Oral Abstracts

1 | Global Overview of Equity: The radiation oncology perspective

Danielle Rodin¹

¹Princess Margaret Cancer Centre, Toronto, Ontario, Canada

Health inequities are associated with social, economic, and structural barriers to care and are observed across the cancer continuum. Although radiation therapy is a key pillar of cancer treatment, it is also an area with some of the largest disparities in access. This presentation will discuss the inequities in radiation oncology that are observed within and between countries, in both high-income and low- and middle-income country settings. These inequities are reflected in challenges in radiation availability and accessibility as well as patient acceptability and affordability of treatment. Beyond characterizing the problems, this talk will explore solutions to address the drivers of these inequities. These solutions include strategies to improve the diversity, cultural competency, and portability of the workforce, novel digital solutions that improve the ease of delivering high-quality care, and policy initiatives efforts at the local, national, and international level.

2 | Global overview of Access: what is ASCO doing to reduce disparities

Robin Zon¹

¹ASCO, Niles, MI, United States

Globally, cancer accounts for nearly 10 million deaths annually, or one in six deaths. Despite successes in reducing cancer incidence and mortality, inequities persist globally and can be linked to a variety of barriers for patients, including but not limited to geography, race and ethnicity, socioeconomic status, age, gender identity and sexual orientation, culture, education, and insurance access. Additionally, socioeconomic disparities and systemic inequities resulting from public policies, racism, ethical development, and access to technological advancements present ongoing and serious factors impacting equity, diversity, and inclusion efforts meant to improve access to health care services. To address many of these factors, ASCO has developed a comprehensive Equity, Diversity, and Inclusion (EDI) strategy aimed at advancing equitable cancer care. This strategy enables greater impact for equitable and inclusive patient care by focusing on EDI programs and tangible steps ASCO can take to move the needle and create substantial and sustainable change.

3 | National advocacy agenda setting to improve the lives of Aboriginal and Torres Strait Islander peoples with cancer

Gail Garvey¹

¹University of Queensland, Brisbane, QLD, Australia

Content not available at time of publishing.

4 | Telehealth in Oncology: ASCO Standards and Practice Recommendations

Robin Zon¹

¹ASCO, Niles, MI, United States

Telemedicine, also commonly referred to as telehealth, can increase access to care for patients with cancer while reducing treatment burden and disruption to patients. Providers who use telemedicine have reported that its benefits include decreased travel time for patients, immediate access to care, early detection of health issues and complications, increased patient autonomy, reduced caregiver burden, and increased patient satisfaction with healthcare. Additionally, virtual visits can provide effective follow-up and enhanced convenience for patients compared with traditional office visits. Telehealth interventions in chronic disease management have been shown to lead to a decline in hospital admissions and re-admissions, length of hospital stays, emergency department visits, and a reduction in mortality. With this in mind, ASCO has developed standards to guide appropriate use and implementation of telehealth in practice.

5 | Teletrials–where are we up to?

Amy Ives¹

¹Royal Brisbane & Women's Hospital, Cashmere, QLD, Australia

Content not available at time of publishing.

6 | Teletrials – how are they working for regional sites?

Hayden Christie¹

¹Wide Bay HHS, Urraween, QUEENSLAND, Australia

Involvement in clinical trials is important, as it may allow patients to undertake a treatment that they could not otherwise have accessed. They are also the mechanism through which the medical system develops its knowledge of therapeutic interventions, including safety, effectiveness, and positioning in the treatment spectrum.

Teletrials are an established mechanism for increasing patient involvement in trials that would otherwise be restricted to those with access to metropolitan health facilities. The Australian Teletrial Program has implemented guidelines and provided resources to help establish this model. This model has had broad acceptance by State Health Authorities and Trials groups. Several trials have successfully utilized the Teletrial model across Australia in recent years. They have demonstrated that this is a feasible and safe model, although infrastructure and governance at satellite sites is often discussed as a barrier.

With the current increase in regional migration in Australia, there is increasing strain on regional health systems. Clinical trials can sometimes be seen as a non-essential activity and potentially as a risk and are therefore not seen as important. This exposes a growing population of patients to trial access inequity. To counteract this, the benefits of Teletrials to regional Health Services need to be highlighted along with the expectation that it is a standard of care.

Through discussing experiences from participation in Teletrials from a regional point of view, the goal is to highlight such benefits. Barriers encountered will also be discussed along with how they can potentially be overcome.

7 | Telehealth: Bridging the gaps in first nations cancer care

Shivanshan Pathmanathan¹

¹Medical Oncology, Townsville University Hospital, Townsville, Queensland, Australia

Indigenous communities often face disparities in cancer treatment due to their geographic isolation and lack of critical infrastructure for effective healthcare delivery. These challenges are exacerbated by difficulties in attracting and retaining a skilled health workforce. However, advances in technology, particularly telehealth, offer promising solutions to bridge these gaps. This presentation explores the successful implementation of telehealth in North Queensland, where it has effectively connected remote communities with tertiary cancer care facilities. Over the past decade, this networked approach has brought cancer care closer to home for Indigenous populations, improving cancer care delivery, survivorship, supportive and end of life care. We will discuss how telehealth systems have been utilized to enhance cancer care accessibility and equity.

8 | Good, bad, short, long, or the space in between: Discussing quality and quantity of life

Michael S Krasovitsky^{1, 2}

¹Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

²St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

Patients with cancer may be confronted with complex questions related to both quantity and quality of life. Such questions span not only the medical domain, but may have significant emotional, psychological, spiritual, practical, and philosophical components. For patients with vulnerabilities over and above those inherently associated with cancer, such as older individuals or those from CALD backgrounds, questions regarding length and quality may be informed by cultural structures that could be different from our own. This presentation aims to discuss the current landscape of knowledge regarding how patients view matters of life expectancy and life quality, and offer a framework for discussing these highly sensitive topics with individuals across the cancer spectrum.

9 | Navigating difficult interactions with family and friend carers

Rebekah Laidsaar-Powell¹

¹Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia

The involvement of family/friend carers in cancer care is typically positive, often resulting in improved patient information, advocacy, support, and care. However, given the stressful and emotional nature of cancer, challenging interactions between health professionals and carers can sometimes occur. This can include carers displaying distress or anger, or situations where the patient and carer are experiencing conflict. Managing these situations can be complicated, time consuming, and stressful for health professionals, who are rarely provided education on evidence-based strategies to avoid or de-escalate these difficult situations with carers.

In this talk, Dr Rebekah Laidsaar-Powell will detail the TRIadic Oncology (TRIO) research program she has led for over a decade, which has resulted in development of the first evidence-based communication guidelines for oncology health professionals to manage carer involvement in cancer consultations. Dr Laidsaar-Powell will highlight several online interventions developed to improve communication with carers, including a professional development module specifically targeting family conflict. This talk will focus on factors contributing to carer distress, conflict, and anger in the cancer setting and will provide key communication strategies for health professionals to manage and de-escalate these situations.

10 | Raising the bar: Discussions about alcohol after a cancer diagnosis

Maree Grier¹

¹Royal Brisbane & Women's Hospital, HERSTON, QLD, Australia

In specialist cancer services, the array of topics to be addressed during patient consultations has expanded as our understanding of cancer and its treatment becomes more comprehensive from a biopsychosocial perspective. Unfortunately, the time available for these discussions has not increased and may even have decreased. Among the many critical topics, alcohol use often receives insufficient attention. Emerging research highlights the significant role of alcohol in the development of certain cancers, emphasizing the need for both individual and population-level awareness in the prevention of cancer. However, the focus on how and why to discuss alcohol use after a cancer diagnosis is more limited.

From the viewpoint of extensive experience in clinical psychology within a large Queensland cancer service, this presentation will explore:  Observations of patients’ understanding of the connection between alcohol and cancer; the unintended consequences of minimal assessment of alcohol use; the reasons for raising the topic; and effective communication approaches, including avoiding stigma. The aim is to pose the question—within the limits of the available time in busy clinics, can we raise the bar when assessing and discussing alcohol use in specialist cancer care services?

11 | Cancer is awkward–dealing with uncomfortable conversations

Nicola Du Thaler¹

¹Choices Cancer Support Centre, Brisbane

“So, how's the vulva going?” said the locum oncologist in a loud voice across the crowded chemo ward. Sounds like fiction but it is not. It is an example of a comment from one of the many uncomfortable conversations that Nicola has had in her six-year lived experience of cancer. Diagnosed in 2018 with a rare cancer, Nicola has been a patient, a survivor, a carer for a terminally ill cancer patient, and a supportive best friend to a friend with ovarian cancer. She will present her personal experience dealing with uncomfortable conversations in these roles.

Cancer is awkward making communication about it challenging. She will describe encounters with health professionals, talking to family and friends about cancer and treatment, and awkward discussions about death and dying.

“Whatever words we utter should be chosen with care for people will hear them and be influence by them for good or ill.”  Buddha.

12 | Multi-morbidity and inferior outcomes in cancer survivors

Susan Dent¹

¹University of Rochester, New York, United States

There are nearly 17 million individuals in the U.S. who are cancer survivors—including those who are currently receiving therapy with curative intent, those with chronic cancer such as chronic lymphocytic cancer (CLL) or metastatic disease who will receive cancer therapy for many years, and long-term survivors.

At the time of diagnosis, many cancer survivors have preexisting comorbidities, such as hypertension, dyslipidaemia, and diabetes, which increase their risk of both cancer and non-cancer-related morbidity and mortality. This is due in part to ageing, and the fact that the development of many cancers have shared risk factors (e.g., obesity and sedentary lifestyles) with cardiovascular disease (CVD). Many individuals will survive their cancer only to have a preventable cardiac death. Management of cardiometabolic comorbidities is essential during and after cancer therapy, yet cancer survivors may not be offered appropriate pharmacotherapy or lifestyle modifications. Non-adherence to medication also places cancer survivors at greater risk of cardiovascular morbidity and mortality. Increased collaboration and communication between the oncology and cardiology care team, primary care providers, and allied healthcare providers is required to adequately manage comorbid risk factors in cancer survivors. Coordination of care and treatment of comorbidities should remain a priority of treatment from the time of cancer diagnosis. The ONE TEAM study (NCT04258813) is exploring the role of primary care providers in the management of hypertension, dylipidaemia, and diabetes, as well as adherence to treatment, in patients with breast, colorectal, and prostate cancer at time of diagnosis.

13 | Multimorbidity in Aboriginal and Torres Strait Islander people

Abbey Diaz¹

¹The Australian National University, Canberra, ACT, Australia

Content not available at time of publishing.

14 | Multimorbidity in cancer survivors – using big data to improve practice

Huah Shin Ng^{1, 2}

¹Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia

²SA Pharmacy, SA Health, Adelaide, SA, Australia

The co-existence of one or more chronic health conditions (comorbidities) is common in cancer survivors, with > 90% suffering from at least one comorbidity, and approximately 70% suffering multimorbidity (≥2 comorbidities). Prevalence of comorbidity in cancer survivors is higher than cancer-free controls and is associated with premature mortality, morbidity, and higher rates of health service utilization.

Big data offers significant opportunities to understand the burden of multimorbidity in the context of cancer in the real world that can inform policy and practice and address the gap in evidence due to exclusion of patients with multimorbidity from many clinical trials.

This presentation will examine available data sources, novel research methodologies, as well as data limitations and priorities for data developments to inform this field.

15 | Multimorbidity – the core business of primary care

Christelle Greeff^{3, 1, 2}

¹General Practice, Ochre Health, Maleny, Queensland, Australia

²Palliative Care, Caloundra Hospital SCHHS, Calundra, Queensland, Australia

³Radiation Oncology, Sunshine Coast University Hospital SCHHS, Birtinya, Queensland, Australia

This presentation explores the impact of multimorbidity—defined as the coexistence of multiple chronic conditions—on cancer outcomes and emphasizes the critical role of primary care in managing these chronic conditions. It begins with an introduction to the concept of multimorbidity and its prevalence among cancer patients, particularly highlighting that nearly 70% of older cancer patients (65+) in Australia experience multimorbidity.

The presentation then delves into the specific ways in which conditions like diabetes and obesity can complicate cancer treatments.

It illustrates the practical challenges and increased mortality risk, associated with multimorbidity. It discusses how lifestyle-related diseases such as cardiovascular disease, diabetes, and mental health disorders, to name a few, can increase the risk of cancer treatment related complications such as treatment dosing and increased toxicity, playing a role in poor cancer outcomes and prognoses.

Primary care's pivotal role in managing multimorbidity is highlighted, showcasing strategies such as regular monitoring, individualized care plans, and lifestyle interventions. The importance of multidisciplinary collaboration between primary care providers, oncologists, as well as nursing and allied health professionals is emphasized to ensure comprehensive care. Barriers and challenges, including systemic issues like resource limitations and patient-specific factors like low health literacy, are acknowledged, alongside proposed solutions like better integration of care and the use of digital health tools and technological advancements.

In summary, general practice is becoming increasingly complex with multimorbidity the norm, rather than the exception. The presentation is calling to bridge the gap between primary care physicians and specialists care, nursing services, pharmacists, allied health professionals, and researchers. We can collectively strive to identify multimorbidity as a modifiable risk factor in order to improve cancer outcomes, advocating for a holistic and coordinated approach to patient care.

16 | Understanding how the impact of cancer varies by geographic location: Insights from the new Australian Cancer Atlas 2.0

Peter D Baade¹, Jessica K Cameron¹, Paramita Dasgupta¹, Thom Saunders², Sarah Azad,², Susanna M Cramb³, Kerrie Mengersen,⁴

¹Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia

²VISER, Queensland University of Technology, Brisbane, Queensland, Australia

³School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia

⁴Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia

Aims: It is widely recognized that the impact of cancer exhibits geographical variation, often attributed to disparities in socioeconomic factors and health behaviours. In 2018, the award-winning Australian Cancer Atlas (atlas.cancer.org.au) was launched online, offering a comprehensive depiction of cancer impact, quantified by incidence rates and survival outcomes, at a fine-grained geographical scale throughout Australia. Since its launch, it has been accessed by > 65,000 distinct users from > 100 countries and has been used to guide policy development and increase cancer prevention and early detection efforts. In 2021, work commenced greatly expand the Atlas with the aim of including additional indicators related to cancer screening, risk factors, clinical characteristics, and hospital treatment modalities; along with temporal changes in the geographical patterns; measures of both relative and absolute burden and more types of cancer.

Methods: Spatial and spatio-temporal statistical models within a Bayesian framework were developed and applied to population-based data obtained from cancer registry, hospital admission, Medicare-funded procedures, screening datasets, and National Health Survey data. Substantial enhancements to the digital architecture and interactive user interface visualized the modelled estimates across at least 2200 small areas alongside their uncertainty.

Results: The Australian Cancer Atlas 2.0 launched in May 2024, revealing substantial geographical disparities in the impact of cancer across Australia, with the magnitude and characteristics of this variation varying by cancer type and indicator. While area-specific trends were generally consistent with the national trend, there was limited evidence that geographic disparities have changed over time. This presentation will feature these geographic disparities, showcase key elements of the new Atlas, and discuss future research priorities and collaboration.

Conclusions: The Australian Cancer Atlas provides unique insights into the “what” and “where” of geographical variation, crucial for informing the development of interventions and policy. The next step is to understand the “why.”

17 | The association between cardiorespiratory fitness and breast, colon, and lung cancer incidence and mortality in 166 124 Swedish women

Kate A Bolam^{1, 2, 3, 4}, Helene Rundqvist⁵, Erin J Howden^{1, 4}, Elin Ekblom-Bak²

¹Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

²The Swedish School of Sport and Health Sciences, Stockholm, Sweden

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

⁴The University of Melbourne, Melbourne, Victoria, Australia

⁵Karolinska Institutet, Stockholm, Sweden

Aims: To investigate the relationships between cardiorespiratory fitness (CRF) and breast, colon, and lung cancer incidence and mortality from a database of employed Swedish women, and to assess whether BMI modified the associations between CRF and cancer incidence.

Methods:

This prospective cohort study was conducted in a population of women who underwent an occupational health assessment between 1982 and 2019 in Sweden. Data analysis was performed in June 2024. CRF was assessed as peak oxygen uptake, estimated with submaximal cycle ergometer test (estimated V0₂ peak). Data on breast, colon, and lung cancer incidence and mortality were drawn from national registers. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression.

Results: Data on 166,124 women (age range, 18–80 years; mean [SD] age, 43 [11]; mean [SD] body mass index, 25 [4.4]) were analyzed. During a mean (SD) follow-up time of 12.5 (6) years, a total of 2578 incident cases of breast, 681 of colon, and 626 of lung cancer were recorded, with 272 deaths due to breast cancer, 183 due to colon cancer, and 425 due to lung cancer. Higher estimated vo2 max was associated with significantly lower risks of colon (HR, .983; 95% CI, .973–.993) and lung (HR, .984; 95% CI, .974–.995) cancer incidence. Higher estimated vo2 was associated with significantly lower risk of lung cancer mortality (HR, .982; 95% CI, .970–.995). BMI significantly modified the associations for breast cancer mortality, BMI < 30: HR, .987; 95% CI .970–1.004, BMI ≥ 30: HR, 1.016; 95% CI .950–1.086 (p = 0.04).

Conclusions: In this large cohort of Swedish women, higher CRF was associated with a lower risk of colon and lung cancer. Higher CRF was associated with a lower risk of lung cancer mortality. CRF appears important for reducing the risk of colon and lung cancer incidence and lung cancer mortality.

18 | Patterns of medication use following breast cancer diagnosis: an Australian population-based study

Huah Shin Ng^{1, 3, 2}, Christoffer Johansen⁴, Ming Li^{2, 5}, David Roder², Kerri Beckmann², Bogda Koczwara^{1, 6}

¹College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia

²Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

³SA Pharmacy, SA Health, Adelaide, SA, Australia

⁴Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

⁵Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

⁶Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia

Aims: Cancer survivors are at increased risks of developing comorbidities and may take multiple medications. This study examined the patterns of medication use following breast cancer diagnosis.

Methods: A retrospective cohort study using the South Australian Cancer Registry linked with medication dispensing records, death registry, and inpatient hospital data. Women diagnosed with breast cancer between July 2012 and March 2014 were followed for 5 years from diagnosis. All medications were defined using the Anatomical Therapeutic Chemical classification and patterns of use were analysed in one-yearly intervals. The changes in the use of medications and polypharmacy (≥5 concomitant medications versus not) over time from Year 2 to Year 5 of breast cancer diagnosis were examined using generalized estimating equations models with binary logistic distribution.

Results: The study included 2005 women (mean age = 61.1 years). There was an increased likelihood of polypharmacy over time [odds ratio (OR): 1.06; 95%CI = 1.04–1.09] with the prevalence ranged from 24% (Year 2) to 29% (Year 5). The likelihood of being dispensed cardiovascular medicines including agents acting on renin-angiotensin system (OR: 1.03, 95%CI = 1.01–1.05), beta-blockers (OR:1.08, 95%CI = 1.04–1.11), cardiac therapy (OR: 1.16, 95%CI = 1.06–1.18), and lipid-modifying agents (OR: 1.06; 95%CI = 1.03–1.08) increased over time. The medication uses for thyroid (OR: 1.04; 95%CI = 1.02–1.07), diabetes (OR: 1.08; 95%CI = 1.05–1.11), obstructive airway (OR:1.09; 95%CI = 1.05–1.13), and bone diseases (OR: 1.12; 95%CI = 1.08–1.17) also increased over time. In contrast, the use of endocrine therapy for breast cancer decreased by 12% (OR: .88; 95%CI = .86–.90). There were no significant changes in other medications, including antibacterial for systemic use, antirheumatics, and anti-anemic preparations over time. Several characteristics were associated with polypharmacy, including older age, a lower socioeconomic status, and a higher burden of comorbidity.

Conclusion: The use of several medication classes increased over time, which may be linked to the development of new comorbidities. An integrated approach to both polypharmacy and multimorbidity should be considered in the management of cancer survivors.

19 | Timeliness and Guideline-Concordant Treatment in Small-Cell Lung Cancer: Factors Influencing Outcomes in Victoria

Sanuki Tissera¹, Evangeline Samuel^{1, 2}, Susan Harden^{1, 3}, John Zalcberg^{1, 4}, Rob Stirling^{1, 5, 6}, Wasek Faisal⁷, Baki Billah¹

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

²Department of Medical Oncology, Latrobe Regional Health, Traralgon, Victoria, Australia

³Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

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

⁵Central Clinical School, Monash University, Melbourne, Victoria, Australia

⁶Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia

⁷Department of Medical Oncology, Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia

Aims: This study aims to identify factors causing delays to specialist appointment and treatment for small-cell lung cancer (SCLC) patients and to examine the delivery of guideline-concordant treatment (GCT) to newly diagnosed SCLC patients in Victoria.

Methods: Prospectively collected data from the Victorian Lung Cancer Registry, collected between July 2011 and November 2023 (n = 1769), was analysed. Multivariable logistic regression assessed delays from referral to specialist appointment and diagnosis to treatment, while survival was analysed using Kaplan-Meier estimates and Cox regression.

Results: Patients with extensive stage (ES)-SCLC were more likely to see a specialist within 14 days of referral (84.4%) compared to those with limited stage (LS)-SCLC (74.3%). Diagnosis-to-treatment delays of ≥14 days were more common in LS-SCLC patients (40.24%) than ES-SCLC patients (19.9%). Overall, 43% of SCLC patients received GCT, with higher rates in ES-SCLC (81.9%) compared to LS-SCLC (64.2%). In SCLC patients, referral delays (≥14 days) were more common among in those aged ≥70 years (70 to < 80 years HR 2.65 [1.07–6.53] p = 0.035, ≥80 years HR 3.62 [1.36–9.61], p = 0.010). Diagnosis-to-treatment delays in SCLC patients were associated with respiratory comorbidities (HR 1.40 [1.04–1.87], p = 0.026), or treatment at inner-regional hospitals (HR 2.14 [1.40–3.29], p < 0.001). Median survival was 1.7 years for LS-SCLC patients, significantly higher than .59 years (6 months) for ES-SCLC patients (p < 0.001). Receiving any form of treatment was associated with higher survival rates. Patients treated with GCT improved survival by 24% (HR .45 [.32–.62]) compared to non-GCT (HR .21 [.15–.30], p < 0.001), while discussion at a multidisciplinary meeting was also associated with significantly higher survival (HR .84 [.75–.96), p = 0.007]).

Conclusion: Patients with ES-SCLC were more likely to receive timely specialist appointments and treatment compared to LS-SCLC patients, however, there was no significant difference in survival. Receiving GCT significantly improved survival, highlighting the need to improve GCT adherence for better SCLC outcomes.

20 | Receipt and response to neoadjuvant chemotherapy treatment and survival outcomes in triple-negative breast cancer in Queensland: a retrospective population-based cohort

Larissa Vaz-Goncalves¹, Louise Marquart-Wilson ¹, Melinda M Protani¹, Jodi M Saunus², Julie Moore³, Michelle J Morris⁴, Marina M Reeves¹

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

²Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia

³Cancer Alliance Queensland, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia

⁴Sunshine Coast University, Sunshine Coast, Queensland, Australia

Aims: To identify triple-negative breast cancer (TNBC) patients who received neoadjuvant chemotherapy (NAC) and achieved pathological complete response (pCR) to examine associations with overall and breast cancer-specific survival (OS; BCSS).

Methods: TNBC patients were identified from Queensland Oncology Repository (female, 18+, 2017–2019); followed up to Dec 2021(BCSS) and Feb 2024(OS). Paget's disease, stage IV, and patients without treatment were excluded. pCR was defined as no residual disease after NAC regardless of lymph node status. Multivariable models identified the likelihood of receiving NAC and achieving pCR. Survival rates were estimated for no NAC versus NAC with pCR, and NAC without pCR, using Kaplan-Meier, and adjusted hazard ratio (HR) were estimated using flexible parametric survival models at 1-, 2-, and 4-year survival.

Results: One thousand twenty-one TNBC patients were included; 21.5% received NAC, with NAC common in those living in major cities (24.4%) and outer-regional/rural areas (21.9%) compared to those in inner-regional areas (12.6%). Patients who received NAC (versus not) were younger (49.0 ± 13.0 vs. 61.4 ± 14.6 y) and more commonly diagnosed with stage IIIa-IIIc (70.5% vs. 53.1%). Among those who had NAC, 42.4% achieved pCR. pCR was more common in those with stage IIa-IIb (62.5%) versus stage IIIa-IIIc (34.9%). Compared to those who did not receive NAC, those who did and achieved pCR had better OS (HR .27–.41; p > 0.05) at 1-, 2- and 4-year post-diagnosis, whereas those who did not achieve pCR had significantly poorer OS (HR 2.22–3.57; p < 0.05) at all follow-up years. Trends were similar for BCSS.

Conclusions: Patients who received NAC and achieved pCR had better survival. Receipt of NAC however, differed by age and geographical region, with those living in inner-regional areas less likely to receive NAC. Equitable access to optimal care is essential for addressing survival disparities. Continued research for TNBC is vital for those who do not benefit from current treatments.

21 | Risk Factors of Colorectal Cancer after a Colonoscopy: A Retrospective Cohort Study of Australian Patients Aged 75 and Older

Molla M Wassie¹, Geraldine Laven-Law¹, Jean M Winter¹, Norma Bulamu¹, Liz Buckley¹, Joshua Trigg¹, Peter Bampton², Charles Cock^{1, 3}, Erin Symonds^{1, 3}

¹Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia

²SA Group of Specialists, Adelaide, SA, Australia

³Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia

Aims: Colorectal cancer (CRC) risk increases with age and can be prevented through ongoing surveillance colonoscopy. However, colonoscopy is generally not recommended beyond age 75y. This study aimed to determine predictors of post-colonoscopy CRC (PCCRC) in people aged ≥75y.

Methods: We conducted a retrospective observational cohort study on individuals aged ≥75y at above-average risk of CRC (due to a prior history of colorectal neoplasia and/or a significant family history of CRC). All individuals were enrolled in a South Australian CRC surveillance program (SCOOP) and undergoing surveillance colonoscopy at guideline-recommended intervals until age 75y. Demographics, family history of CRC, colonoscopy, and prior faecal immunochemical test (FIT) results before turning 75y were extracted from clinical records. CRC was identified through data linkage with the South Australian Cancer Registry. Predictors of PCCRC were identified using Cox proportional hazards regression.

Results: A total of 126 PCCRC cases were diagnosed in 3842 individuals aged ≥75y (54.9% male). The median follow-up time from last colonoscopy was 7.9 years per person (interquartile range 3.1–13.2). Older age (hazard ratio [HR] 2.6, 95% confidence interval [CI] 1.6–4.1, for those aged 80–85y; HR 3.3, 95% CI 1.7–6.4, for those aged above 85y, previous resection of advanced neoplasia (including high-grade dysplasia, size ≥10 mm, villous component, or ≥3 tubular adenomas) (HR 1.8, 95% CI 1.2–3.3), immediately prior incomplete colonoscopy (HR 3.0, 95% CI 1.7–5.2), and greater number of total prior colonoscopies (HR 1.2, 95% CI 1.1–1.4), were each associated with increased risk of developing PCCRC. Risk for PCCRC was reduced for those with greater number of FIT completion (HR .8, 95% CI .7–.9).

Conclusion: PCCRC presents a clinical challenge in people aged ≥75 years. Risk factors for PCCRC, such as previous colonoscopy outcomes (e.g., advanced neoplasia), can help guide the development of future non-invasive surveillance strategies in this increased risk older population.

22 | We can see the future of cancer inequity–can we change it?

