importance of staying updated with the latest advancements in cancer care. Integrating evidence-based practices and incorporating ongoing clinical trials into the multidisciplinary approach has the potential to further enhance patient outcomes.

Viv's experience showcases the transformative power of a multidisciplinary approach in customizing models of cancer care. By harnessing the collective expertise of diverse medical disciplines, the personalized treatment plans offered greater efficacy and improved quality of life for her in managing cancer care. She continues to contribute significantly to the evolution of cancer care, fostering more patient-centered and tailored approaches to combat this challenging disease.

Ben Felmingham

Royal Children's Hospital, Parkville, Victoria, Australia

Content not available at time of publishing.

Abbey Diaz

University of Queensland, Herston, Queensland, Australia

Content not available at time of publishing.

Erin Howden

Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

Content not available at time of publishing.

Alexandra Murphy

Victorian Heart Hospital and Austin Health, Clayton, VIC, Australia

Heart disease and cancer are the two leading causes of death in the developed world. Public health campaigns targeting these conditions have led to significant improvement in population awareness and prevention of disease; however, there remains an inadequate acknowledgement of their coexistence. Due to advancements in modern cancer therapy, we are seeing higher rates of cure and the conversion of a terminal illness into a chronic disease. As a result, cardiovascular disease now competes with cancer as the leading cause of death in survivors of certain tumor streams. Attention to reducing the risk of cardiovascular disease should thus be a priority in the long-term management of oncology patients.

According to the International Cardio-Oncology Society, the guiding principle of cardio-oncology is the integration of clinical disciplines and integral to this is the knowledge of cardiology, oncology, and hematology management. Assessing, understanding, and mitigating the risk of cancer therapy related cardiac disease (CTRCD) is crucial to the safe and effective management of patients with cancer. This must be balanced against the absolute benefit of the cancer treatment and is a dynamic variable that changes throughout the treatment pathway. The principles underlying this are three-fold: firstly, antecedent CVD can influence the cancer treatment selection and tolerability. It has been well established that traditional cardiovascular risk factors (CVRFs) contribute to both total mortality and breast cancer specific mortality and the identification and management of CVRF in cancer patients is a class one recommendation. Secondly, anti-cancer therapy can cause cardiotoxicity that can impact ongoing treatment. The strict management of CVRF coupled with the early identification and treatment of sub-clinical cardiotoxicity offers the best chance of preventing or ameliorating overt CTRCD. Finally, latent cardiotoxicity can negatively impact cancer survivorship. Complicating this are rapidly evolving therapeutics with diverse effects and a limited understanding of long-term cardiovascular impact.

Bryan A Chan^1,2, Shoni Philpot³, Phoebe Leenders³, Nancy Tran³, Julie Moore³

¹Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

²Griffith University, Nathan, Queensland, Australia

³Cancer Alliance Queensland, Wooloongabba, Queensland, Australia

Background: Sinonasal undifferentiated carcinoma (SNUC) is a rare, highly aggressive malignancy that can involve the skull base, nasal cavities, and paranasal sinuses. As a result, there is a paucity of research and evidence to inform optimal management and guide prognostication. This consumer-initiated project aims to describe the epidemiology of SNUC in Queensland including: diagnosis, recurrence, and impact of cancer therapy on survival.

Methods: Data on all Queensland patients diagnosed with SNUC between 1982 and 2021 were sourced from the Queensland Oncology Repository. A comprehensive review was undertaken for each case and information was collected in a SNUC Clinical Quality Registry (CQR).

Results: From 1982 to 2021, there were 58 Queenslanders diagnosed with SNUC (57% male, median age 58 years). The incidence of .01 per 100,000 identifies it as a very rare cancer. At baseline, most had advanced disease (43% stage IV, 19% stage III) and 40% had ≥2 co-morbidities. Treatments included: trimodality with surgery, radiation, and chemotherapy (26%); chemoradiation (22%); surgery with either chemotherapy or radiation (16%); single modality (19%); or no treatment (17%). Recurrence occurred in 43% after a median time of 353 days. All-cause 5-year survival was 56% for trimodality; 44% for surgery plus either chemotherapy/radiation; 38% for chemoradiation; 18% for single modality; and 20% for no treatment. Overall 5-year survival was 37%, but this has improved over the last two decades from 27% (1992–2001) to 42% (2012–2021).

Conclusions: While survival following a diagnosis of SNUC remains poor, multimodality treatment appears to have a survival advantage. Further analysis will examine prognostic and molecular biomarkers to improve outcomes.

Katherine Faulks, Sue Barker, Sophie Lindquist

Australian Institute of Health and Welfare, Canberra, ACT, Australia

Background: Lymphedema is a chronic condition requiring lifelong care and management from a multidisciplinary team. If left unmanaged lymphedema will cause increasing morbidity for the individual. Lymphedema can occur following treatment for several cancers that typically involve the biopsy, dissection, or radiotherapy of the local lymph nodes. These cancers include breast, gynecological, melanoma, head and neck, and genitourinary. There is no Australian prevalence estimate for the number of people living with lymphedema.

Aim: To assess the utility of a range of data sources to provide an estimate of the prevalence of lymphedema in Australia.

Methods: Data sources with a collection period of at least up to and including 2015 were assessed for potential to inform key monitoring areas – risk factors for lymphedema, presence of the condition, and demographics of the study sample. The quality of the data was documented.

Conclusions: No single data source can provide an estimate of the prevalence of lymphedema in Australia. Several data sources were determined to contain information on people living with lymphedema; however, the story contains many gaps and more work needs to be done to provide the information/evidence that is needed to plan for and provide the essential treatment and management services to those with lymphedema.

Visalini Nair-Shalliker^1,2, Albert Bang¹, Sam Egger¹, Karen Chiam¹, Manish Patel³, David P Smith^1,4,5

¹The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, New South Wales, Australia

²Department of Clinical Medicine, Macquarie University, Sydney, Australia

³The University of Sydney, Sydney, NSW, Australia

⁴School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia

⁵Griffith University, Gold Coast, Qld, Australia

Background: Metformin, a common prescription used to treat diabetes, can inhibit cancer growth. There is growing interest in exploring its chemo-preventative properties. The current study prospectively examined the association between metformin prescription and prostate cancer (PC) risk factors, in the diagnosis of aggressive PC.

Methods: Male participants were from Sax Institute's 45 and Up Study (Australia) recruited between 2006 and 2009. Questionnaire and linked administrative health-data from the Centre for Health Record Linkage and Services Australia were used to identify incident PC, defined by a combined measure of Gleason grade group (GG) 1–5 and spread of disease (localized or advanced), healthcare utilizations, reimbursement records for Prostate Specific Antigen testing, and metformin prescriptions (metformin-users). Multivariable Joint Cox regression analyses were used to examine associations between risk of PC diagnosis and its risk factors (first-degree PC family history, obesity [body mass index, BMI ≥ 30 kg/m²], height [≥180 cm]), in metformin-users (versus non-users).

Results: Of 107,706 eligible men, there were 4257 incident PC cases (median age 68.7 years) diagnosed between baseline recruitment and December 31, 2013. Of the 12,987 participants with a record for dispensing of metformin prescription, there were 315 incident PC cases. A multivariate Joint Cox regression analysis showed risk of PC diagnosis across all risk groups was reduced in metformin-users (vs. non-users; HR < 1) and increased in men with a first-degree PC family history (HR > 1). Risk of advanced PC was increased in obese men (vs. non-obese; HR_adjusted = 1.31; 95%CI: 1.01–1.69), and in men > 180 cm in height (versus < 180 cm; HR_adjusted = 1.36; 95%CI: 1.05–1.75). Stratified analyses by metformin-users (versus non-users) showed risk of advanced disease was no longer evident for these risk factors; however, there was a reduced risk of localized PC in obese men (HR_adjusted = .63; 95%CI: .51–.77) and men ≥180 cm (HR_adjusted = .75; 95%CI: .61–.93).

Conclusion: The reduced risk of localized and advanced PC was associated with metformin prescriptions. This adds to the growing body of evidence of the chemo-preventative properties of metformin warrants further investigation.

Andrea L Smith¹, Xue Qin Yu¹, Nehmat Houssami¹, Anne E Cust¹, David P Smith¹, Michael David¹, Sally J Lord²

¹The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

²University of Sydney, Sydney, NSW, Australia

Aim: To estimate number of women living with metastatic breast cancer (mBC) in NSW.

Methods: The linked-record dataset comprised two cohorts of females in the NSW Cancer Registry (NSWCR) diagnosed with breast cancer in 2001–2002 and 2006–2007 linked to administrative hospital records, medicine dispensings, radiation services, and death records up to 2016. Women with mBC were identified from diagnosis or treatment records for metastasis. The number of women living with de novo or recurrent mBC was used as mBC point prevalence on January 1, 2016. We calculated prevalent proportions of mBC at the end of each calendar year and applied these to NSWCR counts of new breast cancers to impute mBC prevalence for cohorts without linked records (2003–2005; 2008–2015).

Results: The primary study cohorts comprised 16,521 women with breast cancer, of which 4364 incident mBC cases were identified (976 de novo mBC; 3388 recurrent mBC). Women with recurrent mBC were identified from NSWCR episode records (2435, 71.9%), with an additional 602 (17.8%) identified from hospital records and 351 (10.4%) from radiation services or dispensed medicines. At January 1, 2016 1240 women with mBC from the 2001–2002 and 2006–2007 cohorts were estimated to be alive (272 de novo, 21.9%; 968 recurrent, 78.1%).

When extrapolated to all those diagnosed with BC in 2001–2015 in NSW, 5009 women were estimated to be living with mBC on January 1, 2016 comprising 1609 (32.1%) de novo mBC and 3400 (67.9%) recurrent mBC. Results were similar when imputation was stratified by age and extent of disease. For context, NSW recorded 290 new de novo mBC and 5372 new non-metastatic breast cancers in 2015.

Conclusion: This study suggests there is a large number of people living with mBC and highlights the importance of identifying those with recurrent metastatic disease. Given people with mBC require lifelong treatment, these estimates can inform funding and delivery of appropriate clinical and supportive care services.

Jin Quan Eugene Tan^1,2, Huah Shin Ng^1,2,3, Bogda Koczwara^1,4

¹Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

²SA Pharmacy, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia

³SA Pharmacy, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia

⁴Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia

Aims: Cardiovascular disease (CVD) is the leading cause of non-cancer death among cancer survivors, but little is known about CVD medication use in the Australian cancer population. We compared the patterns of CVD medication use between people with and without cancer.

Methods: Data of the participants aged ≥25 years from the Australian National Health Survey 2020–2021 were linked to the medication dispensing data (Pharmaceutical Benefits Scheme) through the Multi-Agency Data Integration Project. CVD medications were identified by using the Anatomical Therapeutical Chemical Classification and included cardiac therapy, antihypertensives, lipid-lowering, and antithrombotics. Comparisons were made between cancer and non-cancer population using logistic regression models with the estimates expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CIs).

Results: The analysis included 1828 people with cancer and 7505 people without cancer. People with cancer were more likely to be older (57% vs. 21% aged ≥65 years) and have a higher burden of comorbidities (85% vs. 72% with ≥1 concurrent conditions) and a higher prevalence of CVD (31% vs. 13%) compared to people without cancer. Cancer survivors had a higher odds of receiving any CVD medications (aOR 1.29; 95% CI = 1.13–1.46) than those without cancer. These results remained significant across different types of CVD medication groups, including antihypertensives (aOR 1.18; 95%CI = 1.04–1.34), and antithrombotics (aOR 1.29; 95%CI = 1.06–1.55). Several factors were identified to be associated with higher odds of dispensing any CVD medications, including male sex, older age, unemployment, being overweight/obese, and having ≥1 concurrent health conditions.

Conclusions: Cancer survivors had a higher prevalence of CVD and use of CVD medications than people without cancer. Our findings support the incorporation of cardiovascular risk assessment and management into cancer care plan. Further research is needed to define best practices of monitoring, prevention, and management of CVD in cancer survivors.

Carla Thamm^1,2, Shafkat Jahan^3,4, Daniel Lindsay^4,5, Raymond J Chan¹, Gail Garvey^3,4

¹Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia

²Princess Alexandra Hospital, Woolloongabba, Qld, Australia

³First Nations Cancer and Wellbeing Research Program, The University of Queensland, Brisbane, Queensland, Australia

⁴School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

⁵QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia

Aims: Cancer diagnosis and treatment cause significant financial burdens on patients, families, communities, and health care funders. Direct costs to the funders for Adolescent and Young Adult (AYA) cancer survivors could be higher than adults due to unique treatment and survivorship needs. We aimed to explore the patterns of health service use and related costs for AYA cancer patients in Queensland.

Methods: This study used a Queensland population-based linked administrative dataset (CancerCostMod) containing all AYA cancer survivors (n = 871; aged 15−24) diagnosed between July 2011 and June 2015. Records were linked to Queensland Health Admitted Patient Data, Emergency Department Information Systems (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records. Health service use and associated costs over 7-years post diagnosis (from July 2011 to June 2018) were aggregated into 6-month intervals from the time of diagnosis to quantify total and average cost per person for various healthcare funders.

Results: AYA cancer survivors had a mean age of 20.3 years. The majority (90%) of these cancer survivors lived more than 5 years and half (49.5%) lived outside of Metropolitan areas. Public hospitals incurred higher costs ($33.7 M) compared to private hospitals ($12.6 M), MBS ($3.1 M), EDIS ($2.3 M), and PBS ($.7 M) for AYA cancer survivors. Total and average health service use and costs to different healthcare funders were highest during the first 6 months following a cancer diagnosis, steadily decreased over 7–60 months, and dropped significantly during 61–84 months post-diagnosis.

Conclusions: We quantified health service use and related costs for AYA populations to inform health service delivery and models of care. The high survival rate and costs in the first 6 months highlight the need for targeted interventions shortly after diagnosis. Future studies should assess cost variation due to cancer characteristics and treatment modalities to guide personalized and cost-effective models of care.

Kelly D'cunha¹, Yikyung Park², Louise Marquart-Wilson¹, Melinda M. Protani¹, Marina M. Reeves¹

¹Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Qld, Australia

²Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA

Purpose: Inflammatory and metabolic markers have been associated with prognosis in breast cancer survivors. We examined changes in prognostic biomarkers (hs-CRP and HOMA2-IR) following a weight loss intervention for breast cancer survivors and examined associations between lifestyle behaviors – measures of weight, physical activity, diet, and circadian rhythm disrupting (CRD) behaviors – with these biomarkers.

Methods: Female breast cancer survivors (n = 159; 18–75 years; 25–45 kg/m²; stage I–III) were recruited to participate in a randomized controlled trial of a 12-month behavior change (diet and physical activity) weight loss intervention versus usual care. Behaviors and biomarkers were measured at 6-monthly time points (80.5% retention at 18-months). Linear mixed-effect models were used to examine changes of biomarkers over time and intervention effects. Tobit and linear regression models were used to test for associations of behaviors with hs-CRP and HOMA2-IR respectively at study baseline and the effects of change in behaviors with change in biomarkers (12 months-baseline). Models were adjusted for confounders identified using Directed Acyclic Graphs.

Results: Statistically significant and meaningful (10% difference) improvements from baseline to 12-months were observed for both biomarkers but were not sustained at 18-months for hs-CRP for women in both study arms combined. The intervention did not lead to any significant differences between groups for either biomarker. At baseline, BMI (β = .23, 95% CI: .12–.34) and moderate-to-vigorous physical activity (β = −.05, −.08 to −.01) were associated with hs-CRP, and BMI (β = .07, .02–.12), physical activity (β = −.02, −.03 to −.00), and eating ≥3.5 to <6 times/day (vs. ≥6 to ≤7; β = .63, .09–1.16) with HOMA2-IR (all p < 0.05). No association was observed between energy intake, sleep, and meal timing with the biomarkers. At 12-months, changes in behaviors were not associated with changes in biomarkers.

Conclusions: While lifestyle behaviors were associated with prognostic biomarkers in breast cancer survivors, neither the weight loss intervention nor behavior change explained improvements in either biomarker.

Norah Finn^1,2, Ella Stuart^1,2, Tommy Hon Ting Wong^1,2, Robert JS Thomas³, Kathryn Whitfield², Luc te Marvelde¹

¹Cancer Council Victoria, Melbourne, Victoria, Australia

²Department of Health, Melbourne, Victoria, Australia

³University of Melbourne, Melbourne, Victoria, Australia

Introduction: Screening, as informed by the Optimal Care Pathways (OCP), is important in improving patient outcomes in breast cancer through early detection. This study investigated whether Victorian breast cancer patients who aligned with screening recommendations had better outcomes than those who were not.

Methods: Data used were obtained from a linked dataset that included the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, BreastScreen Victoria (BSV), Victorian Admitted Episodes Dataset, Victorian Radiotherapy Minimum Data Set, and Victorian Cancer Registry (VCR). Women aged between 50 and 69 years diagnosed with invasive breast cancer between 2011 and 2019 (n = 20,069) were identified from the VCR. Alignment with the early detection phase was defined as being diagnosed through BSV or having a non-BSV mammogram from 3 years to 90 days prior to diagnosis. Odds ratios were calculated using logistic regressions and hazard ratios from Cox hazard model.

Results: A total of 11,517 of 20,069 (57%) aligned with screening recommendations (45% through BSV and 12% through non-BSV mammography). Alignment was similar between SES quintiles and remoteness. The proportion of women who were stage 1 at diagnosis was higher for the cohort who aligned (63% compared with 30%). Alignment was associated with earlier stage at diagnosis (OR = .26, 95% CI: .25–.28) after adjusting for age. A higher proportion of women who aligned received breast conserving surgery (82% compared with 61%), which persisted after adjusting for age and stage (OR: .59, 95% CI: .55–.64). There was a survival improvement for those aligned with the early detection phase after adjusting for age and stage (HR: .52, 95% CI: .43–.64).

Conclusion: Alignment with screening recommendations from the OCP was associated with better outcomes in women of screening age who were diagnosed with breast cancer.

Zoe G Gibbs^1,2, Caitlin I Fox-Harding^1,2, Daniel A Galvão^1,2, Dennis R Taaffe^1,2, Rob U Newton^1,2

¹Edith Cowan University, Joondalup, WA, Australia

²Exercise Medicine Research Institute, Joondalup, WA, Australia

Purpose: We examined the manipulation of resistance exercise load in a 12-week randomized controlled trial with a 4-month follow-up wherein effectiveness of training at either high load (HL) or low load (LL) was assessed to refine exercise prescription for management of breast cancer-related lymphedema (BCRL).

Participants and methods: Survivors with BCRL (n = 94, aged 22–84 years, mean 54 years) were randomly allocated to usual care (UC, n = 31), HL (n = 31), or LL (n = 32) exercise groups. Twice weekly exercise consisted of 2–4 sets of upper and lower body resistance exercises progressing from 8- to 5-repetition maximum (RM) for HL or progressing from 18- to 15-RM for LL plus aerobic training (15–25 min at 65%–80% heart rate max). Lymphatic relative volume (LRV), muscle function, and functional performance (repeated chair rise, 400-m walk) were assessed at baseline, 12 weeks, and 4-month follow-up. Statistical analyses included ANOVA and ANCOVA.

Results: Seventy-three participants completed the study. Both HL and LL reduced LRV (HL −8.6%, LL −7.8%; p = 0.001) over the 12-week intervention compared to UC with no further significant change at 4-month follow-up. Muscle strength improved (p = 0.001) in both exercise groups with no change in UC (chest press: HL 4.7 kg, LL 3.8 kg; seated row: HL 9.7 kg, LL 4.9 kg; leg extension: HL 5.6 kg; LL 3.9 kg), and no difference between HL and LL. Performance in the 400-m walk also improved with exercise for both HL (−36.2 s, p = .025) and LL (−18.9 sec, p = .004) with HL producing significantly superior improvement compared to LL (p = .020), with no change for UC.

Conclusion: We demonstrated both high and low load resistance exercise is feasible in survivors with BCRL for effective management of lymphedema and is accompanied by improvements in physical and functional performance up to 4 months postexercise.

Yada Kanjanapan^1,2, Wayne Anderson³, Mirka Smith³, Jenny Green³, Elizabeth Chalker³, Paul Craft^1,2

¹Department of Medical Oncology, Canberra Hospital, Canberra, ACT, Australia

²Australian National University, Canberra, Australia

³Epidemiology Section, Data Analytics Branch, ACT Health Directorate, Canberra, Australia

Introduction: Treatment intensification with adjuvant CDK4/6 inhibitors has improved disease-free survival, in monarchE and NATALEE trials with abemaciclib and ribociclib, respectively, using different eligibility criteria. We assessed the proportion of breast cancer patients represented with these criteria, and their outcome, in an Australian population.

Methods: Consecutive patients from ACT Breast Cancer Treatment Group (6/1997–6/2017) were analyzed. Patients eligible for monarchE had > = 4+ lymph nodes (LN) or 1–3+ LN plus tumor > = 5 cm or grade 3. NATALEE additionally included LN-negative >5 cm, and 2.1−5 cm grade 3 cancers. Groups were compared by Chi-square testing; survival estimated by Kaplan–Meier method.

Results: Of 3840 hormone receptor-positive HER2-negative breast cancer patients, 718 (18.7%) qualified monarchE criteria; 2024 (52.7%) were NATALEE-eligible. monarchE-eligible patients were younger (median 56 vs. 59 years, p < 0.001), with higher proportion premenopausal (34% vs. 22%, p < 0.001). Significantly more monarchE-eligible patients received chemotherapy (81% vs. 33%, p < 0.001). Median overall survival was shorter for monarchE-eligible patients (61 vs. 105 months, HR 1.89, 95%CI: 1.60–2.22, p < 0.001).