Paul B Grogan¹

¹Daffodil Centre, University of Sydney, Sydney, NSW, Australia

Aims: This presentation aims to highlight areas where efforts across disciplines could be coordinated to reduce the 1.45 million cancer deaths predicted in Australia and a widening of multifactorial gaps in outcomes between 2020 and 2044.

Methods: Data draw from comprehensive projections of Australian cancer incidence and mortality, contextualized with analyses of key drivers of predicted patterns. The projections, in the Lancet Public Health, draw from an age-period-cohort model or generalized linear model for 24 cancer types and all cancers combined. Effect of factors such as smoking prevalence and PSA testing (associated with increased prostate cancer incidence) were incorporated, as well as modelled COVID-19 impacts. It is complemented with a summary analysis of additional factors associated with predicted patterns, with a focus on inequity including underinvestment and ad hoc prioritization of research.

Results: From 2020 to 2044, age-standardized mortality rates will fall by 21.5% in men and 20.6% in women on current trends. However, death rates will increase for cancers of the liver and uterus, while there are wide variations in improvements across cancer types (from a 36% fall in melanoma mortality rates to a 3.5% decline for pancreatic cancer). While tobacco control and sun protection will drive prevention benefits, stage-shift through ad hoc early detection and organized screening, and optimal care at all stages, will drive reduced mortality post-diagnosis. Widening variations by cancer type and between demographics will occur, unless there is systematic change. Research investment is not prioritized to need.

Conclusions: A coordinated approach to cancer research, policy and practice reform, mapped against trends in disease burden by cancer type, intervention and evidence gaps, could help drive major reductions in predicted cancer mortality and widening inequity. Cancer control professionals, informed with both clinical evidence and compelling data on trends, can be effective advocates for reform.

Luo Q, O'Connell DL, Yu XQ, Kahn C, Caruana M, Pesola F, Sasieni P, Grogan PB, Aranda S, Cabasag CJ, Soerjomataram I, Steinberg J, Canfell K. Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment delays during the COVID-19 pandemic: a statistical modelling study. Lancet Public Health. 2022 Jun;7(6):e537-e548. doi: 10.1016/S2468-2667(22)00090-1. Erratum in: Lancet Public Health. 2022 Nov;7(11):e895. doi: 10.1016/S2468-2667(22)00260-2. PMID: 35660215; PMCID: PMC9159737.

23 | Unlocking Diversity: A Prospective Study of Ancestry, English Proficiency, Culturally and Linguistically Diverse Participation in NSW Phase 1 Cancer Trials

Chien Ng¹, Udit Nindra¹, Christina Teng², Joe Wei^{2, 3}, Adam Cooper¹, Kate Wilkinson¹, Aflah Roohullah¹, Charlotte Lemech^{2, 3}, Wei Chua¹, Abhijit PAL¹

¹Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia

²Scientia Clinical Research, Randwick, New South Wales, Australia

³Prince Of Wales Hospital, Randwick, New South Wales, Australia

Aims: Australia is culturally diverse with 49% of the population born overseas or having at least one parent born abroad. Cancer patients from culturally and linguistically diverse groups (CALD) are underrepresented in early phase clinical trials (EPCTs). EPCTs are vital to improving cancer therapies; however, inadequate CALD participation limits generalizability of results, potentially increasing health disparities. We aim to characterize patients enrolled in EPCTs across two catchment centers with unique populations.

Methods: All participants enrolled in EPCTs across two major NSW clinical trial units were recruited. Upon commencing their EPCT, participants completed a baseline demographic survey. Details regarding EPCT; participant background (including cultural and linguistic status); parents’ country of birth and English proficiency were recorded. As of July 2024, 84 patients were recruited.

Results: Across two EPCT centers, 84 patients were included with 56% (n = 44) being female. Median age was 64 years (55–71yrs). Considering ancestry/heritage: 21% (n = 18) of patients were born outside of Australia; 38% (n = 32) had at least one parent born overseas; and 68% (n = 57) had both parents born in Australia. English was the preferred language for 89% (n = 75) of patients with 76% (n = 64) reporting “A” Level proficiency; this was followed by Mandarin/Cantonese 5% (n = 4). An interpreter was required for 8% of patients (n = 7). Despite a contributing Southwest Sydney centre with high Arabic and Vietnamese populations, only 11% (n = 3/28) of patients were from these backgrounds. Overall, 21% of patients (n = 18) identified as culturally diverse; 20% (n = 17) were linguistically diverse.

Conclusion: This study reveals underrepresentation of patients without English as a preferred language in EPCTs. There is a notable lack of recent migrants, with most participants having both parents born in Australia. The trial population does not reflect the diverse Australian community in the trial center's catchment areas. Future efforts optimizing EPCT enrolment in multicultural societies can ameliorate underrepresentation.

24 | When good intentions are not enough: The development of the Equity ProcEss frameworK (EPEK) to promote equity in cancer

Brighid Scanlon^{2, 1}, David Wyld^{2, 1}, Jo Durham³, Sam Toloo³, Natasha Roberts^{4, 1}

¹Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

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

³School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia

⁴Surgical, Treatment and Rehabilitation Service (STARS), Metro North Health, Brisbane, Queensland, Australia

Background: Equity in cancer is a global priority, with many countries making commitments to improve outcomes, including Australia. Despite being a burgeoning field of inquiry, research to date has been largely exploratory, with a focus on identifying disparities rather than actively promoting equity. There is currently a lack of high-quality guidance for health systems to respond to cancer inequities through research, policies, or quality improvement activities.

Aims: We aimed to design a guiding process framework for health services to support the promotion of equity in cancer.

Methods: The Equity Process Framework (EPEK) was developed across a three-phase mixed method study, using a sequential, explanatory design in a large tertiary hospital in metropolitan Queensland, Australia. Findings were used from a systematic scoping review, a cohort study (n = 523), and qualitative interviews with clinicians (n = 21). Key constructs were identified to develop the theory to inform this framework.

Results: The EPK has three steps. First, potential cancer inequities are identified, using routinely collected, reproducible and validated measures. Second, an exploration of social, environmental, and structural determinants within the health service and population context. Finally, articulate current strengths that can directly address inequities, and also opportunities to eliminate or reduce causal structures that are responsible. Practically, this can be achieved by identifying current procedures and interventions already in place, and those that can be used. Cycles of continuous evaluation around these three steps are essential to assess effectiveness. Evaluation is tailored to local requirements, and aims to facilitate the responsible use of resources, the discontinuation of ineffective policies and promotes transparency regarding the services’ progress towards health equity.

Conclusions: The Equity Process Framework may support health services with evidence-based, solution-focused guidance to inform cancer equity research, policies, and quality improvement initiatives. Future directions include validation of the framework in a variety of settings.

25 | Rural cancer survivors’ perceived delays in seeking medical attention, diagnosis, and treatment: A qualitative study

Alyssa Taglieri-Sclocchi¹, Ingrid Bindicsova^{1, 2}, Susannah K. Ayre^{1, 3}, Michael Ireland^{4, 5}, Sonja March^{4, 5}, Fiona Crawford-Williams^{6, 7}, Jeff Dunn^{1, 5, 8, 9, 10}, Suzanne Chambers^{8, 9, 11, 12}, Belinda C. Goodwin^{1, 5, 13}, Elizabeth A. Johnston^{1, 3, 14}

¹Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia

²School of Psychology, University of Queensland, St Lucia, Queensland, Australia

³School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia

⁴School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia

⁵Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia

⁶College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia

⁷McGrath Foundation, Sydney, New South Wales, Australia

⁸Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia

⁹Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia

¹⁰Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia

¹¹Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia

¹²St Vincent's Health Network Sydney, Sydney, New South Wales, Australia

¹³School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia

¹⁴Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia

Aims: To investigate perceived delays in seeking medical attention, receiving their diagnosis, and starting cancer treatment among rural cancer survivors, a population group that experiences inequities in cancer outcomes.

Methods: Through subsidized accommodation lodges in city centres throughout Queensland, cancer patients who had travelled > 50 km for cancer treatment were invited to participate in a structured interview collecting information on reasons for any perceived delays in seeking medical attention, receiving their diagnosis, and starting cancer treatment. Content analysis was used to identify reasons for perceived delays and summarized using descriptive statistics.

Results: Interviews were completed by 686 rural cancer patients (54% male; 51% outer regional or remote; 18% breast, 16% head and neck, 12% prostate, 12% skin cancer). Most participants did not report a delay in seeking medical attention (n = 554; 81%), receiving their diagnosis (n = 525; 77%), and starting cancer treatment (n = 529; 77%). Of those that reported a delay in seeking medical attention (n = 132; 19%), most perceived the delay was due to personal reasons, such as deciding not to seek medical care immediately, postponing screening, and employment demands. Of those that reported a delay in receiving their diagnosis (n = 161; 23%), most perceived the delay was due to medical personnel, including the healthcare professional requiring multiple opinions and/or further tests/scans prior to diagnosis or being initially misdiagnosed. Of those that reported a delay in starting cancer treatment (n = 157; 23%), most perceived the delay was caused by challenges accessing the health system, most commonly long waitlists and travel distances for treatment.

Conclusions: Around one in five rural cancer patients perceived a delay in their cancer care, particularly in receiving their diagnosis and starting treatment. Ongoing efforts to implement optimal care pathways in rural health services as well as increasing participation in cancer screening and early help-seeking in rural areas may improve patient care experiences.

26 | Development of an Optimal Care Pathway for people with cancer living in rural and remote Australia

Anna Ugalde¹, Skye Marshall¹, Hannah Jongebloed¹, Kate Whittaker², Hannah Beks³, Rebecca Bergin^{4, 1}, Anna Chapman¹, Megan Varlow²

¹Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia

²Cancer Council Australia, Sydney, NSW

³Deakin Rural Health, Warrnambool, VIC, Australia

⁴Cancer Council Victoria, Melbourne, Vic

Aims: Optimal care pathways (OCPs) are nationally endorsed frameworks to facilitate quality cancer care across the cancer continuum. OCPs are established for several tumor streams, and there is a need to develop OCPs for priority population groups. This project aims to develop the OCP and supporting resources for people living in rural and remote Australia affected by cancer.

Methods: This project will adhere to the OCPs toolkit methodology, including establishing project governance, performing a literature review, populating the OCP template, organizing expert working group meetings, reviewing drafts, engaging in national public consultation, collating feedback, and executing the graphic design.  A call for consultation from recognized oncology experts with a focus in rural and remote health will be undertaken at the 2024 COSA Annual Scientific Meeting.

Results: The anticipated outcome of this work is three key resources: (1) OPC (guide to support health professionals to provide optimal care and support); (2) Quick Reference Guide (summary of the OCP for health professionals and services); and (3) Guide to Best Cancer Care (guide to help people with cancer and their families, friends, and carers understand the optimal care that they should expect to receive). The Guide to Best Cancer Care will be translated into 10 languages. All styling and formatting will be consistent with existing OCPs and resources will be publicly available on key websites. Knowledge and awareness of the OCPs for rural and remote Australia will be evaluated. The project team is seeking expressions of interest to join the Expert Working Group and public consultation by COSA delegates.

Conclusions: Creation and dissemination of the OCP for people living in rural and remote Australia will enable to consistent and improved healthcare delivery and cancer outcomes for all Australians affected by cancer. This represents a crucial step towards achieving equitable cancer outcomes across Australia.

27 | Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with and beyond, breast, prostate or colorectal cancer: a randomized controlled trial

Patricia M Livingston^{1, 2}, Natalie Winter², Liliana Orellana¹, Lahiru Russell¹, Eric O^{1, 3}, Michael Jefford^{4, 5}, Anna Ugalde², Helena Romaniuk¹, Afaf Girgis AM⁶, David Austin⁷, Cathy Mihalopoulos⁸, Richard Chambers⁸, Jo Phipps-Nelson⁴, Dishan Herath⁹, Bodil Rasmussen², Kathryn Whitfield¹⁰, Maria Ftanou⁴, Ben Smith¹¹, Kirsten Pilatti¹², Sally Sara¹³, Addie Wootten¹⁴, Mari Botti², Kate Gillan¹⁵, Madhu Singh¹⁶, David Campbell¹⁶, Brindha Pillay¹⁷, Sue Evans¹⁸, Michael O'Callaghan¹⁹, Elles Stijinen²⁰, Fisaha Tesfay², Victoria White⁷

¹Faculty of Health, Deakin University, Melbourne, VIC, Australia

²Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia

³DS Digital Equipment, Deakin University, Melbourne, VIC, Australia

⁴Peter Maccallum Cancer Centre, Melbourne, VIC, Australia

⁵Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

⁶Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia

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

⁸Monash University, Melbourne, VIC, Australia

⁹Oncology Department, Western Health, Melbourne, VIC, Australia

¹⁰Community Based Health Services, Policy and Improvement, Department of Health, Melbourne, VIC, Australia

¹¹The Daffodil Centre: a Joint Venture with Cancer Council NSW, University of Sydney, Sydney, NSW, Australia

¹²Breast Cancer Network Australia, Melbourne, VIC, Australia

¹³Prostate Cancer Foundation Australia, Melbourne, VIC, Australia

¹⁴Smiling Mind, Melbourne, VIC, Australia

¹⁵Epworth Healthcare, Melbourne, VIC, Australia

¹⁶Barwon Health, Geelong, VIC, Australia

¹⁷Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

¹⁸Victorian Cancer Registry, Cancer Council Victoria, Melbourne, VIC, Australia

¹⁹South Australian Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia

²⁰Australian Prostate Centre, Melbourne, VIC, Australia

Aims: Online mindfulness programs may provide a mechanism to support between 30% and 54% of the cancer population who experience sub-clinical or clinical fear of cancer recurrence (FCR). This study determined the efficacy of MindOnLine, a nine-session mindfulness-based online program for people living with, and beyond, breast, prostate, or colorectal cancer, in reducing FCR.

Methods: Randomized controlled trial comparing MindOnline with a wait-list control.  Adults, ≥18 years, living in Australia, who had completed active treatment/surveillance for stages 1−3 breast, prostate or colorectal cancer, within the past 5 years, had internet access, and FCR Inventory (FCRI) severity scores ≥13 were eligible. MindOnLine incorporated education, mindfulness practices, and meditation. Outcomes were assessed at baseline, 9-weeks and 9-months post-recruitment. Linear mixed models assessed MindOnLine's impact on primary (FCRI total score) and secondary (depression (PHQ-9) and anxiety (GAD-7)) outcomes.

Results: Overall, 358 participants were randomly assigned to MindOnLine (n = 183) or wait-list control (n = 175); 58% had breast, 26% prostate, and 16% colorectal cancer; 52% were ≥60 years old; 69% were female. At 9 weeks, MindOnLine participants demonstrated a significantly larger reduction in FCRI total score (−5.5 points, 95% CI [−8.5, −2.4], p = 0.0004); anxiety score (−1.3, [−2.2, −.5], p = 0.0024); and depression score (−1.4 points, [−2.3, −.5], p = 0.0019) compared to participants in the control group. Significant intervention effects were sustained at 9 months (FCRI: −4.8 points, [8.4, −1.2]; p = 0.0095; anxiety: −1.2, [−2.2, −.16], p = 0.023; depression: −.97, [−1.9, −.02], p = 0.044). When stratified by cancer type, MindOnLine reduced FCR in people living with breast (9 weeks and 9 months) and colorectal (71% female; 9 weeks) cancer, but not males with prostate cancer.

Conclusions: This trial fills a significant gap in the role of self-directed online support programs to address moderate-severe FCR. Further research is required to understand how mindfulness programs can be effective for all population groups.

28 | Identifying and Responding to Domestic Violence Within a Healthcare Setting

Grace Hallewell¹

¹Women's Legal Service Qld, Southport, QLD, Australia

Women's Legal Service Queensland (“WLSQ”) is a state-wide specialist community legal center for women. In collaboration with Health Justice Australia, WLSQ delivers integrated legal and social support to women affected by family and domestic violence who seek care within the healthcare system.

The evidence is clear that people often experience multiple, intersecting health and legal problems. Domestic abuse and cancer are both prevalent issues, and when a person experiencing domestic violence is also diagnosed with cancer, the complexity of their situation escalates. For instance, patients may be dependent on a perpetrator of abuse for financial support, transportation to medical appointments, medication management, or assistance with daily activities. This dependency can inadvertently enhance the perpetrator's control and facilitate the continuation of abuse with minimal resistance. Furthermore, a cancer diagnosis can increase a person's vulnerability to violence due to factors such as social isolation, compromised health, and heightened dependence on others for care.

Patients undergoing cancer treatment may exhibit symptoms that are difficult to distinguish as either side effects of the treatment or manifestations of abuse. Detecting abusive behaviour within a clinical environment can be challenging, as perpetrators may present a façade of support in the presence of medical professionals while continuing their abusive conduct privately. The intersection of cancer and abuse can profoundly impact the health and treatment outcomes for affected patients.

This presentation is designed to equip frontline responders with effective strategies to identify and address concerns related to domestic and family violence among their patients. It underscores the necessity of asking targeted and sensitive questions to uncover potential abuse and to facilitate connections with appropriate legal and support services. By adopting a proactive and integrated approach, professionals can effectively bridge the gap between healthcare and legal assistance, thereby ensuring that individuals affected by domestic violence receive comprehensive and coordinated support.

29 | Disability care and cancer care–we can do both

Shona Edwards¹

¹Cancer Voices South Australia, Adelaide

As a youth cancer patient, Shona Edwards' diagnosis threw her into the worlds of both cancer advocacy and disability advocacy simultaneously. From buying her first walking stick, to applying to the National Disability Insurance Scheme, to founding disabled student clubs at university, Shona's experience has been supported and facilitated by peer support and the knowledge, experience and spirit of the disability community. Disability is inseparable from Shona's experience of cancer.

Disability is diverse and complex. It is an identity, with a thriving community, but is also an administrative category which dictates the allocation of funding and resources, and defines an individual's work life, education, housing, and involvement with other government services including benefits and pensions.

Shona will discuss recent findings from Cancer Council Australia's disability and cancer care issue-based forum. The forum has identified many of the critical issues at the intersection of disability and cancer care in Australia. Disability is more than a pre-existing condition influencing cancer care. Shona emphasizes that we must ensure not only that people with disabilities have equal access to cancer care, but that people with cancer have equal access to disability care. Through her personal experiences and an examination of systemic challenges, Shona calls for actionable change to better support both cancer and disability care pathways. We can do both.

30 | Cancer Care in Custody

Genni Newnham¹, Sue Anne McLachlan¹, Tehreem Rawal¹

¹St Vincent's Hospital, Melbourne, Vic, Australia

Humanitarian guidelines emphasize that equitable access to health care is a fundamental right of all prisoners. The Victorian prison population is growing and ageing, with an associated increase in the requirement for cancer care. This is a uniquely disadvantaged group with high rates of comorbidity and complex health needs, who face additional challenges in accessing cancer care related to equally complex and rigid medical and justice systems. Health professionals providing care to prisoners with cancer also face barriers in providing optimal care to this group.

As the major provider of tertiary medical care to male prisoners in Victoria, St Vincent's Hospital Melbourne is unique in being able to document the outcomes of prisoners with cancer and explore the experiences of health professionals caring for them. Our data identifies a number of potential areas for improvement.

31 | Incorporating class and culture awareness into routine cancer care–strategies to promote equity in Australian cancer systems

Abhijit PAL¹

¹South Western Sydney Local Health District, Sydney, NSW

Australia has one of the best cancer care systems in the world but certain groups in our community repeatedly miss out on some of the life changing cancer innovations available in Australia, and suffer increased morbidity and mortality related to cancer as a consequence. These innovations include screening, timely access to surgery, access to radiotherapy, access to targeted therapy and immunotherapy, or access to cancer clinical trials. The disparities are well documented, but there has been limited success in improving the outcomes for these priority populations. Cancer systems and healthcare services can implement practical strategies to reduce these inequities, including routine identification of vulnerable populations, regular benchmarking to monitor performance, and investment in community engagement. This talk will cover the relationship between cancer outcomes and multiple social determinants of health in Australia including private health insurance status, reliable access to primary care, non-English language preference, health literacy, and class. Finally, there will be a call to action for employing intersectionality and inequity frameworks as routine in all levels of cancer care governance to improve outcomes for priority populations.

32 | Exploring the Impact of Radiation Therapy Education Sessions on the Support, Information Needs and Concerns of First Nations peoples with cancer

Kenneth Carter¹, Thomas F Andrade¹, Shafkat Jahan¹, Lara Stoll¹, Haryana Dhillon², Joan Cunningham³, michael penniment⁴, Sabe Sabesan⁵, Georgia Halkett⁶, Siddhartha Baxi^{7, 8}, Adam Stoneley⁹, Luke McGhee¹⁰, Emily Callander¹¹, Kar Giam¹², Joanne Shaw², Sian Smith¹³, Gail Garvey¹

¹First Nations Cancer & Wellbeing Research Program (School of Public Health), The University of Queensland, Herston, QLD, Australia

²The University of Sydney, Sydney, NSW, Australia

³Menzies School of Health Research, Charles Darwin University, Darwin

⁴Royal Adelaide Hospital, Adelaide, South Australia

⁵Townsville Hospital and Health Service, Townsville

⁶Curtin University, Perth, Western Australia

⁷GenesisCare, Gold Coast

⁸Griffith University, Gold Coast

⁹Icon Cancer Centre, Brisbane

¹⁰Icon Cancer Centre, Cairns

¹¹Monash University, Melbourne

¹²Alan Walker Cancer Care Centre, Darwin

¹³The University of New South Wales, Sydney

Aims: First Nations Australians continue to experience ongoing disparities in cancer incidence and mortality compared to non-Indigenous Australians. Despite efforts to address these inequities, barriers related to culturally safe healthcare and communication persist, impacting access to and treatment outcomes in radiation therapy (RT). This study aims to evaluate the effectiveness of standard RT education sessions on First Nations cancer patients’ support and information needs, and their concerns of RT.

Methods: Three surveys (A, B, and C) using validated measures exploring patient support and information needs; distress levels; and concerns for RT were administered to 30 newly diagnosed adult First Nations cancer patients scheduled for RT across three clinic sites. Surveys were completed following their initial consultation with a radiation oncologist (A), after attending educational sessions with a healthcare provider (B), and within two weeks after completing RT treatment (C). Descriptive statistics and paired sample t-tests were used to evaluate temporal changes.

Results: Following RT education sessions, the support and information needs of patients significantly decreased (A and B: 35.78 vs. 24.52, p < 0.001). Distress levels remained unchanged after the education session (A vs. B) but decreased 2 weeks after completing RT (B and C: 3.84 vs. 2.6, p < 0.04). Following RT patient education sessions, concerns about RT significantly decreased (A and B: 3.6 vs. 2.7, p = 0.02).

Conclusions: Despite small sample size, the findings suggest that standard RT education sessions reduce concerns, support, and information needs for First Nations cancer patients, while distress levels remained unchanged. The potential for further utilizing culturally safe, tailored patient education resources to improve health literacy and treatment outcomes for First Nations Australian RT patients should be explored.

33 | Outcomes from the co-design of a National Framework for Genomics in Cancer Control that privileges Aboriginal and Torres Strait Islander perspectives

Justine Clark^{1, 2}, Jacinta Elston³, Kelly Trudgen³, Sarah McNeill³, Carolyn Der Vartanian³, Ashleigh R Sharman³, Claire Howlett³, Vivienne Milch^{3, 4, 5}, Alex Brown^{1, 2}, Dorothy Keefe^{3, 6}

¹Telethon Kids Institute, Adelaide, SA, Australia

²Australian National University, Canberra, ACT, Australia

³Cancer Australia, Sydney, NSW, Australia

⁴School of Medicine, The University of Notre Dame, Sydney, NSW, Australia

⁵Caring Futures Institute, Flinders University, Adelaide, SA, Australia

⁶School of Medicine, University of Adelaide, Adelaide, SA, Australia

Aims

Genomics is an emerging area of cancer control with potential to personalize cancer care and improve outcomes. The National Framework for Genomics in Cancer Control (the Framework) is being developed to guide Australia's cancer control sector in the use of genomics across the cancer care continuum. We conducted an engagement and co-design process with priority populations including Aboriginal and Torres Strait Islander peoples to ensure that the Framework addresses cancer health inequities.

Methods

Cancer Australia established a multidisciplinary Expert Advisory Group and an Indigenous Governance Group to provide project oversight. Three-hour workshops with Aboriginal and Torres Strait Islander community members, health care workers, cancer patients, and community-controlled health sector representatives were undertaken across Australia. Consultation with other priority population stakeholders was undertaken via virtual focus groups for children, young people and families, rural and remote, culturally and linguistically diverse, and rare cancers. Data were audio recorded, transcribed, and analyzed using inductive thematic analysis. Key themes and findings of a comprehensive evidence review were synthesized into a draft Framework. The draft Framework was presented for final review with Aboriginal and Torres Strait Islander peoples in Brisbane prior to public consultation in late 2024.

Results

We engaged with 35 individuals across five in-person workshops, identifying four key themes: (1) Addressing systemic barriers for equitable access to personalized cancer care, (2) Building trust and relationships within the healthcare system, (3) Co-designing genomics education for the primary health sector and community, and (4) Embedding cultural safety in personalized cancer care. These themes directly informed the draft Framework, spanning underlying domains of prevention and early detection, diagnosis and treatment, supportive care, and awareness and education.

Conclusion

Consultations with Aboriginal and Torres Strait Islander people and other priority populations identified key considerations to inform development of Australia's first National Framework for Genomics in Cancer Control.

34 | Current and future strategies in addressing the Unmet Need of Regional/Rural Early Phase Clinical Trials Access in Australia

Jordan E Cohen^{1, 2}, Rasha Cosman^{1, 2, 3}, Jyoti Parmar¹, Anthony Rodrigues^{1, 2, 3}, Neha Aggarwal^{1, 4, 5}, Anthony Joshua^{1, 2, 3}, Jia (Jenny) Liu^{1, 2, 3}

¹The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia

²Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia

³Garvin Institute of Medical Research, Sydney, NSW, Australia

⁴Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia

⁵Australian National University, Canberra, ACT, Australia

Background: Early-phase clinical trials are primarily run conducted through specialist tertiary centres within major cities of Australia. However, 28% of Australian's reside in regional and remote communities¹Multifaceted efforts are needed to ensure patients affected by cancer from all geographical backgrounds are offered opportunities for clinical trials within oncology. Previous data demonstrated equivalent survival and toxicity outcomes in clinical trials patients regardless of distance from the trial centre²We undertook a retrospective study from patterns of referral to early phase trials at The Kinghorn Cancer Centre (TKCC) Phase 1 unit and the impact of telehealth and COVID-19 on phase 1 enrolment to provide education on the current models of trials.

Methods: Data was prospectively collected from all patients referred to TKCC Phase 1 unit from 2017 until data cut-off July 2024. Baseline demographics, prior history, geographic and trial enrolment data was captured. Data was analysed using SPSS v29.0.

Results: In total, 1625 patients were reviewed between January 2017 and July 2024. Mean age was 60.3 ± 13.1, 91.8% were from NSW. Telehealth reviews were used for 32.2% of initial consultations. Telehealth use significantly increased for initial consultations after 2017–2019 (16.1% vs. 41.7% from 2020 onwards, p < 0.001). During the total period, 28.6% of new patient consultations were from Australian Statistical Geography Standard (ASGS) 2–5 locations, that is, regional or remote. Regional or remote patients were more likely to use telehealth on new patients’ consultations versus ASGS 1 patients (51.7% vs. 24.5%, p < 0.001).