NATALEE-eligible patients were more likely premenopausal with higher chemotherapy-use (66% vs. 16%) than non-eligible patients. Node-negative patients comprised 31% of the NATALEE-eligible cohort, while 26% of LN-negative patients qualified for NATALEE. Survival among NATALEE-eligible patients was inferior to non-eligible patients, median 78 versus 106 months (HR 1.36, 95%CI: 1.16–1.59, p < 0.001).

Among NATALEE-eligible patients, 65% (n = 1306), or 34% of study population, did not qualify for monarchE. Patients eligible for both study criteria had inferior survival to NATALEE-eligible-only patients (median 61 vs. 96 months, HR 1.78, 95%CI: 1.47–2.14, p < 0.001).

Antonia Pearson^1,2, Haryana Dhillon³, Jill Chen³, Janine Lombard^4,5,6, Martha Hickey^7,8, Belinda Kiely^9,10,11

¹Northern Beaches Hospital, Frenchs Forest, NSW, Australia

²University of Sydney, Camperdown, Australia

³Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia

⁴Newcastle Private Hospital, Newcastle, Australia

⁵Medical Oncology, Calvary Mater Newcastle, Newcastle, Australia

⁶University of Newcastle, Newcastle, Australia

⁷University of Melbourne, Melbourne, Australia

⁸Obstetrics & Gynaecology, Royal Women's Hospital, Melbourne, Australia

⁹NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia

¹⁰Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, Australia

¹¹Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia

Aim: We aimed to improve understanding of the perceptions and experiences of genitourinary symptoms (GUS) in women with breast cancer (BC).

Methods: Oncology clinic attendees from nine NSW cancer services and Breast Cancer Network Australia members completed a survey addressing the type and impact of GUS experienced, and perceptions of treatment options.

Results: Surveys were completed by 505 women: mean age 59 years (range 30–83); 52% currently sexually active; 58% currently on endocrine treatment; and 84% had early stage BC. 70% of respondents reported experiencing GUS, with a minority reporting changing (5%) or stopping (4%) their endocrine treatment as a result. Vaginal dryness was the most common symptom reported (62%), followed by pain on penetration (41%) and itch (33%). Only 38% of respondents recalled being warned by their cancer doctor that GUS can be a side effect of BC treatment, and 51% reported never being asked about GUS. Being uncomfortable talking to a male health professional was reported as a moderate or major barrier to seeking help for GUS by 27% of respondents. Few respondents reported using vaginal: lubricants (40%), moisturizers (25%), or estrogens (14%). Amongst women reporting use of vaginal estrogens, 42% found they helped their GUS “quite a bit” or “very much”. The most frequently reported moderate to major barriers preventing use of vaginal estrogens were: packaging saying “not to use if you have been diagnosed with breast cancer” (63%), “worry that vaginal estrogen will increase my risk of breast cancer returning” (58%) and “my cancer doctor has not recommended vaginal estrogens” (48%).

Conclusions: GUS are a common symptom for women with BC yet the majority are not warned about these symptoms. Healthcare professionals could provide more information about GUS and treatment options and monitor for symptoms to reduce their impact on women after BC.

Kate Webber^1,2, Alastair Kwok^1,2, Sok Mian Ng¹, Olivia Cook^3,4, Eva Segelov²

¹Department of Oncology, Monash Health, Clayton, VIC, Australia

²School of Clinical Sciences, Monash University, Clayton, VIC, Australia

³Nursing and Midwifery, Monash University, Clayton, VIC, Australia

⁴McGrath Foundation, Sydney, NSW, Australia

Aims: To assess the impact of real-time PROMs prior to outpatient breast oncology consultations on Emergency Department (ED) presentations and overall survival (OS), and identify symptoms most associated with unplanned presentations.

Methods: Patients with breast cancer were invited to complete the EQ-5D-5L, Edmonton Symptom Assessment System-Revised, and Supportive Care Needs Survey-Short-Form (SCNS-SF34) prior to scheduled appointments, on waiting room iPads (December 2019–March 2020) or remotely online (October 2020–April 2021). Clinical characteristics and ED presentations were extracted from medical records for participants and non-participants. Chi-squared and t-tests were used for between-group comparisons. OS was assessed using the Kaplan–Meier method with Cox regression.

Results: Data were extracted from 559 clinic consultations (170 in-person; 389 telehealth) with 241 patients (mean age 60 [SD 12]; 11% undergoing treatment with palliative intent). PROMs participation was lower among telehealth attendees (47% vs. 60% in-person, p = 0.03), and among people speaking a language other than English (33% vs. 56%, p = 0.02). No significant differences were observed between participants and non-participants in age, stage, treatment intent (curative vs. palliative), or treatment received. Fewer ED presentations within 30 days were recorded among participants than non-participants (9 vs. 25 presentations, p = 0.02). Among PROMs participants, ED presentations were associated with higher mean scores for pain (5.8 vs. 3.3), tiredness (6.9 vs. 4.7), depression (4.0 vs. 2.8), and constipation (3.4 vs. 1.4) at the preceding consultation, all p < 0.05. ED presentations were also associated with lower EQ-5D-VAS and higher SCNS physical and psychological domain scores. OS at 2 years was 95.3% for participants versus 93.6% for non-participants. Age and treatment intent, but not participation in the intervention, were associated with OS (.041, p < 0.001 and 0.42, respectively).

Conclusions: Completing PROMs prior to breast oncology consultations was associated with fewer ED presentations. Targeted interventions focusing on key symptoms and to support participation for people who speak a language other than English and for telehealth attendances are required.

Etienne Brain

Institut Curie, Saint-Cloud, France

Content not available at time of publishing

Heather Lane

Sir Charles Gairdner Hospital, Subiaco, WA, Australia

Integration of Comprehensive Geriatric Assessment (CGA) and management into oncological care improves outcomes for older people with cancer, in particular, reducing chemotherapy toxicity, whilst improving treatment completion rates and quality of life measures. Geriatric Oncology models of care vary with health system structures and resources; however, a variety of different models have been demonstrated to be of benefit. Geriatricians are experts in CGA. They can contribute to cancer care through: providing information about health status, remaining life expectancy, and toxicity risks; managing geriatric syndromes in coexistence with or exacerbated by cancer and associated treatment; and assisting with eliciting and contextualize patient preferences, thus supporting shared decision making and advanced care planning.

Local data from a Geriatric Oncology Clinic demonstrates high rates of new diagnoses (34%), medication changes (24%), advance care planning discussions (24%), and linking into allied health services (79%). These rates suggest broadened access to geriatric assessment and multidisciplinary care is likely to be of benefit. Integration of geriatric assessment and management along the cancer care continuum is required to achieve person-centered and evidence-based care for the large proportion of Australians with cancer who are older.

Michael Krasovitsky

Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

Medical Oncology, Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia

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

St Vincent's Hospital, Darlinghurst, NSW, Australia

The oncological care of older individuals with cancer brings with it not only great satisfaction, but also a variety of both academic and practical challenges. Indeed, the nuanced care of older individuals requires a deeply holistic & fundamentally multidisciplinary approach, one that is often at odds with the real-world requirements of working within a complex, time-poor environment. As our population ages, and the incidence of cancer increases in this demographic, an understanding of the strengths and vulnerabilities of older individuals with cancer will become paramount for all oncology health care workers, particularly nursing, allied health, and medical professionals.

Though the process of ageing may result in numerous advantages, it is equally true that it may bring with it a variety of complexities, including frailty, permanent or intermittent cognitive impairment, social isolation, loneliness, a vulnerability to health care insults, and falls. These may greatly impact the delivery of cancer care, and simultaneously, may also be dramatically worsened by oncological intervention. Indeed, the complex interactions between cancer, treatment, healthy ageing, and vulnerable/impaired ageing is at the very heart of geriatric oncology.

In this session, Dr Krasovitsky will discuss the intricacies of decision making in geriatric oncology, including optimal screening for older individuals, the principles of holistic, age-informed management, and how geriatric oncologists navigate the multiple contributors to both health and illness for older individuals. He will specifically examine the numerous ways that frailty may impact on, and be affected by, cancer management. His presentation will discuss how the principles of geriatric oncology can be generalised to non-specialised cancer care services, and how all health care professionals can implement basic geriatric oncology interventions in their practice.

Polly Dufton

Department of Nursing, University of Melbourne, Carlton, VIC, Australia

Content not available at time of publishing.

Melanie L Plinsinga¹, Louise Koelmeyer², Kira Bloomquist^1,3, Debbie R Geyer^4,5, Hildegard Reul-Hirche^1,6, Sandi Hayes¹

¹Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia

²Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia

³Center for Health Research, Copenhagen University Hospital, Rigshospitalet, Denmark

⁴Cremorne Medical Practice, Sydney, New South Wales, Australia

⁵Lymphoedema Association Australia, Sydney, New South Wales, Australia

⁶Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

More than 20,000 Australians are diagnosed with breast cancer and 6500 with gynelogical cancer each year. Lymphedema is a prevalent, intractable health issue that may develop as a consequence of these cancers. The disease itself, or treatment for the disease, may reduce lymphatic transport capacity or increase lymph load. This in turn may lead to increases in extracellular fluid in the affected area (i.e., stage 0–1 lymphedema), and if left untreated, may progress to visible size changes, and deposition of fatty and fibrotic tissue (stage 2–3). Lymphedema adversely impacts function and quality of life, and has been associated with poorer prognosis. There is no known cure, and available treatment options are costly, time-consuming and lifelong, with treatment burden higher for those with stage 2 and above lymphedema, compared with stage 0 and I. The individual and social burden imposed by lymphedema demands greater research in all areas of lymphedema – prevention through management. However, measuring lymphedema is complex, particularly in the lower limb setting, and choice of measurement influences what we think we know about prevalence, progression, and prevention and management strategies. Nonetheless, despite “noisy data” some signals shine bright. Lymphedema is common; at least 20% of women with breast cancer and at least one in three women with gynecological cancer develop this chronic condition. Higher number of lymph node removal, more extensive surgery, and receipt of adjuvant therapy represent treatment characteristics consistently associated with increased risk of developing lymphedema. Lymphedema is impactful – it adversely influences those living with the condition, and the personal ramifications have a flow on effect to use of healthcare resources and overall public health.

Louise Koelmeyer

Australian Lymphoedema Education Research and Treatment (ALERT) Centre, Macquarie University, NSW, Australia

Lymphedema, a distressing consequence of breast cancer and gynecological treatment, requires effective prevention strategies. The quest for preventing lymphedema following breast and gynecological cancers revolves around identifying risk factors and using effective prevention strategies, which has become a crucial focus of research and clinical practice. Risk factors for breast and gynecological cancer-related lymphedema include more extensive lymph node dissection extent, receipt of radiation or chemotherapy, obesity, rurality, and age. Identifying high-risk individuals enables targeted prevention efforts, improving patient outcomes and quality of life. Regular monitoring and early detection processes are crucial in reducing the impact of lymphedema post-breast and gynecological cancer. Prospective surveillance, using objective validated and reliable measurement techniques, allow for timely interventions, reducing lymphedema severity and chronicity. Compression garments, for the limbs, hands and feet have a pivotal role in lymphedema prevention and management. In the prevention phase, compression aids in reducing swelling during activities that may increase the risk of lymphatic overload. It supports lymphatic function, enhances tissue pressure, and promotes fluid drainage, thus preventing the progression of the condition. Controlled and monitored exercise regimens can reduce the risk of lymphedema. Gentle, graduated exercise routines help stimulate lymphatic flow, improving lymphatic drainage and overall tissue health. Successful implementation requires a multidisciplinary approach, with collaboration between surgeons, oncologists, lymphedema practitioners, and nurses. Standardized protocols for risk assessment and monitoring during follow-up visits enable early detection and timely interventions. Educating cancer survivors empowers them to take an active role in their healthcare. Preventing lymphedema following cancer requires proactive measures. Prospective surveillance, compression therapy, and exercise interventions can improve patient outcomes, mitigate lymphedema-associated burden, and enhance quality of life. The significance of early detection and personalized interventions contribute to the advancement of cancer survivorship care.

Hildegard M Reul-Hirche¹, Melanie Plinsinga², Louise Koelmeyer³, Kira Bloomquist^2,4, Debbie Geyer^5,6, Sandi Hayes²

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

²Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia

³Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia

⁴Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

⁵Lymphoedema Association Australia, Carrum Downs, Victoria, Australia

⁶Cremorne Medical Practice, Sydney, New South Wales, Australia

Lymphedema associated with cancer occurs due to disruption of normal lymphatic drainage pathways, which leads to stagnation of protein-rich lymph fluid and consequent swelling of the affected body part. If left untreated, the dormant protein initiates an inflammatory process and fibro-fatty changes to affected region emerges. Conservative management used a one size fits all approach. This consisted of an intensive phase of daily skin care, manual lymphatic drainage (MLD). and bandaging/garments over several weeks, followed by an extended maintenance period involving regular visits with a lymphatic therapist. This was supported by specific exercise and education. Today, conservative management has become more targeted and individualized. The advent of near-infrared fluorescent lymphatic imaging improved understanding of lymphatic drainage, with findings now used to guide MLD. Bandaging is now largely replaced by use of compression garments, with several grades of compression and types of garments available for use. Guidelines, which previously restricted physical activities, now support engagement in exercise of all types and intensities, and education, which was previously dogmatic with strict “Do's and Don'ts” lists, now applies a more pragmatic and individual approach. The only surgical option available for people with cancer-related lymphedema in the 1970s was radical debulking, consisting of removal of all affected tissue to the deep fascia and closure with skin graft. Today, surgical options include liposuction, lympho-vascular anastomosis, and reverse mapping during axillary node dissection. However, while considered effective for specific subgroups of patients, access to this type of treatment is largely restricted to those of higher socioeconomic status. Despite advancements in lymphedema treatment over the past 40+ years, treatment remains costly, both in time and finances. Furthermore, access to a trained workforce is limited, particularly for those living outside major, metropolitan areas. This in turn has shifted research focus to prospective surveillance, early identification, and early treatment.

Kira Bloomquist^1,2, Melanie Plinsinga¹, Louise Koelmeyer³, Debbie Geyer^4,5, Hildegaard Reul-Hirche^1,6, Sandi c Hayes¹

¹Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia

²Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Zealand, Denmark

³Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia

⁴Lymphoedema Association Australia, Carrum Downs, Victoria, Australia

⁵Cremorne Medical Practice, Sydney, New South Wales, Australia

⁶Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

There is theoretical underpinning for the role of exercise and weight loss in the management of lymphedema. Exercise has well known benefits on the musculoskeletal, cardiorespiratory, and circulatory system. These same physiological systems play an important role in supporting lymphatic function and lymph flow. Consequently, exercise has been a focus in lymphedema management trials over the past 20 years. This evidence base has been evaluated and summarized in a recent systematic review and meta-analysis.

To evaluate the role of exercise in managing lymphedema, the review included 26 intervention studies, of which 22 exclusively included participants with breast cancer-related lymphedema. The mean age of participants was 55 years, and on average they had been diagnosed with lymphedema 3.5 years prior to study participation. The results showed that exercise neither reduced nor exacerbated lymphedema or lymphedema symptoms, including heaviness and tightness. Importantly, improvements in survivorship outcomes including pain, fatigue, upper-body function, quality of life, and muscle strength were observed in planned subgroup analyses. These improvements are particularly noteworthy as those with lymphedema have higher rates of cancer-related morbidity and treatment sequalae than those without lymphedema.

Higher body mass index has been consistently identified as a risk factor for lymphedema. This relationship has led to recommendations of weight maintenance or loss (in overweight or obese individuals) as a management strategy for cancer-related lymphedema. However, to date, only four clinical trials, including 458 breast cancer survivors, have been conducted to test this hypothesis. Data from these trials have been included in a meta-analysis, with subsequent findings showing no reduction of interarm volume difference following weight loss.

Throughout this presentation, some of the strengths and limitations of these findings will be explored, and the clinical implications of findings for women with breast or gynecological cancer will be highlighted.

Debbie D Geyer^1,2, Hildegard H Reul-Hirche^3,4, Louise L Koelmeyer⁵, Melanie M Plinsinga³, Kira K Bloomquist^3,6, Sandi S Hayes³

¹Lymphoedema Association Australia, Melbourne, VIC, Australia

²Cremorne Medical Practice, Cremorne, NSW, Australia

³Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia

⁴Royal Brisband and Women's Hospital, Brisbane, QLD, Australia

⁵Health Sciences, Macquarie University, Sydney, NSW, Australia

⁶Centre for Health Research, Copenhagen University Hospital, Copenhagen, Denmark

Lymphedema, a chronic condition often occurring after cancer treatment, poses a significant challenge to patients and healthcare professionals alike. Over the years, various myths and misconceptions have surrounded the advice and management regarding lymphedema, leading to inconsistencies in care and suboptimal outcomes. It has also increased fears around lymphedema development and progression, and individuals making major changes to the way they live their life, all in the name of lymphedema prevention or management. Throughout the course of this presentation, we will explore common myths, including but not limited to those surrounding exercise, venepuncture and cannulation, and air travel. Throughout the course of the presentation, we will unravel the misconceptions around lymphedema management and highlight areas where we rely upon anecdotal advice, and where there is a lack of evidence-based practice still, and more research is required. It is imperative that we confront these myths head-on and pave the way for improved lymphedema management strategies that align with the best available evidence and help to empower our patients to make informed decisions about what actions they are willing to take to prevent lymphedema or its progression.

Faye Coe¹, Vivek Misra², Yamini McCabe³, Helen Adderley³, Laura Woodhouse³, Zaheen Ayub⁴, Xin Wang⁵, Sacha Howell³, Maria Ekholm⁶

¹Leeds Teaching Hospitals NHS Trust (LTHT), Clifford, West Yorkshire, England, UK

²Department of Clinical Oncology, The Christie Hospital Foundation Trust, Manchester, England, UK

³Department of Medical Oncology, The Christie Hospital Foundation Trust, Manchester, England, UK

⁴Department of Pharmacy, The Christie Hospital Foundation Trust, Manchester, England, UK

⁵Department of Analytics and Statistics, The Christie Hospital Foundation Trust, Manchester, England, UK

⁶Department of Oncology, Ryhov Hospital, Jönköping, Sweden

The aim of this study was to identify factors associated with progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer (MBC) treated with eribulin in a real-world setting, to improve information provision in those considering treatment.

Patients treated with eribulin for MBC at The Christie NHS Foundation Trust, Manchester, UK, between August 2011 and December 2018 were included (n = 439). Data were collected by retrospective review of medical records and electronic prescribing systems. Factors such as biological subtype, distant recurrence-free interval, previous lines of chemotherapy, and the “average duration of previous treatment lines” (ADPT) (calculated as: [date of initiation of eribulin-date of MBC]/the number of previous treatment lines in the metastatic setting) were evaluated for prognostic impact using Cox proportional hazards regression.

In the full cohort, the median PFS and OS were 4.1 months (95% CI: 3.7–4.4) and 8.6 months (95% CI: 7.4–9.8), respectively. Outcomes were significantly inferior for those with triple-negative breast cancer (TNBC) (n = 92); PFS_TNBC: 2.4 months (95% CI: 2.1–3.0), p = < 0.001 and OS_TNBC: 5.4 months (95% CI: 4.6–6.6), p ≤ 0.001. ADPT was the only factor other than subtype significantly associated with PFS and OS. Longer ADPT was also significantly associated with PFS and OS in those with TNBC. For example, women in the lowest ADPT tertile (<5.0 months) achieved a median OS of only 4.3 months, whereas those in the upper ADPT tertile (>8.7 months) had a median OS of 12.1 months (p = 0.004).

Our results indicate that the ADPT lines is an important factor when predicting the outcome with eribulin chemotherapy in a palliative setting and that quantitative guidance on the likely PFS and OS with treatment can be provided using ADPT. Validation in additional cohorts is warranted.

Gail Rowan

Pharmacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Content not available at time of publishing.

Peter Savas

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Immunotherapy now forms the standard of care for certain subtypes of breast cancer. In the current paradigm, immunotherapy combines with other existing and novel therapies to deliver better responses, a higher probability of cure and prolonged disease control. Devising the most effective combination therapies while minimizing toxicity remains a difficult task. Although technologies to interrogate how the immune system interacts with breast cancer have reached unprecedented levels of precision and insight, we are still far from implementing sophisticated immune biomarker testing in the clinic. Looking forward, a better understanding of the role that the immune system plays in the early development of breast cancer may afford exciting opportunities for prevention.

Olivia Smibert

Peter MacCallum Cancer Center, Thornbury, Victoria, Australia

Content not available at time of publishing.

Karen Canfell

Cancer Council NSW, Woolloomooloo, NSW, Australia

Content not available at time of publishing.

Julia Brotherton

University of Melbourne, University Of Melbourne, VIC, Australia

Content not available at time of publishing.

Lisa J Whop

Australian National University, Canberra, ACT, Australia

There are persistent and substantial inequities in cervical cancer morbidity and mortality for Indigenous women in high resource settler-colonial nation states, such as Australia. These inequities are unacceptable. Cervical cancer can be eliminated as a public health problem, using available and highly effective forms of primary and secondary prevention, and, for early stage disease, treatment. Global calls, led by Indigenous women, have urged that cervical cancer elimination targets be equity-driven, and that addressing inequities be central to the elimination agenda. The elimination of cervical cancer for Indigenous peoples requires the elimination of institutionalized racism and racist health system structures. Elimination can be achieved by seeking to address inequities by examining and dismantling structural barriers to care and wellbeing for Aboriginal and Torres Strait Islander women and communities, ensuring that research is strengths-based and transformative – seeking system change rather than focusing on individual or Indigenous deficits. Here, we showcase the various strategies Aboriginal and Torres Strait Islander communities are leading to increase cervical screening and timely access to treatment – key pillars of achieving elimination.

Farhana Sultana

National Cancer Screening Register, East Melbourne, VIC, Australia

Content not available at time of publishing

Louisa G Gordon¹, Stephanie Jones², Giverny Parker², Suzanne Chambers³, Joanne Aitken⁴, Matthew Foote⁵, David Shum⁶, Julia Robertson², Elizabeth Conlon², Mark Pinkham⁵, Tamara Ownsworth²

¹QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia

²School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia

³Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia

⁴Cancer Council Queensland, Brisbane, Queensland, Australia

⁵Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

⁶Department of Rehabilitation Sciences,, The Hong Kong Polytechnic University, Hong Kong, China

Background and Aims: People with primary brain tumor often face more impairments in physical, cognitive, and behavioral function than other cancer groups and they also experience high levels of anxiety and depression. Despite the need for accessible psychosocial interventions to facilitate adjustment, a major barrier to wider uptake is a lack of data on their cost-effectiveness. Our aim was to undertake an economic evaluation of a telehealth psychological support intervention for patients with primary brain tumor.

Methods: A cost-utility analysis over 6 months was performed comparing a tailored telehealth-psychological support intervention with standard care based on a randomized control trial. Data were sourced from the Telehealth Making Sense of Brain Tumor (Tele-MAST) trial survey data, project records, and administrative healthcare claims. Quality-adjusted life years (QALYs) were calculated based on the EuroQol-5D-5L. Non-parametric bootstrapping with 2000 iterations was used to determine sampling uncertainty. Multiple imputation was used for handling missing data.

Results: The Tele-MAST trial included 82 participants and was conducted in Queensland, Australia during 2018–2021. When all healthcare claims were included, the incremental cost savings from Tele-MAST were AU$4386 (95%CI: $4289, $4482) while incremental QALY gains were slightly higher. The likelihood of Tele-MAST being cost-effective versus standard care was 87%. When psychological-related healthcare costs were included only, the incremental cost per QALY gain was AU$10,685 (95%CI: dominant, $24,566) and had a 65% likelihood of the intervention being cost-effective. There was little evidence of cost-offsets for lower psychological service uptake.

Conclusions: The Tele-MAST intervention is considered a cost-effective intervention for improving the quality of life of people with primary brain tumor in Australia. Patients receiving the intervention incurred significantly lower overall healthcare costs than patients in standard care but incurred similar costs for psychological health services.

Lauren Ha^1,2, Claire E Wakefield^1,2, Claudio Diaz³, David Mizrahi⁴, Richard J Cohn^1,2, Karen Johnston¹, Christina Signorelli^1,2, Kalina Yacef³, David Simar⁵

¹Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

²School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Sydney, Sydney, NSW, Australia

³School of Computer Science, The University of Sydney, Sydney, NSW, Australia

⁴The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

⁵School of Health Sciences, UNSW Sydney, Sydney, NSW, Australia

Aims: Physical activity (PA) levels are typically quantified as a total amount using time spent in light, moderate, or vigorous intensity, yet overlook the transient nature of PA such as whether activity is concentrated in certain parts of the day. We analyzed PA behaviors using cluster analysis to explore various behavior profiles in childhood cancer survivors. Understanding PA patterns may assist in tailoring exercise programs to support sedentary populations such as cancer survivors.

Methods: We measured survivors’ PA levels over seven consecutive days using wrist accelerometery (GeneActiv). To identify PA behaviors, we used bouts of physical activity characterized by various intensities (low/moderate/vigorous) and durations (short/moderate/long), then used these as features to cluster survivors’ daily and hourly behaviors. Using logistic regression, we calculated the likelihood of survivors being in more active clusters adjusting for the potential effects of age, sex, and time since treatment completion.

Results: Thirty-seven survivors (aged 11.7 ± 3.0 years) engaged in mean 36.3 (SD = 19.0) min/day of moderate-to-vigorous physical activity (MVPA) and 4.1 (SD = 1.9) h/day of sedentary activity. Most survivors (86%) did not meet recommended PA guidelines (≥60 min/day). On average, survivors achieved ≥60 min on 1.1 (1.5) days/week. We identified five clusters: (i) most active (prevalence 11%), (ii) active (22%), (iii) moderately active + moderately sedentary (35%), (iv) moderately active + high sedentary (5%), and (v) least active (27%). More frequent and sustained bouts of MVPA occurred on weekdays (13:00, 15:00, and 17:00) and prolonged sedentary activity occurred on weekends (8:00, 13:00, and 14:00). Younger survivors and those with less time since treatment completion were more likely to be active.

Conclusions: Many survivors are physically inactive, exacerbating their cardiometabolic risk further. Our approach provides an insightful analysis into the transient nature and timing of survivors’ movement behaviors. Our findings may help to develop targeted interventions to alter patterns of PA and sedentary behaviors in survivors.

Grace Joshy¹, Saman Khalatbari-Soltani², Kay Soga¹, Phyllis Butow³, Rebekah Laidsaar-Powell³, Bogda Koczwara⁴, Nicole M Rankin^2,5, Sinan Brown¹, Marianne Weber⁶, Carolyn Mazariego⁷, Paul Grogan⁶, John Stubbs⁸, Stefan Thottunkal¹, Karen Canfell⁶, Fiona Blyth², Emily Banks¹

¹National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia

²Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

³Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, Australia

⁴Flinders University and Flinders Medical Centre, Adelaide, SA, Australia

⁵Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

⁶The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia

⁷The University of New South Wales, Sydney, NSW, Australia

⁸Independent Cancer Consumer Advisor, Sydney, NSW, Australia

Background: Pain is a common, debilitating, and feared symptom, including among cancer survivors. However, large-scale population-based evidence on pain and its impact in cancer survivors is limited. We quantified the prevalence of pain in community-dwelling people with and without cancer, and its relation to physical functioning, psychological distress, and quality of life (QoL).

Methods: Questionnaire data from participants in the 45 and Up Study (Wave 2, n = 122,398, 2012–2015, mean age = 60.8 years), an Australian population-based cohort study, were linked to cancer registration data to ascertain prior cancer diagnoses. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for bodily pain and pain sufficient to interfere with daily activities (high-impact pain) in people with versus without cancer, for 13 cancer types, overall and according to clinical, personal, and health characteristics. The relation of high-impact pain to physical and mental health outcomes was quantified in people with and without cancer.

Results: Overall, 34.9% (5436/15,570) of cancer survivors and 31.3% (32,471/103,604) of participants without cancer reported bodily pain (PR = 1.07 [95% CI = 1.05–1.10]), and 15.9% (2468/15,550) versus 13.1% (13,573/103,623), respectively, reported high-impact pain (PR = 1.13 [1.09–1.18]). Pain was greater with more recent cancer diagnosis, more advanced disease, and recent cancer treatment. High-impact pain varied by cancer type; compared to cancer-free participants, PRs were: 2.23 (1.71–2.90) for multiple myeloma; 1.87 (1.53–2.29) for lung cancer; 1.06 (.98–1.16) for breast cancer; 1.05 (.94–1.17) for colorectal cancer; 1.04 (.96–1.13) for prostate cancer; and 1.02 (.92–1.12) for melanoma. Regardless of cancer diagnosis, high-impact pain was strongly related to impaired physical functioning, psychological distress, and reduced QoL.

Conclusions: Pain is common, interfering with daily life in around one-in-eight older community-dwelling participants. Pain was elevated overall in cancer survivors, particularly for certain cancer types, around diagnosis and treatment, and with advanced disease. However, pain was comparable to population levels for many common cancers, including breast, prostate and colorectal cancer, and melanoma.

Claire Munsie^1,2,3, Jay Ebert², David Joske^3,4, Jo Collins^1,3, Tim Ackland²

¹WA Youth Cancer Service, Nedlands, Western Australia, Australia

²School of Human Science, The University of Western Australia, Perth, Western Australia, Australia

³Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

⁴School of Medicine, The University of Western Australia, Perth, Western Australia, Australia

Purpose: Adolescents and young adults (AYAs) experience vast symptom burden resulting from cancer treatment-related toxicities (TRTs). Evidence supports integrated exercise to mitigate several TRTs in other cohorts; however, evidence in AYAs is lacking.¹ Conventional reporting of TRTs adopts a maximum grade approach failing to recognize the trajectory over time, of persistent, or lower grade toxicities. Alternatively, longitudinal analysis of toxicities over time (ToxT)2 may provide clinically meaningful summaries of this data. We evaluated the longitudinal impact of an exercise intervention on TRTs in AYAs undergoing cancer treatment.

Methods: A prospective, randomized trial allocated participants to a 10-week exercise intervention (EG) or control group (CG) undergoing usual care. Detailed information on TRTs was collected throughout the intervention. All TRTs were graded per the Common Terminology Criteria for Adverse Events (CTCAE v5.0).

Results: Forty-three participants (63% male, mean age 21.1 years) were enrolled. When categorized to reflect the maximal worst grade experienced (Grade 0, Grade 1–2, and ≥Grade 3), the CG reported an increased incidence of severe fatigue (≥Grade 3) compared with the EG (p = 0.05). No other differences between groups were evident (p > 0.05). ToxT analysis of the four most common toxicities (fatigue, pain, nausea, and mood disturbances) demonstrated no difference in the mean grade of each over time (p > 0.05). Additionally, area under the curve (AUC) analysis revealed trends toward a higher magnitude of fatigue (mean AUC 12.5 vs. 11.1, p = 0.11) and mood disturbances (mean AUC 7.2 vs. 5.7, p = 0.28) over time in the CG. No differences were evident for pain and nausea between groups (p > 0.05).

Eli Ristevski¹, Michael Leach², Koku Sisay Tamirat¹, Mahesh Iddawela^3,4,5,6,7

¹School of Rural Health, Monash University, Warragul, Victoria, Australia

²School of Rural Health, Monash University, Bendigo, Victoria, Australia

³Gippsland Regional Integrated Cancer Service, Traralgon, Victoria, Australia

⁴Latrobe Regional Hospital, Traralgon, Victoria, Australia

⁵Medical Oncology, Alfred Health, Melbourne, Victoria, Australia

⁶School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia

⁷School of Rural Health, Monash University, Traralgon, Victoria, Australia

Aims: To examine the level of and factors associated with financial toxicity (FT) in rural cancer survivors.

Methods: We conducted a facility-based cross-sectional study among cancer survivors who had medical oncology follow-up over 2017–2019 at a regional hospital in Gippsland, Victoria, Australia. Eligible participants had completed curative treatment for lymphoma, breast, prostate, or colorectal cancer. Participants self-completed instruments measuring FT (COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy [COST-FACIT]), health-related quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]), distress (NCCN Distress Thermometer), and supportive care needs (NCCN Problem List). Non-normally distributed COST-FACIT scores were dichotomized at the median (32), for use as an FT outcome in logistic regression.

Results: Overall, 267 cancer survivors were eligible and 208 completed the COST-FACIT. Of 208 participants, most were female (65%), married (54%), had breast cancer (56%), had a concession card (79%), and retired (55%). The mean (standard deviation [SD]) COST-FACIT score was 31.0 (9.7) on a scale of 0–44, where higher scores denote better financial wellbeing. The highest mean item-specific COST-FACIT score of 3.3 (1.1) out of 4 was observed for unconcern about keeping my job while the lowest mean (SD) item-specific COST-FACIT scores of 2.3 (1.5) and 2.3 (1.6) were observed for satisfaction with one's financial situation and control of financial situation, respectively. Additionally, the overall FACT-G score was positively correlated with COST-FACIT score (r = .507, p-value < 0.001). Family problems (adjusted odds ratio [aOR] = 4.63, 95% confidence interval [CI] = 1.44–15.59) and non-retired (aOR = 3.45, 95% CI = 1.08–11.02) were associated with significantly greater FT (i.e., COST-FACIT scores ≤32). Factors unrelated to FT in multivariable logistic regression included age, born overseas, <year 12 education, gender, marital-status, cancer-type, and having a carer.

Conclusion: Greater FT was associated with non-retirement status and family problems. Rural cancer survivors have unmet, interrelated financial and supportive care needs.

Eva YN Yuen^1,2, Carlene Wilson^3,4,5, Trish M Livingston^2,6, Victoria M White⁷, Vicki McLeod¹, Polly Dufton⁸, Alison M Hutchinson^2,9

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

⁶Faculty of Health, Deakin University, Burwood, VIC, Australia

⁷School of Psychology, Deakin University, Burwood, VIC, Australia

⁸Department of Nursing, University of Melbourne, Parkville, VIC, Australia

⁹Barwon Health, Geelong, VIC, Australia

Aims: Research shows that health literacy and social connectedness contribute to overall health and wellbeing across chronic disease and general populations (1–3), yet few studies have explored their influence on the psychological wellbeing of caregivers. The aim of this study was to examine the relationship between caregiver and care recipient health literacy, social connectedness, and social support on caregiver psychological morbidity in a cancer context.

Methods: A total of 125 caregiver-cancer care recipient dyads completed this cross-sectional survey. Surveys completed included: Health Literacy Survey-EU-Q16 (4), Social Connectedness Scale-Revised (5), the Medical Outcomes Study–Social Support Survey (6), and the Depression, Anxiety and Stress Scale-21 (DASS21) (7). Hierarchical multiple regression with care recipient factors entered at Step 1 and caregiver factors at Step 2 was conducted to examine their impacts on the psychological wellbeing (DASS21 total score) of caregivers.

Results: Caregivers predominantly provided care to their spouse (69.6%) with a diagnosis of breast (46.4%), gastrointestinal (32.8%), lung (13.6%), or genitourinary (7.2%) cancer.

Caregivers reported depression and stress scores in the normal range, and mild anxiety (M = 4.02 [SD = 4.07], M = 2.7 [SD = 3.64], and M = 5.48 [SD = 4.24], respectively), with a mean total DASS21 score of 24.38 (SD = 22.48). Regression analyses revealed that only caregiver factors (age, illness/disability, health literacy, and social connectedness) were independent predictors of caregiver psychological morbidity (F[10,114] = 18.07, p < .001).

Conclusion: Caregiver, but not care recipient, factors were found to impact the psychological wellbeing of caregivers. Although both health literacy and social connectedness were found to impact the psychological outcomes of caregivers, perceived social connectedness had the greatest influence. Strategies and resources to optimize health literacy in cancer caregivers, as well as facilitating skills to ensure the development and maintenance of social connection when providing care, have the potential to enhance adequate psychological wellbeing in cancer caregivers.

Jennifer Cohen¹, Lauren M Touyz¹, Paayal Gohill¹, Amy Lovell², Kristin Mellett³, Claire E Wakefield¹

¹School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW, Sydney, Randwick, NSW, Australia

²Nutrition & Dietetics, School of Medical Sciences, Starship Child Health, Auckland, Aotearoa

³Nutrition & Dietetics, Monash Children's Health, Melbourne, Victoria, Australia

Aims: Cancer treatment affects a child's food preferences and eating habits leading to poor dietary intake and higher rates of fussy eating than their peers after treatment. Poor dietary habits in childhood cancer survivors (CCS) can increase their risk of increased morbidity and early mortality due to obesity and metabolic syndrome as adults. We aimed to assess the feasibility, acceptability, and efficacy of a hybrid online & telehealth parent-led program (Reboot) to improve the dietary intake of CCS early after treatment completion.

Method: This study was a mixed methods wait-list randomized controlled trial. Participants (n = 73) were parents of CCS aged 2–16 years old. Participants completed the Reboot intervention: three online learning modules and three telehealth support calls, addressing strategies to manage fussy eating and improve fruit and vegetable intake. Using a pre–post survey, participants dietary intake, self-efficacy, and program acceptability were assessed. End of program interviews were conducted to assess in-depth parental views of their experiences with Reboot.

Results: There was an increase in children's fruit serves (2–2.9), and vegetable serves (1.6–2.1) from baseline to post program with higher intakes of both fruit (2.9 vs. 2) and vegetable (2.1 vs. 1.6) serves compared to control group, post-program. There was a 56% increase in parents post-program reporting confidence in managing their child's eating habits compared with no change in the control group. Parents reported positive behavior change following the program, including increased variety in children's diet including fruits and vegetables, increased confidence to introduce and try new foods, and cooking together as a family. There was high acceptability with the program with 96% of parents rating the quality of information as high.

Conclusion: Reboot was positively received by parents of CCS and led to promising improvements in children's dietary intake and parent confidence in managing their child's eating habits post-treatment.

Prue Cormie^1,2, Peter Martin³, Meg Chiswell³, Ashleigh Bradford¹, Chris Doran⁴, Boyd Potts⁴, Mei Krishnasamy^1,2,5

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²University of Melbourne, Melbourne, VIC, Australia

³Deakin University, Melbourne, VIC, Australia

⁴Central Queensland University, Brisbane, QLD, Australia

⁵Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia

Aim: To explore enablers to exercise conversations among cancer health professionals.

Methods: Multidisciplinary healthcare professionals delivering clinical care to people with cancer were invited to take part in online questionnaire, semi-structured interviews, and clinical communication workshops. Health professionals who directly provide exercise services were excluded. Questionnaire and interviews explored health professional information and resource needs to facilitate exercise recommendations. Communication workshops explored training needs to overcome challenges in discussing exercise. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were analyzed using interpretive description analysis framework.

Results: Participants were aged 48 ± 11 years, 84% female, and 68% nurses. A total of 383 participants responded to an online questionnaire, 31 to semi-structured interviews, and 18 took part in clinical communication workshops. Top ranked resources that facilitated health professional exercise discussions included having referral options for exercise services (91%), and having a quick, simple referral process (91%). Information on tailoring exercise discussions according to performance status (86%), different symptoms (78%), exercise delivery options (77%), and people who have never exercised (74%) were identified as opportunities to enable exercise discussions. Seventy-four percent of health professionals said they would routinely use exercise evidence summaries with patients, while 74% said that information on the cost of exercise services would help routine discussion. Common communication challenges focused on how to introduce exercise into consultations, provide personalized recommendations, explore difficulties of exercising, and develop a shared decision on plan of action, within time constrained consultations.

Conclusions: Oncology health professionals recognize mitigable barriers to routinely using exercise as part of usual care. Pragmatic solutions include: low-burden referral options to cancer-specific exercise services, evidence-based information summaries, information to help tailor the exercise discussion, and information on the cost of exercise. These data are informing the development of co-designed strategies and tools to support clinician-patient conversations about exercise as a component of routine clinical-practice.

Suzanne Grant¹, Mayra Ouriques², Abhijit Pal^1,3,4, Sharon Lee⁵, Sheetal Challam², Lindsey Jasicki², Tracey O'Brien²

¹Western Sydney University, Sydney, NSW, Australia

²Cancer Institute NSW, Sydney, NSW, Australia

³Liverpool Hospital and Bankstown Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia

⁴University of Sydney, Sydney, NSW, Australia

⁵Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia

Aims: People with cancer from culturally and linguistically diverse (CALD) backgrounds who are not proficient in English face challenges accessing clinical trials (CT). Lack of diversity can limit the validity of CT findings when applied to real-world settings and contribute to disparities in cancer outcomes in minority populations.

Lack of trained healthcare interpreters (HCI) is a recognized barrier to CT access for patients not proficient in English. There is no specific training in CT or research terminology for HCI.

This two-phase study was conducted to build workforce capability for HCI in cancer CT.

Methods: Phase 1: Subject matter experts and NSW HCI sector managers co-designed a survey to identify knowledge and skill gaps. An anonymous survey (Qualtrics) was sent to approximately 700 HCI in NSW.

Phase 2: Training comprised five sections about CT (basic concepts, governance and ethics, phases, informed consent, and role of interpreters) using videos, polls, and discussions. A pre- and post-training assessment was used to measure the effectiveness of the training.

Statistical analysis used descriptive statistics and t-tests.

Results: In Phase 1, 133 (19%) HCI responded to the initial survey, with most responders (79%) working as HCI > 10 years. CT interpreting experience was limited (43% not interpreting for a CT in the past year). Mean knowledge accuracy was 71%, with uncertainty/lack of knowledge of CT concepts such as randomization, phases, ethics and governance, and clinical trial sponsors.

In Phase 2, 92 interpreters attended in-person or online training. The assessment found training increased mean accuracy knowledge about CT from 75% to 92%, and confidence in understanding CT terminology increased from 20% to 62%.

Discussion: Training improved HCI knowledge and confidence in cancer CT, which may benefit CALD patients considering a CT. Training modules will be available online for ongoing use.

Ella Sexton¹, Hannah Ray², Jacqui Frowen^2,3, Karla Gough^3,4,5, Wendy Poon⁶, Shannon Turnbull⁷, Shaza Abo⁸, Michael Barton⁹, Jenelle Loeliger^2,10, Maria Ftanou^1,3

¹Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia

⁴Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁵Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia

⁶Nurse Consultant Head & Neck Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁷Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁸Physiotherapy & Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁹Western & Central Melbourne Integrated Cancer Services, Melbourne, VIC, Australia

¹⁰School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

Aims: Radiotherapy for patients with head and neck cancer (HNC) is associated with significant physical impacts and high rates of distress. This study aimed to (1) develop a stepped model of prehabilitation care (Prep-4-RT) designed to prepare HNC patients for the physical and psychological impacts of radiotherapy, including the co-design of self-management prehabilitation resources; and (2) evaluate the feasibility and acceptability of Prep-4-RT in clinical practice.