Conclusion: This study highlights the ability to utilize telehealth within a phase 1 unit to ensure equitable recruitment to trials for regional and remote Australians. Integration of technology into decentralized trial models helps bridge regional oncology inequities. Further analyses exploring impact of regional/rural locality, type of trial enrolled, and treatment outcomes for regional/rural participants will be detailed at the symposium.

1. Rural and Remote Health. Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health (Accessed: 5 July 2024).

2. Lim, J. et al. (2022) ‘Impact of travel distance on outcomes for clinical trial patients: The Kinghorn Cancer Centre experience’, Internal Medicine Journal, 53(2), pp. 242−249. doi:10.1111/imj.15561.

3. Aggarwal, N. et al (2022), Impact of COVID-19 on early phase clinical trials recruitment and treatment in a major metropolitan Phase 1 Unit, Poster Abstracts. Asia-Pac J Clin Oncol, 18: 33–51. https://doi.org/10.1111/ajco.13856.

35 | Increasing recruitment of CALD population to MRI Clinical Trials in Radiation Oncology

Robba Rai^{1, 2, 3}, Doaa Elwadia^{1, 4}, Trang Pham^{1, 2, 3}, Penny Phan^{1, 2}, Ben Smith⁵, Joseph Descallar^{2, 3}, Kylie Dundas^{1, 2, 3}

¹Liverpool and Macarthur Cancer Therapy Centre, Casula, NEW SOUTH WALES, Australia

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

³South Western Sydney Clinical School, The University of New South Wales, Liverpool, NEW SOUTH WALES, Australia

⁴The University of Sydney, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Sydney, NEW SOUTH WALES, Australia

⁵The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NEW SOUTH WALES, Australia

Introduction: In South West Sydney, 45% of the population speak a language other than English. Culturally and linguistically diverse (CALD) patients are significantly less likely to participate in clinical trials compared to non-CALD with language and health literacy impacting participation. This study aimed to determine if an educational intervention led to increased willingness of CALD patients to participate in magnetic resonance imaging (MRI) clinical trials for radiotherapy (RT).

Methods: Eligible patients required an Arabic or Vietnamese interpreter for their RT planning scans and were allocated to one of three study arms: (a) eligible for MRI clinical trial and require MRI as standard of care (SOC), (b) not eligible for MRI clinical trial but require MRI as SOC, and (c) does not require MRI as SOC. Patients were asked to watch a 5-min video in their preferred language, detailing the role of MRI trials in RT. Embedded within the video were pre and post 7-item surveys assessing whether the video improves health literacy, using a 5-point Likert scale. Pre and post results were compared using symmetry tests in SPSS.

Results: To date, 92 participants have been recruited [52 Vietnamese and 40 Arabic-speaking, median age = 68 years (60–93)]. Patients were more likely to want to participate in an MRI clinical trial (pre 52% vs. post 77%) after viewing the educational video in arms b & c (p = 0.023 and p < 0.001, respectively). There were also significant improvements (pre 76% vs. post 88%) in beliefs that clinical trials will improve future cancer treatment in arms b & c (p = 0.008 and p = 0.039, respectively).

Conclusion: Preliminary results suggest that an educational intervention increases the willingness of CALD patients to participate in MRI clinical trials. Providing patients with clinical trials information in their preferred language and an accessible format is an important strategy to increase CALD patient recruitment.

36 | Examining the long-term financial toxicity of survivorship care for childhood brain cancer

Chloe Willemsen¹, Jordana McLoone^{2, 3}, Christina Signorelli^{2, 3}, Claire Wakefield^{2, 3}, Elysia Thornton-Benko^{3, 4}, Karen Johnston², Rachael Baldwin^{2, 3}, Sheena Arora⁵, Richard Cohn^{2, 3}

¹UNSW, Kensington, NSW, Australia

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

³Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia

⁴Bondi Road Doctors, Bondi, Sydney, NSW, Australia

⁵Centre for Health Economics Research and Evaluation (CHERE) at the University of Technology Sydney, Sydney, NSW, Australia

Aims: Survivors of childhood brain cancer (CBCS) need ongoing care to for the management of chronic late effects. However, healthcare costs can be prohibitive, leading to lower adherence to health recommendations, and cause financial strain and psychological stress. Engage Brain, our CBCS intervention, offered multidisciplinary case reviews and personalized health recommendations to CBCSs. This study aimed to evaluate the out-of-pocket expenses required to follow these recommendations.

Method: We used the Australian Medicare cost calculator to estimate the out-of-pocket costs for adhering to health recommendations. Recommendations were assigned minimum and maximum costs to reflect both public/bulk billing and private/gap-payment scenarios. We calculated the average costs for adherence, adherence rates at 6-month follow-up, and compared care costs based on factors like age, tumour grade, treatment site, and type of treatment received.

Results: Fifty-nine CBCSs participated (50% male, average age = 22 years; average time since diagnosis = 15 years). The mean total cost per survivor was $479 (range = $0–1128, SD = $247) for the minimum-cost scenario and $1407 (range = $284–5603, SD = $1193) for the maximum-cost scenario. Dentistry (24%), mental health (21%), and neuropsychology (18%) services comprised the largest share of costs. Survivors who underwent chemotherapy (t = −3.207, p < 0.002) or radiotherapy (t = −2.256, p < 0.028) faced significantly higher minimum total costs compared to those who did not. On average, survivors adhered to 40% of recommendations (range = 0%–81%, SD = 19%), with an average expenditure of $142 (range = $0–543, SD = $160) and $338 (range = $0–1043, SD = $259), in the minimum and maximum-cost scenario, respectively.

Conclusions: Services not covered by Medicare, limited bulk-billing, and long public waiting lists are substantial contributors to increased costs, therefore presenting barriers to care. These are crucial targets to address to reduce financial toxicity and improve adherence to survivorship care.

37 | Enhancing Information Equity: Sustainable Production of Patient-Comprehensible Trial Information Using Large Language Models with Expert Supervision – Preliminary Findings

Minh Tran^{1, 2}, Kate Saw¹, Jeremy Mo^{1, 3, 2}, Lucy Haggstrom^{1, 3, 2}, Emma-Kate Carson⁴, Kate Macdonald⁵, Rachel Dear^{3, 2}, Elgene Lim^{1, 3, 2}, Frank Lin^{1, 2, 6, 7}

¹The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia

²School of Clinical Medicine, UNSW, Sydney

³The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

⁴Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia

⁵Lived Experience Researcher, Sydney

⁶NHMRC Clinical Trials Centre, University of Sydney, Sydney

⁷Department of Oncology, Prince of Wales Hospital, Sydney

Background: Oncology clinical trial information is highly complex and may present a barrier to understanding for patients and families. However, producing accurate but comprehensible patient-facing materials requires many resources. Recent advancements in generative AI and large language models (LLMs) present a unique opportunity to efficiently generate quality patient information through text summarization capabilities.

Methods: As part of the Eva—Clinical Trials Navigator Project, we conducted a technical development study to optimize how LLMs can translate trial information into lay-accessible language. Using a randomized, blinded design, an expert panel (four medical oncologists, one live-experienced consumer) iteratively assessed the machine-translated text based on accuracy, acceptability, and understandability (5-point Likert scales). Three LLMs (Llama-3-8B, Mistral-7B, and GPT-4) and prompt engineering strategies were assessed in a factorial design. We report the preliminary results in selected Australian breast cancer trials translated using this open-source prompt optimization pipeline.

Results: Raw data from 15 trials retrieved from ClinicalTrials.gov were translated into lay language by the LLMs. The machine translation using the zero-shot prompting methods yielded variable accuracy, with mean scores across four oncologist reviewers of 3.6 (range 1–4), 4.4 (3-5), and 4.6 (3-5) for Llama-3-8B, Mistral-7B, and GPT-4, respectively. Key qualitative insights were obtained from the expert panel feedback: a preference for succinctness of concepts to aid understanding, identification of erroneous or incomplete information, and the appropriateness of language that was too informal or awkward in context. This suggests that LLM translations require iterative refinement to achieve the effective quality required for this task.

Conclusions: Our preliminary results showed significant variability in the quality of machine-generated translations across LLMs, necessitating the combination of AI with expert supervision to successfully develop patient-facing trial navigation tools. These results will inform future research on investigating equity in information understanding among cancer patients from diverse backgrounds.

38 | Access Programs and the evolving role of the Pharmacist

Anna SHI¹

¹Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Medicine access programs (MAPs) provide Australian cancer patients with opportunities to access treatment options not available on the PBS. They represent a small but important proportion of available treatments. What are some of the challenges pharmacists and institutions face in supporting MAPs? A snapshot of how these are managed by different Australian hospitals may give inspiration for your site. In theme with this year's ASM, this session will also touch on potential inequities. These include the limited ability for public hospital patients to access cost-share programs, lack of information on MAP availability and challenges in access to small, remote or regional sites. There is also the growing disparity between public and private hospitals in accessing PBS listed high-cost inpatient therapies. Are MAPs the answer to bridge this gap? What is the role of the pharmacist in this evolving landscape? Join me for a discussion on all things MAPs.

39 | Triple Negative Breast Ca- A Therapeutic Update and Case Study presentation

Nicole Pringle¹

¹Gold Coast University Hospital Medical Oncology, Southport, QLD, Australia

Triple-negative breast cancer (TNBC) is classified by its lack of expression of estrogen/progesterone and human epidermal growth factor receptor 2 (HER2) status. This subtype of breast cancer is highly proliferative and therefore usually responsive to chemotherapy. It accounts for 10%–15% of all breast cancer diagnoses, is more commonly diagnosed in women aged under 40, and is associated with inherited mutations such as BRCA1/2. Compared to other breast cancer subtypes, TNBC is more likely to distantly recur in visceral sites such as liver, lung, and central nervous system, whereas hormone-positive disease more commonly recurs in bone. TNBC has a worse short-term prognosis with a higher risk of recurrence within the first 2 years after diagnosis.

For patients with early-stage TNBC, the majority will receive neoadjuvant chemotherapy with the addition of immunotherapy for those with stage II/III disease. The goals of this treatment are to reduce the risk of distant recurrence, induce downstaging, reduce extent of surgery, assess response to systemic treatment which then assists with guiding adjuvant therapies. Adjuvant treatment depends on response to neoadjuvant therapy as well as breast cancer susceptibility gene (BRCA) mutation status.

Unfortunately, up to 30% of patients will develop distant metastatic disease after their early-stage diagnosis. Metastatic TNBC treatment is guided by tumour burden, previous neoadjuvant/adjuvant therapies received, BRCA status, and programmed cell death ligand 1 (PD-L1) status. Chemotherapy in combination with immunotherapy for patients with a PD-L1 combined positive score (CPS) > 10 or chemotherapy alone if the CPS score < 10 is indicated for first line treatment. For patients with a BRCA mutation, poly (ADP-ribose) polymerase (PARP) inhibitors have shown efficacy but are not currently listed on the pharmaceutical benefits scheme (PBS). Antibody drug conjugates (ADCs) such as Sacituzumab Govitecan in the second-line setting have shown efficacy compared to standard of care chemotherapy agents. Despite this, the prognosis for patients with metastatic TNBC remains poor compared to advanced hormone positive disease. Further research into predictive and prognostic biomarkers as well as utilizing differing combinations of chemotherapy, immunotherapy and ADCs are currently being investigated to further improve patient outcomes.

40 | Drug Repurposing in Cancer Care

Nikola A Bowden¹

¹School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Callaghan, NSW, Australia

Ongoing efforts to find new drug targets are continuing, but traditional drug development requires approximately 12–16 years processing time and investment of USD$1–2 billion to achieve market approval. This lengthy development pipeline, while necessary for identifying innovative treatments, is not the only option for providing patients with timely access to efficacious, cost-effective therapy. Drug repurposing is a method for identifying new uses for approved or investigational drugs that are outside the scope of the original intended or approved medical use. The development of repurposed drugs is attractive because therapeutic advances and new drug options for treatment-resistant cancer has been far slower than expected.

The Australian program for drug repurposing for treatment-resistant ovarian cancer is rapidly delivering data to support the development of clinical trial concepts for the use of repurposed drugs specific for treatment resistant ovarian cancer.

The program team uses computational chemistry approaches to examine the British Pharmacopeia, currently the most globally comprehensive pharmacology database, for Federal Drug Administration (FDA) and European Medicines Agency (EMA) approved drugs that bind to well-defined targets specific to treatment-resistant cancers. Consumer, clinician, and scientific input is gathered at each step of the pipeline and health research economic analysis conducted on all repurposed drug candidates. The drug repurposing pipeline can be adapted for any known drug target for any disease or condition.

41 | New Opportunities in healthcare economics

Dean Ho¹

¹National University of Singapore, Singapore, SINGAPORE

The fields of precision and personalized medicine seek to tailor patient treatment via molecular profiling-guided therapy and other approaches. These strategies have led to improvements over standard of care for certain cancers. It is also important to note that patients evolve during the course of treatment. Therefore, evolving treatment alongside the patient may augment our abilities to optimize care in a prolonged manner. To address this challenge, this talk will discuss the role of small data and how it can be longitudinally harnessed to modulate interventions such as combination therapy design and dosing in a dynamic manner. Corresponding opportunities to lower healthcare costs will also be described.

42 | Promoting physical activity in practice: more than just guidelines

Brigid Lynch¹

¹Cancer Council Victoria, East Melbourne, VIC, Australia

Physical activity plays an important role in primary and tertiary prevention of cancer.

For primary prevention, Australian physical activity guidelines recommend that adults aim to achieve 150 minutes of moderate intensity physical activity a day, or 300 minutes a day for additional health benefits including cancer prevention. At least two sessions of muscle-strengthening activities each week are also recommended. For the primary prevention of cancer, dose-response effects mean that moving from ‘inactive’ to ‘modestly active’ achieves important benefits. Further, for some sites, risk reduction continues to decrease with greater volumes of physical activity.

For tertiary prevention, the COSA Position Statement on Exercise in Cancer Care recommends progressing towards and maintaining at least 150 minutes of moderate intensity aerobic exercise and two to three muscle-strengthening sessions each week. The dose-response relationships between exercise and health outcomes in adults who have had a cancer diagnosis are less well understood.

This presentation will discuss how the estimated effects of physical activity are operationalised, and how guidelines should be considered in this context. Suggestions as to how clinicians can encourage and support engagement in physical activity will be provided.

43 | Practical strategies for discussing diet and nutrition and referring to support

Lizzy Johnston^{2, 3, 1}

¹Cancer Council Queensland, Fortitude Valley, QLD, Australia

²School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

³Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

Starting with insights into dietary intake behaviours of Australians from Cancer Council Queensland's (CCQ) Cancer Risk Calculator 2.0, and a look at the geographical disparity in poor diet quality from the Australian Cancer Atlas 2.0, this presentation will (i) overview available evidence on practical strategies for oncologists, GPs, and nurses to discuss diet and nutrition in their practice and refer to support; and (ii) showcase new initiatives at CCQ to promote health behaviours for cancer prevention and access to support in the community.

44 | Smoking Cessation

Henry Marshall¹

¹University of Queensland, Herston, QLD, Australia

Content not available at time of publishing.

45 | Cardiovascular Health after Cancer Treatment

Susan Dent¹

¹University of Rochester, New York, United States

Improved screening strategies and advances in cancer treatment have led to significant improvements in clinical outcomes for patients with cancer. Although gains in life expectancy are to be applauded, it should be recognized that cancer survivors are at an increased risk of non-cancer related morbidity and mortality including cardiovascular disease. Post-menopausal women with early-stage breast cancer, several years out from their diagnosis, have a great risk of mortality from cardiovascular that recurrence of their cancer. Cancer survivorship begins at the time of a cancer diagnosis and therefore models of survivorship care should provide individualized care throughout the patient's cancer journey. Cardio-oncology has emerged as a discipline to manage cardiovascular health in patients throughout and following cancer treatment. Clinical guidelines, which address cardiovascular health in cancer survivors, have been developed by several organizations, including the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), and the European Society of Cardiology (ESC). Key strategies include risk stratification, primary prevention, lifestyle interventions, pharmacological management, appropriate cardiovascular monitoring, and tailored exercise programs. Risk of CV toxicity is a dynamic variable that changes throughout survivorship based on modifiable and non-modifiable conditions, as well as the type, duration, and intensity of cancer therapies. Effective cardiovascular care of cancer survivors hinges on collaboration between specialists and patients, underscoring the importance of shared-care models in survivorship.

46 | Improving equity and quality cancer care through meaningful inclusion in research: Co-design with priority and under-served cancer populations

Joanna Fardell^{1, 2}, Rebekah Laidsaar-Powell³, Reema Harrison⁴, Bronwyn Newman⁴, Emilie Francis-Auton⁴

¹Maridulu Budyari Gumal (SPHERE), University of New South Wales, NSW, Australia

²Behavioural Sciences Unit (BSU), Kids Cancer Centre, University of New South Wales, NSW, Australia

³Psycho-oncology Co-operative Research Group, The University of Sydney, CAMPERDOWN, NSW, Australia

⁴Australian Institute of Health Innovation, Macquarie University, NSW, Australia

The Australian Cancer Plan places co-design with stakeholders firmly at the centre of Australian cancer research and practice. But what is co-design, and how can it be used to improve equity and delivery of quality cancer care for priority cancer populations?

In this symposium, we will discuss different approaches to achieving best practice co-design in the development, adaptation, evaluation, and implementation of healthcare interventions and health service improvements. We will provide insights into different co-design methodologies and key learnings from engaging with diverse groups of Australian cancer service users. We will focus on four priority or under-represented cancer populations: The first talk will discuss application of cross-cultural communication methodology using three case studies targeting identified inequities in medication safety, access to care coordination, and continuity of care between primary and specialist providers with multicultural communities. The second talk will present a case study using a co-creation framework to co-develop and implement supportive information resources for adolescents and young adults with cancer. The third talk will explore the unique needs of family carers of people with cancer and will present two case studies using co-design with carers to support carer communication with healthcare professionals, and manage carer anxiety and/or depression. Talk four will present inclusive co-design approaches for people with intellectual disability and cancer to develop and implement an experience measure suitable for people with intellectual disability. Talk five will present results of a recently completed state of the art review on experience-based co-design which highlights variation in application of terminology, theory and practice, making application to real-world settings challenging.

The goal of this symposium is to share key methodological and practical insights into using co-design in a meaningful, user-centred way to support improvements in equity and quality across Australian cancer care and research.

47 | Co-designing information resources with Adolescents and Young Adults (AYAs) with Cancer: addressing unmet needs and supporting uptake and accessibility

Joanna Fardell^{1, 2}, Sarah Ellis¹, Clarissa Schilstra¹, Jennifer Cohen^{1, 3}, Kristina Clarke³, Mary Burns⁴

¹University of New South Wales, Randwick, NSW, Australia

²Western Sydney Youth Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney

³Canteen Australia, Sydney

⁴Sydney University, Sydney

Aims: Adolescents and young adults (AYAs) diagnosed with cancer report unmet information needs for remaining engaged in education or work through cancer treatment and beyond. To address this gap, we used co-design with AYAs with cancer to support uptake and accessibility.

Methods: We applied Pearce's co-creation framework which specifies four collaborative processes with AYAs with cancer and education/career counsellors at partner organization Canteen, with aim of increasing uptake and accessibility. We used interviews and focus groups with iterative rounds of feedback and followed the four phases specified by Pearce: i) co-ideation, ii) co-design, iii) co-implementation, and iv) co-evaluation.

Results: Our consumer stakeholder group consisted of five AYAs living with and after cancer and three education career consultants from Canteen. Through iterative rounds of feedback, we have codesigned AYA specific resources, which are currently being co-implemented and co-evaluated. Key learnings across co-creation and co-design with AYAs with cancer include: i) challenges with recruiting AYA stakeholders mirror challenges AYAs with cancer have with accessing information and supportive care resources; ii) unmet information needs across many domains were reflected in challenges AYAs had with communication with peers, teachers and employers, rather than lack of knowledge as has been suggested previously; iii) AYAs preferences for how information was delivered often differed from education and career counsellors suggestions reflecting age differences in the experience of online environments; and iv) there is tension in balancing what AYAs preferences for information resources against what is capable within the scope of current funding and technology.

Conclusions: Co-design of resources with AYAs with cancer has the capacity to uniquely address their unmet needs and support uptake. However, challenges with ensuring representation of diversity of stakeholder opinions of AYAs who are “hard to reach” and resource limitations (e.g., funding, time, technology) can impact success of co-design and co-implementation in practice.

48 | Using co-design with family carers of people with cancer: Focusing on meeting the unique needs of this often-overlooked cancer population

Rebekah Laidsaar-Powell¹, Sarah Giunta¹, Lisa Beatty², Claire Hudson³, Iona Gurney³, Joanne Shaw¹

¹Psycho-oncology Co-operative Research Group, The University of Sydney, CAMPERDOWN, NSW, Australia

²Flinders University, Adelaide, SA, Australia

³School of Psychology, The University of Sydney, Sydney, NSW, Australia

Aim: Carers are an under-represented cancer population, with unique and specific needs that are often overlooked. Indeed, many existing “carer support” interventions focus on how the carer can better care for the patient, rather than themselves. Given the poor psychological and physical health outcomes experienced by cancer carers, there is an urgent need to better understand carers' unique needs and design interventions that are truly carer-centered.

This presentation will report on the co-design of two carer-focused interventions: eTRIO—an online program to empower carers when communicating with health professionals and CarersCanADAPT—an online cognitive behavioral therapy intervention for carers with anxiety and/or depression.

Methods: The Person-Based Approach (Yardley et al., 2015) was used to ensure intervention content and design were grounded in end-user needs and preferences. Qualitative interviews with stakeholders (carers, people with cancer, oncology health professionals) were conducted across the project continuum. Ensuring diversity of stakeholder experiences was key, with input sought from carers with varying demographics and caregiving roles/intensity. All interviews were transcribed verbatim and analysed using qualitative methods.

Results: Sustained stakeholder engagement led to key insights into the unique needs and experiences of carers, as well as barriers and facilitators to successful intervention implementation. Indeed, the patient-focused nature of Australian healthcare and limited resources allocated to carer-specific support was a crucial barrier that needed to be considered during intervention design. Carers’ needs and roles throughout the cancer trajectory were distinct from the person they care for, underscoring the importance of tailored interventions.

Conclusions: In designing carer-centered interventions, carers and other stakeholders must be meaningfully involved in co-design at all stages of planning, development, refinement, and user testing to ensure that carer experiences are accurately represented and their supportive needs are met in a way that is accessible and facilitates program uptake and implementation.

49 | Navigating cross cultural communication in co-design

Reema Harrison¹, Ashfaq Chauhan¹, Mashreka Sarwar², Mary Li^{1, 3}, Paul Gorgees⁴

¹Macquarie University, Canberra, NSW, Australia

²Consumer Researcher, c/o Macquarie University, Sydney, NSW, Australia

³Multicultural Health, Western Sydney Local Health District, Sydney, NSW, Australia

⁴Multicultural Health, South Western Sydney Local Health District, Sydney, NSW, Australia

Aims: Cross-cultural communication is central to co-design work with multicultural communities that seeks to redress inequities in cancer care and outcomes. Best practice cross-cultural communication is characterized by awareness, humility, openness, identification, and provision of appropriate resources. This session aims to explore the application of these principles in co-design work conducted in cancer care using three case studies from projects targeting identified inequities in medication safety, access to care coordination, and continuity of care between primary and specialist providers with multicultural communities in New South Wales (NSW) and Victoria.

Methods: Three central strategies were employed to enhance opportunities for consumers with limited English language proficiency to contribute equitably in the process of each co-design: 1) pre-briefing bicultural bilingual health workers with consumers at the outset and ahead of each session about the scope of work, purpose of each session and how they wish to work with an interpreter, 2) providing a certified translation of the key materials ahead of the session and interpreter during the sessions in addition to bicultural bilingual staff, and 3) debriefing from each session with both consumers and bicultural staff.

Results: The opportunity to engage with multisource cultural and linguistic support facilitated shared understanding of the purpose of the process, navigating cultural “bumps” in concepts and terminology. Consensus about how to transfer meaning from one cultural world to another could be generated from the synthesis of formal and informal interpretation. Inclusion of certified translations and interpreters to support consumers and bicultural bilingual staff generated a rich environment for contributions to be made but also reduced cultural burden on bicultural staff.

Conclusions: Co-design work with multicultural communities may benefit from the adoption of cross-cultural communication strategies that are established and resourced from the outset to enhance equitable contributions to be made.

50 | Codesigning with People with Intellectual Disability

Bronwyn Newman¹, Laurel Mimmo², Matthew Van Hoeke³, Maya Tokutake³, Karen Phillips³, Debbie Van Hoek³, Kim Bowen³, Elizabeth Manias³, Pandora Paterson³, Reema Harrison¹

¹Macquarie University Sydney Australia, Macquarie University, NSW, Australia

²Sydney Children's Hospital Network, Sydney, New South Wales, Australia

³Consumer Leadership Group- Listen to Me Project, AIHI Macquarie University, Macquarie Park, New South Wales, Australia

Aims: Patient outcome and experience data are increasingly used to inform cancer care and service priorities. However, routinely used patient measures are often unsuitable for people with intellectual disability. Engaging people with intellectual disability in research to inform care is vital to address long recognized disparities in health care access and outcomes. We aimed to develop, implement, and evaluate an experience measure suitable for people with intellectual disability using inclusive codesign methods.

Methods: We used inclusive codesign activities, including Delphi survey, to determine priority topics, suitable questions, and format of a patient experience measure for people with intellectual disability. We implemented a citizen science approach incorporating inclusive arts-based research methods. The codesign group includes eight consumers with lived experience, three researchers, digital design specialists, and health practitioners and service experts invited for input as needed. We conducted four codesign workshop meetings, with flexible engagement between workshops, to develop a digital data collection tool prototype. Themes developed in the workshops were shared using an inclusive Delphi approach to gain broader input.

Results: In this session, we will report the inclusive codesign approach and Delphi survey used to develop a digital prototype experience measure for people aged 6 and above, with intellectual disability. We will provide reflections relevant for cancer care service planners and practitioners seeking to engage people with intellectual disability in inclusive codesign and present the resulting tool.

Conclusions: Engaging people with lived experience in development, implementation, and evaluation is essential to produce engagement strategies, such as patient-reported experience measures, suitable for people with intellectual disability.

When creating data collection tools to inform change, input from all stakeholders throughout the process is important. Including perspectives of consumers, alongside practitioners and policy makers, enriches the quality of data collected to enable meaningful improvement and ensure data usability.

51 | A state-of-the-art literature review of how experience is represented in published empirical studies. Implications for codesign in cancer research and practice

Emilie Francis-Auton¹, Colleen Cheek¹, Reema Harrison¹, Robyn Clay-Williams¹

¹Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

Introduction: Experience-based co-design (EBCD) aims to reform healthcare service delivery through improving the experience of consumers and users of the service. Accurately representing their perspectives ensures improvements that they value most are prioritized for codesign. Based on a state-of-the-art literature review, this presentation demonstrates that the essence of EBCD—the experiences and perspectives of consumers and users—may be diminished by methodological choices.  This presentation aims to stimulate conceptual and practical discussion about collecting and representing experience in EBCD. It will also identify implications for co-design in cancer research and practice.

Methods: A comprehensive systematic electronic search of four databases was conducted from inception to December 2022. Data were extracted using a structured data extraction tool. Thematic synthesis was undertaken to identify the scope and nature of the literature, justification for using EBCD methodology, collection, and representation of experience in practice, and methodological conclusions including facilitators and challenges.