Methods: The research team developed the Prep-4-RT model of care, including conducting three co-design workshops with consumers and health professionals to develop and assess acceptability of the prehabilitation self-management resources. Then, a single site feasibility study was conducted over 24-weeks with HNC patients scheduled for radiotherapy. All patients received self-management resources and were screened for malnutrition, dysphagia, sarcopenia, physical impairment, and mental health concerns. At-risk patients were stepped-up/referred for specialist prehabilitation with relevant health professionals. Patients and health professionals completed program evaluation surveys. Feasibility outcomes included adoption (uptake and intention to try), acceptability, and satisfaction.

Results: Twenty-one consumers and health professionals reached a consensus and developed and endorsed a suite of self-management resources on five priority areas. For the feasibility study, the majority of patients consented to screening (65/68, 96%; uptake), with 38 of those consented, assigned to specialist prehabilitation and 93% of valid specialist referrals accepted (intention to try), exceeding our feasibility criterion of 70%. Of those patients who completed the acceptability and satisfaction surveys (n = 33 and n = 29 respectively), 100% rated Prep-4-RT self-management and specialist prehabilitation pathways as acceptable/very acceptable and mostly/very satisfied. Nine of 10 health professionals rated Prep-4-RT as acceptable/very acceptable and rates of self-reported acceptability and satisfaction also exceeded pre-specified feasibility criterion (≥70%).

Conclusions: The Prep-4-RT stepped-care model is a feasible and acceptable model of prehabilitation for HNC patients prior to radiotherapy. Further evaluation is required to determine its impact on clinical and health service outcomes.

Jessica Nash^1,2, Emily Stone^3,4, Shalini Vinod^5,6, Tracy Leong⁷, Paul Dawkins⁸, Rob Stirling^9,10, Fraser Brims^1,11

¹Curtin Medical School, Curtin University, Perth, Western Australia, Australia

²Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

³Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia

⁴School of Clinical Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia

⁵Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia

⁶South Western Sydney Clinical School, University of NSW, Liverpool, New South Wales, Australia

⁷Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia

⁸Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand

⁹Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia

¹⁰Central Clinical School, Monash University, Melbourne, Victoria, Australia

¹¹Institute of Respiratory Health, Perth, Western Australia, Australia

Aims: Disparity and inequity in lung cancer care have been repeatedly described in Australia and New Zealand. Quality indicators are an effective tool to systematically identify unwarranted variation in practice, however, are not routinely measured in Australasia. The study aim was to develop clinical quality indicators (CQIs) applicable to lung and other thoracic cancers, to serve as a basis for future quality improvement initiatives.

Methods: A three-round modified electronic Delphi consensus process was performed. Expressions of interest were sought from clinicians, patient advocates, and researchers. The first two rounds were conducted as online surveys using REDCap, with candidate CQIs rated on a 7-point Likert scale. The final round was a hybrid (in-person and virtual) discussion meeting, with voting conducted using an online platform (Slido). Consensus was set at 70% throughout.

Results: Participants were medical practitioners, patient advocates, researchers, and specialist nurses, with representation from all Australian states and territories, and New Zealand. Clinical disciplines represented included Medical Oncology, Palliative Care, Pathology, Radiology, Radiation Oncology, Respiratory Medicine, and Thoracic Surgery.

In Round 1, 79 participants evaluated 57 CQIs; in Round 2, 63 participants evaluated 60 CQIs; and in Round 3, 23 participants evaluated 44 CQIs. On completion, 27 CQIs reached consensus, covering the continuum of lung cancer care: referral and diagnostic investigations (10 CQIs), performance status, staging, and multidisciplinary team review (4), supportive care (1), treatment (10), and mortality (2). The indicator set includes CQIs relevant to all thoracic malignancies (8 CQIs), all lung cancer (6), non-small cell lung cancer (9), small cell lung cancer (3), and mesothelioma (1).

Conclusion: A modified eDelphi consensus process successfully established 27 CQIs to support the holistic evaluation of the quality of thoracic oncology care in Australia and New Zealand. Implementation will now be performed as part of the Lung Cancer Clinical Quality Data Platform project.

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 synthesized 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 utilized 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 specialized training; however, P/Cs preferred face to face counselling while HP/Rs favored 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.

Shom Goel

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

The steady, incremental improvements in outcomes for both early stage and advanced breast cancer patients are, in large part, attributable to the success of novel systemic therapies. In this talk, I will discuss key conceptual paradigms that have underpinned this success including (1) targeting the driver: the identification and targeting of major oncoproteins in breast cancers; (2) targeting the lineage pathway: inhibition of those pathways that drive normal mammary epithelial cell proliferation that retain importance in cancer; (3) targeting precisely: the application of molecular classifiers to refine therapy selection for specific cancers, and of antibody-drug conjugates to pinpoint tumor and tumor promoting cells for eradication; and (4) exploiting synthetic lethality: leveraging unique vulnerabilities that cancer-specific molecular alterations induce. I will describe some promising examples of novel therapies that have been discovered within each of these paradigms and suggest how future drug development efforts might benefit from the continued application of these principles.

Stephen Luen

Peter MacCallum Cancer Centre, Glen Iris, VIC, Australia

In this educational session, there will be a discussion about our current understanding of the genomic landscape of breast cancer. This will include what a genomic alteration or aberration is, what different types of genomic alterations exist, what tests can be used to identify them, and what findings we might expect in breast cancer. Finally, there will be a commentary on the clinical relevance of genomic alterations in breast cancer, and whether this type of testing should be considered as part of routine care now and in the future.

Kerry Patford, Olivia Cook, Jane Mahony, Jenny Gilchrist, James Townsend

Nursing Program Team, McGrath Foundation, North Sydney, NSW, Australia

Research has identified the need for greater supportive care for people affected by metastatic breast cancer, recognizing that they experience complex unmet supportive care needs. Since 2010 the McGrath Foundation has funded and placed 43 new breast care nurse positions across the Australia dedicated to the care of people with metastatic breast cancer. In this presentation, we will report on the impact and contribution of metastatic McGrath breast care nurses (mMBCNs) across Australia to date. We will also share the comprehensive professional development and support program offered to mMBCNs to enable them to provide complex care to people with metastatic breast cancer and contribute meaningfully to the MDT. A content analysis of activity reported by the mMBCNs between 2010 and 2023 was conducted to identify the impact, reach and categorization of care provided by the mMBCNs. Descriptive statistics were applied to analyze data by type of care provided, time period, jurisdiction, and episodes of care. In the first half of 2023, mMBCNs delivered over 25,000 episodes of care and collectively admitted over 1500 new patients to their services. We know that as emerging treatment options continue to extend the survival for people with metastatic breast cancer, the need for specialist nursing care will continue to increase. The care provided by mMBCNs can be broadly categorized as education, psychosocial support, clinical care, and care coordination. To ensure that mMBCNs are well prepared and supported in their roles the McGrath Foundation provides clinical supervision; experiential learning through practicum placements and robot assisted learning; comprehensive online learning modules, clinical leadership; and conference attendance and in-person workshops. Support is also required from oncology teams to fully integrate and utilize mMBCN roles to their full potential. Development of a dedicated model of care for metastatic disease is planned to support the full integration of mMBCN roles into multidisciplinary care.

Steven David

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

This presentation will discuss oligometastatic and oligoprogressive breast cancer and the rationale for different treatment paradigms and strategies. An overview of the evidence supporting these approaches will be presented with a particular focus on stereotactic ablative body radiotherapy (SABR) as a treatment strategy. The importance of integrating locally ablative therapies with systemic therapy will be discussed an overview of future directions will be presented.

David Speakman

Peter MacCallum Cancer Institute, Melbourne, VIC, Australia

Content not available at time of publishing.

Barbara Hayes

Northern Health, Heidelberg, VIC, Australia

Content not available at time of publishing.

Aaron K Wong¹, Andrew A Somogyi², Pal Klepstad³, Justin Rubio⁴, Sara Vogrin⁵, Brian Le¹, Jennifer Philip⁵

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²University of Adelaide, Adelaide, Australia

³St. Olavs University Hospital, Trondheim, Norway

⁴Florey Institute of Neuroscience & Mental Health, Melbourne, Australia

⁵University of Melbourne, Melbourne, Australia, Australia

Background: Pharmacogenomics is increasingly important to guide objective, safe, and effective individualized prescribing. Opioids, the gold standard for cancer pain relief, are among the commonest medications prescribed in palliative care practice. The influence of pharmacogenomics on opioid response has been increasingly studied, but most of these are in a non-cancer context.

Aims: We aimed to examine the effects of 36 gene variants in advanced cancer to examine associations with pain scores, opioid dose, and adverse effects.

Methods: This Australian-first multi-centre Opioid Pharmaogenomics (OPPtiC) study recruited patients receiving opioids for advanced cancer pain. Clinical data (demographics, opioids), validated instruments (pain and adverse effects), and blood (DNA, opioid pharmacokinetic data) were collected. Univariate and multivariate logistic regression was used to evaluate associations between clinical outcomes (opioid dose, pain, and adverse effects), and genotypes of interest.

Results: Fifty-four participants were recruited to the study. Observations on statistically significant associations between gene variants and outcomes of interest will be described, particularly with relating to receptor genes (DRD2, HTR2A, OPRM1, OPRD1), neuroimmune activation pathway genes (ARRB2, BDNF, COMT, IL2, IL6R, MYD88, STAT6, TLR4), and other genes (NF1B, RHBDF2, SLC6A4). The relationship between CYP2D6, oxycodone pharmacokinetics, and the study outcomes will also be discussed.

Conclusions: The presence of certain gene variants was observed be associated with clinically and statistically significant differences in opioid dosing, pain scores, and adverse effect outcomes in people with advanced cancer pain.

Natalie Ngan

Melbourne Institute of Plastic Surgery, Richmond, Victoria, Australia

Content not available at time of publishing.

Gillian Farrell

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Content not available at time of publishing

Cheng Hean Lo

Western Health, St Albans, Victoria, Australia

Gender dysphoria may be defined as discomfort or distress that is caused by a discrepancy between a person's gender identity and their sex assigned at birth. Treatment is individualized and may involve changes in gender expression or physical modifications. Psychological therapy, hormonal therapy, voice and communication therapy, social support, and surgery are some of the treatment modalities available.

Chest reconstruction surgery is sought after and frequently performed in the female-to-male transgender community, helping individuals to live in their affirmed gender with safety and confidence. This presentation will present an overview of gender dysphoria, and pre-operative and post-operative issues relevant to chest reconstruction surgery. Most commonly asked questions regarding surgery will also be addressed.

Victoria Gurvich

BCNA, Melbourne, Victoria, Australia

People diagnosed with breast cancer require information that is accurate, evidence-based, and timely. This is true for breast reconstruction, where there are also disparities in access and waiting times in different parts of the country and due to cost factors.

How many surgeries will I need and in what order will they take place? What is a tissue expander? How do I navigate confronting conversations with young children? How do I make sense of medical appointments that feel like a blur, whilst managing extreme fatigue? “Are you back to normal now?” “Don't raise your arms beyond 90 degrees.”

Victoria will outline some of her lived experiences, fears, and some happier outcomes during her “journey” with breast cancer, from the shock of diagnosis through to reconstruction.

Naveena Nekkalapudi

Consumer Representative, Melbourne, VIC, Australia

Maintaining a patient's quality of life during and posttreatment needs to take into consideration their sexual health and wellbeing. Patients find it difficult to discuss sex and sexuality as it remains a taboo subject for many individuals (especially in a multicultural society like Australia). They privately muse about their symptoms and often dismiss them, thinking they alone face these issues. In addition, they receive mixed messages from health professionals, family, and friends, peers, and other sources about the options available to alleviate the severity of the symptoms.

This session will draw upon the lived experience of the speaker as well as her fellow consumer representatives from BCNA, to dispel myths and propose ways in which the sexual health and well-being of patients can be improved.

Eliza Bailey

Peter MacCallum Cancer Centre, Coburg North, VIC, Australia

How do we discuss sexuality with our patients if we don't even know what it is and how it differs from sexual health? Sexuality is widely spoken about but remains somewhat of an elusive concept. The definition will be explored alongside the use of sex positivity as a framework to initiate, conduct and respond compassionately in conversations about sexuality with cancer patients and survivors.

Every non-judgemental conversation requires an attitude of sex positivity, the belief that all people have a right to engage in pleasurable, consensual and shame free sexual activity, with themselves and others, in a way that is right for them. Sex positivity also acknowledges every persons right to adequate sex education, an understanding of sexual health and treatment related causes of dysfunction. Implementing attitudes and practises from sexology and psychotherapy into our interpersonal skill set will complement the application of communication frameworks. The goal being to create a comfortable environment for your patient to honestly share their questions, concerns and real life experiences.

Wendy Vanselow

Royal Women's Hospital, Parkville, VIC, Australia

Content not available at time of publishing.

Safeera Y Hussainy

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Anti-cancer therapies can cause severe sexual dysfunction, such as libido, body confidence, genital dysfunction, and erectile dysfunction. Whilst these side effects can cause high levels of distress that impact partnered relationships, self-esteem, and quality of life, they are not readily discussed by health professionals who are focused on concerns such as nausea, pain, and fatigue. Patients want health professionals to discuss sex, sexuality, and sexual health at diagnosis, during treatment and after treatment into survivorship, yet there are barriers to conversation, and consequently assessment, referral, and documentation, such as confidence and comfort.

In this presentation, A/Prof Safeera Hussainy will highlight the common sexual health side effects of anti-cancer therapies across tumor streams, their pharmacological management, and counselling tips for pharmacists and other health professionals using established person-centered communication frameworks.

Dilanka L De Silva^1,2, Anita R Skandarajah^1,3, Lisa Devereux^1,4, kirsten Hogg⁵, Maira Kentwell², Allan Park³, Luxi Lal^3,4,6, Magnus Zethoven⁴, Madawa W Jayawardena^1,4, Fiona Chan⁷, Paul A James^1,2,3,4, Bruce Mann^1,3,8, Geoffrey J Lindeman^1,4,2,6, Ian Campbell^1,4

¹The University of Melbourne, Melbourne, VIC, Australia

²Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia

³The Royal Melbourne Hospital, Melbourne, VIC, Australia

⁴Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁵Murdoch Children's Research Institute, Melbourne, VIC, Australia

⁶Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia

⁷The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia

⁸Royal Women Hospital, Melbourne, VIC, Australia

Background: Identification of germline mutations in hereditary breast cancer (HBC) genes can impact breast cancer (BC) therapy and risk management of family members. In addition, tumor sequencing can reveal clinically relevant somatic features, such as homologous recombination deficiency (HRD) and mutational signatures, which are not discernible by germline sequencing that can further inform treatment decisions.

Methods: A total of 650 consecutive patients presenting with non-metastatic BC (invasive BC, high-grade DCIS, and pleomorphic LCIS) were recruited in two phases between June 12, 2020 and March 22, 2023. In phase one, 157 participants underwent combined germline and somatic whole genome sequencing (WGS) while for phase two, 495 participants underwent only germline whole exome sequencing.

Pathogenic variants were interrogated in BRCA1, BRCA2, PALB2, ATM, CHEK2, BARD1, BRIP1, RAD51B, RAD51C, RAD51D, MLH1, MSH2, MSH6, PMS2, CDH1, PTEN, STK11, TP53, and NTHL1. HRD score was calculated using HRDetect (Nat Med. 2017;23:517). For BCs showing a high HRDetect score (>.75), all HBC gene promoter CpG islands were assessed for hypermethylation using the Twist NGS Methylation system. Mutational signatures were calculated from somatic mutations identified from whole genome sequenced BCs using the DeconstructSig package in R (Genome Biol. 2016;17:31).

Results: All BRCA1, BRCA2, and PALB2 mutation positive tumors demonstrated high HRDetect scores, indicative of a role in pathogenesis, while a PMS mutation positive tumor exhibited a low HRD score, suggestive of a “passenger” mutation. In phase one participants without a germline pathogenic variant, 16% (18/117 invasive and 3/13 DCIS) had an HRDetect score of >.7 indicative of an HR defect and potentially “BRCA-like”.

Conclusion: Tumor sequencing confirmed HBC genes that were “driver” mutations and identified three times as many cases than germline testing alone (16% vs. 5.4%) who might be eligible for HR repair defect targeted therapy.

Ashish Banerjee¹, Reid M Groseclose², Jeremy A Barry², Tinamarie Skedzielewski², Gerald McDermott², Chakravarthi Balabhadrapatruni², William Benson², Yongle Pang², David K Lim², Hoang Tran², Mike Ringenberg², Keyur Gada³, Amine Aziez⁴, Elaine Paul⁵, Hasan Alsaid²

¹GSK, Melbourne, Australia

²GSK, Collegeville, Pennsylvania, USA

³GSK, Waltham, Massachusetts, USA

⁴GSK, Basel, Switzerland

⁵GSK, Raleigh, North Carolina, USA

Aims: There remains an unmet need to provide effective treatments for patients with primary and metastatic brain tumors; lack of drug penetration across the blood brain barrier is a key factor. Here, we evaluated brain penetration and distribution of niraparib and olaparib in a mouse brain tumor model.

Methods: Female mice (CrTac:NCr-Foxn1nu; 6 w/o) received 2.5E5 luciferase-transfected human breast cancer line (MDA 231-BRM2-831) via intracardiac injection. Mice were imaged twice/week using bioluminescence imaging (BLI) to monitor tumor growth. On day 35, mice with brain metastases (BM) were treated via oral gavage once daily for 5 days with niraparib (35 mg/kg, n = 4 BM, n = 3 control), olaparib (50 mg/kg, n = 3 BM, n = 3 control), or vehicle (n = 3 control). Terminal blood samples and brains were collected 2 h postfinal dose. Serial brain sections were collected for MALDI-IMS, H&E, and IHC staining from five distinct horizontal planes. Tissue between imaging planes was homogenized for LC-MS bioanalysis.

Results: Tumor presence was confirmed using ex vivo IHC. Quantitative MALDI-IMS of coronal brain sections from niraparib-administered mice showed consistent concentrations distributed throughout the parenchyma with locally higher concentrations detected from tumor regions. LC-MS and MALDI-IMS detected concentrations are summarized in Table 1. The estimated mean unbound brain-to-plasma partition coefficient (K_p,uu,brain) was 3.0x and 4.7x higher for niraparib compared to olaparib in control and BM mice, respectively.

Conclusions: Herein, we demonstrated that niraparib has a higher brain penetration and distribution compared with olaparib in both control mice and mice with BM.

 

Richard J Rebello¹, Tharani Sivakumaran², Clare Fedele³, Samantha Webb², Ruining Dong¹, Aidan Flynn¹, Wendy Ip¹, Georgia Scott², Shohei Waller², Owen Prall², Catherine Mitchell², Nadia Traficante², Camilla Mitchell¹, Joseph Vissers¹, Huiling Xu², Atara Posner¹, Alexander Caneborg¹, Shiva Balachander¹, Krista Fisher², Hui Li Wong², Ian M Collins⁴, Mark Warren⁵, Bo Gao⁶, Madhu Singh⁷, Christopher Steer⁸, Pei Ding⁹, Stephen Quinn¹⁰, Narayan Karanth¹¹, Anna Kuchel¹², Rachel Wong¹³, Zhen Siow¹³, Mark Shackleton¹⁴, Zee Wan Wong¹⁵, Louise Nott¹⁶, Shamsudeen Padinharakam¹⁷, Sarah Jane Dawson², Rodney Hicks¹⁸, David Bowtell², Andrew Fellowes², Stephen Fox², Louisa Gordon¹⁹, Oliver Hofman¹, Sean Grimmond¹, Penny Schofield¹⁰, Linda Mileshkin², Richard Tothill¹

¹University of Melbourne, Melbourne, Victoria, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³CSL Innovation, Melbourne, Victoria, Australia

⁴South West Healthcare, Warrnambool, Victoria, Australia

⁵Bendigo Cancer Centre, Bendigo Health, Bendigo, Victoria, Australia

⁶Westmead Private Hospital, Westmead, New South Wales, Australia

⁷Barwon Health Cancer Services, Barwon, Victoria, Australia

⁸Border Medical Oncology, Albury Wodonga Regional Cancer Centre, New South Wales, Australia

⁹Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia

¹⁰Swinburne University of Technology, Department of Health Science and Biostatistics, Melbourne, Victoria, Australia

¹¹Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, Australia

¹²Department of Medical Oncology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

¹³Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

¹⁴Department of Medical Oncology, Alfred Health, Melbourne; Central Clinical School, Monash University, Melbourne, Victoria, Australia

¹⁵Oncology Unit, Peninsula Health, Peninsula, Victoria, Australia

¹⁶Royal Hobart Hospital, Hobart, Tasmania, Australia

¹⁷Launceston General Hospital, Launceston, Victoria, Australia

¹⁸Department of Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia

¹⁹QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia

Introduction: Cancer of unknown primary (CUP) is a metastatic cancer that evades a primary site diagnosis and is the 6th most common cause of cancer-related death in Australia. CUP patients have difficulty in accessing precision treatments given tissue of origin (TOO) is often a prerequisite. Whole genome and transcriptome sequencing (WGTS) can help resolve a TOO and identify precision treatments in CUP, but requires validation in a real-world setting.

Study design: Molecular testing was applied to CUP patients from 12 Australian sites using gene-panel (Illumina TSO500) and/or WGTS. Patient eligibility included a standardized diagnostic work-up (ESMO guidelines). Patients were excluded if they had a poor ECOG (>2). Curated molecular reports were delivered to the treating physician and pathologists via a molecular tumor board. Diagnostic impact of testing was assessed by surveying pathologists and treating clinicians.

Results: We recruited 203 patients overs 18 months to the SUPER-NEXT study. For molecular testing, 90% of cases involved formalin-fixed paraffin embedded (FFPE) tissues; predominantly core tissue biopsies (81.5%). Fifty-three percent (107/203) were suitable for both WGTS and TSO500 cancer panel. Twenty-six percent (53/203) of cases were suitable for TSO500 only and 18% (36/203) received no test. Additional reportable variants were found by WGTS in 85.7% of cases receiving both tests. An algorithmic TOO classifier (CUPPA) was applied to WGTS data and predicted TOO with high-likelihood in 52% of cases. Based on pathologist surveys, a WGTS + CUPPA result impacted the diagnostic opinion for 80% (86/107) of cases and assisted single site TOO diagnosis in 64% (68/107) that received WGTS+CUPPA compared with only 38% (17/45) of cases receiving TSO500 only.

Conclusion: Clinical WGTS was possible in more than half of patients with CUP despite use of FFPE samples. WGTS was superior to TSO500 panel in resolving a cancer diagnosis. This data supports the utility WGTS as part of a histopathology work up for CUP patients.

Wei Zhao, Qian Liu

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Background: The accurate assessment of lateral pelvic lymph node (LPLN) metastasis (LPLNM) in preoperative examination data of rectal cancer patients is vital to identify those who would benefit from LPLN dissection (LPLD). Our objective was to develop an MRI-based radiomics model for individual preoperative prediction of LPLNM in patients with locally advanced rectal cancer.

Methods: We retrospectively enrolled 263 patients with rectal cancer who underwent total mesorectal excision and LPLD at our center between April 2015 and September 2022. Radiomics features from the primary lesion and LPLNs on baseline MRI images were utilized to construct a radiomics model with feature selection based on the minimal-redundancy-maximal-relevance criterion. The radiomics scores of the primary tumor and LPLNs were then combined to develop a radiomics scoring system. A clinical prediction model was developed using logistic regression. A hybrid predicting model was created through multivariable logistic regression analysis, integrating the radiomics score with significant clinical risk factors (baseline CEA, clinical circumferential resection margin status, and the short axis diameter of LPLN). This hybrid model was presented with a hybrid clinical-radiomics nomogram, and its calibration, discrimination, and clinical usefulness were assessed. The study protocol was registered on clinicaltrials.gov (NCT04850027).

Results: A total of 148 patients were included in the analysis and randomly divided into a training cohort (n = 104) and an independent internal testing cohort (n = 44). The hybrid clinical-radiomics model exhibited the highest discrimination, with an AUC of .843 (95% confidence interval, .706–.968) in the testing cohort compared with the clinical model and radiomics model. The hybrid prediction model also demonstrated good calibration, and decision curve analysis confirmed its clinical usefulness.

Conclusion: This study developed a hybrid MRI-based radiomics model that incorporates a combination of radiomics score and significant clinical risk factors. The proposed model holds promise for individualized preoperative prediction of LPLNM in patients with locally advanced rectal cancer.

Xiaohe Zhou, Chengdong Wu

Medical School of Southeast University, Nanjing, China

Background: Neutrophil extracellular traps (NETs) are involved in the progression and metastasis of a variety of malignancies. Our previous studies have confirmed that tumor cell-released autophagosomes (TRAPs) induced immunosuppression TME formation. However, it remains to be investigated whether TRAPs-treated neutrophils contribute to the metastatic colonization of the lungs by tumor cells. To explore TRAPs induced neutrophils to form NETs and its regulatory mechanism of tumor metastasis, providing possible targets for disease treatment.

Methods: NETs were observed by scanning electron microscopy (SEM) and Confocal Microscope. Western blot and ELISA were used to quantify MPO-DNA, NE, and cit-H3 which are important components of NETs. In vivo, TRAPs were injected into the tail vein of mice and Beclin1 knockdown 4T1 tumor cells engineering to reduce TRAPs release were injected into mice subcutaneously. The characteristic molecules of NETs in plasma were detected. The study used antibody blocking assays to identify key DAMPs on the surface of TRAPs. Flow cytometry was used to evaluate T cell and lung infiltrating T cell function, as well as to monitor late lung metastases in neutrophils treated with TRAPs suppressor.

Results: Numerous reticular structures significantly increased in the cell culture supernatant after TRAPs treatment. In vivo, NETs were significantly increased in plasma after tail vein injection of TRAPs as well as in 4T1 tumor-bearing mice. Conversely, NETs were significantly decreased in the plasma of Beclin1 knockdown 4T1 tumor-bearing mice. TRAPs derived from breast tumor cell lines induced neutrophil formation of NETs via the HMGB1-TLR4-MyD88-ERK/p38 pathway. This process inhibited the proliferation and secretion of IFN-γ in CD4+ and CD8+ T cells, ultimately leading to increased lung metastasis.

Conclusions: TRAPs promote breast cancer lung metastasis by modulating neutrophil extracellular traps formation. Overall, these findings define a novel mechanism mediated by TRAPs in neutrophils, which may suppress anti-tumor T cell immunity and highlight TRAPs as an important target for future tumor immunotherapy.

Daniel D Buchanan^1,2, Peter Georgeson¹, Khalid Mahmood^1,3, Jihoon E Joo¹, Romy Walker¹, Kristy P Robledo⁴, Michelle M Cummins⁴, Amanda B Spurdle⁵, Deborah Smith⁶, Mark Clendenning¹, Julia Como¹, Susan Preston¹, Sonia Yip⁴, John Andrews⁴, Peey-Sei Kok⁴, Yeh Chen Lee⁴, Martin R Stockler⁴, Linda Mileshkin⁷, Yoland C Antill^8,9

¹Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne, VIC, Australia

²Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia

³Melbourne Bioinformatics, University of Melbourne, Parkville, VIC, Australia

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

⁵QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

⁶Mater Pathology, University of Queensland, Brisbane, QLD, Australia

⁷Department of Medical Oncology, Sir Peter MacCallum Cancer Centre, Parkville, VIC, Australia

⁸Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, VIC, Australia

⁹Cabrini Health, Malvern, VIC, Australia

Background: In the single arm phase 2 PHAEDRA trial, MMR-deficiency (dMMR) was predictive of response to durvalumab (1500 mg IV Q4W), with an objective tumor response rate (OTR; defined by iRECIST) of 47% in dMMR compared with 3% in MMR-proficient (pMMR) advanced endometrial cancer (AEC). This substudy investigates MMR molecular subtypes and other genomic tumor features and their correlation with treatment outcomes.

Methods: Testing was performed to determine molecular subtypes of dMMR, including germline MMR pathogenic variant carriers (Lynch syndrome), biallelic somatic MMR mutations, and somatic MLH1 promoter hypermethylation. DNA from FFPE tumor tissue and matched blood was available from 41/71 925dMMR, 16 pMMR participants for testing on a targeted 298 gene panel including the MMR genes and key somatic AEC driver genes. The derived tumor genomic features included tumor mutational burden (TMB), COSMIC v3.2 tumor mutational signatures, and insertion/deletion (Indel) somatic mutation count.

Results: Of the 71 patients recruited, 35 were dMMR and 36 were pMMR. Median follow-up was 44 versus 52 months in dMMR versus pMMR participants, respectively. The dMMR molecular subtypes were 4 (11.4%) Lynch syndrome, 4 (11.4%) somatic MMR mutation, 25 (71.4%) MLH1 methylated, and 2 (5.7%) dMMR-uncategorized. The OTR rate was 100% (4/4; 95%CI: 40%–100%) for Lynch, 75% (3/4; 95%CI: 22%–99%) for somatic MMR mutations, and 40% (10/25; 95%CI: 22%–61%) for MLH1 methylated groups. The median TMB (assessed in 41/71) was higher in those with a confirmed radiological response (37, IQR: 26–50) versus non-responders (16, IQR: 9–25; p < 0.001). Within the MLH1 methylated group, TMB was also higher in responders vs non-responders (40 vs. 21; p = 0.03). Somatic mutations in KRAS, PTEN, PIK3CA, ARID1A, and TP53 were not associated with OTR rate.

Conclusions: Dmmr-MLH1 methylated AEC demonstrated greater heterogeneity in OTR to single agent durvalumab than the Dmmr-Lynch and Dmmr-somatic MMR mutation molecular subtypes. Higher TMB was seen in responders, and specifically within Dmmr-MLH1 methylated responders, compared to non-responders.

Amelia Hyatt^1,2,3,4, Karen Canfell⁵, Rob Moodie⁴, Sanchia Aranda³

¹Peter MacCallum Cancer Centre/University of Melbourne, Coburg, VIC, Australia

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

³Department of Nursing, University of Melbourne, Melbourne, VIC, Australia

⁴School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

⁵Daffodil Centre, University of Sydney, Sydney, NSW, Australia

Aims: In 2020, the World Health Organization (WHO) launched the strategy for the global elimination of cervical cancer comprising three targets for vaccination, screening, and treatment. However, many nations face a range of social, political, and economic barriers which impact effective implementation and scale-up of cervical cancer programs needed to achieve these targets. This study therefore used a cross-sectional ecological approach to investigate health system factors associated with successful progress toward cervical cancer elimination targets, to better inform policy and optimize health system performance and planning.

Methods: Four established conceptual frameworks describing the social determinants of health, WHO building blocks of health system performance, universal health coverage, and cervical cancer elimination were analyzed to determine core domains appropriate for measurement. Indicators which provide direct or indirect measurement of these domains were identified in publicly available global datasets. Descriptive statistics, and Kendall's Tau and Pearson's r were employed to describe and measure the strength of association between indicators and progress toward WHO elimination targets.

Results: A total of 155 countries were included in the analysis, with data from 62 indicators analyzed. Descriptive analysis demonstrated that overall, progress toward the 2030 elimination targets is being made, however, there are significant disparities across WHO regions. Indicators measuring contextual factors associated with the social determinants of health such as democratic governmental systems and macroeconomic, social and public policies focusing on improved equity all had large associations with successful progress toward cervical cancer elimination. Increased access to healthcare via universal health coverage, optimal service delivery, health workforce availability, robust health information systems, and increased health financing were likewise associated with country level progress toward all elimination targets.

Conclusions: Economic, political, socio-cultural, health system function, and coverage factors are associated with the successful implementation and scale up of cervical cancer elimination programs. Policy and health system strengthening opportunities exist to improve global progress toward cervical cancer elimination.

Grace L Rose^1,2, Janine Porter-Steele³, Vivian Chiu³, Brent J Cunningham³, Alex N Boytar³, Briana Clifford⁴, Fernanda Luft³, Alexandra McCarthy^3,5

¹School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia

²School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia

³School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia

⁴School of Health Sciences, University of New South Wales, Sydney, NSW, Australia

⁵Mater Misericordiae, Brisbane, Queensland, Australia

Background: Exercise for breast cancer populations can reduce treatment side effects; however, little support and evidence is available for the 20,000 Australian women treated for gynecological cancer to implement exercise. This ongoing randomized controlled trial primarily investigates the effects of individualized exercise on quality of life. Preliminary feasibility of this program is presented.

Methods: After baseline assessment, women following treatment for gynecological cancer (n = 97, ovarian = 26%, median age = 58 years [range 21—82], mean body mass index = 28.3 kg/m² [range 19.7–55.3]) were randomized (1:1) to supervised exercise training with an Accredited Exercise Physiologist (AEP), or usual care. The exercise group completed three, ∼60-min combined aerobic and resistance exercise sessions per week for 12 weeks (50% self-managed). An intervention acceptability, appropriateness, and feasibility measure (AAFIM; 5-point Likert scale) was collected from participants (n = 41), and AEPs (n = 33) to assess perceived domain ratings. Additionally, study uptake and reasons for declining to participate were captured.

Results: Almost all participants and AEPs agreed that the program met their approval and was appealing across acceptability domains (participants and AEP = 100%); was suitable across appropriateness domains (participants and AEP = 100%); and was implementable across all feasibility domains (participants = 100%, AEP = 94%). The majority “completely agreed” with these statements (score = 5/5, participants = 67%–80%, AEP = 60%–73%). Attendance (89%) and compliance (80%) to the intervention are high. Meanwhile, recruitment to the study is low (24%) compared to median recruitment rate of other exercise oncology studies (38%). The most common reasons for declining to participate were lack of interest (25%) and busyness (20%).

Conclusions: Despite preliminary acceptance of the program by participants and AEPs, there remains an imbalance between feasibility of program delivery compared to program uptake. Our results suggest that future exercise implementation for women following treatment for gynecological cancers must focus on strategies to enhance the enrolment of women who are disinterested in exercise and time poor.

Scott C Walsberger¹, Emily Spencer¹, Matthew Vaughan¹, Karen Price¹, Pene Manolas², Teresa Fisher², Sarah McGill², Tracey O'Brien²

¹ACON, Surry Hills, NSW, Australia

²Cancer Institute NSW, St Leonards, NSW, Australia

Background: Most cervical cancers occur in people who are overdue or never screened. In Australia LGBTQ+ people with a cervix are less likely to screen due to unique barriers. Self-collection reduces barriers to screening, including pain and fear of penetration. From July 2022, self-collection is available to all people eligible for cervical screening. Awareness of self-collection is very low.

The Own It campaign promoted self-collection and other options with the aim to increase cervical screening participation. As part of a multi-year partnership, ACON and Cancer Institute NSW co-designed this inclusive cervical screening campaign targeting people with a cervix aged 25—35 years.

Methods: Community talent were recruited to share experiences of cervical screening. Selection was based on opportunities to address identified barriers. Draft campaign materials were focus tested (6 sessions) with the target audience. The campaign ran for 6 weeks in January/February 2023. Campaign evaluation included an online survey (n = 384) and analysis of social media channels and website engagement.

Results: 56% of the target audience recalled the campaign. Among the target audience, 53% reported taking action after seeing the campaign. 83% of those surveyed said they were motivated to have a Cervical Screening Test when next due, less for those who use a different term to describe their gender (58%). A larger proportion of respondents rated the self-collection creative effective at communicating its message (71%) compared to other creative. A total of 44,481 users visited the Can We website during the campaign.

Conclusion: Own It is Can We's most successful campaign to date. Honest and empowering messaging, information about self-collection, and a straightforward call to action was a winning combination for a memorable campaign that drives action. More information campaigns about self-collection are needed and is likely to increase cervical screening participation. Further effort is needed to motivate gender diverse people to screen.

Kate Webber^1,2, Alastair Kwok^1,2, Sok Mian Ng¹, Olivia Cook^3,4, Eva Segelov²

¹Department of Oncology, Monash Health, Clayton, VIC, Australia

²School of Clinical Sciences, Monash University, Clayton, VIC, Australia

³Nursing and Midwifery, Monash University, Clayton, VIC, Australia

⁴McGrath Foundation, Sydney, NSW, Australia

Aims: To assess the impact of real-time Patient Reported Outcome Measures (PROMs) prior to outpatient gynecological cancer consultations on Emergency Department (ED) presentations and overall survival (OS), and identify PROMs data predictive of subsequent unplanned presentations.

Methods: Patients with gynecological cancer were invited to complete the EQ-5D-5L, Edmonton Symptom Assessment System-Revised, and the Supportive Care Needs Survey Short-Form-34 prior to scheduled appointments, on waiting room iPads (December 2019–March 2020) or remotely online (October 2020–April 2021). Clinical characteristics and ED presentations were extracted from medical records for participants and non-participants. Chi-squared and t-tests were used for between-group comparisons. OS was assessed using the Kaplan–Meier method with Cox regression.

Results: Data were extracted from 334 clinic consultations (99 in-person; 235 telehealth) with 104 patients (mean age 61 [SD 13]; 49% undergoing treatment with palliative intent). PROMs participation was 50%, with no significant difference by consultation mode. People speaking a language other than English had lower participation (28% vs. 57%, p = 0.01). No significant differences were observed between participants and non-participants in age, stage, primary tumor, treatment intent (curative vs. palliative), or treatment received. An ED presentation occurred within 30 days of 7.6% of participating consultations compared to 13.5% non-participating (p = 0.10). Among PROMs participants, ED presentations were associated with higher mean symptom scores at the preceding visit for nausea (3.4 vs. 1.0), poor appetite (3.6 vs. 1.8) and shortness of breath (4.5 vs. 1.8), and lower EQ-5D VAS scores (58.3 vs. 83.8), all p < 0.05. OS at 2 years was 79.8% for participants and 60.8% for non-participants. Treatment intent was associated with OS, with a trend for participation in the intervention (p < 0.001 and 0.057, respectively).

Conclusions: Completion of PROMs prior to gynecological cancer consultations was associated with trends to fewer ED presentations and improved OS. Targeted interventions focusing on symptoms associated with ED presentations and to support participation among people who speak a language other than English are required.

Aleesha Whitely¹, Robert Rome², Sharnel Perera¹, Sherine Sandhu¹, Mahendra Naidoo¹, Simon Hyde³, Adam Pendlebury³, Orla McNally⁴, Deborah Neesham⁴, Tom Jobling⁵, Tran Nguyen¹, Tahlia Knights¹, John Zalcberg¹

¹School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

²Epworth HealthCare, East Melbourne, VIC, Australia

³Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, VIC, Australia

⁴Oncology and Dysplasia Service, Royal Women's Hospital, Parkville, VIC, Australia

⁵Department of Gynaecological Oncology, Monash Health, Bentleigh East, VIC, Australia

Background: The COVID-19 pandemic caused significant disruption to healthcare delivery in Victoria, Australia. However, specific impacts on ovarian cancer care and survival have not been elucidated.

Aim: To determine the impact of the COVID-19 pandemic on ovarian cancer diagnosis, management, and survival in Victoria, Australia.

Methods: Data were extracted from the National Gynae-Oncology Registry (NGOR). Patients with epithelial ovarian, tubal or peritoneal (OTP) cancer initially diagnosed between 2017 and 2023, who received first-line treatment at six major treatment centers in Victoria, were analyzed. Descriptive, regression, and survival analyses were performed. All relevant ethics and governance approvals were obtained prior to data collection.

Results: Complete data were available for 1255 patients who met the inclusion criteria. After adjusting for stage, those diagnosed with OTP cancer between January 1, 2020 and December 31, 2021 had lower odds of 18-month survival (OR .65, 95% CI: .47–.91, p = 0.013) compared to those diagnosed from 2017 to 2019; however, no significant change in odds was observed for one-year survival (OR .83, 95% CI: .56–1.21, p = 0.321). Patients diagnosed in 2021 had higher odds of being diagnosed with stage III–IV disease, compared to patients diagnosed from 2017 to 2020 and 2022 to 2023, and the proportion of stage III–IV ovarian cancer diagnoses was largest in the first quarter of 2021 (52 of 64 patients; 81.3%). No impact on timeliness of primary surgery, interval surgery, adjuvant chemotherapy, or neoadjuvant chemotherapy was detected for those diagnosed during a COVID-19 lockdown in Victoria. Subgroup analyses revealed no significant differences in survival or timeliness of treatment between patients diagnosed during COVID who were residing in metropolitan areas, compared to rural and remote areas.

Conclusions: Timeliness of first-line treatment did not appear to be impacted by COVID-19 in Victoria, whilst NGOR data indicates that 18-month survival and stage III–IV ovarian cancer incidence was affected.

Dilanka L De Silva^1,2, Lesley Stafford^2,3, Anita Skandarajah^2,3, Michelle Sinclair⁴, Lisa Devereux^2,5, Kirsten Hogg^2,6, Maira Kentwell^1,2, Allan Park³, Luxi Lal^3,5,6, Magnus Zethoven⁵, Madawa W Jayawardana^2,5, Fiona Chan⁴, Phyllis N Butow⁷, Paul A James^1,2,3,5, Bruce Mann^2,3,4, Ian G Campbell^2,5, Geoffrey J Lindeman^1,2,3,6

¹Parkville Familial Cancer Centre, The Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia

²The University of Melbourne, Melbourne, VIC, Australia

³The Royal Melbourne Hospital, Parkville, VIC, Australia

⁴The Royal Women's Hospital, Parkville, VIC, Australia

⁵Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁶The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

⁷Centre for Medical Psychology and Evidence-based Decision Making, The University of Sydney, Sydney, NSW, Australia

Background: For patients with newly diagnosed breast cancer, identification of germline pathogenic variants in hereditary breast/ovarian cancer (HBOC) genes can inform clinical management and identify a subset who might benefit from targeted therapy. Current guidelines for germline testing, however, fail to identify all patients with germline pathogenic variants. The MAGIC (Mutational Assessment of newly diagnosed breast cancer using Germline and tumour genomICs) study examined whether universal germline testing is feasible, clinically useful, and acceptable to patients and clinicians.

Methods: Patients (n = 650) with newly diagnosed non-metastatic breast cancer or high-grade pre-invasive disease were prospectively recruited through the Parkville Breast Service between June 2020 – March 2023 in 2 phases. Phase 1 participants (n = 157) underwent germline and tumour DNA sequencing and their perceptions of genetic testing, psychological distress and cancer-specific worry were surveyed before and after genetic testing. Phase 2 participants (n = 493) underwent germline testing only. Only pathogenic variants (Class 4 and 5) were reported. The yield of pathogenic variants identified by universal testing was compared to patients selected using current guidelines (Manchester ≥15 and CanRisk ≥10% scores) as well as recently updated NCCN (v3.2023) guidelines. Clinical management of participants with a pathogenic variant was formally re-considered at the Breast Service multidisciplinary team meeting.