Results: We found great diversity in the application of the philosophical concepts, use of terminology, and reporting of methods. Touchpoints, a core feature of EBCD, are not always identified. Some studies do not identify the type of analysis used, while others hold divergent views regarding the appropriate type of analysis but provide no justification. A lack of methodological guidance, the extent of resources required to elicit consumer experience, and conducting EBCD with vulnerable populations including cancer patients, were highlighted as particular constraints by authors.

Conclusion: EBCD is distinct from other codesign methodology in that the lived experience of consumers and users is privileged and emphasized. This presentation will provide guidance for cancer research and practice assuring quality and safety in representing lived experience.

52 | Evaluation of a co-designed culturally adapted supportive care program for Chinese-, Vietnamese- and Arabic-speaking women with cancer

Suzanne Grant¹, Eric Yeung², Jing Liu¹, Ghufran Alhassani¹, Lianne Ngo¹, Hala Al Duleimi³, Sarah Chung⁴, Harry Nguyen¹, Farynaz Basiri¹, Thao Dinh¹, Chloe Berenger¹, Sheetal Challam⁴, Joel Rhee⁵, Cannas Kwok⁶, Elisabeth Elder⁷, Jolyn Hersch⁸, Tinashe Dune¹, Ash Malalasekera⁹, Judith Lacey¹⁰, Nadine El Kabbout¹¹, Carolyn Ee¹

¹Western Sydney University, Penrith, NSW, Australia

²CanRevive, Sydney, NSW, Australia

³Arab Council Australia, Sydney, NSW, Australia

⁴Cancer Institute New South Wales, St Leonards, NSW, Australia

⁵University of New South Wales, Sydney, NSW, Australia

⁶Charles Sturt University, Bathurst, NSW, Australia

⁷Westmead Breast Cancer Institute, Sydney, NSW, Australia

⁸University of Sydney, Sydney, NSW, Australia

⁹Sydney LHD, Sydney, NSW, Australia

¹⁰Chris O'Brien Lifehouse, Camperdown, NSW, Australia

¹¹NA, Sydney, NSW

Aims: Cancer survivors from culturally and linguistically diverse (CALD) backgrounds have greater unmet needs, higher depression, and poorer quality of life compared to Anglo-Australians. Few supportive care programs in Australia address the unique needs of CALD cancer survivors. This project aims to evaluate the impact of a 6-week co-designed, community-based, culturally adapted supportive care program delivered in language for Chinese-, Vietnamese-, and Arabic-speaking women with cancer and their carers.

Methods: Face-to-face focus groups were conducted after each 6-week program by bilingual facilitators, and explored the impact of the program on wellbeing, barriers/enablers of attending, and suggested changes. Focus group discussions were audio recorded, transcribed verbatim, translated into English by a native speaker, and subjected to thematic analysis.

Results: Seven programs were conducted (three each with Chinese- and Arabic-speaking women, one with Vietnamese-speaking women) with a total of 67 participants (58 women and 9 carers). Sixty-five participants provided qualitative data in seven focus groups. Major themes included the value of facilitated peer connection in language, improved health literacy and feeling empowered, and being able to move forward with joy, confidence and gratitude. Enablers were delivery of the program in language and in familiar community settings by experienced bilingual facilitators and presenters, delivery of mind-body therapies (qigong, yoga) at each session, and the provision of healthy food as a method of facilitating peer connection. Barriers included intercurrent illness and lack of transport. Suggested changes to the program included navigation (e.g. education on the Australian healthcare system), addressing cultural myths about cancer, addition of outdoor activities, for example, nature walks, and increasing the duration and number of program sessions.

Conclusions: A culturally adapted supportive care program had a positive impact on wellbeing and confidence. Future research should focus on expansion of the program to other language groups, mixed genders, and sustainability of such initiatives.

53 | Reducing preventable emergency visits: Results from the Oncology Nurse Practitioner-led Rapid Access Clinic (RACE) service at a tertiary regional cancer centre

Cassandra Mazza¹, Martina O'Neill¹, Kacy Ringshaw¹, Kelly Collins¹, Lily O'Riley¹, Madeline Danielsen-Jensen¹, Natalie Bradford², Nicole Gavin^{4, 5, 3}, Vanessa N Brunelli⁶, Bryan A Chan^{1, 7, 8}

¹Adem Crosby Centre, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia

²Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia

³Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia

⁴Innovation and Research, Community and Oral Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia

⁵School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia

⁶Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia

⁷Griffith University, Nathan, Queensland, Australia

⁸University of the Sunshine Coast, Sippy Downs, Queensland, Australia

Background: Cancer complications or treatment-related toxicities frequently necessitate urgent evaluation and intervention, often resulting in emergency department (ED) visits and hospitalizations.

To address this, in January 2023, we launched a nurse-led Rapid Access Clinic Expansion (RACE) service, designed to offer a streamlined model for patients undergoing cancer treatment and reduce unnecessary ED presentations.

Aim: To describe the characteristics, interventions and outcomes for patients who accessed RACE.

Methods: A retrospective review was conducted of all patients accessing the RACE service from 23 January 2023 to 6 June 2024. Demographics, presenting symptoms, interventions, and outcomes were recorded and data analysed using descriptive statistics.

Results: RACE received 628 telephone calls and managed 337 patients in the study period. 81% (507/628) of calls were managed entirely as outpatients. For most of the calls (530/628, 84%), ED presentation was avoided.

The remaining 98 calls (16%) were appropriately directed to present to the ED.

Patients made on average 1.86 calls (Median 1, Range 1–13)

The median age was 64 years (Range 6–93 years; Standard Deviation 13 years).

Patients accessing the service were receiving systemic intravenous or oral therapies.

Pain, fatigue, and decline in performance status were the most frequent presenting symptoms.

Majority of calls 59% (371/628) were managed with phone advice.

Patients managed in the outpatient setting were scripted with required medications or admitted to the day unit for intravenous infusions.

Conclusions: The RACE service provided streamlined and efficient outpatient care for oncology patients undergoing treatment, while reducing ED presentations.

It has been widely accepted by cancer care staff and patients.

54 | ‘Engage’: A novel distance-delivered intervention to support childhood cancer survivorship care

Jordana McLoone^{1, 2}, Christina Signorelli^{1, 2}, Claire Wakefield^{1, 2}, Mark Donoghoe^{1, 2, 3}, Elysia Thornton-Benko^{2, 4}, Karen Johnston¹, Rachael Baldwin^{1, 2}, Richard Cohn^{1, 2}

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

²Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia

³Kirby Institute, UNSW, Sydney, NSW, Australia

⁴Bondi Road Doctors, Bondi, Sydney, NSW, Australia

Aims: Although comprehensive survivorship care is recommended, many survivors face barriers, which can lead to healthcare disengagement. Australia's survivorship services are reaching capacity, and the traditional clinical-care model is struggling to meet the growing survivor populations needs. This study evaluated the effectiveness of a novel telehealth intervention called “Engage” on survivors’ health-efficacy and quality of life. “Engage” offers multidisciplinary reviews and personalized health recommendations to survivors, aiming to facilitate transition of low to mid-risk survivors into primary-care.

Methods: “Engage” is a distance-delivered intervention comprising: i) an online patient-reported health and lifestyle assessment, ii) an online nurse-led consultation, iii) a multidisciplinary case-review, iv) personalized education, recommendations, and a treatment summary for survivors and their Primary Care Physician, and v) a follow-up online nurse-led consultation to ensure understanding. Childhood cancer survivors treated at Sydney Children's Hospital, who had not received cancer-related care in over 2 years and were more than 5 years post-diagnosis, participated. We assessed survivors’ outcomes prior to the intervention and at 1-, 6-, 12-, and 24-month post-intervention.

Results: Seventy-eight survivors participated (62% male, mean-age = 30 years, mean time since diagnosis = 23 years, 14% living rurally). Survivors’ health-related self-efficacy significantly increased from pre- to post-intervention (p < 0.001) and remained high for 24 months (p < 0.001). 88% of survivors reported increased confidence in managing their healthcare. Satisfaction with care improved significantly from 63% pre-intervention to 94% at 24-month post-intervention (p = 0.008). Information needs decreased from pre- to post-intervention (p = 0.02). Survivors valued telehealth delivery of care, reporting “[Engage was] fast and easy to do, given it could be completed from my own home.”

Conclusions: The “Engage” program is an innovative, distance-delivered intervention that is feasible and highly acceptable, promoting health-related self-efficacy and empowering survivors to advocate for their own health. Findings emphasize the importance of targeted interventions to reduce treatment-related health problems and improve adherence to survivorship care recommendations among survivors.

55 | The CARE PLUS Implementation Toolkit: A set of resources to guide successful implementation of early palliative care in advanced cancer care

Jennifer Philip^{1, 2, 3}, Kylee Bellingham², Nicole Rankin⁴, Farwa Rizvi², Mei Krishnasamy⁵, Gregory Crawford⁶, Anna Collins², Geoffrey Mitchell⁷, Anna Nowak⁸, Vijaya Sundararajan², Brian Le³

¹St Vincent's Hospital, Fitzroy, Victoria, Australia

²Medicine, University of Melbourne, Parkville, Victoria, Australia

³Palliative Care, Melbourne Health, Parkville, Victoria, Australia

⁴School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia

⁵School of Nursing, University of Melbourne, Parkville, Victoria, Australia

⁶Medicine, University of Adelaide, Adelaide, South Australia, Australia

⁷Medicine, University of Queensland, Brisbane, Queensland

⁸Medicine, University of Western Australia, Perth, Western Australia

Background: Despite global evidence for the benefits of early palliative care integration into advanced cancer care, there remain gaps in translation, with limited information about the effective implementation strategies to affect this practice change.

Aim: To introduce the Care Plus implementation toolkit package as an online resource, supporting the implementation and sustainability of palliative care integration into cancer services.

Design, methods: Guided by the Medical Research Council methodological framework for developing complex interventions, Care Plus, a model of early palliative care designed to address known implementation barriers, was delivered through a multi-site stepped wedge, mixed methods implementation study across four Victorian and South Australian hospitals. We conducted qualitative interviews with palliative care consultants, oncologists, nurses, patients, and carers to understand implementation approaches and their utility. We developed an implementation toolkit based on data outputs from healthcare providers to operationalize a standardized approach to early palliative care for advanced cancer patients in their own organizations.

Results: Interviews with 49 participants in the Care Plus study highlighted the effective implementation strategies to establish and evaluate the outpatient-focused Care Plus model co-designed with relevant clinical teams. The Care Plus implementation toolkit (https://www.careplusau.org/about-5) was then developed as an online resource, guiding the implementation of the pathway through three phases: Planning and Engagement, Implementation, and Maintenance. The implementation strategies, core activities, and supporting materials directly address barriers to why, who, when, and how patients can access early palliative care at pre-agreed nominated trigger points with organizational processes flexible to local context.

Conclusions/lessons learned: The Care Plus toolkit (free online), developed using a data-driven approach, offers improved understanding of strategies to underpin successful systematic implementation, translation, and ongoing evaluation of early integrated palliative care models in cancer practice.

56 | Healthcare Costs for Patients with Head and Neck Cancer in Australia: A Population Data Linkage Study

Justin Smith^{3, 1, 2}, Madhavi Chilkuri², Daniel Lindsay^{1, 4}, Katharina Merollini^{5, 6}

¹University of Queensland, Brisbane, Queensland, Australia

²College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

³Princess Alexandra Hospital, Brisbane, Queensland, Australia

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

⁵School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia

⁶Sunshine Coast Health Institute, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia

Aims: To quantify the healthcare costs of patients with head and neck cancer (HNC) in Australia and investigate factors associated with increased costs.

Methods: A sub-study was performed using linked patient data from “Lifetime Costs of Surviving Cancer—A Queensland Study (COS-Q).” Queensland residents diagnosed with a first primary mucosal head and neck squamous cell carcinoma (HNSCC) between 1997 and 2015 and who incurred costs from 2013 to 2016 were included. Healthcare costs were reported as a total mean cost per patient per year and included emergency department (ED) costs, hospital admission costs, cost for medical and allied health services, and pharmaceutical (PBS) costs.

Results: There were 4929 patients with HNSCC included in the study. The total mean annual cost was $21,646 per patient with the highest costs in the first-year post treatment. Regional ($23,312) and rural ($33,627) patients experienced higher healthcare costs than those from major cities ($20,300, p < 0.001). Overall costs were predominantly driven by hospital admissions with a mean annual cost of $15,119 (SD $29,140) per person, which was incurred by 70% of patients. Factors strongly associated with an increased overall healthcare cost included living in a remote location (RR 1.51, p < 0.001), having a nasopharynx (RR 1.41, p = 0.027) or hypopharynx (RR 1.60, p < 0.001) cancer, or being never married (RR 1.34, p < 0.001). There were 644 patients (13%) who developed a second primary malignancy and this sub-group experienced higher overall costs ($46,453 vs. $24,966, p < 0.001).

Conclusions: Healthcare costs for patients with HNC are significant, particularly for those from rural Australia or who develop second malignancies. Future research is needed to explore ways in which healthcare delivery can be optimized to reduce cost to healthcare system and improve quality of care for patients with HNC.

57 | Oncology antimicrobial stewardship: safe intravenous-to-oral switch and antimicrobial optimization (OASSIS)

Karen F Urbancic^{1, 2, 3}, Adele Batrouney^{1, 2}, Belinda Yeo^{3, 4}, Niall C Tebbutt^{3, 4}, Olivia Smibert^{2, 3}, Jason A Trubiano^{2, 3}, Gemma K Reynolds^{2, 3}

¹Pharmacy, Austin Health, Heidelberg, VIC, Australia

²Infectious Diseases, Austin Health, Heidelberg, VIC, Australia

³University of Melbourne, Melbourne, VIC, Australia

⁴Medical Oncology, Austin Health, Heidelberg, VIC, Australia

Aim: Patients receiving cancer treatment are frequently exposed to antibiotics, increasing the risk of antibiotic resistance1. Emerging evidence supports shorter durations, and oral courses, in clinically stable patients^2,3This study aimed to evaluate the effectiveness of infectious diseases (ID) post-prescription review and feedback (PPRF) of antimicrobials in Oncology-admitted inpatients.

Methods: An antimicrobial stewardship (AMS) program, involving an ID physician and pharmacist conducted twice-weekly, 15-min PPRF with Oncology teams. Antimicrobial recommendations were made including: (i) stop; (ii) start; (iii) change; (iv) dose optimization; (v) intravenous (IV)-to-oral switch; (vi) refer for a more detailed ID consult or antibiotic allergy assessment. The primary outcome of this initial implementation evaluation was recommendation acceptance within 24 h of multidisciplinary rounds.  Secondary outcomes included antimicrobial days of therapy (DOT) per overnight bed days (OBD), and recommendation acceptance rates for febrile neutropenia (FN) infections. Prospectively collected data from PPRF were compared with retrospectively data from a 6-month pre-implementation period to evaluate changes in antimicrobials DOT/OBD.

Results: Implementation began in August 2023, with 9 months of collected data available for review. A total of 298 patients and 977 prescriptions were reviewed. A median of 10 patients (IQR: 8.5–12) and 14 orders (IQR: 12, 16.5) were reviewed per meeting. Three hundred seventy-six antimicrobial recommendations (38% of total orders) were made with overall acceptance at 87%. Most recommendations were to stop (196;52%) or switch to oral antimicrobials (68;18%), with 168 (86%) and 59 (87%) recommendations accepted respectively. Twenty-two episodes of FN were reviewed with 21 recommendations to stop (14/21), switch (5/21), optimize (1/21), or refer (1/21) made and 100% acceptance. A reduction in broad-spectrum IV DOT/OBD, particularly piperacillin-tazobactam from an average of 9.75 to 6 DOT/OBD was observed.

Conclusion: ID-led PPRF was well accepted and reduced broad spectrum antimicrobial use over the study period. Future work will evaluate patient safety outcomes.

1. Aitken, S. L, Nagel, J. L, Abbo, L., et al. Antimicrobial Stewardship in Cancer Patients: The Time is Now. J Natl Compr Canc Netw. 2019;17(7): 772–775.

2. Aguilar-Guisado M, Espigado I, Martín-Peña A, et al. Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 trial. The Lancet Haematology. 2017;4(12):e573-e583

3. Vidal L, Ben Dor I, Paul M et al. Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients. Cochrane Database Syst Rev. 2013, Issue 10. Art No.: CD003992

58 | Quantifying the diagnosis and survival of early-onset bowel cancer among First Nations peoples in Queensland, Australia

Tsegaw Amare Baykeda¹, Shafkat Jahan¹, Kirsten Howard², Rakhee Raghunandan², Gail Garvey¹

¹First Nations Cancer and Wellbieng Research Program, The University of Queensland, Brisbane, QLD, Australia

²Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

Introduction: Despite the increasing trend in Australia and globally, the burden of early-onset bowel cancer (EOBC) among First Nations Australians is rarely determined. This study aimed to quantify the diagnosis and survival of EOBC among First Nations peoples in Queensland, Australia.

Methods: We used data from the CancerCostMod, a linked administrative dataset that includes all cancer patients diagnosed in Queensland, Australia between 2011 and 2015. EOBC was defined as a diagnosis of bowel cancer (i.e., colon, rectosigmoid, or rectal cancer) at 18−49 years of age. A multivariable logistic regression analysis was employed to determine the association of Indigenous status (and other factors) with a diagnosis of EOBC. Five-year average survival rates were used to estimate the survival rate.

Results: Of 11,702 bowel cancer cases, 9.19% (95% CI: 8.67−9.72) were EOBC, with 19.35% among First Nations peoples and 9.05% among non-First Nations. First Nations peoples had 2.62 times the odds of EOBC diagnosis (95% CI: 1.73−3.99) compared with non-First Nations peoples. Overall EOBC patients showed a significantly higher five-year survival rate of 77.11% compared with 59.66% for late-onset patients. However, First Nations EOBC patients showed a lower five-year survival rate (73.18%) than that of non-First Nations EOBC patients (77.20%).

Conclusion: First Nations Australians have more than double early onset bowel cancer diagnosis and subsequent lower 5-year survival rates compared to non-First Nations. While the recent lowering of the age eligibility for national bowel screening is a beneficial strategy to address the increasing trend in EOBC, special consideration should be given to addressing the higher likelihood of EOBC diagnosis among First Nations Australians. This study raises the potential of further lowering the age eligibility for First Nations Australians in Australia to ensure that younger First Nations Australians can access treatment earlier thereby improving their survival outcomes from bowel cancer.

59 | Australian Aboriginal and Torres Strait Islander females and survival from breast cancer

Alice RT Bergin^{1, 2}, Luc te Marvelde³, Luis Lara Gonzalez^{1, 2}, Katie Meehan^{4, 5}, Lisa Spalding^{4, 5}, Peter Savas^{1, 2}, Stephen Luen^{1, 2}, Jia-Min Pang¹, Jasmine Kay^{1, 2}, Franco Caramia^{1, 2}, Jianan Wang^{1, 2}, Leanne Pilkington⁶, Andrea Casey¹, Jay Hamman¹, Nicole Watt⁷, Roger Milne⁸, Roberto Salgado⁹, Andrew Redfern^{4, 5}, Gail Garvey¹⁰, Sue Evans³, Sherene Loi^{1, 2}

¹PeterMacCallum Cancer Centre, Melbourne, VIC, Australia

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

³Victorian Cancer Registry, Melbourne

⁴Harry Perkins Institute of Medical Research, Nedlands, WA

⁵University of Western Australia, Crawley, WA

⁶Community member, Perth, Western Australia

⁷St Vincent's Hospital, Melbourne

⁸Cancer Epidemiology Division, Cancer Council Victoria, Melbourne

⁹Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium

¹⁰Faculty of Medicine, University of Queensland, Brisbane

Background: Despite access to universal health care, Aboriginal and Torres Strait Islander females (respectfully referred to hereon as Aboriginal) in Australia have higher breast cancer incidence and mortality rates. In this study we investigate survival outcomes for Aboriginal females in Victoria.

Methods: Aboriginal females (n = 275; .52%) and non-Aboriginal females (n = 52,780; 99.48%) with breast cancer were identified using the Victorian Cancer Registry (VCR). Clinical, pathological, demographic, and socioeconomic variables were correlated. Endpoints were overall (OS) and breast cancer specific (BCSS) survival. Survival analyses were adjusted for above using Cox regression. Bulk RNA-Seq expression data was obtained from archival tumous from Aboriginal females (n = 123) compared with the Cancer Genome Atlas (TCGA) (n = 663). Tumour infiltrating lymphocyte (TIL) quantity and immune deconvolution was performed.

Results: Registry data showed that Aboriginal females were significantly younger (p < 0.001) and had higher stage disease (p = 0.007). In addition, Aboriginal females were more likely to live in rural areas (p < 0.001) and in areas of greater socioeconomic disadvantage (p < 0.001) than non-Aboriginal females. Multivariate analyses for OS showed that Aboriginal females were at increased risk of death from any cause (OS) but not BCSS, after adjustment for age. Increasing age, stage, and tumour grade was significantly associated with worse OS and BCSS. All breast cancer subtypes from Aboriginal females had a significantly reduced TIL infiltrate and TNBC from Aboriginal females had significantly reduced TIL compared to TNBC in TCGA.

Conclusions: In this population-level cohort, survival outcomes for Aboriginal females diagnosed with breast cancer are determined by known clinical and pathological factors. The lower quantities of immune infiltrate warrant further investigation.

60 | Piloting First Nations Cancer Navigators in Queensland Hospitals

Gail Garvey¹, Doreen Tapsall², Jennifer Faulkner³, Glen Kennedy⁴, Damian Topp⁵, Lara Stoll⁶, Sharon Avery³, Michael Smith⁴, Raymond Chan⁷

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

²Princess Alexandra Hospital, Brisbane

³Cairns Hospital, Cairns

⁴Royal Brisbane and Women's Hospital, Brisbane

⁵PA Research Foundation, Brisbane

⁶School of Public Health, The University of Queensland, Brisbane, Queensland, Australia

⁷Flinders University, Adelaide

Aim: Healthcare systems are complex and as a result patients may experience fragmentation of services. First Nations cancer patients experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The cultural needs and barriers to First Nations cancer patients accessing culturally safe cancer care are well documented as is the shortage of a First Nations cancer workforce. The aim of this study was to address these gaps through piloting First Nations Cancer Nurse Coordinators (FNCNC or patient navigators) in Queensland.

Methods: FNCNCs were employed in three diverse Queensland cancer services to provide culturally responsive supportive care to First Nations cancer patients and their families. Qualitative data from the FNCNC, patients, and families were analysed using thematic analysis.

Results: Preliminary results indicate FNCNCs are essential to providing emotional and practical support to First Nations cancer patients and their families. They are invaluable in supporting patients and families to navigate the complexities of cancer and cancer treatment. Patients reported feeling isolated “I'm so grateful for all the support and connecting me back with my family.” Patients and family reported the FNCNCs ability to break down medical terminology and help them to make informed decisions about their care and treatment options. Having a trusted and culturally sensitive advocate by their side throughout the entire process was crucial to keeping engaged in services. We are also seeing some initial benefits in improving the cultural safety and appropriateness of cancer service, the “FNCNC has taught us all so much”- Nursing Director.

Conclusion: FNCNC play an important role in achieving equity in cancer care and outcomes for First Nations people. Australia's investment in cancer navigation programs must consider targeted positions for First Nations navigators in cancer services.

61 | Aboriginal and Torres Strait Islander peoples’ views and perceptions of pathways to pain management and early palliative care for people with pancreatic cancer

Gail Garvey¹, Isabel E Young², Melanie Lovell², Mei Krishnasamy³, Gregory Crawford^{4, 5}, Nicole Rankin⁶, Kara Burns⁷, Kylee Bellingham⁸, Georgia Christopolous⁸, Farwa Rizvi⁸, Jennifer Philip^{10, 8, 9}

¹Indigenous Health Research, Univeristy of Queensland, Brisbane, Queensland, Australia

²Palliative Care, HammondCare, Greenwich, NSW, Australia

³School of Nursing, University of Melbourne, Parkville, Vic, Australia

⁴Medicine, University of Adelaide, Adelaide, South Australia, Australia

⁵Palliative Medicine, Lyell McEwin Hospital, Modbury, South Australia, Australia

⁶School of Population and Global Health, University of Melbourne, Parkville, Vic, Australia

⁷Centre for Digital Transformation of Health, University of Melbourne, Parkville, Vic, Australia

⁸Medicine, University of Melbourne, Parkville, Victoria, Australia

⁹Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Vic, Australia

¹⁰St Vincent's Hospital, Fitzroy, VIC, Australia

Aims:  To develop pathways to timely pain management, including interventional pain management and palliative care, with supporting materials for people with pancreatic cancer. The need for this work was set out in the National Pancreatic Cancer Roadmap, developed by Cancer Australia.

Method: Themed working groups involving clinicians and community members were established to develop and review evidence-based summaries. Four online Yarning groups facilitated by a senior Aboriginal researcher were held with Aboriginal and Torres Strait Islander health workers from different Australian states and regional areas. Participants reviewed the relevance, applicability, and provided broad reflections of the pain assessment and management, palliative care, education and information, and implementation materials. Feedback was re-presented to working groups for consideration and adaptation.

Results: A number of discussion points raised in the Yarning groups had resonance for, and resulted in modifications of, all components of the pathways, clinical guidance, and education/information resources developed.

Key points highlighted across all Yarning groups were:

The person is the expert of their own experience.

The focus of care and language should be around “self-determination.”

Trust is imperative to and within health care professional interactions, with relationships being central to care.

Historical and current trauma will influence the experiences of symptoms and illness, and also the expression of pain.

The importance of acknowledging and using cultural strengths including truth telling and storytelling.

The importance of giving examples of other patients’ stories and outcomes.

The need for early involvement of Aboriginal and Torres Strait Islander Health Workers to support patients across the care pathway.

Conclusion: Yarning groups with Aboriginal and Torres Strait Islander health workers were enormously rich, and the outcomes of these discussions led to adjustments and improvements of the national pathways and supporting materials.

62 | “Helping my mob” – embedding a First Nations research coordinator to improve First Nations engagement and recruitment

Mettassa Zaro¹, Amy Brown¹, Rachael Jaenke², Gail Garvey²

¹Townsville Hospital and Health Service, Townsville, QLD, Australia

²The University of Queensland, Herston, QLD, Australia

Aim: To describe the learnings in recruiting Aboriginal and Torres Strait Islander research participants from a regional cancer centre.

Methods: First Nations patients with cancer and/or their caregivers were screened and approached as potential study¹ participants using two different approaches: (1) Clinician researcher/external research assistant (RA) and (2) an embedded First Nations research coordinator (FNRC). These different approaches were reviewed and adapted during team meetings, and discussion notes and recruitment logs were reviewed to reflect on adaptations and processes.

Results: Prior to embedding a First Nations RC, recruitment and survey completion was low. Reflections included the importance of collaborating with the Indigenous Hospital Liaison Officers; making meaningful local connections; building rapport with potential participants; allowing time for relationship building and trust, whilst considering study timelines. Importantly, the FNRC role is not solely focused on the research study, but also ensures participants are well supported throughout their journey, with the FNRC advocating for and connecting to additional support when the need is identified.

Conclusion: Embedding a First Nation's RC within our cancer center has improved participant engagement and, ultimately, recruitment and data collection. Our key learnings throughout this process include knowing your local community helps identify what will work; building capacity and capability of the First Nations research workforce is important, as is having flexibility in the RC role to support both clinical care and research; empowering potential participants in both their health journey and their choice in participating in research is critical. In the words of the RC: “We are humans before we are patients.”

Jaenke R, Girgis A, Aoun S, Cunningham J, Wakefield C, Shahid S, Smith B, Diaz A, Garvey G. The Supporting Our Carers Study: Developing a measure to assess the supportive care needs of Indigenous Australians with cancer. J Psychosoc Oncol Res Pract. 2023;5(S1):72-73.

63 | Implementing a First Nations Cancer Coordinator to Improve Cancer Outcomes and Enhance Cultural Safety for the Aboriginal and Torres Strait Islander Community in Victoria

Marissa Mulcahy¹, Mollie Wilson^{2, 3, 4}, Brian Le⁵, Dilu Rupassara⁶, Gail Garvey⁷, Jennifer Philip^{2, 3, 4}

¹First Nations Health Unit, The Royal Melbourne Hospital, Melbourne, VIC, Australia

²St Vincent's Hospital Melbourne, East Melbourne, VICTORIA, Australia

³Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴University of Melbourne, Melbourne, VIC, Australia

⁵The Royal Melbourne Hospital, Melbourne, VIC, Australia

⁶Western Central Melbourne Integrated Cancer Services, Melbourne, VIC, Australia

⁷University of Queensland, Brisbane, QLD, Australia

Background: Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Aboriginal) experience poorer cancer outcomes and higher mortality rates compared to non-Indigenous Australians. Barriers in accessing and engaging with cancer care services contribute significantly to these disparities. The First Nations Cancer Coordinator (FNCC) role, developed in collaboration with an Aboriginal Community Advisory Group, offers a model that combines cultural and coordination support to improve the navigation of cancer services for Aboriginal people.

Aim: This project aimed to assess the effectiveness of the FNCC role in addressing the cultural, coordination, and care needs for Aboriginal patients with cancer and their families. 

Methods: A co-design methodology was used, underpinned by community governance and ongoing partnership with an Aboriginal Community Advisory Group. An iterative, collaborative Yarning process was embedded to prioritize Aboriginal perspectives.

A mixed-methods approach was used, including semi-structured interviews with healthcare professionals, stakeholders, and Aboriginal patients, alongside a medical record audit to evaluate the FNCC role's impact. Evaluation outcomes were determined in alignment with optimal care pathways and local community needs.

Outcomes: The core components of the FNCC role included strong connections with multidisciplinary cancer teams and Aboriginal health units; continuous, between service coordination; knowledge about cancer-specific needs; and advocacy and education about cultural safety in cancer care. The project identified areas where additional cultural support was most valuable, including communication with community-controlled services, attendance at outpatient clinics and multidisciplinary cancer meetings. Factors that could impact the role of effectiveness were role visibility, understanding, and early identification of Aboriginal patients.

Conclusion: The findings highlight the critical importance of FNCC roles in advocating for and enhancing cultural safety in cancer care, essential for addressing disparities and improving cancer outcomes for Aboriginal Australians.

64 | Establishing and Implementing a First Nations Cancer Coordinator: An Implementation Toolkit

Mollie C Wilson^{1, 2, 3}, Marissa Mulcahy⁴, Brian Le⁵, Dilu Rupassara⁶, Gail Garvey⁷, Jennifer Philip^{1, 2, 3}

¹St Vincent's Hospital Melbourne, East Melbourne, VICTORIA, Australia

²Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³University of Melbourne, Melbourne, VIC, Australia

⁴First Nations Health Unit, The Royal Melbourne Hospital, Melbourne, VIC, Australia

⁵The Royal Melbourne Hospital, Melbourne, VIC, Australia

⁶Western Central Melbourne Integrated Cancer Services, Melbourne, VIC, Australia

⁷University of Queensland, Brisbane, QLD, Australia

Background: Cancer is a leading cause of illness among Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Aboriginal), with poorer outcomes and higher mortality rates than non-Aboriginal Australians. This project aimed to design and implement an evidence-based First Nations Cancer Coordinator (FNCC) role tailored for Aboriginal people affected by cancer. The role was endorsed by an Aboriginal Community Advisory Group and implemented in a large urban hospital, incorporating community feedback throughout its development.

Aims: Drawing on the Korin Korin Balit-Djak evaluation findings, this project aimed to:

Identify effective strategies for implementing the FNCC role across cancer services

Develop a toolkit to guide the implementation of similar roles in other health settings.

Methods: A co-design methodology was used, underpinned by principles of community governance and empowerment, to ensure the project's relevance and utility for the Aboriginal community. An iterative and collaborative Yarning process was employed to prioritize Aboriginal voices.

Implementation followed the Consolidated Framework for Implementation Research and aligned with the Optimal Care Pathways for Aboriginal and Torres Strait Islander people with cancer, the Victorian Aboriginal Community Controlled Health Organisation's Cancer Journey Strategy and local community needs.

Outcomes: The project produced an implementation toolkit that includes: a recommended model of care, identified challenges and opportunities, required resources and suggested evaluation metrics.

The toolkit is organized into three phases:

Planning and Engagement: Initial planning and stakeholder engagement strategies (e.g., partnership with local community)

Implementation: Best practices for rolling out the FNCC role (e.g., maintaining role visibility within service)

Maintenance and Sustainability: Long-term maintenance and sustainability plans (e.g., strategies to acquire ongoing funding)

Conclusion: This toolkit provides a structured approach for establishing a FNCC role in various health settings, supporting similar initiatives, and enhancing cancer care for Aboriginal people through community-informed practices.

65 | Cancer-related malnutrition and sarcopenia: challenges and opportunities for improved care

Nicole Kiss¹

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

Cancer-related malnutrition and sarcopenia are distinct albeit related conditions that lead to serious adverse outcomes, which may compromise the ability to complete cancer treatment. This presentation will discuss each of these conditions, how they differ, and why their early identification is so important. The current challenges in identifying people at risk will be explored, including how and why we are missing people who would benefit from early access to care. Opportunities and resources to improve practice for better outcomes will be presented.

66 | Improving delivery of exercise in oncology:  an implementation science approach

Mary Kennedy¹

¹Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia

Exercise is recommended as a therapy to address several health-related side effects of cancer treatment, but it is not routinely offered during care. This “know-do” gap between what research has shown to be effective and what is actually being delivered in real-world oncology practice is preventing people from receiving best practice care. Implementation science is the scientific study of strategies to promote the use of evidence-based practices in routine clinical care. I will explore common barriers to exercise delivery and provide implementation science-informed solutions for success.

67 | Nutrition matters: exploring models of care and strategies to support patients with cancer-related malnutrition

Jenelle Loeliger^{1, 2, 3}

¹Peter MacCallum Cancer Centre, Victoria, VIC, Australia

²School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia

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

The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. Cancer-related malnutrition remains a highly prevalent condition in people with cancer with poor clinical outcomes and high healthcare costs. Despite good progress in this space, a myriad of challenges exist. This presentation will explore different models of nutrition care, what core elements underpin these models, and pragmatic approaches that health services can take to develop, implement, and embed nutrition care across the cancer trajectory.

68 | Art Making–Process and Planning

Beata Batorowicz¹

¹University of Southern Queensland, Darling Heights, QLD, Australia

In acknowledging the ongoing and significant contribution of the arts on emotional psychological and physiological wellbeing within the health sector, there is much to be explored regarding the role of art beyond an arts therapy context. Focusing on the fine art genre, this presentation identifies and explores the strategies and roles that contemporary art can potentially play in foregrounding person-centered knowledge and insights as necessary information that reclaims subjectivity and the personal premise in expanding and contributing to a broader interdisciplinary understanding and approach/es to cancer care. Contemporary art is discussed in terms of being a catalyst for individual agency-formation, self-identity legacy-building through art making, resulting in artist-assisted exhibition and artist book outcomes. The latter seeks to empower individuals living with cancer as well as help cultivate socio-cultural health communities by making visible the learning opportunities from individual's experiences with advanced cancer. Contemporary art can become a vehicle for advocating for personal legacy, family connectivity as part of, as well as, beyond the cancer journey. Further visual art studies on individual narratives across multimodal forms can potentially lead to new insights on more interdisciplinary and holistic treatment regarding cancer care.

69 | Art in Oncology: “Art of the Clinician: Looking to See”

Katherine E Francis^{2, 1}

¹Medical Oncology, Wollongong Hospital, Wollongong, NSW, Australia

²National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia

Let not your conceptions of the manifestations of disease come from words heard in the lecture room or read from the books.

See, and then reason and compare.

But see first.

—William Osler

At its heart, medicine is a discipline of observation, where the clinician's ability to see—truly see—can make the difference between a missed detail and a life-saving diagnosis or life-changing conversation. As technology advances and the science of medicine becomes ever more complex, the essential skill of observation is increasingly challenged by time pressures and the growing reliance on digital tools. Yet, this core aspect of medicine remains as vital as ever.

In this talk, Dr. Kat Francis, a medical oncologist and visual artist, explores the intersection of art and medicine through the lens of observation. Drawing on the words of Sir William Osler—“See, and then reason and compare. But see first.”—Dr. Francis will examine how the practice of visual arts can enhance a clinician's observational skills, offering a pathway to deeper understanding and more compassionate care.

The presentation will delve into the concept of “Looking to See,” where observation is not just about gathering data, but about truly seeing the person —whether patient, colleague, or self. It will also explore the acknowledgment of being seen, the role of self-reflection, and the ability to “see through” complex situations in clinical practice.

Through personal insights and practical examples, Dr. Francis will demonstrate how reconnecting with the art of seeing can enrich both the clinician's practice and the patient's experience. This talk invites clinicians to embrace the visual arts as a powerful tool for enhancing their capacity to observe, understand, and care for those in their charge.

70 | “Sing me a rainbow”: the music therapist's palette in paediatric oncology

Karen Elliott¹

¹OT/MT Dept, Queensland Children's Hospital, Brisbane, South Brisbane, QLD, Australia

There is no doubt that music is an intrinsic part of our lives and plays an important role in our health and well-being. Over recent years, we have been reminded of this as we witnessed the beauty and power of digital choirs to unite people, the devastation of silent stages across the world and the thrill of shared music-making as neighbors in lockdown stood on balconies and played together. It reminded us of the value of shared musical experiences and the power of music. Music itself can also be very personal; it can evoke strong memories, emotion, and become an anthology of our lives. Music can serve so many different functions across the continuum of health and well-being, including music therapy.

Music therapy is a research-based allied health profession that uses music, its elements, and the therapeutic relationship to support people to achieve health, functioning, and wellbeing. Music therapy in the pediatric setting supports patients with a broad spectrum of needs, including pain and anxiety management, procedural support, coping and adjustment, and end of life. The music therapy program at the Queensland Children's Hospital, funded by Redkite, is a well-established program supporting patients and their families along a complex and often difficult path. In this presentation, Karen will present music therapy as part of a continuum of music for health and well-being, providing examples to illustrate how the use of music changes across the continuum. Karen will also provide clinical examples from her work in paediatric oncology to showcase the colors of both song and music-making, and the ways music therapy can enhance health and well-being for both patients and their families in this setting.

71 | Why I write

David Schlect¹

¹GenesisCare, Auchenflower, QUEENSLAND, Australia

To be provided

72 | Patient perspective on the role of Art

Amanda J Quennell¹

¹Medical Oncology, Gold Coast Uni Hospital, Gold Coast, QLD, Australia

The therapeutic power of art can be both a personal and professional tool for coping with the emotional demands of a cancer nurse. But what happens and what is the power of art when the cancer nurse becomes the patient with stage 4 cancer? 

Can art flourish even in the face of life's most profound challenges?  Furthermore, can art provide an outlet for healing, coping, symptom relief, and hope for patients as they move through their cancer treatment and journey? 

This presentation will discuss the importance of art and the role it plays in managing the multifaceted impacts of cancer.  Not only aiding in symptom management, and coping with a cancer diagnosis, but also in creating lasting memories and legacy pieces for loved ones.

73 | VAD Policy, implementation, challenges and the future

Liz Reymond^{2, 1, 3}, Enna Stroil-Salama³, Lesley McLeod³, Elisha Cole³

¹Metro South Health, Eight Mile Plains, QLD, Australia

²Brisbane South Palliative Care Collaborative, Queensland Health, Eight Mile Plains, QLD, Australia

³QVAD Support & Pharmacy Service, Eight Mile Plains, QLD, Australia

Voluntary-assisted dying (VAD) was enacted in Queensland on 1^st January 2023. VAD allows eligible adults who are dying and suffering intolerably an additional end-of-life choice, allowing them to choose the timing and circumstances of their death. This presentation concerns a brief introduction to the establishment of the VAD system in Queensland, an outline of the VAD process, a summary of VAD activity to date, and an overview of on-going challenges.

Planning for governance of VAD began in September 2021 when the VAD ACT was passed. In short measure, an implementation taskforce was established as were a Review Board, a central VAD Unit, committees, an information management system, the Queensland VAD Support and Pharmacy Service, an Authorised Practitioner training system, and Hospital and Health Services governance systems.

The demand for VAD has outstripped modelling and is disrupting the provision of quality end-of-life planning and delivery. VAD intersects with advance care planning, palliative care and delivery of hospital, residential aged care, and community-based care. By 31^st March 2024, there had been 1749 first assessments, 77% with a cancer diagnosis, 80% known to specialist palliative care services, 85% living at home, and 808 VAD deaths in Queensland. Despite the majority of Queensland's population living in southeast Queensland, 59% of substance deliveries occurred outside metropolitan areas (MM1).

Immediate and on-going challenges for VAD include a steadily increasing demand for VAD coupled with a limited workforce and care impediments due to an antiquated Commonwealth Criminal Code. In addition, clinicians’ personal responses to VAD can impact individuals’ choices for end-of-life care. Finally, limited awareness of VAD can lead to late VAD referrals that require expedited processes which can poorly impact patient, carer, and clinician outcomes.

VAD is in a nascent period and on-going research is required to ensure delivery of best practice, integrated VAD services.

74 | Voluntary Assisted Dying: A Pharmacist's perspective

Elisha Cole¹, Liz Reymond¹, Lesley McLeod¹, Enna Stroil-Salama¹

¹Queensland Voluntary Assisted Dying Support and Pharmacy Service, Eight Mile Plains, QUEENSLAND, Australia

Introduction

In Australia and New Zealand, 7208 people have sought Voluntary-Assisted Dying (VAD), with cancer being the most prevalent primary diagnosis amongst these patients. Despite its increasing relevance, VAD remains a new practice area for many Australian clinicians, including those in oncology. Given the intersection of VAD and cancer, it is beneficial for oncology professionals to understand the role of all VAD clinicians (including pharmacists) in a patient's end-of-life journey.

In Queensland, pharmacists with the Queensland Voluntary Assisted Dying Support and Pharmacy Service (QVAD SPS) are responsible for dispensing VAD substances and educating eligible patients, their families, and clinicians on the management and administration of these substances. These pharmacists play a pivotal role in end-of-life care, often working closely with the broader healthcare team to provide holistic, patient-centred care. To effectively offer these services, pharmacists need extensive knowledge and training in all aspects of end-of-life care.

Objective

This presentation will examine the unique role of QVAD SPS pharmacists, focusing on their specialized skills and expertise that enable them to support eligible VAD patients at end of life.

Key Findings/Description

QVAD SPS pharmacists undergo extensive training upon onboarding, which includes VAD legislation and processes in Queensland, pharmacology of VAD substances, substance management, referral pathways for end-of-life services, practical aspects of death, end-of-life communication, and bereavement care. They are trained to offer standardized VAD substance counselling that is compassionate, tailored to the individual, and also covers their legislative and professional obligations. Furthermore, QVAD SPS provides opportunities for pharmacists to debrief, reflect, and enhance their practice through supervision.

Conclusion

QVAD SPS pharmacists are well-supported and trained to provide high-quality VAD services in Queensland. Their role is crucial in collaborating with the wider healthcare team to ensure that patients, their families, and clinicians receive comprehensive support with VAD substance supply and administration.

75 | Voluntary Assisted Dying–Equity and access to VAD in regional/rural areas

Jill L Mann¹

¹Statewide Navigator Service, Barwon Health, Geelong, VIC, Australia

Equity and access to VAD in regional and rural areas

Access to health care for Victoria's regional and rural population is inequitable in comparison with the metropolitan population. This includes access to specialist care and consulting specialist medical practitioners. This disparity occurs also with regard to accessing the Voluntary-Assisted Dying Legislation.

A patient story will demonstrate the barriers and challenges that the person, their family, carers, health team, and the navigator service face.

Exploration of the identified barriers with recommended actions to improve access for regional and rural people will be discussed.

An update on Victorian data, including trained medical practitioners in relation to those wanting to access VAD pathway.

76 | Legal evolution of VAD and its access

Cameron McLaren¹

¹Voluntary Assisted Dying Australia and New Zealand (VADANZ), Berwick, VIC, Australia

Voluntary-Assisted Dying (VAD) became a legal option for residents of Victoria in 2019. Successive legislation has passed in all Australia states, in the ACT, and in New Zealand. As an early adopter of VAD and the founder of Voluntary Assisted Dying Australia and New Zealand, Dr McLaren provided his experience in providing VAD across Australia and internationally to inform the evolution of legislation.

Dr McLaren will be discussing his experience in Victoria, and how the Victorian model has influenced VAD in other states. Dr McLaren will present data from VAD Review Boards in each jurisdiction, and from the recently released State of VAD Report from Go Gentle Australia.

77 | Exercise Rehabilitation for Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Controlled Trial

Briana K Clifford¹, David Goldstein^{3, 2}, Kimberley Au¹, J. Matt McCrary⁴, Terry Trinh^{5, 2}, Tiffany Li⁶, Masarra Al Deleemy⁶, David Mizrahi⁷, Carole A Harris^{2, 8}, Benjamin C Forster^{6, 9}, William Huynh^{5, 6}, Frances Boyle^{6, 9}, Monica Tang^{3, 2}, Victoria Choi¹⁰, Peter Grimison^{6, 10}, Shelley Kay¹⁰, Brent Collier¹¹, Alexandra M Smith¹, Jasmine Menant⁵, Susanna B Park⁶

¹School of Health Sciences, University of New South Wales, Sydney, Australia

²University of New South Wales, Sydney, Australia

³Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

⁴Institute of Human Genetics, Hannover Medical School, Hannover, Germany

⁵Neuroscience Research Australia, Sydney, Australia

⁶University of Sydney, Sydney, Australia

⁷The Daffodil Centre, University of Sydney, Sydney, Australia

⁸St George Hospital, Kogarah, Australia

⁹The Mater Hospital, North Sydney, Australia

¹⁰Chris O'Brien Lifehouse, Camperdown, Australia

¹¹Peak Health, Gymea, Australia

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating complication in cancer survivors, impacting 68% of patients treated with neurotoxic chemotherapy. Exercise may improve CIPN symptoms and function, however, the effect of structured exercise on objectively measured CIPN has not been comprehensively investigated in cancer survivors.

Aim: To quantify the impact of exercise on objective neuropathy severity and patient function in cancer survivors.

Methods: A multi-site, open-label, randomized controlled trial was undertaken.  Participants were randomized to an 8-week supervised exercise intervention or usual care. The primary outcome was the neurological grading scale Total Neuropathy Score clinical (TNSc). Secondary outcomes included patient-reported CIPN (EORTC CIPN20). The multimodal intervention incorporated aerobic and resistance exercise and balance training. Planned accrual target was 96 participants (48 per group), powered to demonstrate a 1.7-point difference in TNSc between treatment groups at 8 weeks (80% power, α = .05). A linear mixed model was used to assess differences between groups at 8 weeks using an intention to treat approach. Post hoc comparison of change scores within and between groups was also conducted.

Results: Between March 2019 and July 2023, participants were recruited from four oncology centers in Sydney, Australia. One hundred ninety-seven patients were assessed for eligibility, 90 were randomized and underwent baseline assessment (Intervention n = 46, Control n = 44). Seventy-six returned for follow up assessment after the 8-week intervention (Intervention n = 37, Control n = 39). Preliminary analysis demonstrated a post intervention, between group mean difference in TNSc of 1.41 points (95% CI: −.009, 2.874; p = 0.016). There was also a significant effect of exercise on the EORTC CIPN20 total score, with mean change score of −5.64 (95% CI: −7.91, −3.37; p < 0.001) after exercise and mean change score of −1.83 (95% CI: −4.06, .40; p = 0.11) after usual care.

Conclusions: Eight weeks of multimodal exercise may improve objectively assessed CIPN in cancer survivors.

78 | Preventing Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: The ALLO-Active Trial

Hayley T Dillon^{1, 2}, Nicholas J Saner^{2, 3}, Tegan Ilsley^{4, 2}, David S Kliman⁵, Steve J Foulkes^{2, 6, 7}, Christian J Brakenridge^{2, 8}, Andrew Spencer⁹, Sharon Avery¹⁰, Piet Claus¹¹, David W Dunstan^{1, 2}, Robin M Daly¹, Steve F Fraser¹, Neville Owen^{2, 8}, Brigid M Lynch^{2, 12, 13}, Bronwyn A Kingwell^{14, 2}, Andre La Gerche^{6, 11, 15, 16}, Erin J Howden^{2, 17}

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

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

³Institute for health and sport, Victoria University, Melbourne, VIC, Australia

⁴Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, AU

⁵Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia

⁶Heart, Exercise and Research Trials (HEART) Lab, St Vincent's Institute, Melbourne, VIC, Australia

⁷Faculty of Nursing, University of Alberta, Edmonton, Canada

⁸Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia

⁹Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Please Select, Australia

¹⁰Liz Plummer Cancer Care Centre, Cairns and Hinterland Health Service, Cairns, QLD, Australia

¹¹Department of Cardiovascular Science, KU Leuven, Leuven, Belgium

¹²Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

¹³Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

¹⁴CSL, Melbourne, VIC, AU

¹⁵Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia

¹⁶HEART Lab, Victor Chang Cardiovascular Research Institute, Darlinghurst, NSW, Australia

¹⁷Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia

Background and Aim: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for haemotological malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multi-component activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.

Methods: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month Activity program (n = 30) or usual care (UC, n = 32). Activity comprised a multi-component exercise training (3 days/week) and sedentary time reduction (at least 30 min/day) program and was delivered throughout hospitalization (∼4-weeks) and for 12 weeks post-discharge. Physiological assessments conducted pre-admission, and 12-weeks post-discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake (V̇O_2peak), exercise cardiac MRI for peak cardiac (CI_peak) and stroke volume (SVI_peak) index, echocardiography-derived left-ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (troponin-I, B-type natriuretic peptide).

Results: Fifty-two participants (84%) completed follow-up (25 Activity; 27 UC), and median (IQR) Activity adherence was 74% (41%–96%). There was a marked decline in VO_2peak in UC (−3.4 mL/kg/min [95%CI −4.9, −1.8]) that was attenuated with Activity (−0.9 mL/kg/min [95%CI −2.5, .8]; interaction, p = 0.029). Activity preserved exercise cardiac function, with preservation of CI_peak (.30 L/min/m², [95%CI −.34, .41]) and SVI_peak (0.6 mL/m² [95%CI −1.3, 2.5]), both of which declined with UC (CI_peak: −.68 L/min/m², [95%CI −1.3, −0.32]; interaction, p = 0.008; SVI_peak: −2.7 mL/m² [95% CI −4.6, −.9]; interaction, p = 0.014). There were no treatment effects of Activity on cardiac biomarkers or echocardiography.

Conclusion: Intervening during and following allo-SCT with a multi-component exercise intervention is beneficial for preserving patient's cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality following allo-SCT.

79 | Patient Reported Measures as the Optimal Assessment of Chemotherapy-Induced Peripheral Neuropathy

Tiffany Li¹, Hannah C Timmins², Fawaz M Mahfouz¹, Terry Trinh², David Mizrahi¹, Lisa G Horvath³, Michelle Harrison³, Peter Grimison³, Michael Friedlander⁴, Gavin Marx⁵, Frances Boyle⁶, David Wyld⁷, Robert Henderson⁷, Tracy King⁸, Sally Baron-Hay⁹, Matthew C Kiernan², Claudia Rutherford¹, David Goldstein¹⁰, Susanna B Park¹

¹Faculty of Medicine and Health, University of Sydney, Sydney

²Neuroscience Research Australia, Randwick

³Chris O'Brien Lifehouse, Camperdown

⁴Prince of Wales Hospital, Randwick

⁵Sydney Adventist Hospital, Wahroonga

⁶Mater Hospital, North Sydney

⁷The University of Queensland, Brisbane

⁸Institute of Haematology, Royal Prince Alfred Hospital, Camperdown

⁹Royal North Shore Hospital, St Leonards

¹⁰Prince of Wales Clinical School, UNSW, Kensington

Introduction: Chemotherapy-induced peripheral neurotoxicity (CIPN) is a significant and persisting toxicity of anticancer treatments, impacting dose delivery and quality of life. There is a lack of consensus on the optimal method of CIPN assessment in clinical settings. This study compared the validity and responsiveness of patient-reported outcome measures (PROMs) against neurological, neurophysiological, and sensory assessment approaches of CIPN.

Methods: A multi-center dual study design evaluated patients treated with neurotoxic chemotherapy across two cohorts: patients commencing treatment assessed prospectively and patients who completed treatment assessed cross-sectionally. CIPN was assessed via PROMs (EORTC-CIPN20, FACT/GOG-Ntx, PRO-CTCAE), neurological and neurophysiological assessment (Total Neuropathy Score, sural and tibial compound nerve amplitudes), and sensory functional measures (Grating orientation, Von Frey monofilament, and 2-Point discrimination tasks). Convergent and known-groups validity were assessed cross-sectionally following treatment completion and responsiveness was evaluated prospectively during treatment. Neurological, neurophysiological, and sensory outcome measure scores were compared between high and low CIPN symptom reporters.

Results: A total of 1033 patients were recruited, incorporating 1623 assessments. PROMs demonstrated superior ability to identify CIPN (convergent validity; α = .75–.85, all p < 0.001), to discriminate between CIPN severity (known-groups validity; all p < 0.001) and to detect changes in CIPN development (responsiveness; Cohen's d = .65–.83) compared to neurological, neurophysiological, and sensory assessment approaches. These other measures did not achieve threshold for convergent validity (α < .7). and did not demonstrate acceptable responsiveness (Cohen's d < .5). Neurological, neurophysiological, and sensory outcome measures were significantly impaired in patients who were high CIPN symptom reporters compared to low (all p < 0.05).

Conclusion: PROMs represent a valid method of CIPN assessment, with preferential measurement properties over other approaches to assessing neuropathy. Adoption of PROMs in clinical practice will allow for accurate representation and early recognition of CIPN, leading to reduced long-term morbidity in this key long-term toxicity in cancer survivors.

80 | Cardiovascular mortality in people with cancer compared to the general population: a systematic review and meta-analysis

Huah Shin Ng^{1, 2}, Rosie Meng¹, Tania S Marin¹, Raechel A Damarell³, Elizabeth Buckley¹, Joseph B Selvanayagam^{1, 4}, Bogda Koczwara^{1, 5}

¹College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia

²SA Pharmacy, SA Health, Adelaide, SA, Australia

³Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia

⁴Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, SA, Australia

⁵Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia

Aims: Cardiovascular disease (CVD) is the leading cause of non-cancer death in cancer survivors, but the risk of CVD varies between cancers. To synthesize available evidence on patterns and magnitude of CVD mortality risk.

Methods: A systematic search of Medline (OVID), CINAHL, and Scopus databases from 01 January 2000 to 16 July 2023 of studies of people with cancer, reporting CVD mortality in cancer population compared with a reference population (e.g., general population) as standardized mortality ratios (SMR). Meta-analysis of SMRs across cancer and CVD types were pooled using a random-effects model to allow for heterogeneity of the true effect size across studies.