Results: Pathogenic variants were identified in 50/650 (7.7%) participants, including in BRCA1 (n = 10), BRCA2 (n = 12), PALB2 (n = 7), CHEK2 (n = 10), ATM (n = 4), RAD51C (n = 2), BARD1 (n = 3), PMS2 (n = 2) and MSH6 (n = 1). Twenty-two of 50 carriers (44%) would have met current genetic testing guidelines, using CanRisk and/or Manchester scores, while 44/50 (88%) met updated NCCN testing criteria. Clinical management changed in 40/50 (80%) of participants carrying a pathogenic variant. Acceptance of routine genetic testing was high among patients (90/103, 87% agreed, 13/103 neutral); no decision regret or adverse impact on psychological distress or cancer-specific worry were reported. Clinicians reported genetic test results helped treatment decisions; none reported patient distress.

Conclusion: Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.

De Silva et al. Med J Aust. 2023 218(8):368 373. doi: 10.5694/mja2.51906.

Christine Muttiah

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Content not available at time of publishing

Michelle Wilson

Auckland City Hospital, Mt Eden, Auckland, New Zealand

Content not available at time of publishing

Jolyn Hersch^1,2,3

¹Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia

²Sydney Health Literacy Lab (SHeLL), School of Public Health, The University of Sydney, Sydney, NSW, Australia

³Wiser Healthcare, Sydney, NSW, Australia

Aims: Informed consent is a vital but challenging aspect of research and clinical practice, particularly in genomic settings characterized by unprecedented uncertainty and complexity. We are developing an innovative intervention for cancer patients to improve the quality of decision making and COnsent in GENomic Testing (CoGenT). The intervention incorporates an online Dynamic Consent Platform (DCP) and Question Prompt List (QPL).

Methods: Participants included cancer patients who were and were not taking part in genomic research, carers, study coordinators, and clinicians. We conducted semi-structured qualitative interviews to elicit information needs around genomic testing/research (for the QPL) and “think aloud” feedback on a DCP previously developed for non-cancer genomic research. Interviews were content-analyzed, and recruitment continued until data saturation.

Results: Interviews (n = 34) identified key information needs around genomic testing, results and their implications, and aspects of research participation. To address these, we drafted the world-first genomics QPL including brief answers on which consent staff can elaborate if desired. The QPL is being pilot-tested and refined via further interviews (n = 22 to date) with patient and professional stakeholders. Views on the DCP highlighted its potential value to inform patients, let them enact their preferences, and identify areas where they need more support. The data also showed the importance of optimizing clarity, accessibility, and engagement in the content and navigation of the CoGenT DCP – now under development.

Conclusions: This work will facilitate equitable access to cancer genomic research by ensuring consent processes meet the needs of key stakeholders. Moreover, CoGenT evidence-based resources will help ensure ethical processes are followed when genomic testing enters routine care, with patients and families well prepared and supported before, during, and after testing.

Brigid Lynch

Cancer Council Victoria, East Melbourne, VIC, Australia

It was previously estimated that 1814 (1.6% of incident cancers) were attributable to physical inactivity in Australia in 2010, when only three sites were considered attributable to physical inactivity. We estimated the burden of cancer due to physical inactivity in Australia for 13 sites. The population attributable fraction estimated site-specific cancer cases attributable to physical inactivity for 13 cancers. The potential impact fraction was used to estimate cancers that could have been prevented in 2015 if Australian adults had increased their physical activity by a modest amount in 2004–2005. We used 2004–2005 national physical activity prevalence data, 2015 national cancer incidence data, and contemporary relative-risk estimates for physical inactivity and cancer. We assumed a 10-year latency period. Results: An estimated 6361 of the cancers observed in 2015 were attributable to physical inactivity, representing 4.8% of all cancers diagnosed. If Australian adults had increased their physical activity by one category in 2004–2005, 2564 cases (1.9% of all cancers) could have been prevented in 2015. These updated estimates mean more than three times as many cancers are attributable to physical inactivity than previously reported. Physical activity promotion should be a central component of cancer prevention programs in Australia.

Anna Boltong^1,2, Julia Brancato², Daniel Chaji², Melissa Austen², Adam Lambert²

¹Kirby Institute, UNSW Medicine, The University of New South Wales, Sydney, Australia

²Cancer Australia, Surry Hills, NSW, Australia

The Australian Cancer Plan (the Plan) is a 10 year national framework that will accelerate world class cancer outcomes and experiences and improve the lives of all Australians affected by cancer.

The Australian Cancer Plan will complement and leverage a number of existing national and global supportive care initiatives aimed at improving cancer outcomes through diet and exercise, and will support world-class health systems to improve equitable cancer outcomes and experiences for all people affected by cancer.

Darren Brenner

University of Calgary, Calgary, Canada

Our research team is focused on moving data to evidence and impact with novel analytics and visualizations. The presentation will highlight several of the data-driven research initiatives underway to advance cancer prevention and screening efforts in Canada. Our team has been actively engaged in epidemiologic studies of risk factors for common cancers. As part of the translation of this work, we completed Canadian Population Attributable Risk of Cancer (ComPARe) Project. The ComPARe project was a comprehensive research effort to estimate the population-level cancer burden related to all known modifiable (lifestyle, infectious, and environmental) exposures in Canada. An impactful knowledge mobilization campaign followed the completion of the research with many of the knowledge products now available online https://prevent.cancer.ca. As a follow-up to this work, we have also integrated our estimates into a microsimulation framework that can estimate the costs associated with risk-factor associated cancers and may present as a framework to evaluate the cost-effectiveness of future prevention activities/programs. The presentation will highlight the national collaborations and frameworks that were essential to complete this work. These efforts have now been included in provincial and national cancer control strategy documents that are focused on mitigating the impact of cancer, and amplifying awareness in cancer prevention and screening. The presentation will also detail efforts to employ novel data visualizations through digital data dashboards, communication tools, and knowledge translation strategies to fast-track the journey from research data to evidence and impact.

Camille E Short

University of Melbourne, Parkville, VIC, Australia

Supporting the adoption and maintenance of healthy lifestyles is a globally recommended cancer control strategy.

Digital health interventions delivered via apps, websites, and wearable sensors have the potential to improve the scale and scope of health behavior change support in Australia. RCT level evidence suggests they are safe, acceptable, and can be effective in cancer prevention and survivorship settings. However, they have not yet led to drastic changes in behavior change support, or health behavior change at scale.

This presentation will provide a critical review of the research evidence, outline priority areas for enhancing the real-world impact of digital behavior change interventions, and highlight innovative projects aiming to address these priorities.

Kin Yin Chan^1,2, Michael Suen^1,2, Susan Coulson¹, Janindra Warusavitarne³, Janette Vardy^1,2

¹The University of Sydney, Sydney, NSW, Australia

²Concord Repatriation General Hospital, Concord, NSW, Australia

³St. Mark's Hospital, London, UK

Aim: Bowel and pelvic floor dysfunction can be challenging after colorectal cancer (CRC) treatment. We examined the prevalence of both in CRC survivors treated with curative intent.

Methods: A prospective, longitudinal observational study of CRC patients following anterior resection surgery ± neoadjuvant/adjuvant treatment attending Concord Hospital from 2019 to 2023. Bowel, bladder, and sexual function were screened with the Low Anterior Resection Syndrome Score (LARS) and study-specific questionnaire at baseline (6+ months postbowel reconstruction) and minimum 12-months later. Primary outcome: LARS prevalence. Secondary outcomes included bladder and sexual dysfunction, and factors associated with LARS. Descriptive analysis and Chi-squared test were used.

Results: A total of 103 patients completed baseline, and 75 follow-up assessments. Mean age 64.5 (SD13.2) years; 67 (65%) males. Fifty-three (51.5%) had sigmoid and 50 rectal cancer. Disease stage: 19% stage I/II, 59% stage III, and 2% stage IV. Surgical procedure performed: high (54%), low (18%), and ultralow (27%) anterior resection. 30/103 (29%) had temporary stoma, mean duration 8 months (range 1–17). Twelve (12%) had neoadjuvant treatment, 62/103 (60%) had adjuvant chemotherapy. Baseline time from bowel reconstruction mean 17.5 (range 6–72) months. 6/75 completed data excluded due to recurrence or lost to follow-up at 12-months. At baseline, 69/103 (67%) had No LARS, 33% had Minor (n = 18) or Major LARS (n = 16). At 12-month assessment (n = 75), LARS improved in 54%, 33% remained unchanged. Six had no LARS at baseline but developed LARS at follow-up. Bladder and sexual dysfunction symptoms at baseline were 34% and 23%, respectively. Tumor site (p < 0.0004), type of resection (p < 0.0002), temporary stoma (p < 0.0005), and neoadjuvant treatment (p < 0.002) were associated with severity of LARS.

Conclusion: Bowel, bladder, and sexual dysfunction is prevalent in CRC survivors. Bowel symptoms may continue to improve beyond 18-months after CRC treatment. Pelvic floor functional screening and rehabilitation should be considered for cancer survivorship care for CRC patients.

Lara Edbrooke^1,2, Catherine L Granger^1,3, Jill J Francis^2,4, Thomas John^5,6, Nasreen Kaadan⁷, Emma Halloran⁸, Thomas Davies^9,10, Bronwen Connolly¹¹, Linda Denehy^1,2

¹Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia

²Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Physiotherapy, The Royal Melbourne Hospital, Melbourne, VIC, Australia

⁴Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia

⁵Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁶The Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁷Consumer Representative

⁸The Lung Foundation Australia, Milton, Queensland, Australia

⁹William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK

¹⁰Adult Critical Care Unit, Royal London Hospital, London, UK

¹¹Wellcome-Wolfson Institute for Experimental Research, Queen's University Belfast, Belfast, UK

Aims: With treatment-related improvements in survival, lung cancer rehabilitation is essential. Significant heterogeneity exists in the outcomes and instruments used to evaluate the impact of rehabilitation. The aim of this research was to develop a core set of lung cancer rehabilitation outcomes for use in clinical practice.

Methods: An international Delphi consensus study involving consumer, healthcare professional, and researcher stakeholder panels was conducted. To develop the potential list of outcomes, preparatory work involved (1) an overview of systematic reviews; and (2) focus groups and individual interviews with people with lung cancer. Participants rated the importance of each outcome (1–9 point Likert scale) over two survey rounds. Consensus criteria for each panel included “retain outcome” if >70% of participants scored 7–9 (critical to include) and <15% scored 1–3 (not important); and “remove outcome” if <50% of participants scored 7–9.

Results: A total of 112 participants from 19 countries completed round 1 and 85% (95/112) completed round 2 (consumers n = 8/11, healthcare professionals n = 46/56, and researchers n = 41/45). Twenty-seven outcomes were included in round 1, with an additional two outcomes (survival and frailty) added in round 2. Consensus was achieved after two survey rounds. The outcomes reaching consensus as “critical to include” in the lung cancer rehabilitation core outcome set by all stakeholder groups were breathlessness, activities of daily living, physical function, health-related quality of life, emotional and mental well-being, and pain. No outcomes met the consensus criteria for removal.

Conclusions: Consensus was achieved across each stakeholder group regarding six core outcomes to be used in clinical practice to evaluate lung cancer rehabilitation programs. The next stage of this project will include a second Delphi study to reach consensus regarding use of a single instrument for measuring each of these outcomes.

Registration: Prospectively registered on the Core Outcome Measures in Effectiveness Trials database (www.comet-initiative.org/Studies/Details/2086).

Xinxin Hu¹, Katrina Tonga^1,2,3, Christopher Rofe⁴, Kwun Fong^5,6, Henry Marshall^5,6, Fraser Brims^7,8, Annette McWilliams^9,10, Renee Manser^11,12,13, Brad Milner¹⁴, Emily Stone^1,3

¹Department of Thoracic Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia

²The University of Sydney, Sydney, New South Wales, Australia

³The University of New South Wales, Sydney, New South Wales, Australia

⁴Sydney Children's Hospital, Sydney, New South Wales, Australia

⁵Thoracic Research Centre and Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia

⁶The University of Queensland, Brisbane, Queensland, Australia

⁷Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia

⁸Curtin Medical School, Curtin University, Bentley, Western Australia, Australia

⁹Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia

¹⁰The University of Western Australia, Perth, Western Australia, Australia

¹¹Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia

¹²Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia

¹³Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

¹⁴Department of Medical Imaging, St Vincent's Hospital, Sydney, New South Wales, Australia

Introduction and aim: The Australian lung cancer screening program using low-dose CT chest is due to commence in 2025. The aim of this study was to compare the utility of categorical selection criteria (United States Preventative Services Task Force USPSTF2021) and a risk calculation model (PLCOm2012) in identifying high-risk patients for lung cancer screening.

Methods: We compared the screening eligibility of applicants in the NSW cohort of the International Lung Screening Trial (ILST) according to USPSTF2021 and PLCOm2012 (1.5%/6 years) criteria. We also compared the calculated lung cancer risk using the PLCOm2012 model and risk factor profiles of eligible applicants by each criteria. All variables were reported as mean ± standard deviation and number (percentage). Statistical analysis was completed using the Mann–Whitney, McNemar, and Chi-squared tests. A p-value < 0.05 was deemed significant.

Results: The NSW ILST cohort had 926 applicants. All were assessed by PLCOm2012 (risk calculation) and USPSTF2021 (categorical) criteria. The PLCOm2012 criteria selected fewer candidates than USPSTF2021 (54% vs. 59%, p = 0.002) but selected those with higher calculated risk than USPSTF2021 (4.94 ± 4.24%/6 years vs. 4.35 ± 4.33%/6 years, p < .001). Compared with USPSTF2021, candidates eligible via PLCOm2012 were older (66 ± 6 vs. 64 ± 6 years, p < 0.001), had higher smoking pack-years (49 ± 22 vs. 46 ± 21, p = 0.002), and more likely to have a family history of lung cancer (28% vs. 21%, p = 0.011). Sixty-nine applicants were eligible via PLCOm2012 criteria but excluded by the USPSTF2021 criteria. These applicants had similar calculated lung cancer risk (3.16 ± 1.43%/6 years vs. 4.35 ± 4.33%/6 years, p = 0.956), were older (71 ± 5 vs. 64 ± 6 years, p < 0.001), had similar number of smoking pack-years (48 ± 28 vs. 46 ± 21, p = 0.853), and were more likely to have a family history of lung cancer (51% vs. 21%, p < 0.001) compared to applicants selected by the USPSTF2021 criteria.

Conclusion: Selection of high-risk lung cancer screening candidates via USPSTF2021 categorical criteria may exclude candidates eligible via risk calculation with family history of lung cancer.

Andrew Dean¹, Davide Melisi², Teresa Macarulla³, Roberto A Pazo Cid⁴, Sreenivasa R Chandana⁵, Christelle De La Fouchardière⁶, Igor Kiss⁷, Woojin Lee⁸, Thorsten O Goetze⁹, Eric Van Cutsem¹⁰, Scott Paulson¹¹, Tanios Bekaii-Saab¹², Shubham Pant¹³, Richard Hubner¹⁴, Zhimin Xiao¹⁵, Huanyu Chen¹⁵, Fawzi Benzaghou¹⁵, Zev A Wainberg¹⁶, Eileen M O'Reilly¹⁷

¹St John of God Subiaco Hospital, Subiaco, Australia

²Invesitigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

³Vall d'Hebron University Hospital, Barcelona, Spain

⁴Hospital Universitario Miguel Servet, Zaragoza, Spain

⁵Cancer and Hematology Centers of Western Michigan, Grand Rapids, Michigan, USA

⁶Centre Léon Bérard, Lyon, France

⁷Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czechia

⁸National Cancer Center, Goyang, Republic of Korea

⁹Krankenhaus Nordwest, Frankfurt, Germany

¹⁰University Hospitals Gasthuisberg and KULeuven, Leuven, Belgium

¹¹Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, Texas, USA

¹²Mayo Clinic, Scottsdale, Arizona, USA

¹³MD Anderson Cancer Center, Houston, Texas, USA

¹⁴The Christie NHS Foundation Trust, Manchester, UK

¹⁵Ipsen, Cambridge, Massachusetts, USA

¹⁶University of California, Los Angeles, California, USA

¹⁷Memorial Sloan Kettering Cancer Center, New York, USA

Aims: NAPOLI 3 (NCT04083235) investigated the efficacy and safety of liposomal irinotecan 50 mg/m², 5-fluorouracil 2400 mg/m², leucovorin 400 mg/m², and oxaliplatin 60 mg/m² (NALIRIFOX) versus nab-paclitaxel 125 mg/m² and gemcitabine 1000 mg/m² (Gem + NabP) as first-line therapy in patients with mPDAC.

Methods: Eligible patients with confirmed untreated mPDAC were randomized to receive NALIRIFOX on days 1 and 15 of a 28-day cycle or Gem + NabP on days 1, 8, and 15 of a 28-day cycle. The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival (PFS), overall response rate (ORR), and safety. OS was evaluated when at least 543 events were observed using a stratified log-rank test with an overall one-sided significance level of .025.

Results: Overall, 770 patients (NALIRIFOX, n = 383; Gem + NabP, n = 387) were included. Baseline characteristics were balanced between arms. At a median follow-up of 16.1 months, 544 events had occurred. Median OS was 11.1 versus 9.2 months in the NALIRIFOX and Gem + NabP groups, respectively; median PFS was 7.4 versus 5.6 months (Table). Grade 3/4 treatment-emergent adverse events occurring in ≥10% of patients receiving NALIRIFOX versus Gem + NabP included diarrhea (20.3% vs. 4.5%), nausea (11.9% vs. 2.6%), hypokalemia (15.1% vs. 4.0%), anemia (10.5% vs. 17.4%), and neutropenia (14.1% vs. 24.5%).

Conclusions: First-line NALIRIFOX demonstrated clinically meaningful and statistically significant improvement in OS and PFS versus Gem + NabP in patients with mPDAC, with no new safety concerns.

Keywords: metastatic pancreatic ductal adenocarcinoma, first-line, NALIRIFOX, liposomal irinotecan, survival rate

Acknowledgments: Funded by Ipsen.

Prue Cormie^1,2, Ashleigh Bradford¹, Peter Martin³, Meg Chiswell³, Chris Doran⁴, Boyd Potts⁴, Mei Krishnasamy^1,2,5

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²University of Melbourne, Melbourne, VIC, Australia

³Deakin University, Melbourne, VIC, Australia

⁴Central Queensland University, Brisbane, QLD, Australia

⁵Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia

Aim: To explore the information needs, messaging strategies and resource requirements people with cancer need to adopt exercise in their care plan.

Methods: Online questionnaire and semi-structured interviews were administered to people with any type of cancer within 3-years of starting treatment. Questionnaire explored factors relating to information, approaches, and resources required to influence exercise behavior. Interviews probed key themes. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were analyzed using interpretive description.

Results: Participants included 453 people with cancer who were 58 ± 13 years, 63% female, 66% currently receiving treatment, and 25% met exercise guidelines. Top ranked way to receive exercise information was via discussion with doctor, which was significantly preferred over written or online resources (p < 0.001). The majority of participants responded that their thoughts on exercising would be influenced “very much” by their doctors (67%) and nurses’ (62%) recommendation, with only 1% “not at all” influenced. Most people (70%) preferred to receive information before/at the start of treatment, 24% regularly, and only 6% during/after treatment (p = 0.001). Over 75% of people identified 18 different types of messages about exercise, that would help convince them to exercise. Qualitative data indicated individualized messaging would be most convincing. Resources ranked as most helpful were: referral by the care team to cancer-specific exercise services (87%); written exercise recommendations from doctor/nurse (73%); and a list of exercise benefits for people with cancer (70%).

Conclusions: People with cancer would be more likely to consider exercise as part of their cancer care plan if their doctor/nurse discussed exercise early in the care continuum using messaging that was individualized and supported by referral to cancer-specific exercise services. These data are informing the development of co-designed strategies and tools to support health professionals discuss exercise in a way that prompts people with cancer to view exercise as adjunct therapy.

David E Goldsbury^1,2, Philip Haywood³, Alison Pearce^1,2, Louisa G Gordon⁴, Deme Karikios^5,6, Gill Stannard⁷, Karen Canfell^1,2, Julia Steinberg^1,2, Marianne F Weber^1,2

¹Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

²The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia

³Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia

⁴Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

⁵Department of Medical Oncology, Nepean Hospital, Sydney, NSW, Australia

⁶Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia

⁷Cancer Voices NSW, Sydney, NSW, Australia

Aims: Out-of-pocket (OOP) costs for healthcare in Australia are estimated at ∼AUD$30 billion annually, potentially placing a substantial burden on those affected by disease. We aimed to describe individual-level OOP healthcare costs, with a focus on costs by cancer status.

Methods: We analyzed self-reported OOP healthcare costs using the Sax Institute's 45 and Up Study¹ in NSW (n = 267,357 recruited at baseline 2005–2009), among participants who completed a follow-up questionnaire sent out in 2020. The questionnaire included several categories of health costs and detailed sociodemographic information. Cancer information was included via linkage² with the NSW Cancer Registry. Logistic regression was used to test for associations between higher OOP costs (>$1000 and >$10,000) and cancer status, adjusting for participants’ characteristics.

Results: There were 45,061 respondents, with 43% reporting >$1000 in OOP costs for their healthcare in the previous 12 months. Cost types with higher OOP costs included doctors/specialists (10% > $1000), dental care (10% > $1000), and medications (6% > $1000). People diagnosed with cancer in the previous 2 years (n = 861) were more commonly in the higher OOP cost categories (55% > $1000 total spend, adjusted odds ratio [aOR] 2.14 vs. no cancer [42% >$1000], 95% confidence interval 1.82–2.52), as were people diagnosed > 2 years prior (45%, aOR 1.22 vs. no cancer, 1.15–1.29). OOP costs > $1000 were also associated with socioeconomic advantage, particularly private health insurance and higher household income. OOP costs > $10,000 were strongly associated with recent cancer diagnoses (9% vs. 3% for no cancer, aOR 3.30, 2.56–4.26).