Results: We identified 136 studies from 16 countries. Sample sizes ranged from 157 to 7,529,481. The majority (n = 98; 72%) were conducted in the United States, followed by Europe (n = 22; 16%). The most common cancers studied were gastrointestinal (n = 34 studies), hematological (n = 31), and breast (n = 29). A total of 876 CVD SMRs were extracted across diverse CVD conditions. Of those, the majority (535; 61%) indicated an increased risk of CVD death (SMR > 1), 109 (12%) a lower risk of CVD death (SMR < 1), and 232 (27%) an equivalent risk (95%CI of SMR included 1) compared to the general population. The meta-analysis of all reported SMRs showed an increased risk of CVD death (SMR = 1.55, 95%CI = 1.40–1.72) in cancer survivors compared with the general population. The SMR varied between CVD conditions and ranged from 1.36 (95%CI = 1.29–1.44) for heart diseases to 1.56 (95%CI = 1.39–1.76) for cerebrovascular diseases. SMR varied across cancer types, ranging from 1.14 (95%CI = 1.04–1.25) for testicular/germ cell tumors to 2.82 (95%CI = 2.20–3.63) for brain/central nervous system tumors.

Conclusions: Cancer survivors are at an increased risk of premature CVD mortality compared to the general population, but the risk varies by cancer type and CVD. Future research should focus on understanding mechanisms behind the increased CVD risk to develop appropriate interventions.

81 | A randomized controlled waitlist trial of a telehealth group cognitive intervention (BRAINS-LaTCH) for people with primary brain tumour

Kerryn E Pike^{1, 2, 3}, Sian EB Virtue-Griffiths^{1, 2}, Carl I Moller^{1, 4}, Dianne M Legge^{5, 6}, Mark B Pinkham^{7, 8}, Dean Vuksanovic⁹, Louise Saliba¹⁰, Joanne Shaw¹¹, Haryana M Dhillon¹¹

¹Griffith Centre for Mental Health & School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia

²Department of Psychology, Counselling & Therapy, School of Psychology & Public Health, La Trobe University, Melbourne, Vic, Australia

³John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Vic, Australia

⁴The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Vic, Australia

⁵Oliva Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, Vic, Australia

⁶Curtin School of Nursing/ Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia

⁷Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia

⁸University of Queensland, St Lucia, QLD, Australia

⁹Department of Psychology, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia

¹⁰Monash Health, Clayton, Vic, Australia

¹¹Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Background: Cognitive changes are common following primary brain tumor (PBT), impacting employment, independence, relationships, and quality of life (QOL). Despite this, tailored interventions are largely unavailable in Australia. The La Trobe and Caulfield Hospital (LaTCH) cognitive rehabilitation group has demonstrated efficacy in older adults without PBT.

Aims: To examine the efficacy of LaTCH adapted for people with PBT (BRAINS-LaTCH), delivered by telehealth to increase access.

Methods: We used a Type 1 hybrid implementation design randomized controlled trial (RCT) with a waitlist control (WLC). Adults > 3-months post-PBT diagnosis, and > 1-month post-radiation therapy, from healthcare services and community groups across Australia were randomized to: (i) Intervention [6-week group sessions; 2 h/week] delivered over Zoom (n = 3-7/group); or (ii) WLC and intervention offered at 16 weeks. Primary outcome was self-perceived cognitive function; secondary outcomes included: QOL, fatigue, mood, and objective cognition (attention, working memory, processing speed, memory, executive function). Between group differences post-intervention and 6 weeks later (maintenance) were analysed using linear mixed models.

Results: Sixty participants (M age = 49.0, SD = 10.4 years, 57% female, 55% high-grade) were randomized; 29 intervention, 31 WLC. The intervention group participants reported significantly improved self-reported memory ability, satisfaction, strategy use, and strategy knowledge post-intervention compared to WLC. Effect sizes were moderate to large (ηp² range .06–.21) and were maintained for memory ability (t = 4.26, p < .001, ηp² = .18), memory satisfaction (t = 2.23, p = 0.028, ηp² = .18), and memory strategy knowledge (t = 2.92, p = 0.004, ηp² = .09). There was no intervention effect on secondary outcomes.

Conclusions: Our findings indicate BRAINS-LaTCH delivered via telehealth improved memory-related outcomes in people with PBT. Benefits were maintained after the intervention was completed. Despite the lack of improvement in objectively measure cognition, this intervention should be offered to people with PBT self-reporting memory decline.

82 | Effects of structured exercise on lean body mass and muscle strength in patients with metastatic breast cancer: The multinational randomized controlled PREFERABLE-EFFECT Study

Helene Rundqvist¹, Gustav Joernaker¹, Dorothea Clauss², Mark Trevaskis³, Anouk E Hiensch⁴, Martina E Schmidt⁵, Evelyn M Monninkhof⁴, Phillip Zimmer⁶, Jon Belloso⁷, Elisa Heyrman¹, Rodrigo Fernandez Gonzalo¹, Joachim Wiskemann⁸, Jana Mueller⁸, Renske Altena¹, Bruce Mann⁹, Prudence Francis¹⁰, Gary Richardson¹¹, Yoland Antill¹¹, Michelle White¹¹, Peter Savas^{9, 10}, Elsken van der Wall⁴, Neil K Aaronson¹², Elzbieta Senkus¹³, Ander Urruticoechea⁷, Martijn M Stuiver¹², Karen Steindorf⁵, Wilhelm Bloch², Yvonne Wengstrom^{1, 14}, Anne M May⁴, Eva M Zopf^{3, 15}

¹Karolinska Institutet, Stockholm, Sweden

²German Sport University Cologne, Cologne, Germany

³Australian Catholic University, Melbourne, Victoria, Australia

⁴University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

⁵German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany

⁶Institute for Sport and Sport Science, Dortmund University, Dortmund, Germany

⁷Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain

⁸Heidelberg University Hospital and NCT Heidelberg, Heidelberg, Germany

⁹The Royal Melbourne Hospital, Melbourne, Victoria, Australia

¹⁰Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

¹¹Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia

¹²Netherlands Cancer Institute, Amsterdam, The Netherlands

¹³Medical University of Gdańsk, Gdańsk, Poland

¹⁴Karolinska University Hospital, Stockholm, Sweden

¹⁵Cabrini Health, Melbourne, Victoria, Australia

Aims: Reduced lean body mass (LBM) is common in patients with metastatic breast cancer (mBC) and has been associated with increased treatment-related toxicity and poorer treatment outcomes. Exercise can improve LBM and muscle strength, however evidence in patients with mBC is lacking. The multinational randomized controlled PREFERABLE-EFFECT study (NCT04120298) showed that exercise significantly reduces fatigue and improves quality of life in patients with mBC. Here, we report the exercise effects on LBM and muscle strength (secondary outcomes).

Methods: Patients with mBC from five European countries (Germany, Spain, Netherlands, Poland, Sweden) and Australia were eligible for inclusion. Participants were randomized to usual care (UC) or a 9-month supervised and individualized exercise program (EX) involving twice weekly aerobic, resistance, and balance exercises. LBM was assessed via dual-energy x-ray absorptiometry in a subset of patients (n = 66). Body mass index (BMI) was assessed as standard. Lower leg strength was assessed via hypothetical 1-repetition maximum test on the leg press, where deemed safe (n = 126). Changes from baseline to 3 and 6 months were compared between groups using adjusted mixed models for repeated measures.

Results: A total of 357 patients were randomized (EX = 178, UC = 179; accrual target = 350). Mean age was 55.4 ± 11.1 years, mean BMI 26.2 ± 5.2 kg/m², 74.8% were on 1^st/2^nd treatment lines, and 67.2% had bone metastases. Compared to UC, EX resulted in improved LBM at 3 months (between-group difference = .8 kg, 95%CI [.2; 1.4], p = 0.018) with no difference between groups at 6 months (.3 kg, [−.3; .9], p = 0.333). No difference between groups was observed for BMI. EX improved lower leg strength at 3 months (18.3 kg, [7.7; 28.9], p = 0.001) and 6 months (34.2 kg, [23.0; 45.4], p < 0.001), compared to UC.

Conclusions: The results of this large multinational study support the prescription of supervised aerobic and resistance exercise in patients with mBC to improve LBM and muscle strength.

83 | “Too young to have this kind of diagnosis”: A qualitative exploration of younger adults’ experiences of colorectal cancer diagnosis

Rebecca J Bergin^{1, 2, 3}, Anna Ashley⁴, Jodie Hardstaff⁴, Victoria White^{5, 4}

¹Department of General Practice and Primary Care, University of Melbourne, Melbourne, Vic, Australia

²Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

³Centre for Quality and Patient Safety Research, Institute of Health Transformation, Deakin University, Geelong, Vic, Australia

⁴School of Psychology, Deakin University, Melbourne, VIC, Australia

⁵Behavioural Science Division, Cancer Council Victoria, Melbourne, VIC, Australia

Aims: Worldwide, the incidence of colorectal cancer is rising among adults under the age of 50 (early-onset colorectal cancer). It is the leading cause of cancer mortality for those aged 25–44 in Australia. Of concern, this population are more likely to have advanced-stage disease, suggesting their diagnostic pathway may be prolonged. To better understand factors influencing this pathway, this study explored patients’ experiences of decision-making during a diagnosis of early-onset colorectal cancer.

Methods: Qualitative, semi-structured online/phone interviews were conducted with 17 people with early-onset colorectal cancer diagnosed in 2021–2022 in Victoria, Australia. Interviews were conducted an average seven months (range 1–13 months) after diagnosis and lasted 30–75 min. Ten participants had advanced (stage III/IV) disease. Analysis was approached from a critical realist perspective, with themes developed inductively using reflexive thematic analysis.

Results: Five themes were identified: Shifting Perception of Urgency, Multidimensional Perception of Role, Making the Most of Resources, Stage of Life, and COVID Adds Complexity. The decision-making process during the diagnostic interval was not static or uniform but evolved depending on the urgency perceived by younger adults and their health care team. As people perceived an urgency to act, they took on a more active role in decision-making, utilizing personal resources to access more timely care. Their decisions were shaped by stage-of-life considerations, such as employment, reproductive health, study or caring for a young family. The COVID-19 pandemic also shaped decisions, adding “…a whole other layer of complexity.”

Conclusions: Younger adults with colorectal cancer make decisions in the context of unique considerations, adapting to reduce time to diagnosis, with decisions complicated by the COVID-19 pandemic. Greater support from health care providers and health systems in the diagnostic period may improve the timeliness of colorectal cancer diagnosis and outcomes in younger adults.

84 | A 12-week exercise program improves exercise capacity in acute leukemia patients post intensive chemotherapy

Lauren LB Burnham¹, Nicholas NS Saner², Sarah SA Alexander¹, Hayley HD Dillon¹, Catherine CV Vassili³, Catriona CP Parker⁴, Shaun SF Fleming³, Andrew AW Wei^{6, 5}, Erin EH Howden¹

¹Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

²Victoria University, Melbourne, Victoria, Australia

³The Alfred, Melbourne, VIC, Australia

⁴Transfusion Research Unit, Monash University, Melbourne, VIC, Australia

⁵Royal Melbourne Hospital, Melbourne, VIC, Australia

⁶Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Introduction: Survivors of acute lymphoblastic leukemia (ALL) and myeloid leukemia (AML) are treated with intensive chemotherapy, which can leave patients physically deconditioned. Exercise improves survivorship outcomes in other patient groups but has not been tested in early survivorship for ALL and AML patients. Accordingly, we sought to test the feasibility and efficacy of an exercise program in early survivorship.

Methods: Eighteen patients (52 ± 16y, 62% male) with AML or ALL were recruited within 3 months of completion of intensive and consolidation chemotherapy to participate in a 12-week exercise intervention. The intervention consisted of individualized aerobic training: two moderate-intensity continuous [50%–70% heart rate reserve (HRR); 20–30 min] and one high interval (> 70%HRR; 4 × 2—4 min) sessions per week, and two resistance training sessions per week (6–10 upper and lower body exercises).  To evaluate efficacy, changes in peak oxygen uptake (VO2peak) and peak watts were assessed by cardiopulmonary exercise testing, functional capacity change in 6-minute walk distance (6MW), and body mass index (BMI). To assess the feasibility the %sessions completed are reported (100% of completed session = 36).

Results: Three participants did not complete follow up CPET due to disease relapse. Eleven participants completed > 75% of the prescribed exercise, and adherence ranged from 63–97%. Training increased both absolute and relative VO2peak 14.1% (1.95 ± .42 to 2.23 ± 0.48 L/min, p < 0.001) and 10.4% (23.1 ± 5.2 to 25.5 ± 5.2 mL/kg/min, p < 0.001) respectively; and peak watts by 16.5% (168 ± 36 vs. 195 ± 43 W, p < 0.001). BMI increased by 2.8% (29.5 ± 6.1 vs. 30.3 ± 6.5 kg/m², p = 0.003). In a subset of patients who completed 6MW at follow-up (n = 9) distance increased by 4.7% (559 ± 39 vs. 585 ± 43 m, p = 0.02).

Conclusions: Exercise training that is individualized is feasible to complete during early AML and ALL survivorship and leads to improved cardiorespiratory fitness and functional capacity. Further research is required to determine the impact on long-term survivorship outcomes.

85 | Adapting a web-based intervention (RESTORE) to support self-management of cancer-related fatigue in people living with a brain tumour

Rachel Campbell¹, Joanne M Shaw¹, Hannah Banks¹, Thomas Carlick¹, Mona M Faris¹, Megan S Jeon¹, Dianne M Legge², Claire Foster³, Robyn Leonard⁴, Raymond J Chan⁵, Meera R Agar⁶, Annie Miller¹, Haryana M Dhillon¹

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

²Olivia Newton-John Cancer & Wellness Centre, Austin Health, Heidelberg, Victoria, Australia

³Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, UK

⁴Brain Cancer Collective, NHMRC Clinical Trials Centre, Sydney, Australia

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

⁶Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia

Aims: Cancer-related fatigue (CRF) is a debilitating symptom commonly reported by people with a brain tumour (BT). RESTORE is an online intervention that has demonstrated preliminary efficacy in enhancing self-efficacy to self-manage CRF following primary cancer treatment. Previous evaluations of RESTORE did not include people with BT. Given the unique functional deficits experienced by people with BT, we aimed to explore the appropriateness of RESTORE to support self-management of fatigue in this population, and identify modifications required.

Methods: We conducted semi-structured interviews with people with BT, their caregivers, and healthcare professionals (HCPs) who treat them. Before the interview, participants viewed a video summarizing the intervention components and accessed the intervention. Interviews explored the appropriateness of RESTORE for this population, and modifications to improve its relevance and suitability. Interviews were transcribed, coded and analysed thematically using interpretive description to devise recommendations.

Results: We interviewed 40 participants (24 people with BT, 5 caregivers, 11 HCPs). We identified four themes: (1) feedback on content; (2) feedback on format; (3) feedback on use; and (4) barriers to engagement. These themes were linked by an overarching need for flexible and responsive tailoring to the unique needs of people with BT. We derived 32 recommended modifications from feedback to optimize RESTORE for this population.

Conclusion: Our results suggest a BT-specific version of RESTORE is desirable and would be acceptable to address fatigue self-management in this population. However, to be effective for people with BT, adaptations such as greater flexibility and tailoring of content and format are required. Based on these recommendations, we are developing a BT-specific version of RESTORE; the prototype will be presented at the conference. Barriers to engagement including digital access and literacy, caregiver burden, and awareness of the resource, will need to be addressed in the implementation of this BT-specific version of RESTORE.

86 | What information and support do people diagnosed with sarcoma require about exercise and nutrition?

Georgia Halkett¹, Connor Farnell¹, Jenny Davies¹, Mandy Basson², Tania Rice-Brading Rice-Brading³, Mariana Sousa⁴, Janene Sproul⁵, Helen DeJong^{7, 6}, Chloe Maxwell-Smith⁸, William Lorimer¹, Haryana M Dhillon⁹, Joanna Fardell^{10, 11}, Joanne Shaw⁹, Moira O'Connor⁸

¹Curtin School of Nursing/ Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia

²Sock it to Sarcoma!, Perth, WA, Australia

³Cooper Rice-Brading Foundation, Sydney, NSW, Australia

⁴Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

⁵School of Education, Murdoch University, Perth, WA, Australia

⁶Occupational Therapy, South Metropolitan Health Service, Fiona Stanley Fremantle Hospital Group, Perth, WA, Australia

⁷Curtin School of Allied Health, Curtin University, Perth, WA, Australia

⁸Curtin School of Population Health/Curtin Health Innovation Research Institute/Curtin enAble Institute, Curtin University, Perth, WA, Australia

⁹Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia

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

¹¹Western Sydney Youth Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia

Background: Exercise and nutrition can promote recovery, reduce treatment side effects, and improve quality of life for people diagnosed with cancer. Many people diagnosed with sarcoma have surgery on their extremities, require limb salvage, and/or receive extensive treatment over a long period of time, impacting their ability to exercise and reducing well-being. However, there is a lack of research exploring what exercise and nutrition support is provided to people diagnosed with sarcoma.

Aim: We aimed to gain an understanding of the exercise and nutrition support provided to people with sarcoma from the perspectives of people with sarcoma, their carers, and health professionals.

Method: Using an inductive qualitative methodology, semi-structured interviews were conducted with three participant groups (people diagnosed with sarcoma, carers, health professionals) across Australia. Interviews were conducted online, audio-recorded, transcribed, and thematic analysis was used to analyse the data. Thematic saturation was used to determine when to cease data collection and was achieved in each participant group independently.

Results: We interviewed 60 participants (people diagnosed with sarcoma n = 20, carers n = 11, and health professionals n = 23). Six themes were identified. Four themes related to exercise: overlooked need; getting back to normal; exercise promotes well-being; and uncertainty about which exercises are safe and best for recovery. Two themes were specific to the role of nutrition in promoting physical functioning and recovery: managing nutrition during treatment and loss of appetite. People with sarcoma and carers emphasized the need for more information and support around exercise and nutrition.

Conclusion: Themes emphasized the gap in high-quality, consistent information about exercise and nutrition play in the sarcoma context. Uncertainty about exercise and nutrition were barriers to engaging with this support until late into treatment or recovery. Exercise and nutrition resources and models of care are needed to support people with sarcoma throughout treatment and into recovery.

87 | Are our exercise oncology guidelines fit-for-purpose for women with recurrent ovarian cancer? Results from a mixed methods exercise trial (the ECHO-R trial)

Sandi Hayes¹, Monika Janda², Elizabeth Eakin³, Catherine Shannon⁴, Jeffrey Goh⁴, Vanessa Beesley⁵, Dimitrios Vagenas⁶, Penny Webb⁵, Jermaine Coward⁷, Louisa Collins⁵, Helene O'Neill⁴, Sheree Rye¹, Melissa Newton¹, Gabrielle Gildea⁸, Melanie Plinsinga⁸, Carolina Sandler⁹, Tamara Jones¹⁰, Sara Baniahmadi⁴, Marcelo Nascimento¹¹, James Nicklin¹², Andrea Garret⁴, Andreas Obermair⁴, Rosa Spence¹

¹Cancer Council Queensland, Brisbane, QLD

²Centre for Health Services Research, University of Queensland, Brisbane, QLD

³Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD

⁴Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, QLD

⁵Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD

⁶School of Public Health and Social Work, Queensland University of Technology Faculty of Health, Kelvin Grove, QLD

⁷Faculty of Medicine and ICON Cancer Care Centre, The University of Queensland, Brisbane, QLD

⁸School and Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD

⁹Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, NSW

¹⁰Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Vic

¹¹Gold Coast University Hospital, Southport, QLD

¹²Gynaecological Cancer, Royal Brisbane and Women's Hospital, Herston, QLD

Background and aims: People with rare cancers, lower survival prospects, and higher morbidity have been under-represented in exercise oncology trials. The ECHO-R trial evaluates the safety, feasibility, and potential efficacy of a pragmatic, telehealth-delivered exercise program in the understudied population of recurrent ovarian cancer patients.

Methods: Fifty women receiving chemotherapy for recurrent ovarian cancer were recruited to this pre-post, mixed-method exercise trial. The 6-month intervention was delivered by Exercise Professionals via 12 telephone sessions and up to five in-person sessions. The weekly exercise intervention target was consistent with exercise oncology guidelines—150 min of moderate-intensity, multimodal exercise—with prescribed volume and mode individualized. Primary outcomes were feasibility (minutes of exercise completed) and harms profile (exercise-related adverse outcomes) of the intervention. Secondary outcomes, assessed at baseline and post-intervention, included quality of life (FACT-O), fatigue (FACT-Fatigue), anxiety and depression (HADS), and neurotoxicity (FACT-GOG-NTX). Thirteeen women participated in post-intervention qualitative interviews to provide a deeper understanding of factors influencing exercise participation.

Results: The average minutes of weekly exercise completed did not meet the target (median 142 min/week, min: 0; max 533). 38% of the sample reported ≥1 harm (range 0–7 harms/person; no serious harms reported), with 71% of harms impacting exercise participation (11% moderate-major impact). There was no meaningful change in health outcomes observed between pre- and post-intervention. The importance of social support and the physical environment, the “hurdles” of side effects, the power of advice from health professionals, a “yearning” for the outdoors, and a tendency to “resort” to walking emerged as qualitative themes influencing physical activity participation.

Conclusion: Findings support that those delivering exercise therapy to people with recurrent ovarian cancer should focus on each person's “why” and that factors influencing exercise participation may be more psychosocial than physical.

88 | ‘What is this brain's story?’: Healthcare professionals' management of brain tumour related personality and behaviour changes

Emma McDougall¹, Anna Nowak², Haryana Dhillon³, Lauren Breen^{4, 5}, Karin Piil⁶, Georgia KB Halkett¹

¹Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia

²Medical School, University of Western Australia, Perth, WA, Australia

³Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia

⁴Curtin enAble Institute, Curtin University, Perth, WA, Australia

⁵Curtin School of Population Health, Curtin University, Perth, WA, Australia

⁶Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark

Background: Management of brain tumour related personality and behaviour changes (BTrPBc) is complex. Contributing factors include tumour location, treatment side effects, and psychological adjustment to the diagnosis. While clinicians’ roles should include providing support and management for personality and behaviour changes, scant research has focused on management of BTrPBc.

Aim: We aimed to explore how neuro-oncology healthcare professionals manage personality and behavior changes in adults with a primary brain tumor.

Method: An interpretive description approach was taken, with semi-structured interviews conducted with healthcare professionals practicing in neuro-oncology across Australia. Interview recordings were transcribed and analysed using thematic analysis.

Results: Twenty-two interdisciplinary healthcare professionals practicing in neuro-oncology participated in interviews with a median duration of 34 min (range 17–57 min). Four key themes were developed. The first, “Building trusting relationships,” included sub-themes “Involving and supporting carers,” and “Respecting patients' autonomy and confidentiality.” The second theme, “What is this brain's story?”, incorporated the sub-theme “Sharing care.” The third theme, “Brief Intervention,” encompassed the sub-themes “Information provision” and “That's the tumour talking.” Lastly, “Targeted Intervention” includes the sub-themes “Modifying environments and managing cognitive resources,” “Acceptance of personality changes,” and “Enriching the relationship.”

Healthcare professionals recognized the need to build trusting relationships with patients and carers to be able to discuss sensitive or difficult experiences including personality changes. Healthcare professionals emphasized involving carers in patient care and ensuring carers have their own support. Finally, participants highlighted the importance of providing information about causes and contributing factors to BTrPBc and possible impacts on functioning.

Conclusion: Our results provide insight into the diverse support healthcare professionals provide for the management of BTrPBc. Our data point to the potential for a stepped care approach to managing BTrPBc, however further testing in clinical practice is required.

89 | What constitutes optimal care coordination for primary brain tumours and how do we assess it in Australia: a Delphi consensus study

Megan S Jeon¹, Sharon He¹, Joanne Shaw¹, Eng-Siew Koh^{2, 3}, Brian Kelly⁴, Mark B Pinkham^{5, 6}, Dianne M Legge^{7, 8}, Georgia Halkett⁸, Raymond J Chan⁹, Tamara Ownsworth¹⁰, Ursula Sansom-Daly^{11, 12, 13}, Marina Kastelan¹⁴, Haryana Dhillon¹

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

²Liverpool Cancer Centre, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia

³South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia

⁴School of Medicine and Public Health, University of Newcastle (UON), Callaghan, NSW, Australia

⁵Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia

⁶University of Queensland, St Lucia, QLD, Australia

⁷Oliva Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia

⁸Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia

⁹Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford, SA, Australia

¹⁰The Hopkins Centre, School of Applied Psychology, Griffith University, QLD, Australia

¹¹Behavioural Sciences Unit, School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine & Health, University of New South Wales, Kensington, NSW, Australia

¹²Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

¹³Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia

¹⁴The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia

Aim: People with primary brain tumours (PwBT) and their caregivers experience diverse issues across physical, cognitive, behavioural, and psychosocial domains. These impacts can create barriers to seeking care and support. While care coordination (CC) is a critical process to achieve high-quality care for PwBT, a framework of optimal CC to guide clinical practice is lacking. We aimed to develop a consensus framework and assessable indicators for the delivery of optimal CC for PwBT.

Methods: A two-phase, modified Delphi process was conducted from June 2023 to April 2024. In Phase 1, a preliminary framework of 4 domains and 140 items was identified from a scoping review and expert stakeholder advisory group (n = 14) discussion. In Phase 2, multidisciplinary panel members (n = 40) with expertise in clinical management and support for PwBT indicated the level of agreement (defined as ≥80% agreement and a median score of ≥4) on proposed items using a 5-point Likert scale against consensus criteria in a two-round iterative Delphi survey. The expert stakeholder advisory group met to finalize components and indicators based on panel consensus findings.

Results: Consensus was achieved for 97 of 140 items across four domains of CC (definition, objective, components, and indicators). A further 33 items approached consensus following the two survey rounds. Panel opinions about what indicates quality CC varied, especially for items related to performance indicators of governance/system (ranging between 48% and 79% agreement). The expert stakeholder panel finalized the inclusion of an additional six items based on qualitative feedback from panelists, producing a final list of 136 items.

Conclusions: We defined a novel framework of CC specific to PwBT. This presents consensus definition and objectives for optimal CC and a comprehensive list of components and indicators of quality CC. This provides a useful template for developing models of CC in the Australian clinical context.

90 | A Systematic Review of Peer Support Interventions for Enhancing Psychosocial Functioning in Cancer Survivors: Applicability to Rural Rare Cancer Survivors

Laura Hemming¹, Saskia FA Duijts², Nienke Zomerdijk³, Christine Cockburn⁴, Eva Yuen5, Ruth Hardman⁶, Julia Van Vuuren¹, Tamsin Farrugia¹, Carlene Wilson³, Evelien Spelten¹

¹La Trobe University, Reservoir, VIC, Australia

²Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, Netherlands

³University of Melbourne, Melbourne

⁴Rare Cancers Australia, Bowral

⁵Deakin University, Melbourne

⁶Sunraysia Community Health Services, Mildura

Aims: We aimed to systematically review research on the impact of peer support interventions designed to enhance psychosocial functioning among cancer survivors. We also sought to identify key components necessary for developing a support intervention specifically tailored for patients with rare cancers living in rural, regional, or remote areas.

Methods: A comprehensive search was conducted across EMBASE, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library to identify papers examining peer support interventions. Inclusion criteria targeted studies involving (i) rare cancer patients or (ii) patients residing in rural, regional, or remote locations, or (iii) interventions delivered online or via telehealth. After screening, data were extracted regarding study characteristics, intervention components, and their impact on psychosocial functioning. A quality assessment of included studies was performed, and findings were synthesized narratively.