Katharina MD Merollini^1,2, Louisa Gordon^3,4,5, Joanne Aitken^6,7,8, Michael Kimlin^9,10

¹University of the Sunshine Coast, Sippy Downs, Queensland, Australia

²Sunshine Coast Health Institute, Sunshine Coast University Hospital, Birtinya, Queensland, Australia

³Health Economics, QIMR Berghofer Research Institute, Herston, Queensland, Australia

⁴School of Public Health, University of Queensland, Brisbane, Queensland, Australia

⁵School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia

⁶Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia

⁷School of Public Health, University of Queensland, Herston, Queensland, Australia

⁸School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia

⁹Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia

¹⁰Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia

Aim: The aim of this research was to quantify palliative care costs of cancer patients in the public acute care setting in Queensland, Australia.

Methods: The study cohort comprised population-level data of Queensland residents, diagnosed with a first primary malignancy between 1997 and 2015 who underwent palliative care in a public acute hospital setting between July 2012 and December 2016. Administrative databases were linked with cancer registry records to capture health service utilization. Health service costs were analyzed using a bottom-up costing approach on a cohort as well as patient-level.

Results: A total of N = 17,012 individuals with a history of cancer underwent palliative care in a public acute setting during the study period, of which 94.7% received palliative care due to cancer and 76% died in hospital. Total expenditure on a cohort level over 4.5 years was AU$262.6 million with highest total palliative care costs for lung (AU$49 m), colorectal (AU$31.5 m), and prostate cancer (AU$27.8 m). Highest mean cost per person were incurred by individuals with a history of brain (AU$21,950, SD 23,370) and cervical cancer (AU$19,424, SD 22,629). Palliative care costs were the highest for younger age groups 0–24 years (AU$20,951 mean total cost, SD 29,150) and steadily decreased with age (lowest for 90 years+ (AU$12,293, SD 14,291). Individuals accessing palliative services in major cities and inner regional areas had lower mean costs and shorter LoS (AU$14,800, LoS: 8.3 days) compared to patients in outer regional (AU$18,000, LoS: 11.1 days), remote (AU$22,350, LoS: 13.2 days), and very remote areas (AU$28,000, LoS: 14.3 days).

Conclusions: Palliative care was accessed by around ∼4000 cancer patients/year. More research is needed to determine causality of factors contributing to a high economic burden. This research may support future programs and investments in end-of-life care to optimize patient outcomes and to reduce the economic burden.

Brighid BS Scanlon^1,2, Natasha NR Roberts³, David DW Wyld^2,4, Ghasem (Sam) GT Toloo¹, Jo JD Durham¹

¹School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia

²Royal Brisbane and Women's Hospital, Herston, Queensland, Australia

³Surgical, Treatment and Rehabilitation Service (STARS), Metro North Health, Brisbane, Queensland, Australia

⁴Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Background: High-income countries such as Australia have seen substantial advances in cancer screening, treatment, and outcomes. International evidence suggests that Culturally and Linguistically Diverse (CALD) migrant populations experience significant cancer inequities spanning the cancer continuum, which have yet to be explored in the Australian context.

Methods: Equity was quantified and compared for CALD migrant and Australian born cancer patients through an exploratory sequential mixed methods study, incorporating a retrospective cohort study (n = 523) and qualitative interviews (n = 21) at a large, tertiary hospital in Queensland, Australia. Quantitative data were analyzed through bivariate and multivariate logistic regression and qualitative data were analyzed using The Framework Method.

Results: Firstly, CALD migrants exhibited lower odds of smoking (OR  =  .63, CI: .401−.972) and higher odds of “never drinking alcohol” (OR  =  3.4, CI: 1.473−7.905) but had lower odds of cancer detection via screening (OR  =  6.493, CI: 2.429−17.359). Secondly, CALD migrants displayed a statistically significant delay in time from diagnosis to first treatment commencement for radiation (p = 0.03) and surgery (p = 0.02) and had 16.6 times higher odds of declining a recommended chemotherapy (OR = 16.573, CI: 4.604–59.665). Third, CALD migrants had a higher frequency of unplanned admissions (p = 0.00), longer length of those admissions (p = < 0.00), and higher failure to attend appointments (p = < 0.00). The qualitative interviews revealed: (i) a strong institutional focus on linguistic diversity, with little attention given to patients’ cultural needs; (ii) a high institutional reliance on assumptions and informal mechanisms to identify CALD patients and assess their needs; and (iii) a common experience of moral conflict among healthcare staff when providing inequitable care, that is discordant with their professional values.

Conclusions: Several areas of concern have been identified regarding equitable cancer treatment and outcomes for CALD migrants. There is a demonstrable need for both cultural and structural change if equity is to be promoted and operationalized within Australian healthcare institutions.

Ben Smith^1,2,3,4, Natalie Taylor⁵, Alison Pearce^2,6, Verena Wu^3,7, Afaf Girgis¹, Heather Shepherd⁸, Gail Garvey⁹, Jia (Jenny) Liu^10,11, Laura Kirsten^4,12, Iman Zakhary¹³, Annie Miller¹⁴, Carolyn Ee^15,16,17, Dan Ewald¹⁸, Joanne Shaw^4,19

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

⁵UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia

⁶Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

⁷South West Sydney Clinical Campuses, University of New South Wales (UNSW) Sydney, Liverpool, NSW, Australia

⁸Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

⁹School of Public Health, The University of Queensland, Brisbane, QLD, Australia

¹⁰The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia

¹¹St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, NSW, Australia

¹²Nepean Cancer Services, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia

¹³Multicultural Services, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia

¹⁴Cancer Council NSW, Sydney, NSW, Australia

¹⁵NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia

¹⁶Caring Futures Institute, Flinders University, Adelaide, SA, Australia

¹⁷Chris O'Brien Lifehouse Cancer Centre, Sydney, NSW, Australia

¹⁸Sydney University Medical School, Northern Rivers University Centre for Rural Health, Lismore, NSW, Australia

¹⁹School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Aims: Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We aimed to develop an evidence- and consensus-based clinical pathway to assist healthcare professionals identify and manage FCR.

Methods: Healthcare professionals and researchers managing/studying FCR in adult cancer survivors were invited to participate in a two-round Delphi study through professional organizations (e.g., COSA) and Twitter. The Round 1 online survey presented 38 items regarding FCR: (1) screening; (2) triage, assessment, and referral; and (3) stepped care treatment (e.g., stepped care is appropriate for managing FCR). Participants rated how optimal (i.e., representative of best-practice) and feasible (i.e., able to be implemented in practice) items were on a 5-point Likert scale, with qualitative feedback optional. Consensus was defined as ≥80% of participants (strongly) agreeing an item was optimal, with feasibility ratings guiding future implementation. Round 1 items without consensus were re-presented in Round 2 alongside summarized Round 1 responses and new items from content analysis of qualitative feedback.

Results: With 96 participants (target n = 48) in Round 1 (89% healthcare professionals, 34% nursing), 26/38 items reached consensus as optimal, 6/38 as feasible. There was moderate-high consensus regarding: FCR screening (6/7 items); triage, assessment, and referral (4/6 items). Consensus varied regarding stepped care for different FCR levels: specialist care for severe FCR (5/5 items); supported self-management for moderate FCR (2/6 items); and universal care for minimal-mild FCR (4/6 items). Content analysis indicated necessity for: refining FCR conversation timing; tailoring FCR treatment to survivor preference, FCR severity, and resources; and healthcare professional training. Round 2 presented 10 original and 13 new items, with the finalized pathway to be presented at the meeting.

Conclusions: This is a world-first clinical pathway for optimal FCR care. Tailored strategies are needed to address feasibility of implementation in varied contexts and populations.

Srinivas Teppala¹, Paul Scuffham¹, Haitham Tuffaha²

¹Menzies Health Institute Queensland, Gold Coast, Queensland, Australia

²Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia

Background: Approximately 5%–17% of prostate cancer cases are linked to heritable mutations and >50% of these are in BRCA genes. Genetic testing to identify BRCA mutations could inform targeted treatments (e.g., olaparib) in men with metastatic prostate cancer (mPCa). Genetic testing of family members of the men who test positive could inform cancer prevention (e.g., mastectomy in female relatives) and early detection (e.g., prostate specific antigen in male relatives). However, the value for money of genetic testing of men with mPCa is unknown.

Aim: To perform an economic evaluation of germline BRCA testing in mPCa followed by cascade testing of first-degree relatives of mutation carriers.

Methods: We conducted a cost-utility analysis of germline BRCA testing in 1) mPCa patients alone, 2) mPCa patients and first-degree relatives (FDRs) of the proband and contrasted them with the standard of care without testing. A Markov multistate health transition model was constructed with relevant parameters from the literature and using a lifetime horizon. The analyses were performed from an Australian health payer perspective. Costs and outcomes were discounted at an annual rate of 5%. We set the willingness-to-pay threshold at $AU 75,000/QALY. Decision uncertainty was characterized using probabilistic analyses, and various scenarios were explored.

Results: Compared with no testing, BRCA testing was associated with an incremental cost of AU$2158 and a gain of .008 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of AU$271,473/QALY. The addition of cascade testing of male FDRs yielded an ICER of AU$73,866/QALY and the ICER after testing both male and female FDRs was AU$10,433/QALY.

Conclusion: This is the first study of the cost-effectiveness of BRCA testing in mPCa. Our results suggest that BRCA testing in mPCa performed as a standalone strategy is not cost-effective but demonstrated significant value for money after the inclusion of cascade testing of first-degree relatives of mutation carriers.

Megan Varlow

Cancer Council Australia, Haymarket, NSW, Australia

Financial toxicity is the negative patient level impact of the cost of cancer care and is unfortunately a side effect of cancer for too many Australians. Despite the known negative psychological and physical impacts of financial toxicity on people affected by cancer, it is only in recent years that financial toxicity has become a priority for clinicians, researchers, and health services to address. As the opening presentation in the delegate-designed symposium hosted by the COSA Financial Toxicity Working Group, this presentation will provide an overview of the COSA definition of financial toxicity in cancer care, update delegates on work to address financial toxicity in Australia including the Standard for Informed Financial Consent, and outline work underway within the COSA Financial Toxicity Working Group.

Louisa Gordon

QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia

Aim: The economic burden of cancer is growing across all health systems and financial toxicity arising from the diagnosis and treatment of cancer is common for patients. We sought to understand the opinions and current practices of health professionals on the topic of addressing cancer-related financial toxicity among patients.

Methods: A nationwide cross-sectional online survey was distributed through Australian clinical oncology professional organizations and networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient-clinician discussions, opinions about their role, strategies used and barriers to providing solutions for patients. Descriptive statistics were used and sub-group analyses were undertaken by broad occupations.

Results: A total of 277 health professionals completed the survey. The majority were female (n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed these discussions were an important part of high-quality care. However, 73 (28%) stated they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group; 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation.

Conclusion: Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial-related discussions for all health professionals are urgently needed to advance action in this field.

Jordana McLoone^1,2, Megan Varlow³, Louisa Gordon⁴, Raymond Chan⁵

¹UNSW, Kensington, NSW, Australia

²Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia

³Cancer Control Policy, Cancer Council Australia, Sydney, NSW, Australia

⁴Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

⁵Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia

As the impact of cancer-related financial toxicity is increasingly recognized, greater understanding of Australian healthcare professionals’ (HCP) perspectives on how to improve the care and management of cancer-related financial toxicity, including relevant practices, services, and unmet needs is critical.

Methods: We invited Australian HCPs who currently provide frontline cancer care within their workplace to complete an online survey, which was distributed via the networks of Australian clinical oncology professional associations and organizations. The survey was developed by the Clinical Oncology Society of Australia's Financial Toxicity Working Group and contained 12 open-ended items. These were analyzed using descriptive content analysis and NVivo software.

Results: HCPs (n = 277) reported that identifying and addressing financial concerns within routine cancer care was vital and most reported that they believed this to be the responsibility of all HCP involved in patient care. However, financial toxicity was seen as a “blind spot” within a medical model of healthcare, with a lack of services, resources, and appropriate training identified as barriers to providing the patient with adequate support in this domain. Social workers reported that while assessment and advocacy were a part of their role, there lacked sufficient formal training and appropriate referral services for complex financial issues and laws. HCPs reported positive attitudes toward transparent discussions of costs and actioning cost-reduction strategies within their control, but feelings of helplessness when they perceived no solution was available.

Conclusion: Identifying financial needs and providing transparent information about cancer-related costs was viewed as a cross-disciplinary responsibility; however, a lack of training and services limited the provision of support. Increased cancer-specific financial counselling and advocacy, via dedicated roles or developing HCPs’ skills, is urgently needed within the healthcare system.

Raymond J Chan¹, Reegan Knowles¹, Megan Varlow², Amanda Piper³

¹Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia

²Cancer Council Australia, Sydney, NSW, Australia

³Cancer Council Victoria, Melbourne, Victoria, Australia

Background: Financial toxicity (FT) in cancer is a negative patient-level impact of the cost of cancer and can cause both physical and psychological harms, affecting decisions which can lead to suboptimal cancer outcomes. To date, little evidence-based, impactful interventions have been developed and tested to eliminate or alleviate FT. We aim to identify innovative solutions to address financial toxicity (direct and indirect costs) associated with cancer and its treatment and to develop a roadmap to address financial toxicity in clinical care (including service delivery, and education), research, and advocacy.

Methods: A mixed-methods research methodology was utilized to address the aims of the project. The project is led by the Clinical Oncology Society of Australia (COSA) FT Working Group as a collaboration between COSA and Flinders University. A national FT Think Tank was convened as a one-day, face-to-face, professionally facilitated national workshop involving selected stakeholders. A pre-Think Tank online survey was conducted with key stakeholders to generate initial ideas to stimulate discussions at the at the National Think Tank. Low and negligible risk ethics approval was obtained prior to commencement.

Results and discussion: A total of 40 cancer consumers, health professionals, researchers, policy makers, and representatives from private health organizations, not-for-profit organizations, finance, and industry attended the workshop. The data are being analyzed and will be disseminated at the COSA ASM 2023.

Stefanie Carino

Climate and Health Alliance, Melbnourne, VIC, Australia

Content not available at time of publishing.

Angie Bone

Department of Health and Human Services, Melbourne, VIC, Australia

Content not available at time of publishing.

Forbes McGain^1,2

¹MDHS, University of Melbourne, Melbourne, VIC, Australia

²Western Health, Melbourne, VIC, Australia

Climate change, biodiversity loss, pollution of land, water and air, and species mass extinctions are all consequences of unsustainable practices by humans. Healthcare itself does harm by excessive and often wasteful use of resources with consequential waste production. Australian healthcare is responsible for approximately 7% of Australia's total carbon emissions.

Yet how do we continue to provide modern healthcare in the face of such headwinds? How does Australian healthcare become high value AND low carbon/low waste? Is oncology even at the beginning of this journey?

Here, we discuss what other fields of medicine are undertaking to become high value, low carbon. Particular emphasis will be placed upon what evidence there is around the world as healthcare systems join the Race To Zero (carbon), preventing, avoiding, reducing, and reusing where possible. Life cycle assessment (environmental footprinting) evidence in the fields of anesthesia, surgery, and intensive care will be particularly discussed given their “carbon hotspot” status and their growing body or research work. Opportunities for the oncology community to join the environmental sustainability research agenda will be explored.

Full Sails on Our Journey!

Felicity Wright

Sydney Children's Hospital, Randwick, New South Wales, Australia

Content not available at time of publishing.

Michelle Wilson

Auckland City Hospital, Mt Eden, Auckland, New Zealand

Content not available at time of publishing

George Au-Yeung

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Endometrial cancer is rising in both incidence and mortality globally. Improved understanding of endometrial cancer through molecular profiling has identified different molecular alterations that may have implications both in the adjuvant and advanced setting. Data from recent trials involving immunotherapy combinations or antibody drug conjugates will be presented.

Simon Hyde

Mercy Hospital for Women, Heidelberg, VIC, Australia

Content not available at time of publishing.

Rachel Delahunty

Peter MacCallum Cancer Centre & Mercy Hospital for Women, Melbourne, VIC, Australia

Content not available at time of publishing

Jodie Lydeker

Qld Audit Office, Hamilton, QLD, Australia

“Sometimes the side effects are worse than the cancer.”

A cancer diagnosis brings with it a kaleidoscope of challenges for a patient and their families, but these challenges often get worse at the time when active treatment ceases. For people with advanced disease, these challenges endure.

This session will offer a lived experience perspective beyond the treatment bubble where navigating fear, loss, grief, and confusion becomes a necessary pathway to recovery along with managing the impact of debilitating side effects.  

In the context of optimal care, health service delivery needs to focus on the whole person rather than the disease.

In the context of living well, people impacted by cancer need to be supported to redefine the quality of their life rather than being defined by their prognosis.

Paul Glare

Pain Medicine, University of Sydney, Northern Clinical School, St Leonards, NSW, Australia

This session will discuss the problem of chronic pain as a survivorship issue.

Pain is prevalent among outpatient oncology patients, affecting 2/3–3/4 of patients. While it may be due to cancer or a side-effect of treatment, people with cancer can also have concomitant non-malignant pain, approximately 2/3 in one survey.¹ In the past, opioids were the mainstay of pain relief in cancer patients. As patients are living longer after diagnosis, continuing opioid therapy long-term in cancer patients is causing similar concerns as in the chronic non-cancer pain population (diminishing efficacy but ongoing risks of side effects, tolerance, addiction, and overdose).

Elizabeth J Pearson

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Fatigue during and after cancer treatment is common. Patients continue to report that fatigue is their most troublesome symptom related to cancer and treatment. While health professionals often recognize fatigue as a problem, it is seldom routinely addressed. This gap is often due to lack of knowledge and/or time. The aims of this presentation are to briefly explore the experience and language of fatigue, describe a clinical toolkit and professional education, and provide tips for implementing fatigue management.

The experience of cancer-related fatigue (CRF) is not uniformly appreciated. Language such as “tired” used to describe fatigue can dismiss its impact. The CRF experience involves body sensations, lack of stamina, and cognitive effects with variable severity and onset. These effects are disabling and distressing, completely changing a person's life.¹

Guidelines for CRF typically lack practice tools, posing implementation challenges. A clinical toolkit based on a Canadian CRF management guideline was developed and piloted in Melbourne. Screening methods classify fatigue severity as mild, moderate, or severe. A fatigue management guide based on severity level is part of the toolkit.

Fatigue management must be time efficient for both patients and health professionals. Screening and education should align with existing practice. Teaching people how to self-rate their fatigue can help bridge the fatigue language barrier. Patients can be given agency to self-screen, identify, and report potential contributing factors and self-manage when appropriate.²

Joshua Wiley

Monash University, Clayton Campus, VIC, Australia

Content not available at time of publishing.

David Speakman

Peter MacCallum Cancer Institute, Melbourne, VIC, Australia

Content not available at time of publishing.

Fiona Hegi-Johnson

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Content not available at time of publishing.

Satomi Koide

Alfred Health, Surrey Hills, VIC, Australia

Content not available at time of publishing.

Joshua Lin

General Surgery, Barwon Health, Geelong, VIC, Australia

Geelong's University Hospital is uniquely positioned as the only Victorian tertiary hospital in a regional setting, with a catchment area between Werribee and the South Australian border. While the hospital offers a comprehensive range of breast surgical and reconstructive modalities, individualizing treatment often requires us to account for the challenges of regional living. In this discourse, we explore the efficacy of embracing simplicity, discussing how this approach can sometimes be best.

Karen Trapani¹, Maarten IJzerman^1,2, Fanny Franchini¹, Sophy Athan¹

¹Centre for Cancer Research, Cancer Health Services Research, University of Melbourne, Melbourne, Victoria, Australia

²Health Services Management & Organisation (HSMO), Erasmus School of Health Policy & Management, Rotterdam, Netherlands

Aims: To maximize patient benefit in a large federally funded research program by establishing an independent, autonomous consumer advisory panel. This presentation addresses a health policy concern raised by Australia's Health Technology Assessment (HTA) agencies and how patient engagement early in the research can improve patient and research outcomes.

Methods: From inception, the research team included a senior consumer leader who designed the consumer engagement approach prior to gaining funding for the research program. The entire research team participated in briefings on the value of a consumer partnership model and embraced this approach. A competitive recruitment process to attract the right consumers was executed and an independent panel of experienced consumer representatives was established. The panel has operated independently over the course of the research program providing advice, insights, and direction for the duration of the program.

Results: The panel has actively participated in the research program and have directly influenced research methodology for Horizon Scanning to incorporate patient perspectives and priorities. Panel members have presented at the inaugural Horizon Scanning Forum in Canberra and participated in the Medicines Australia Health Technology Assessment Review, advocating for the role of consumers in the review and providing a submission outlining the lack of consumer engagement in the current HTA processes. The panel is also leading research and preparing publications reflecting the work undertaken.

Conclusion: Research of the future must feature strong and genuine consumer partnership. Models that deliver true consumer partnership are novel and provide leverageable learnings for the research community, both in panel establishment and the results achieved. We have demonstrated how an independent advisory panel can be autonomous and effective across a large federally funded program of work, providing opportunities for informed consumer input and recommendations to drive government funded research.