Results: Twenty-three unique studies were included in the review, predominantly focusing on peer support for middle-aged women with breast cancer. The interventions identified were primarily online or telephone-based and targeted various psychosocial outcomes including depression, anxiety, distress, quality of life and coping. Significant improvements were observed in coping abilities and reductions in loneliness. The most effective interventions utilized online, group formats facilitated by healthcare professionals. However, there was a notable lack of data specifically addressing rare cancers and the unique challenges faced by rural populations.

Conclusions: There is a scarcity of research on peer support interventions for individuals diagnosed with rare cancers living in rural, regional, or remote areas. Although the evidence demonstrates a mixed impact on different measures of psychosocial functioning, promising elements of peer support might be adapted for rare cancer patients in these settings. The limited findings underscore the need for further research to develop targeted interventions. For oncologists, findings highlight the importance of considering peer support as a viable component of comprehensive care, particularly for patients in underserved areas.

91 | Balancing communication challenges in neuro-oncology: A cross-sectional interview study with neuro-oncology healthcare professionals

Dianne M Legge^{1, 2}, Megan Jeon³, Hannah Banks³, Joanne Shaw³, Sharon He³, Thomas Carlick³, Lauren J Breen⁴, Rebekah Laidsaar-Powell³, Georgia K B Halkett², Haryana Dhillon³

¹ONJ Cancer Centre, Austin Health, Heidelberg, Victoria, Australia

²Curtin School of Nursing/Curtin Health Innovation Research Institute(CHIRI), Curtin University, Perth, WA, Australia

³The Psycho-oncology Co-operative Group (PoCoG), School pf Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

⁴School of Psychology, Faculty of Allied Health, Curtin University, Perth, WA, Australia

Background: Primary brain tumors are rare and associated with significant symptom burden and high supportive care needs. Timely and comprehensive patient navigation is vital, ensuring both people with brain tumors (PwBT) and their caregivers have the resources needed to negotiate the multidisciplinary team, treatment and survivorship care. We explored HCPs experiences and perceptions of the challenges in communicating with PwBT and their families.

Methods: This study formed part of a qualitative exploratory study investigating the roles, training, and support needs of HCPs involved in neuro-oncology care coordination (NOCC) for PwBT and their families. Semi-structured interviews were conducted with HCPs via videoconferencing and were audio-recorded and transcribed. Themes were developed in the data using interpretive description with three coders using Nvivo(v14) software. Questions focused on communication experiences and challenges in the NOCC role.

Results: Interviews were conducted with 12 HCP during 2023, lasting a median of 58 (range: 43–82) min. The participants from Australia/New Zealand had a median of 13 years of neuro-oncology clinical experience across medical, nursing, and allied health. A theme of ‘communication is key’ was identified and supported by three themes describing elements of communication in neuro-oncology: (1) In safe hands; describing care navigation for patients and families, providing a safety net during diagnosis and early treatment; (2) Delicate balance; managing elements of communication during each interaction.  Balancing hope with reality, family with patient needs, process with time. (3) Creative communication; describing creative and adaptable communication styles in neuro-oncology.

Conclusion: Our results highlight the unique challenges and complex nature of communicating with PwBT and their families. There is no doubt of the centrality of communication when navigating care with PwBT. The findings will support development of training and support for health professionals already working within neuro-oncology and assist in defining core skills and future training needs.

92 | Routine collection of patient-reported outcomes (PROs) in people treated curatively for head and neck cancers (HNC)

Chindhu Shunmuga Sundaram¹, Haryana Dhillon¹, Michael Veness^{2, 3}, Eunji Hwang³, Isidoro Ruisi³, Puma Sundaresan^{2, 3}

¹Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia

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

³Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia

Aims: Head and neck cancers (HNC) significantly impact patients' lives, affecting vital functions and appearance. This study aimed to evaluate changes in health-related quality of life (HRQL) information from patients treated curatively for HNC with definitive or adjuvant radiation therapy (RT), using patient-reported outcome measures (PROMs) as part of standard clinical practice.

Methods: The study included adult patients, diagnosed with HNC, and treated with either curative definitive or adjuvant RT, attending follow-ups at The Crown Princess Mary Cancer Centre Westmead or Blacktown Cancer and Haematology Centre from December 2020 to April 2023. HRQL was assessed using EORTC QLQ-C30 and QLQ-HN35 at multiple timepoints: T1 (0–6 months), T2 (6–12 months), T3 (1–2 years), T4 (2–3 years), T5 (3–5 years), and T6 (> 5 years). Changes over time were analysed for 15 participants who completed PROMs at least four times post-treatment. Socio-demographic and clinical data were collected from electronic medical records.

Results: The sample (n = 152, mean age = 63.7 years, 75% male, 27% diagnosed with Oropharyngeal cancer & 89% definitive RT) showed overall improvement in HRQL over time. General HRQL domains, including physical, role, emotional, cognitive, and social functioning, as well as global quality of life, improved by T6 as expected. HNC-specific issues such as pain, swallowing, speech, senses, social eating, social contact, sexuality, mouth opening, dry mouth, sticky saliva, and coughing also showed improvements at T6. The 15 participants with longitudinal data at all time points demonstrated HRQL improvements and reduced HNC-related symptoms over time. Routine PROM collection in this cohort is feasible and ongoing as part of standard clinical practice, and further analyses will be conducted as more data become available.

Conclusions: Most HNC-specific HRQL issues and symptoms improved post-treatment. These preliminary findings offer real-world benchmarks and help define post-treatment symptom trajectories. Routine PROMs collection in clinics is feasible and supports ongoing evaluation.

93 | Understanding the financial burden of head and neck cancer as experienced by patients and their caregivers: a qualitative study

Ashleigh R Sharman^{2, 1}, Justin Smith³, Puma Sundaresan^{4, 5}, Haryana M Dhillon⁶, Poorva Pradhan¹, Richard De Abreu Lourenco⁷, Jonathan R Clark^{1, 8, 9}, Carsten Palme^{1, 8}, Rebecca L Venchiarutti^{2, 1}

¹Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia

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

³Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia

⁴Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia

⁵Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia

⁶Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia

⁷Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia

⁸Central Clinical School, The University of Sydney, Camperdown, NSW, Australia

⁹Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW, Australia

Aims: Head and neck cancer (HNC) affects vital functions (speech, swallowing, breathing), increasing long-term health care needs, health service utilization, and inability to work. Consequently, people living with and beyond HNC may experience financial toxicity associated with treatment and survivorship needs. We sought to understand the financial burden of HNC as experienced by patients and their caregivers.

Methods: Participants were recruited through HNC clinics and social media advertisements. Participants were purposively sampled to ensure representation by tumour site, gender, age, and treatment location. Semi-structured interviews were conducted via phone and videoconferencing. Recruitment continued until thematic saturation was achieved across each group. To ensure inclusiveness of participants with verbal communication difficulties, a version of the interview guide was provided as a written questionnaire (n = 2). Interviews and completed questionnaires were analysed thematically using NVivo.

Results: Thirty-one participants (22 patients, 9 caregivers) completed interviews (median age 59). The majority were female (61%) and most common tumor site the oral cavity. Financial burden was most frequently reported during the post-operative period due to the nature and length of recovery from HNC, including specialist and allied health appointments, diet modifications, medication, and time off work. Several participants cited ongoing costs associated with dental care, though other aspects of care were prioritized over dental care. Some participants highlighted the importance of social workers and nurses providing information about financial support services. However, for many, this was never offered nor discussed by their treating team. All participants encountered out-of-pocket costs related to travel and parking, these costs varied according to distance from the treating center.

Conclusions: We identified novel aspects of the financial burden of HNC on patients and their caregivers in Australia. Our findings will inform research and policy changes to provide support for survivors of HNC, especially groups at the highest risk of financial toxicity.

94 | Palliative Invasive Interventions for Cancer Pain

Antony Kodsi¹

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

Background: Large-scale studies suggest the overall up to 35% of cancer survivors experience pain, with up to 30% experiencing moderate to severe pain restricting major activity (1). Treatment strategies advocate for multimodal and multidisciplinary management, with a growing interest in opioid-sparing strategies. The introduction of the 4th step to the World Health Organization analgesic ladder (2) that includes invasive and minimally invasive techniques, providing a bidirectional relationship between escalation and de-escalation. There has been also increasing visibility (3) of the extent and need for better supportive therapies for cancer pain with the new ICD-11 cancer pain taxonomy (4) with reporting from January 2022, that may lead to more funding for cancer-pain interventional treatment.

Teaching points: Cancer pain interventions are one of many approaches to managing pain associated with cancer and its treatment. These interventions include treatment-directed approaches as well as pain-modifying treatments. Several types of minimally invasive to invasive interventions are used to manage cancer pain (5), including 1) neurolytic blocks, 2) neuraxial analgesia, 3) vertebral procedures, 4) neurosurgical techniques (such as cordotomy/myelotomy), 5) neuromodulation (peripheral nerve or Spinal cord stimulation). The most recognised and thoroughly studied approach is the celiac plexus neurolysis for epigastric or back pain arising from exocrine pancreatic cancer (6). A Pain specialist or interventional radiologist commonly approach this via image intensification. Phenol is usually preferred over alcohol as it is painless to inject for the purposes of neurolysis. It can also be done endoscopically to target the celiac ganglion. There is level 1 evidence for decreasing opioid dose, pain and constipation at 4 weeks and also before death (7). Neuraxial analgesia has level 2 evidence of treatment effectiveness, and while has a high initial cost, in well selected patients it lowers systemic side effects and can offer superior improvement in analgesia over systemic conventional medication management (8)(9). Vertebral procedures have limited studies evaluating use in cancer pain, with a 2015 systematic review (5) finding only five studies meeting inclusion criteria, and kyphoplasty alone receiving a recommendation in favour in the setting of vertebral bone pain/compression fracture without neurological sequalae, particularly if patient has limited life expectancy where complex surgery or radiofrequency are not effective (10). Percutaneous cordotomy exploits the decussation of the spinothalamic tract and is used predominantly for unilateral pain originating below C4 dermatome level, by disrupting the tract between C1 and C2 vertebrae either via open approach or percutaneous radiofrequency. There is level 4 evidence, and often used in malignant mesothelioma (11). Neuromodulation remains limited but promising, with many barriers including cost, invasiveness, and lack of high-quality evidence (12).

Summary: Interventions for cancer pain face many barriers, including clinician knowledge and available technology. Even in resource-rich settings, treatment barriers persist, and the evidence base continues to evolve.

References

1. Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States. Jiang, Changchuan, et al. 8, 2019, JAMA Oncology, Vol. 5, pp. 1224-1226.

2. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Miguel, R. 2, March 2023, Cancer control: journal of the Moffitt Cancer Center, Vol. 7.

3. Should cancer pain still be considered a separate category alongside acute pain and chronic non-cancer pain? Reflections on ICD-11. Backryd, Emmanuel. May 2024, Frontiers in Pain Research, Vol. 5.

4. The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Bennett, M I, et al. 1, 2019, Journal of Pain, Vol. 160, pp. 38-44.

5. Interventional Techniques for the Management of Cancer-Related Pain: Clinical and Critical Aspects. Kurita, G P, et al. 4, 2019, Cancers (Basel), Vol. 11, p. 443.

6. Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. Porta, M, Fabregat, X and Malats, N. 2005, Clinical Translation Oncology, p. 7:189.

7. Celiac plexus block for pancreatic cancer pain in adults. Arcidiacono, Paolo Giorgio, et al. 2011, Cochrane Database Systemic Review, Vol. 3, p. CD007519.

8. Pain Management, Including Intrathecal Pumps. Smith, thomas, Swainey, Craig and Coyne, Patrick. 6, 2004, Current Oncology Reports, pp. 291-296.

9. Intrathecal Drug Delivery Systems for Cancer Pain: An Analysis of a Prospective, Multicenter Product Surveillance Registry. Stearns, Lisa, et al. 2, 2020, Anesthesia & Analgesia, Vol. 130, pp. 289-297.

10. Interventional pain management in cancer patientsa scopin

95 | Neoadjuvant chemotherapy versus upfront surgery in early pancreatic cancer- are we any wiser in 2024?

Sarah Maloney^{1, 2}, Nick Pavlakis^{1, 2}, Stephen Clarke^{1, 2}, Jaswinder Samra^{1, 2}, Anubhav Mittal^{1, 2}, Sumit Sahni¹

¹Kolling Institute, University of Sydney, Royal North Shore, St Leonards, NSW, Australia

²Royal North Shore Hospital, St Leonards, NSW, Australia

For the few patients who have early (upfront or borderline resectable) disease at the time of diagnosis, treatment traditionally involved surgery followed by adjuvant chemotherapy; however, up to 30% of patients did not receive chemotherapy due to the morbidity associated with surgery. Low rates of adjuvant chemotherapy administration in combination with the success of neoadjuvant chemotherapy in the locally advanced setting led to an increased interest in neoadjuvant chemotherapy in patients with early (upfront or borderline resectable) disease. Whether this approach is superior to the traditional upfront surgery in patients with early disease is contentious. Over the last 10 years, many groups have attempted to answer this question through randomized controlled trials with conflicting results.

96 | Radiotherapy innovations in pancreatic cancer

George Hruby¹

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

SPAN-C was a single centre, single-arm, phase II clinical trial performed by the Pancreatic Group at RNSH which enrolled 30 patients with locally advanced, borderline resectable and/or metastatic pancreatic cancer. Following induction chemotherapy patients were treated with 35 to 45 Gy in 5 fractions of external beam radiotherapy. Fiducial marker (FM) placement was mandated. Primary endpoint was freedom from local failure at 12 months and secondary endpoints included survival, acute and late toxicity, surgical outcomes and palliation.

Results: Median FU was 35.2 months (QR 30.8-39.5). Twenty-six patients completed per protocol treatment (4 FM placement failures). Nine patients (34.6%) became resectable, 4 of whom had R0 resection and 2 had complete pathologic response. Survival data is pending. The maximum toxicity recorded was grade 3, with 3/26 patients (11.5%) reporting acute grade 3 toxicity. No patients reported late high grade toxicity. Nine patients (34.6%) had local recurrences, 6 required instrumentation and none had uncontrolled pain at death.

Conclusions: SBRT was safe and feasible with high rates of local control at 12 months and low rates of toxicity. A significant proportion of patients were converted to resectable status. Local palliation was excellent.

97 | “Signing up for the PRoCESS [Pancreatic cancer Relatives Counselling and Education Support Service] Trial was the most important thing I did as a carer”

Vanessa L Beesley^{1, 3, 2}, Natalie Roset¹, Jane Turner⁴, Patsy Yates³, David Wyld^{5, 3, 4}, Melissa Eastgate^{5, 4}, Raymond Chan⁶, Louisa Collins⁷, Michelle Stewart⁸, Hanna Beebe¹, Maryrose Malt¹, Caroline Kelly⁹, Rachel Neale^{10, 4}

¹Psychedelic Medicine and Supportive Care Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia

²School of Psychology, The University of Queensland, Brisbane, Queensland, Australia

³School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia

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

⁵Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia

⁶Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia

⁷Health Economics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia

⁸PanKind, The Australian Pancreatic Cancer Foundation, Sydney, New South Wales, Australia

⁹Consumer Representative, Sydney, New South Wales, Australia

¹⁰Cancer Aetiology & Prevention Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

Background: Pancreatic cancer is rare and lethal, leaving patients and their families little time to adjust to the diagnosis. Family carers are thrust into roles requiring them to manage complex physical symptoms, while also providing emotional, financial, and spiritual support, often with minimal guidance. This study aimed to evaluate the effects of a nurse-led counselling support service on carer and patient-reported outcomes, survival, and use of medical services. Data collection will be completed October 2024. Preliminary results are presented.

Methods: PRoCESS is a hybrid effectiveness-implementation trial. Carers of patients with pancreatic cancer were randomized 1:1 to: (i) structured telephone counselling intervention plus a comprehensive information package; or (ii) the information package alone. The intervention, grounded in a self-efficacy paradigm, involved assessing stressors and delivering psychoeducation. Participants in the intervention were offered 10 one-hour video conferencing or telephone sessions over four months, with optional monthly sessions thereafter. Participating carers and patients completed questionnaires and consented to data linkage.

Results: A total of 181 Australian carers were randomized to: (1) intervention group (n = 53 carers without participating patients; n = 35 carer-patient dyads; n = 3 carer-carer dyads; and n = 1 carer-carer-patient triad); and (2) control group (n = 47 carers participating alone; n = 36 carer-patient dyads; and n = 1 carer-carer-patient triad). The majority of carer participants were female, caring for patients with non-resectable disease, and nearly half resided outside capital cities. All except six intervention participants completed or are on track to complete at least six counselling sessions, meeting the fidelity threshold. To date, 734 core and 484 optional counselling sessions have been delivered. The most significant stressors initially expressed by intervention participants centred around: (1) coping with uncertainty; (2) carers’ own health; (3) patient concerns; and (4) family concerns. At the end of the intervention, participants reported valuing the continuous support over time and the opportunity to share their concerns and experiences with an impartial listener who has the expertise to provide practical and emotional support.

Conclusions and Significance: Preliminary findings suggest that the telehealth nurse-led counselling intervention is a valuable resource for carers, is accessible to all, and has the potential to improve patient outcomes and reduce healthcare costs.

98 | Exploring the costs of healthcare utilization for pancreatic cancer diagnoses in Queensland, Australia

Shafkat Jahan¹, Daniel Lindsay², Abbey Diaz³, Rachel Neale², Joan Cunningham⁴, Gail Garvey¹

¹The University of Queensland, Herston, QLD, Australia

²QIMR Berghofer Medical Research Institute, Brisbane

³Australian National University, Canberra

⁴Menzies School of Health Research, Charles Darwin University, Darwin

Aims: With increasing cancer survival rates due to advances in screening and treatment, the costs associated with cancer diagnoses are gaining attention. Limited studies have explored the healthcare costs related to pancreatic cancer. This study aims to describe the costs to the healthcare systems for hospital admissions and emergency department (ED) presentations due to pancreatic cancer patients within the first three years after diagnosis.

Methods: We utilized a linked administrative dataset, CancerCostMod, which includes all cancer diagnoses in Queensland from 1 July 2011 to 30 June 2015 as recorded in the Queensland Cancer Registry. Each record was linked to Queensland Health Admitted Patient Data Collection and Emergency Department Information Systems records from 1 July 2011 to 30 June 2018, allowing for at least 3 years of follow-up. The study cohort comprised patients aged 18+ diagnosed with primary pancreatic cancer (ICD-O-C25) (n = 2086). Costs were assessed over 36 months post-diagnosis and analyzed by sociodemographic characteristics and treatment modalities.

Results: Over 3 years post-diagnosis, hospital admissions for pancreatic cancer totaled an estimated AUD 99.6 million (26,285 admissions), while ED presentations cost AUD 3.5 million (4228 presentations). Most events occurred within the first 12 months, significantly impacting total and average admissions and costs per patient. People with the shortest survival times (0–6 months) accounted for 49.8% of patients and 38.3% of total hospital admission costs in the first year. Cost variations were observed across demographic categories, with higher costs among younger age groups, First Nations Australians, individuals in regional and socio-economically disadvantaged areas, as well as those underwent surgery and received palliative care.

Conclusion: Our findings underscore the substantial economic burden of pancreatic cancer on healthcare systems, particularly within the first-year post-diagnosis. Targeted strategies are needed to optimize healthcare delivery and resource allocation, ensuring equitable access and improved pancreatic cancer outcomes.

99 | Improving Equity in Access to Cancer Treatment

Danielle Rodin¹

¹Princess Margaret Cancer Centre, Toronto, ONTARIO, Canada

Disparities in access to cancer treatment continue to be a critical public health and health equity issue. Patients from racial, ethnic, and linguistic minority groups as well as other marginalized populations such as older adults and those living in rural communities continue to face disproportionate barriers to receiving timely, high-quality, and patient-centered care. These disparities are driven by the interdependency of factors operating at the level of the patient, provider, community, and regional, national, and international policies and priorities. A multilevel framework is therefore critical to identifying potentially modifiable barriers to care as well as levers for coordinated intervention. This session will discuss key actionable opportunities for the oncology community to improve equity in access, patient experience, satisfaction with care, and ultimately, patient outcomes. Interventions that focus on mitigating implicit bias amongst care providers, improving workforce representation, leveraging novel care delivery models, and supporting evidence-based advocacy will be discussed.

100 | Evaluating cancer outcomes–How do we measure equity

Euan Walpole^{1, 2, 3}, Danica Cossio², Victoria Donoghue², Nathan Dunn², Shoni Philpot²

¹University of Queensland, Brisbane, QLD, Australia

²Cancer Alliance Queensland, Queensland Health, Brisbane, QLD, Australia

³Princess Alexandra Hospital, Woolloongabba, QLD, Australia

Variations in cancer outcomes unfortunately exist despite excellent outcomes measures in Australia and Queensland specifically. We have now published measures of cancer outcomes via a Quality Index over domains of care for all cancers and large volume cancers separately.

Analysis of factors affecting breast cancer outcomes show that access to treatment is an independent variable and is driven by dependence on public sector care.

We will discuss the data options available on a population level and viability to monitor equity. Any option requires ease of measurement during clinical care to enable/monitor rather than traditional measures focused on death. We will present data reflecting the effect of delay in public/private sector, health service, and jurisdictional comparisons. Recently through our indigenous advisory committee, we have been able to examine the effects of delay in our indigenous population.

Using the population process of data linkages allows us to focus on real-time measures via multidisciplinary cancer teams software solutions. This identifies cancer populations specific to hospital/services before the usual delay seen in population statistics. A dashboard approach identifies performance against disease-specific indicators. Results are also presented as funnel plots for service comparisons though individual services are not named unless they agree.

We suggest that routine monitoring and development of accepted KPIs will allow us to measure the impact of service enhancements and focus on specific populations with the equity lens. This approach will be vital in delivering gains needed for the Australian Cancer Plan and Queensland Cancer Strategy.

101 | Radiotherapy and Equity

Mei Ling Yap^{1, 2, 3}

¹Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), UNSW Sydney, Liverpool, NSW, Australia

²The George institute for Global Health, UNSW Sydney, Barangaroo, NSW, Australia

³Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, NSW, Australia

Radiation therapy is an evidence-based, cost-effective component of comprehensive cancer care. It has been estimated that one in two people diagnosed with cancer should receive radiation therapy as part of their management. However, even in high-income countries with universal health care, there is a clear access gap, with many jurisdictions demonstrating ∼ 1 in 3 people diagnosed with cancer actually receive radiation therapy. In low- and middle-income countries, there is a huge deficit in the availability of radiation therapy, and this continues to grow. Affordability of radiation therapy is an increasing issue.

This talk will outline equity issues resulting in this access gap, including the existing barriers for populations who experience marginalization.  It will also outline how patient referral pathways contribute to the access gap. Current and future solutions, including advocacy, education, policy changes, and culturally specific initiatives will be discussed.

102 | Implementation of measures to improve First Nations cancer outcomes

Claire Howlett¹, Jacinta Elston¹, Caroline Nehill¹, David Meredyth¹, Dorothy Keefe¹

¹Cancer Australia, Surry Hills, NSW, Australia

Cancer is now the leading cause of mortality for Aboriginal-and-Torres-Strait-Islander-peoples.  In 2023 Cancer Australia led development of the Australian Cancer Plan (the Plan) providing a 10-year reform agenda for the Australian cancer community. The Plan prioritizes supporting Aboriginal-and-Torres-Strait-Islander-knowledge, strength and sovereignty in a health system that achieves equity for First Nations people affected by cancer.

The Plan has a specific strategic objective to achieve equity in cancer outcomes for First Nations people, with 15 of the Plan's 46 actions developed by, and specific to First Nations people. The Plan acknowledges that First Nations health belongs in First Nations hands and gives priority to closing the gap in cancer outcomes by addressing institutional racism and discrimination across cancer services.

The Plan emphasizes the need to co-design services, deliver place-based care, build the First Nations cancer workforce, and partner with First Nations-people to deliver culturally safe and appropriate care across the cancer continuum.

Cancer Australia is progressing several initiatives to improve cancer outcomes for First Nations Australians. These are being implemented in partnership with key First Nations organizations, health professionals, researchers, and consumers and include:

A grant program to support innovative approaches to enhance culturally safe cancer care for First Nations people through partnerships between cancer services and Aboriginal community-controlled organizations.

Postgraduate scholarships to grow the cohort of First Nations people who lead and contribute to cancer control research, planning, and service delivery.

Building the First Nations cancer care workforce through promotion of a career in cancer and partnering with colleges to better support trainees.

A research grants program to build capability and improve cancer outcomes for First Nations people.

A toolkit providing guidance to support health policy, program, and service development with and for First Nations peoples, for use by all stakeholders progressing the actions of the Plan.

103 | Supporting people living with and beyond cancer

Michael Jefford^{2, 3, 1}

¹Department of Health Services Research, Peter MacCallum Cancer Cantre, Melbourne, VIC, Australia

²Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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

There are roughly 1.4 million Australians with a personal history of cancer, that is, “cancer survivors.” Most are long-term survivors, who might have completed treatment 5, 10, or more years ago. Others will still be having treatment, some of whom will be living with treatable but not curable cancers. The transition from on-treatment to the post-treatment phase can be difficult. This was recognized in the seminal US Institute of Medicine report, “From cancer patient to cancer survivor: Lost in transition.”

Survivors often report feeling lost and abandoned after treatment, or a period of treatment, has ended. They commonly experience a range of issues and consequences from cancer and cancer treatments, including physical effects (e.g., fatigue, pain, reduced function), emotional and psychological issues (e.g., fear of cancer recurrence, worry), and practical issues (e.g., financial toxicity, difficulty returning to work or study). Some are at risk of serious late effects. The major focus of “follow up” in Australia continues to be on surveillance for disease recurrence or second cancers, however this limited focus frequently leaves survivors with a range of unmet needs. Primary care and community-based providers, including general practitioners, are not well integrated into follow up.

People with treatable but not curable cancers may have periods on and off treatment. They, and their caregivers, report a range of unmet needs. There is growing recognition of the need for specific focus on, and improved models of care, for this group of survivors.

This presentation will review the profile of survivors in Australia, common unmet needs, current models of care (and gaps between current and more ideal care), and will consider how to support more integrated care, so that survivors—those living with and beyond cancer—experience fewer tricky care transitions and rickety bridges, and more complete, comprehensive, and seamless care.

Institute of Medicine and National Research Council. 2006. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press. https://doi.org/10.17226/11468.

104 | Transition to nurse led clinics from medical oncology clinics – benefits and challenges

Helen Anderson¹

¹Gold Coast Hospital Health Service, Southport, QLD, Australia

Nurse-led clinics provide a safe and effective model of care that's proven to have equivocal outcomes when compared to medical-led clinics in terms of symptom management, quality of life, patient satisfaction, and self-management.

The specialist cancer nursing team at Gold Coast University Hospital have developed and implemented nurse-led clinics across various tumor streams and treatment pathways. The clinics provide biopsychosocial assessments, monitoring of patient's condition, self-management strategies, education, and referrals to allied health and community support services as required. In collaboration with multiple key stakeholders, specific nurse-led clinic guidelines have been developed to ensure a structure and framework exist. These guidelines provide information relating to specific eligibility criteria, referral processes, clinic processes, escalation criteria, and evaluation.

This presentation will discuss the challenges and benefits of implementing nurse-led clinics in a real-world clinical setting and factors that need to be considered in the evaluation of these clinics in the future.

105 | Transitioning to end of life care – Palliative care and Voluntary Assisted Dying

Corrine Haugstetter¹

¹Gold Coast Health, Gold Coast, Queensland, Australia

Transitions throughout the cancer care continuum are often not consciously perceived by patients and their families, however that perception changes when crises occur that require conscious, reactive change. One of the most significant transitions experienced by cancer patients comes where there are no further treatment options possible, or acceptable, and they enter the end-of-life phase of their cancer journey.