Fanny Franchini¹, Jennifer Soon^1,2, Karen Trapani¹, Benjamin Daniels³, Marliese Alexander², Yat Hang To^2,4, Sophy Athan¹, Grant McArthur^1,2, Ben Solomon², Peter Gibbs^2,4, Sallie Pearson³, Maarten IJzerman^1,5

¹University of Melbourne, Melbourne, Victoria, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³University of New South Wales, Sydney, New South Wales, Australia

⁴Walter and Eliza Hall Research Institute, Melbourne, Victoria, Australia

⁵Erasmus School of Health Policy and Management, Rotterdam, Netherlands

Aims: This study aims to conduct comprehensive analyses of initial and subsequent treatment lines (TL) among individuals diagnosed with melanoma (MEL), colorectal (CRC), and non-small cell lung (NSCLC) cancers in Victoria from 2010 to 2019. This scope of work has not been performed before in population-based cancer studies. For illustration, we primarily focus on CRC results.

Methods: We examined treatment data from Victorian CRC patients diagnosed between 2010 and 2019, linking the Victorian Cancer Registry to administrative hospital data, Medicare Benefits Scheme (MBS), and Pharmaceutical Benefits Scheme (PBS) records. Systemic therapies were categorized by their mechanisms of action, and treatment data were classified into corresponding TLs to map the entire care trajectory. Analyses included survival and treatment utilization, unveiling current oncology practice in Victoria and associated patient outcomes.

Results: We incorporated data from 90,522 patients diagnosed with CRC (41.3%), MEL (30%), and NSCLC (28.7%). Among the 37,605 CRC patients, 21.7% were diagnosed at stage I, 22.7% at stage II, 22% at stage III, and 17.7% at stage IV. In patients with metastatic disease, median overall survival was 20 months. A Cox proportional hazard model, accounting for gender, diagnosis year, age, and birth region, found no significant survival difference between genders. However, patients diagnosed between 2016 and 2019 showed improved survival (HR .76, 95% CI: .71–.82). Treatment patterns were visualized using Sankey and sunburst diagrams, underscoring chemotherapy's critical role in CRC management. Among stage IV patients, 66% received chemotherapy, and 42% a VEGF-inhibitor. Oxaliplatin, fluorouracil, and bevacizumab were the most prescribed drugs.

Conclusion: Leveraging PRIMCAT's unique linked dataset, this study offers insights into treatment patterns of nominated cancers in Victoria. Our study examines the common treatment sequences and their relationship with patient outcomes, thereby filling a significant knowledge gap in contemporary cancer reporting. Our findings lay the groundwork for modelling work that forecasts the number of eligible patients. These results have substantial implications for health policy and clinical practices.

Ou Yang¹, Judith Liu¹, Fanny Franchini¹, Yat Hang To^2,3, Peter Gibbs^2,3, Maarten IJzerman^1,4, Yuting Zhang¹

¹University of Melbourne, Melbourne, Victoria, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Walter and Eliza Hall Research Institute, Melbourne, Victoria, Australia

⁴Erasmus School of Health Policy and Management, Rotterdam, Netherlands

Aims: This study investigates the influence of clinical and socioeconomic factors on treatment costs for colorectal cancer (CRC), lung, and melanoma cancers in Victoria, Australia, through a detailed analysis of patient-level medical and pharmaceutical data. We illustrate our findings with CRC.

Methods: We used data from Victorian patients diagnosed with CRC from 2010 to 2019, linking the Victorian Cancer Registry to administrative hospital data, Medicare Benefits Scheme (MBS), and Pharmaceutical Benefit Schedule (PBS) records. We evaluated factors such as disease stage, CRC type, multiple diagnoses, molecular profile, progression status, patient age, birth country, socioeconomic status (SEIFA index), and first language. We performed descriptive and log-linear regression analyses to study total cost, claimed benefits, and out-of-pocket expenses.

Results: The results from our analysis for CRC indicate that costs varied with disease stage, years since diagnosis, and whether the patient had a gene mutation. Higher SEIFA quintiles corresponded with higher costs. Rectal cancer patients and those born in Australia generally had higher costs. Regression analysis showed a decrease in costs, expenses, and benefits over the years post-diagnosis, with older patients having lower costs. Disease progression also influenced costs, but this was not statistically significant.

Conclusion: Our findings from analysis for CRC support early detection and treatment, targeted care strategies to reduce CRC costs, and the need to address socioeconomic disparities and support late-stage patients. The results also suggest a focus on gender-sensitive healthcare and cultural inclusivity.

Benjamin Daniels¹, Fanny Franchini², Jennifer Soon³, Marliese Alexander⁴, Yat Hang To⁵, Maarten IJzerman², Sallie-Anne Pearson¹

¹Medicines Intelligence Research Program, School of Population Health, University of New South Wales Sydney, Kensington, NSW, Australia

²Centre for Cancer Research, Cancer Health Services Research, University of Melbourne, Melbourne, VIC, Australia

³Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

⁴Pharmacy Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia

⁵Walter and Eliza Hall Research Institute, Melbourne, VIC, Australia

Aims: New systemic cancer therapies offer hope for improved survival and quality of life; however, uptake of novel treatments in the real-world clinic is not well known. We described uptake patterns of cancer medicines post-Pharmaceutical Benefits Scheme (PBS) listing with the aim of informing future uptake based on horizon scanning for new non-small cell lung cancer (NSCLC) treatments.

Methods: We examined alectinib (PBS-listed January 2018) and crizotinib (PBS-listed July 2015) as they aligned with the horizon scanned medicine lorlatinib. We used Victorian Cancer Registry data (2010–2019) linked with PBS dispensing records (2008–2021) to estimate patient eligibility and medicine use. Monthly initiation rates were calculated as the number of new users (numerator) over the medicine's eligible population (denominator), expressed per 10,000. When eligibility was contingent on gene mutations, we used epidemiological prevalence estimates and bootstrap sampling to estimate the eligible population. We summarized the monthly rates over time for each medicine and used negative binomial regressions to quantify the monthly rate of uptake.

Results: Uptake of alectinib was highest during the first month of subsidy (29/10,000/month); thereafter decreasing by 5%/month to average 5 initiations/10,000/month between February 2018 and December 2020. Uptake of crizotinib was highest during the first month of subsidy (18/10,000/month); thereafter decreasing by 4%/month to average 3 initiations/10,000/month between August 2015 and December 2020.

Conclusion: Uptake was highest immediately following subsidy, reflecting the population of patients who may not have responded to existing treatments as well as prevalent users previously accessing treatments through compassionate access schemes. Pathology data would help improve estimates of populations eligible for these medicines; however, our findings suggest that uptake has been steady, if low, following initial month of PBS availability. These results can inform uptake expectations for similar, newly subsidized treatments.

Fanny Franchini¹, Koen Degeling¹, Jennifer Soon^1,2, Benjamin Daniels³, Yat Hang To^2,4, Peter Gibbs^2,4, Marliese Alexander², Ben Solomon², Grant McArthur^1,2, Sallie Pearson³, Maarten IJzerman^1,5

¹University of Melbourne, Melbourne, Victoria, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³University of New South Wales, Sydney, New South Wales, Australia

⁴Walter and Eliza Hall Research Institute, Melbourne, Victoria, Australia

⁵Erasmus School of Health Policy and Management, Rotterdam, Netherlands

Aims: This study predicts the potential impact of novel therapies on the patient eligibility, resource allocation, and treatment pathways for colorectal (CRC), melanoma (MEL), and non-small cell lung (NSCLC) cancers. These insights support health technology assessment bodies and policymakers in optimizing resource planning, reimbursement decisions, and patient access to novel, effective medicines. We illustrate our results with CRC.

Methods: We used our comprehensive Victorian linked-dataset, which includes Victorian Cancer Registry records linked to PBS, MBS, and hospital data to develop discrete-event simulation (DES) models for each cancer type. These models capture the current standard of care in Australia, estimating the number of patients treated per stage and line of treatment. Forecast incidence, stage at diagnosis distribution, and mutation prevalence are integrated for robust estimates. Horizon scan (HS) results shape scenario analyses to evaluate future therapy impacts.

Results: Our forecasts suggest that from 2022 to 2026, 116,753 colorectal cancer treatments will be provided across all stages in Australia, with 43% representing advanced disease. Scenario analysis of the introduction of pembrolizumab for deficient mismatch-repair in metastatic CRC as first-line treatment would result in 706 patients per year being treated, considering a full uptake and a hazard ratio of .6 for the time-to-progression.

Conclusion: Our forecasting analysis suggests an increase in the proportion of patients’ progression to further lines of treatment with the introduction of pembrolizumab. However, an extended time-to-progression counterbalances this increase, thereby maintaining similar levels of downstream treatment utilization in second-to-fourth lines. Hence, the addition of pembrolizumab to the first-line treatment regimen appears to offer clinical benefits to patients without significantly escalating treatment demand over a 5-year time horizon. Other HS outputs, such as relatlimab in melanoma and lorlatinib in NSCLC, were used to predict future impact.

Christina Signorelli^1,2, Jordana K McLoone^1,2, Carolyn Mazariego³, Skye McKay³, Joseph Elias^2,3, Karen Johnston^1,2, Rachael Bell^1,2, Claire E Wakefield^1,2, Natalie Taylor³, Richard J Cohn^1,2

¹Discipline of Pediatrics; School of Clinical Medicine, UNSW Sydney, Kensington, NSW, Australia

²Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

³School of Population Health, UNSW Sydney, Sydney, NSW, Australia

Over 80% of childhood cancer survivors report experiencing multiple and complex treatment-related health problems, which often develop after a long latent period and continue to increase. While comprehensive survivorship care is recommended to manage these health problems, access to survivorship care in Australia is limited and many survivors disengage from care due to various well-documented barriers.

“Engage” is a remotely delivered, multidisciplinary survivorship program which aims to improve survivors’ health-related self-efficacy (i.e., their confidence in their ability to self-manage their complex health needs in survivorship), and to improve their quality of life in survivorship. “Engage” involves (i) an online patient reported health assessment, (ii) an online nurse-led consultation, (iii) a remote multidisciplinary case review, (iv) written, personalized education, recommendations, and care plan for survivors and their general practitioner, and (v) an online nurse-led consultation to ensure survivors understand the recommendations and can troubleshoot barriers to achieving them and accessing care needed.

The evaluation of “Engage” is ongoing and includes simultaneous evaluation of the program's effectiveness and its implementation across several children's hospitals in Australia. We assess survivors’ outcomes pre-intervention and 1-, 6-, 12-, and 24-months post-intervention and the perspectives of various key stakeholders critical to the evaluation and ongoing delivery of Engage. To date >200 survivors have been through the program across the project's lifespan and 28 stakeholders (researchers, oncology staff, and general practitioners) have participated in interviews.

This presentation will describe some of the successes and challenges of adopting Engage in clinical practice, such as adapting to “real-life” clinical scenarios, managing varying levels of buy-in, adjusting to site-specific needs, “fitting” online care in existing practice, and timing “implementation” and engagement with collaborators to support successful integration. In addition, we will detail our experience of adapting the program to new groups, for example, establishing “Engage Brain” specifically for childhood brain cancer survivors.

Lisa Beatty¹, Emma Kemp¹, Nick Hulbert-Williams², Bogda Koczwara^1,3

¹Flinders University, Adelaide, SA, Australia

²Edge Hill University, Ormskirk, Lancashire, UK

³Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

Aims: While co-designing tailored interventions for specific populations and presenting concerns are the ideal, this process is costly and time consuming. One method for increasing the efficiency of the research to clinical care pipeline is to repurpose existing interventions. This presentation summarizes the benefits, challenges, and outcomes arising from adapting Finding My Way (FMW), an evidence-based digital health intervention, to new clinical populations and settings.

Methods: FMW is a 6-week/6-module psychosocial program that addresses the most commonly experienced issues that arise following diagnosis of curatively treated cancer. Following the successful randomized controlled trial (RCT) of FMW, we scaled up the program as a free-access resource in Australia, and scaled out to different settings (e.g., UK) and clinical populations (e.g., metastatic breast cancer).

Results: Since scaling up, FMW has had more diverse and distressed users than during the RCT, with lower uptake and usage, yet achieving larger changes in outcomes. When scaling out to other settings and populations, all FMW adaptations retained: (a) the core overall structure (6 modules, multi-media, interactive) and (b) the therapeutic framework (CBT-based), but altered aspects of (c) content to tailor it to the setting (e.g., links to UK resources, use of local representatives for video content) or clinical population (e.g., metastatic breast cancer specific examples). These adaptation studies have consistently demonstrated feasibility, with acceptable to strong uptake (60% of eligible individuals signing up), and engagement (e.g., 55% available UK content viewed; 2.2 modules completed for MBC), but clinical outcomes have differed notably from the original trial (e.g., no significant between-group effects in the UK replication study).

Conclusions: While support for the scalability of Finding My Way has been demonstrated in terms of feasibility of this approach, findings also demonstrate that one size may not fit all in terms of content. Implications for future research will be discussed.

Natalie Winter¹, Lahiru Russell¹, Brindha Pillay², Kirsten Pilatti³, Michael O'Callaghan⁴, Sally Sara⁵, Anna Ugalde¹, Liliana Orellana¹, Vicki White¹, Patricia Livingston¹

¹Deakin University, Geelong, Victoria, Australia

²Psychology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Breast Cancer Networf of Australia, Melbourne, Victoria, Australia

⁴The South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia

⁵Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia

Aim: To measure effectiveness of recruitment strategies when inviting people with breast, bowel, or prostate cancer who have elevated levels of fear of cancer recurrence into MindOnLine: a 9-week online mindfulness program; and to inform strategies for implementing interventions in the community setting.

Methods: Recruitment strategies included (i) paid services: cancer registries, hospital outpatient clinics, social media ads managed by the research team; (ii) unpaid services: partner organization cancer registries; and (iii) community promotion: cancer government services, social media posts, online and community cancer peer support groups, and general community groups. Invitations included a brief overview of the study. In outpatient clinics people were initially screened by a research assistant and if interested were sent an email with further details of the program. Potential participants were directed to the project manager or study website for screening and registration. This study is a cost-benefit calculation for paid recruitment services during a randomized controlled trial.

Results: Recruitment commenced in October 2020 and is ongoing. Over 900 people were invited via one paid registry ($12,000); social media ads were displayed on-screen 1.4 million times ($7591); and over 500 people were approached via outpatient clinics (research assistant salary $21,112). Of those formally screened (n = 1361), eligible participants from paid services were cancer registries (n = 12, $1000/per participant); clinics (n = 19, $1111/per participant); and social media ads (n = 34, $199/per participant).

Conclusions: Recruitment costs and participant reach vary between paid cancer registries, recruitment via outpatient clinics, and self-managed social media ads. In this study, social media ad reached over more than 1 million more people than registries or outpatient clinics, and were 75% cheaper than other paid recruitment sites. These findings highlight the potential role of social media ads when implementing technology-based resources into community cancer care.

Ursula M Sansom-Daly^1,2,3, Lauren Kelada^1,2, Holly E Evans^1,2, Kate Hetherington^1,2, Brittany C McGill^1,2, Jessica Buster^1,2, Eden Robertson^1,2,4, Annette Beattie⁵, Kirsty Ross⁶, Nicole Schleicher⁴, Fatima S Espinoza-Salgado^7,8, Lynda Hill⁹, Richard J Cohn^1,2, Claire E Wakefield^1,2

¹School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia

²Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

³Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospitals, Randwick, NSW, Australia

⁴Services and Impact Department, Redkite, Sydney, NSW, Australia

⁵Cancer Information and Support Services Division, Cancer Council NSW, Woolloomooloo, NSW, Australia

⁶Psychology Clinic, School of Psychology, Massey University, Palmerston North, New Zealand

⁷Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico

⁸Oncology Service, National Institute of Pediatrics, Mexico City, Mexico

⁹Family Support Team, The Joshua Tree, Cheshire, UK

Introduction: Following cancer treatment, both adolescent and young adult (AYA) cancer survivors, and parents of child cancer survivors, face numerous psychological challenges. Few rigorously evaluated, skills-based psychological support programs exist, and are accessible, in Australia. To address this need, we designed two online, cognitive-behavioral therapy interventions, delivered in videoconferencing groups with peers: “Recapture Life” for AYA survivors, and Cascade for parents of young people under 18. Following Phase-II trials to establish Recapture Life^1–3 and Cascade's^4,5 feasibility, acceptability, safety, and impact on coping, we implemented both interventions in partnership with several community-based cancer support organizations [delivery-partners].

Method: We evaluated the community implementation of Recapture Life and Cascade using implementation-effectiveness trials with pre-post participant assessments, guided by the RE-AIM framework. AYAs aged 13–40 received the Recapture Life intervention through our delivery-partners, Canteen or Country Hope for AYAs aged 13–25 years (younger version: “Recapture Life”), and Cancer Council NSW for 25–40-year-olds (older version: “Reclaim Life”). Cascade was integrated within five delivery-partners across four countries (Australia, New Zealand, UK, and Mexico). In both trials, we undertook local adaptation of the manualized interventions, then trained deliver-partner staff to facilitate/deliver both interventions. We interviewed delivery-partner staff to assess their intervention-delivery confidence, perceived barriers/facilitators to implementation, recruitment experiences, and financial sustainability.

Results: This talk will highlight “lessons learned” through both implementation trials, and implications for community-based intervention delivery. In the Recapture Life trial, we delivered 11 experiential training sessions to 19 staff, with 41 AYAs participating in online groups. In the Cascade trial, nine staff delivered Cascade to 35 parents, with 77% completion. Both interventions were well-received and experienced some common challenges to implementation (e.g., the pandemic, prolonged site-specific approvals).

Eden G Robertson, Nicole Schleicher

Redkite, Surry Hills, NSW, Australia

Overview: Redkite is a not-for-profit organization that provides financial, emotional, and practical support to families affected by childhood cancer. Our critical support services help families to survive through and beyond the cancer experience.

Over the past 8 years, we have implemented four resources/interventions initially developed by the Behavioural Sciences Unit at the Kids Cancer Centre, Sydney Children's Hospital – “By My Side” and the related “Walking Alongside,” “Cascade,” and “Refresh Kids’ Eating” (previously known as “Reboot”).

“By My Side” is a free book that shares the experiences of bereaved parents – in their own words. Since implementation in 2016, “By My Side” has been requested by 357 families through Redkite's online services platform, “myRedkite,” and disseminated through our in-hospital and community-based social workers. “Walking Alongside” complements “By My Side” to provide guidance to health professionals, using insights from bereaved parents, on how best to support newly bereaved caregivers.

“Cascade” is an online, group-based, cognitive behavioral therapy intervention that equips caregivers with useful skills to manage their cancer-related concerns early in their child's survivorship period and how to live “life after cancer”. Having been recently implemented in mid-2022, “Cascade” has now been delivered to 14 parents by our Redkite social workers. Quality improvement evaluations are underway.

As a part of myRedkite, we are currently adapting and implementing “Refresh Kids’ Eating”, an online, parent-led intervention to improve fruit and vegetable intake in children who have finished their cancer treatment. “Refresh Kids’ Eating” will be launched on myRedkite in Q3 2023, to complement Redkite's other online services such as the Financial Assistance program.

Presentation objectives: In this presentation, Redkite will share their experiences in partnering with the Behavioral Sciences Unit over many years to develop and implement high quality resources/interventions, and the critical success factors for impactful research-to-practice partnerships.

Sherene Loi

Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia

The quantity of tumor-infiltrating lymphocytes (TILs) in breast cancer is a robust prognostic factor for improved patient survival, particularly in triple-negative and HER2− overexpressing breast cancer subtypes. In the last year, pembrolizumab, a T checkpoint based therapy has been approved for the treatment of patients with early stage and late stage triple negative breast cancer. In this talk, I will discuss the latest clinical updates, upcoming potential trials as well as the complexities in patient management.

Cary Adams

Union for International Cancer Control, Geneva, Switzerland

Content not available at time of publishing

Michael Jefford

Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Content not available at time of publishing.

Dorothy Keefe

Cancer Australia, Surry Hills, NSW, Australia

The development of Australia's first national Cancer Plan is a major milestone in cancer control. Created in collaboration with the Australian cancer sector, the Plan serves as a blueprint for advancing our world-renowned cancer system, with a focus on improving outcomes for all Australians affected by cancer in the next 10 years and beyond. The Plan was delivered to the Minister for Health and Aged Care in April 2023.

Using the 50th year of the COSA Annual Scientific Meeting as a springboard, Cancer Australia will outline changes we can look forward to seeing in the cancer sector leading up to COSA's 60th. The Plan marks a new era in cancer care in Australia, where equitable and optimal care is within reach for everyone.

In this interactive plenary session, the spotlight will be on the implementation of the Australian Cancer Plan, which demands coordinated leadership and partnerships across the entire cancer control system, including government bodies, non-government organizations, and the health and research sectors. Led by Professor Dorothy Keefe, CEO of Cancer Australia, a panel of cancer control experts will delve into the priority actions already underway by the Australian Government, including the development of a national comprehensive data framework, activation of Optimal Care Pathways, research design, and service delivery, a workforce pipeline for Aboriginal and Torres Strait Islander cancer clinicians, establishment of an Australian Comprehensive Cancer Network, and a national framework for genomics in cancer control.

The plenary will also explore the lines of effort required by the cancer control community to achieve other priority actions outlined in the Plan. Delegates will have an opportunity to pose questions and contribute key national policy initiatives or scalable programs that will support the implementation of the Australian Cancer Plan.

Panelists:

Professor Tanya Buchanan, CEO, Cancer Council Australia

Professor Tom Calma AO, National Coordinator, Tackling Indigenous Smoking

Professor Shelley Dolan, CEO, The Royal Melbourne Hospital

Lillian Leigh, Consumer

Tania Rishniw, Deputy Secretary, Primary and Community Care, Department of Health and Aged Care