This transition to end of life care has become more complex in recent years in Australia, since the introduction of Voluntary assisted dying laws that have undoubtedly impacted the choices and autonomy afforded to dying persons. Where Palliative Care aims to help people to live as well as possible with their disease—neither prolonging or shortening their natural life—addressing spiritual, physical, and existential aspects of distress. Despite this goal, there have long been those who wish for a hastened death, feeling that this was the ultimate demonstration of autonomy and allowing them dignity at end of life. Voluntary assisted dying laws were introduced in response to this perception, with all states allowing persons with a terminal illness causing intolerable suffering access to a substance which they can choose to take (or have administered) that will allow them to die at a time and place of their choosing.

This presentation will discuss the complex interplay between these two seemingly opposed end of life options; discuss evolving models of care in this space; and explore how care can be improved to allow for more seamless transitions for those facing end of life decisions, regardless of the choices that person makes, to provide truly person-centered care.

106 | ARCHWAYS – AfteR Cancer Health and Wellness for Adolescents & Young adults – supporting self-management and transition to community care

Sandra Gleaves^{1, 2}

¹Qld Health, Gold Coast, Queensland, Australia

²Queensland Youth Cancer Service, Gold Coast, Queensland

AfteR Cancer Health and Wellness for Adolescents & Young Adults (ARCHWAYS) is an innovative survivorship care model developed by the Queensland Youth Cancer Service (QYCS) to address the unique needs of young cancer survivors aged 15–25 years. With a 5-year survival rate of 92% for this age group in Queensland (2013–2017), the number of young people living with and beyond cancer continues to rise, highlighting the need for comprehensive survivorship care. ARCHWAYS aims to ensure equitable access to care, empowering young people to manage their health post-treatment and transition smoothly to community-based primary care. The program aims to connect with 100% of eligible AYA cancer patients within six months of completing acute cancer treatment, utilizing a telehealth model to provide state-wide coverage.

Personalized care plans are central to the ARCHWAYS approach, incorporating psychosocial assessments and long-term follow-up strategies that promote self-management, chronic disease prevention, and overall well-being. The model is guided by principles of inclusivity, timeliness, evidence-based care, and a person-centred approach, ensuring that young survivors are actively involved in their health decisions. ARCHWAYS also emphasizes a seamless transition from acute to primary care, supporting AYAs and the primary health professionals involved in their ongoing care. ARCHWAYS is designed to provide a bridge between primary and hospital care teams, reducing the risk of potential errors from miscommunications and empowering young people to obtain care locally when appropriate and desired.

By reducing the burden on hospital outpatient departments and facilitating integrated care across all service levels, ARCHWAYS empowers general practitioners (GPs) to deliver holistic survivorship care with the necessary support and resources. The program's commitment to accessible, equitable, and developmentally appropriate care positions it as a critical service for young cancer survivors in Queensland. Insights gained from the implementation of ARCHWAYS will guide future expansion and enhance survivorship care, ensuring that all AYA cancer survivors receive the support they need as they transition to life after cancer.

107 | Development and pilot testing of a Cancer Nurse Self-Assessment Tool

Thi Thuy Ha Dinh¹, Fiona Crawford-Williams², Julia Morphet¹, Gabrielle Brand^{1, 3}, Gillian Kruss², Jane Mahony², Carla Thamm^{4, 5}, Gemma McErlean^{5, 6}, Craig Lawn⁷, Victoria Turner⁷, Lorraine Breust⁷, Olivia Cook^{2, 1}

¹Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia

²McGrath Foundation, Sydney, NSW, Australia

³Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC, Australia

⁴College of Nursing and Health Sciences, Flinders University, Caring Futures Institute, Bedford Park, SA, Australia

⁵Cancer Nurses Society of Australia, Gabbadah, WA, Australia

⁶School of Nursing, University of Wollongong, Wollongong, NSW, Australia

⁷Cancer Voices NSW, Sydney, NSW, Australia

Introduction: The Australian Cancer Nursing and Navigation Program (ACNNP) will increase the number of specialist cancer nurses (SCNs) across Australia. As SCNs come into new roles with diverse qualifications and experiences in oncology, a tool that can be used to assess skill level is needed in order to provide appropriate education and training to a growing workforce. Thus, this study aimed to develop and psychometrically test a tool that assesses cancer nursing skills.

Methods: A three-phase study was conducted to develop a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT). Phase 1: An expert working group consisting of cancer nurses, nurse educators and cancer consumers was formed to develop initial domains and item content. Phase 2: A modified Delphi process was used to assess the importance of each domain in the tool with a diverse group of cancer nursing experts. The Content Validation Index (CVI) was used to assess the relevance and clarity of items, with CVI of .78 required for an item to be included in the final tool. Items scoring less than .78 were revised or removed based on open-ended comments. Phase 3: The tools were tested for reliability and construct validity with SCNs affiliated with the Cancer Nurses Society of Australia.

Results: The initial draft CaN-SAT consisted of 94 total items across 15 domains of nursing practice. To date, 14 cancer nursing experts have participated in the first round of the modified Delphi (41.2% of invited participants). Further reliability and validity testing is ongoing and will be completed by October 2024.

Conclusion: The CaN-SAT is a comprehensive tool specifically designed for the Australian specialist cancer nurse context. Using this tool that identifies current skill level and learning needs, tailored education can be provided to upskill cancer nurses and ensure optimal care for patients.

108 | Personalised Care Plans for Patients with Rectal Cancer; registry data repurposed

Grace Gard^{1, 2}, Kelsey Serena¹, Michael Harold¹, Joanna Oakley¹, Helen Anderson³, Judi Byrne³, Jo Cockwill³, Jim Cormack³, Graeme Down³, George Kiossoglou³, Peter Gibbs^{1, 2}

¹WEHI, Parkville, VIC, Australia

²Medical Oncology, Western Health, Melbourne

³WEHI Consumer Program, WEHI, Melbourne

Background/Aims: Cancer treatment is increasingly complex, individualized to patient characteristics, disease stage, biomarkers, and treatment intent. Currently, patients typically receive limited, generic written information about their cancer diagnosis and planned treatment. A personalized care plan generated from data captured in an existing clinical registry could better educate and inform patients and GPs.

Methods: Comprehensive clinical data for patients at Western Health (Melbourne) diagnosed between September 2023 and May 2024 with rectal cancer was captured in real time as part of the ongoing colorectal cancer registry (TRACC). In a pilot project co-designed by clinicians and consumers, registry data was extracted to auto-populate a personalized care plan, including diagnosis, planned treatment, and surveillance information. Patients and GPs were provided with a copy of the plan and, along with oncology clinicians, were invited to complete evaluation surveys and interviews.

Results: The personalized care plan was provided to 23 patients and their GPs, with 16 patients (70%) and eight GPs (35%) completing evaluation surveys. All responding patients recommend the personalized care plan for other patients, confirming acceptability¹This finding was reinforced by comments such as “extremely useful,” and “having this in writing is really helpful.” Seven of eight (88%) responding GPs found that the care plan supported better communication about treatment and follow-up with their patient. Eight of nine (89%) oncology clinicians reported that the care plan added value to their discussions with patients. Seven GPs (88%) and nine (100%) of oncology clinicians indicated that integrating the personalized care plan into routine practice would be feasible.

Conclusions: Registry-generated personalized care plans are a feasible and efficient way to present important patient information in an accessible and acceptable format. Future projects include expansion of the rectal cancer plans to additional sites, including regional settings, and developing registry-generated plans for other cancer types.

1. Sekhon, M., Cartwright, M., & Francis, J.J. (2022). Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions. BMC Health Services Research. 22, 279. DOI: 10.1186/s12913-022-07577-3

109 | Practical strategies for starting a conversation about fear of cancer recurrence: Findings from direct observation of gynae-oncology outpatient consultations

Darcy Malady-Meek¹, Stuart Ekberg², Bronwyn Jennings³, Nisha Jagasia³, Ben Smith^{4, 5}, Elizabeth (Lizzy) Johnston^{6, 7, 8}

¹School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland, Australia

²College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia

³Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, Queensland, Australia

⁴The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, New South Wales, Australia

⁵South West Sydney Clinical Campuses, Faculty of Medicine & Health Sciences, University of New South Wales, Sydney, New South Wales, Australia

⁶School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

⁷Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

⁸Cancer Council Queensland, Fortitude Valley, QLD, Australia

Aims: Fear of cancer recurrence is a significant concern for gynaecological cancer patients and a highly ranked unmet need for support. This study aimed to identify communication practices that clinicians can use to initiate conversation about fear of cancer recurrence during outpatient consultations after treatment for gynaecological cancer.

Methods: A corpus of 30 audio-recorded outpatient consultations, involving 4 gynae-oncologists, 30 women who had completed treatment for endometrial or ovarian cancer, and 11 family members/friends, were analysed to identify instances where fear of cancer recurrence was discussed. Instances were transcribed and analyzed using conversation analysis, a leading approach for studying real-world communication in healthcare settings.

Results: Six consultations included conversations about fear of cancer recurrence initiated by the same gynae-oncologist. Two recurrent practices were used to initiate these conversations: (i) universal claims, and (ii) general claims. Universal claims involved the use of a full-inclusivity device (e.g., “always”), allowing the gynae-oncologist to frame fear of cancer recurrence as a routine part of follow-up consultations raised with all gynaecological cancer survivors. Conversely, general claims involved the use of a partial-inclusivity device (e.g., “some,” “a lot of”) with a generic third-person reference (e.g., “people”) to indirectly suggest that the patient may be experiencing fear of cancer recurrence. General claims provided opportunity for the patient to expand on their own experience of fear of cancer recurrence, if relevant to them, and for the gynae-oncologist and patient to discuss available support.

Conclusions: Fear of cancer recurrence was not regularly discussed in the consultations analysed. Findings from direct observation show how gynae-oncologists can use universal and general claims to create space for these conversations, including patients’ experiences of fear of cancer recurrence. These strategies provide practical guidance for clinicians to start a conversation about fear of cancer recurrence and available support with cancer survivors.

110 | My Heart and Cancer”: an information and support website for patients at risk of cardiovascular disease after cancer

Reegan Knowles¹, Emma Kemp¹, Bogda Koczwara¹, Michelle Miller²

¹Flinders Cancer Research, Flinders University, Adelaide, SA, Australia

²College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

Aim: People diagnosed with cancer are frequently unaware of their risk of cardiovascular disease (CVD), and do not know how to manage this risk. Resources to assist them are limited. We aimed to codesign and test the usability of a patient-facing website to guide risk-reduction.

Methods: Using codesign methodology, we conducted two rounds of online and face-to-face focus groups and interviews to seek patients’ and cancer-care providers’ preferences for content, format, navigation and user-interaction of the website. In Round 1, a researcher-developed and evidence-informed wireframe facilitated participant feedback, which in turn informed the development of a prototype for further feedback in Round 2. Audio-recordings and field-notes, and researcher discussion guided website revisions. In collaboration with website-developers, the “My Heart & Cancer” website was developed. For usability testing, we will use the “Think Aloud” technique, where participants verbalize perceptions during website use.

Results: In Round 1, 16 participants contributed preferences including the importance of including pictures and videos, simple language, and brevity of information but with options for detail. In Round 2, 10 participants expressed they generally found the website fit-for-purpose and comprehensive. They made suggestions for minor changes, for example, further simplification, and “takeaway points” sections. The revised website is simple, easy-to-navigate and guides users via text, pictures, videos, activities, and links. It consists of six main sections: CVD risk information, assessment, symptoms, self-management, healthcare and services; with sub-sections providing more guidance and interactive activities to encourage risk reduction behaviors, including physical activity and quitting smoking. It is anticipated users will find the website usable, and feedback will inform further improvements.

Conclusions: The “My Heart & Cancer” website is a novel resource to support patients at risk of CVD in cancer. The website will be tested for feasibility and effectiveness before routine adoption.

111 | Examining the outcomes and impacts on the cancer services workforce of a professional development grants program

Helena Rodi¹, Linda Nolte¹

¹North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

Background: The Victorian Cancer Plan 2020–2024 recognizes workforce as a key system support to meet priorities. It is crucial that cancer clinicians can meet the needs of people with cancer and their families. In 2023, NEMICS ran a competitive Professional Development Grants program to support the cancer services workforce and align with the goals of the Victorian Cancer Plan in the region.

Aim: To evaluate the outcomes and impact of the NEMICS 2023 Professional Development Grant program on the cancer services workforce.

Methods: Successful grant recipients were asked to complete a qualitative report after participating in their professional development activity. Reports were analysed thematically.

Findings: Forty-four professional development grant applications were received and 27 were partially or fully funded. These included conferences, training, and higher education. Almost all recipients completed the required reporting (96%). Recipients reported positive outcomes from professional development participation across 17 relevant areas; however, most commonly reported increased knowledge relating to cancer treatment (50%) and supportive care (38%) and networking (42%).

Almost all recipients (96%) reported that they would organize staff training and education programs to share knowledge and skills, the majority (69%) also stated that they would implement learnings directly into clinical care. Over half (58%) of recipients also described that they would undertake service improvement activities. Recipients also stated that as a direct result of participating in the funded professional development, they produced patient education resources (12%), formed research collaborations (8%), developed a national special interest group (4%), formed global research and clinical collaborations (4%), and participated in strategic planning (4%).

Conclusion: Funding relevant professional development can assist in supporting the cancer services workforce to develop and share knowledge and skills aligned with the Victorian Cancer Plan priorities and facilitate improvements leading to the provision of optimal care.

112 | Estimating rates of immune-related adverse events in an Australian state-wide hospital population

Bishma Jayathilaka^{1, 2, 3}, Fan He², Maarten IJzerman^{2, 3, 4}, George Au-Yeung^{3, 5}, Fanny Franchini²

¹Pharmacy Department, Peter MacCallum Cancer Centre, Parkville, VICTORIA, Australia

²Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

³Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

⁴Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands

⁵Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: Immune-related adverse events (irAE) complicate the use of immune checkpoint inhibitors (ICI). There are limited real-world studies examining potential contributors to identify patients at risk. We aimed to estimate rates of irAE among patients in hospital admitted and emergency episodes across Victoria, Australia using linked administrative datasets.

Method: We analysed episodes of care coded by International Statistical Classification of Diseases and Related Health Problems ¹⁰th Revision Australian Modification (ICD-10-AM) to infer irAE-related admissions/visits. We used the PRedicting the population health economic IMpact of current and new CAncer Treatments dataset containing patients in Victorian Cancer Registry diagnosed with specific cancers between 2010–2021. Patients were linked to Commonwealth datasets (Pharmaceutical Benefits Scheme [PBS], Medicare Benefits Scheme, National Death Index). We identified patients who received at least one ICI dose (ipilimumab, nivolumab, pembrolizumab, durvalumab, avelumab, atezolizumab, cemiplimab). We developed definitions for irAE occurrence based on ICD-10-AM codes. We applied definitions to the Victorian Admitted Episodes Dataset (VAED) and Victorian Emergency Minimum Dataset (VEMD) to estimate irAE occurrence rates among ICI exposed patients.

Results: Among 213,476 patients, 7175 received at least one ICI dose. Colitis/enterocolitis was the most identified irAE inferred in VAED and VEMD. Combined rate for all colitis/enterocolitis definitions was 21.26%. Rarer irAE types were inferred from VAED, including neurological and cardiac. Inference rate of neuropathy was 1.20%. Inference rates for myocarditis and pericarditis were .84% and .70%, respectively.

Conclusion: Our findings are comparable to observational/cohort studies suggesting our method to infer irAE at a population-level may be appropriate but requires validation in different datasets. Identifying irAE occurrence is a crucial step towards evaluating factors associated with irAE risk, which is the next stage of research. Our project contributes to the growing knowledge on real-world irAE prevalence and underscores the potential use of administrative data to examine irAE risk factors.

113 | A prospective study of definitive chemoradiation with immunotherapy (CRIO) in locally or regionally advanced, unresectable cutaneous squamous cell carcinoma

Charles Lin^{1, 2}, Gary Ng¹, Michelle Nottage^{1, 2}, Karen Hay³, Jacqui Keller¹, Wendy Pritchard¹, Brett Hughes^{1, 2}

¹Royal Brisbane and Women's Hospital, Herston, QLD, Australia

²Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia

³Queensland Institute of Medical Research, Berghofer Medical Research Institute, Herston, QLD, Australia

Background: There is limited prospective data to guide the management for patients with cutaneous squamous cell carcinoma (cSCC) presenting with locally advanced, unresectable disease.  Previously we conducted a prospective study of chemoradiation (CRT) for patients with unresectable cSCC (1).  The purpose of this study was to evaluate the efficacy and safety of CRT combined with checkpoint inhibitor immunotherapy with durvalumab for this patient cohort.

Methods: Patients with locally advanced or nodal metastatic cSCC deemed unsuitable for surgery, by a multidisciplinary clinic, were treated with definitive RT (70 Gy in 35 fractions), concurrent weekly chemotherapy (cisplatin 40 mg/m² or carboplatin AUC 2 mg/mL/min) and durvalumab 1500 mg every 4 weeks, starting on the first week of CRT. Assessment was performed at 19 weeks, after five cycles of durvalumab. Patients who achieved a complete response (CR) did not receive further treatment.  Patients with residual, but not progressive, disease could continue durvalumab for a further six cycles, with or without salvage surgery. Primary endpoints were CR and safety.

Results: Fifteen patients were enrolled between May 2019 and June 2021. Fourteen (93%) had regional nodal disease classified as non-metastatic stage IV. CR was observed in 9/15 (60%) with no patients undergoing salvage surgery. All patients who achieved CR were alive without progression or died from another cause at data cutoff, with median follow-up of 39 months (26–44). The six patients who did not achieve CR all progressed; five died due to disease progression and one received further systemic therapy on a clinical trial. Grade 3 adverse events related to immunotherapy was reported in one patient (7%).

Conclusions: This is the only prospective series of chemoradiation in combination with checkpoint inhibitor immunotherapy for unresectable cSCC.  A high CR rate was achieved and responses were durable.  No unexpected adverse events were identified.

Nottage MK, Lin C, Hughes BG, Kenny L, Smith DD, Houston K, Francesconi A. Prospective study of definitive chemoradiation in locally or regionally advanced squamous cell carcinoma of the skin. Head Neck. 2017 Apr;39(4):679-683. doi: 10.1002/hed.24662. Epub 2016 Dec 29. PMID: 28032670.

114 | Embedding a culture of consumer involvement across research

Allison Ogden¹, Anna Jones¹, June Smith², Tiel Lillehagen², Brenda Cherednichenko², Gabrielle Prior², Geraldine McDonald¹

¹Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²Peter MacCallum Cancer Centre Consumer Register member, Melbourne, VIC, Australia

Aim: Engaging consumers as advisors ensures research is relevant, impactful, and aligned with the needs of people affected by the outcomes¹In 2019, Peter Mac Research had little consumer involvement with its 700 staff spanning laboratory; health services and implementation; clinical; and clinical trials research. The aim of this project was to embed a culture of consumer involvement in all research domains across multiple levels, from project to education and governance.

Methods: A research consumer engagement pilot was implemented, guided by diverse stakeholders including consumers and senior leaders as champions of cultural change. A permanent program resulted, facilitating implementation and expansion of consumer engagement across research. This involved building and maintaining a diverse, capable, and engaged consumer network; co-designing education materials for consumers and researchers; implementing processes for appropriate pairing of consumers and researchers for effective working relationships; engaging consumers in leadership roles; and evaluation.

Results: Peter Mac's Research Consumer Engagement Program enables meaningful collaborations between consumers and researchers. The Consumer Register expanded by 24% in the 2023–2024 fiscal year, reaching 285 members. Since 2021, researchers have made 221 requests for consumer input, with nearly 90 in 2023 alone. Consumers advise on research at the project level, strategic leadership, education and in determining internal funding.

Preliminary findings from a 2024 evaluation indicate program success. Although the survey is still open, over 85% of researchers (n = 43) report significant or some positive impact, especially on funding success and improved communication. Over 75% (n = 36) of consumers felt effective in their collaborations and their input valued. More comprehensive evaluation results will be shared at the conference. 

Conclusion:This work demonstrates that rapid, transformational change in consumer involvement in research is achievable, embedding consumers across all research domains from project to leadership levels. Key success factors include resourcing, consumer leadership, and senior leader endorsement.

Staley K.(2009) Exploring Impact: Public involvement in NHS, public health and social care research. INVOLVE, Eastleigh.

115 | Cytokine release syndrome incidence with tebentafusp: A case series of real-world data at two hospitals

Lachlan Roth^{1, 2}, Marissa Ryan^{1, 3}, Victoria Atkinson^{4, 3}

¹Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia

²Sunshine Coast University Hospital and Health Service, Brisbane, QLD, Australia

³The University of Queensland, Brisbane, QLD, Australia

⁴Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia

Aim: Tebentafusp, used for advanced uveal melanoma, involves intra-patient dose escalation to decrease the likelihood of cytokine release syndrome (CRS). Inpatient admission is recommended for the dose escalation for CRS monitoring and to provide appropriate supportive treatment. This audit aims to describe the incidence and potential risk factors for symptomatic CRS (Grade 2 or above) in a real-world setting.

Methods: A retrospective audit was conducted of tebentafusp use at two hospitals between 01/07/2021 and 15/06/2024 by a single prescriber. Data collected included burden of liver disease, baseline blood pressure, and presence and Grade of CRS. Results were compared to the pivotal Phase III trial data.

Results: Fifteen patients received therapy, 47% (n = 7) experienced CRS Grade 2 or above (Grade 2 n = 5, 33%; Grade 3 n = 2, 13%) versus 77% of patients in the trial setting. Five out of the 7 patients had at least 50% of the liver involved with metastatic disease (4 had > 75%, 1 had 50%, and 2 had < 25%), compared to the patients who did not have CRS Grade 2 or above, where only two out of eight had at least 50% of the liver involved with metastatic disease (2 had 50%, 6 had < 25%). Four out of the seven (57%) patients in the symptomatic CRS group had lactate dehydrogenase (LDH) 3x the upper limit of normal (ULN) compared to none in the group that did not experience symptomatic CRS. In this case series, all symptomatic CRS occurred at the first dose of tebentafusp, with two patients discontinuing treatment post-first dose due to rapid progression.

Conclusion: Burden of liver disease and LDH 3xULN were associated with an increased risk of symptomatic CRS. Future research should explore a larger real-world patient cohort to identify high-risk patients, removing the requirement for inpatient admission during dose escalation for low-risk patients.

116 | Evaluating the Implementation of Multidisciplinary Team Plans in Metastatic Breast Cancer Management: A Prospective Analysis

Belinda Sassé¹, Sammy Shaya¹, Jessica Nimmo¹, Katie Cao¹, Steven David¹, Daphne Day¹, Katie Evans¹, Catherine Healy¹, Gwo-Yaw Ho¹, Gillian Kruss¹, Amelia McCartney¹, Linda Mojzisova¹, Ranjana Srivastava¹, Kate Webber¹, Michelle White¹, Marion Harris¹

¹Monash Health, Clayton, VIC, Australia

Introduction: Metastatic breast cancer guidelines recommend multidisciplinary meetings (MDM), but there is limited research on their impact. This prospective study examines the impact of a metastatic breast MDM on clinician management plans and the associated implementation rate.

Methods: Consecutive patients presented at the Monash MDM were prospectively enrolled. Oncologists recorded their management plans before the MDM. Following the MDM, the consensus plan was recorded and compared to the pre-MDM plan. Plans were categorized as no change, low impact, or high impact. High impact was defined as major treatment changes or clinical trial referrals. Medical records were reviewed four months post-MDM to assess the management plan implementation rate. The primary endpoint was the proportion of patients in whom all high impact plan elements were implemented. A one-sample binomial test determined whether this rate was > 75%, with 80% power. 75% was selected after reviewing MDM implementation rates in other tumor streams. Target accrual was 48. Demographic and oncological data were also collected in a study-specific prospective database.

Results: 114 MDM presentations for 95 patients were recorded from 18 October 2023 to 3 July 2024. Sixty-six (57.9%) presentations resulted in a plan change (p < 0.001), of which 33 (28.9%) were high impact (p < 0.001). Follow-up data was collected for 77 MDM presentations, of which 65 (84.4%) were implemented. Forty-three MDM presentations had plans containing high impact elements, of which 40 (93.0%) had all elements implemented (p = 0.005). The population was ethnically and linguistically diverse, with 52.6% born overseas and 24.4% from non-English speaking backgrounds.

Conclusion: This study demonstrated that metastatic breast MDMs significantly impact clinician management plans. The 92.6% high impact implementation rate underscores the effectiveness of MDMs in ensuring adherence to evidence-based and consensus-driven treatment strategies. The study demonstrates that MDMs are critical in enhancing the quality of care for a diverse patient population.

117 | Omitting Axillary Dissection In Breast Cancer With Sentinel-Node Metastases: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

Lorhayne K. C. Scalioni Galvao¹, Ana Clara F. de Farias², Fernanda V. Zamora¹, Afshan Nizami³, Camilla M. Yamada¹, Andres V. Zamora¹, Nicole dos Santos Pimenta⁴, Swathi Vellaichamy⁵

¹Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil

²School of Pharmacy, City University of São Paulo, São Paulo, SP, Brazil

³Apollo Institute of Medical Sciences and Research, Telangana, India

⁴Faculty of Medicine, Federal University of the State of do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

⁵Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India

Background: In recent decades, numerous trials have shown a similar benefit between completing the axillary dissection or performing only a biopsy on patients with sentinel-note metastasis but clinically with node-negative axilla. Aiming to reinforce these results by gathering data from an extensive population, we conducted a meta-analysis of randomized controlled trials (RCTs) and a trial sequential analysis (TSA) on the theme.

Methods: We searched the PubMed, Embase, and Cochrane databases through May 2024 for studies comparing omission to complete axillary dissection in patients with breast cancer with sentinel-node metastasis. We computed odds ratios (ORs) for binary endpoints and mean differences (MDs) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics.

Results: Eight trials were reported in 16 studies comprising 7788 patients, of whom 3933 (50.5%) underwent omission of axillary dissection. The intervention group had a lower number of cancer-related deaths (OR .69; 95% CI .53, .89; I² = 0%; p = 0.004), confirmed by the TSA. However, there were no significant differences between the groups overall (HR .97; 95% CI .77, 1.23; I² = 36%; p = 0.82) and disease-free survival over 10 years (HR .97; 95% CI .76, 1.24; I² = 61%; p = 0.81). The recurrence incidence (OR .96; 95% CI .77, 1.21; I² = 0%; p = 0.74) was also similar between the groups.

Conclusion: Our findings suggest that omitting axillary dissection does not compromise overall or disease-free survival at 10 years. Moreover, the intervention group showed a positive trend with fewer cancer-related deaths, and the recurrence incidence was similar between the groups The study supports omitting axillary dissection for selected patients to reduce surgical morbidity without compromising oncological outcomes. Further research and longer follow-up are needed to confirm these findings and refine patient selection criteria.

118 | Early Referral to Palliative care – Don't make it weird!

Joanne Doran¹

¹GCHHS, Parkwood, QLD, Australia

Exploring the possibilities of early referral to palliative care.

The who, when, what why, and how.

119 | Challenges for the Medical Oncologist in Managing Patients with a Cancer of Poor Prognosis

Wade Pullin¹

¹Gold Coast University Hospital, Southport, QLD, Australia

Content not available at time of publishing.

120 | Supporting Patients and their families with poor prognosis cancers – the role of the specialist cancer nurse

Anita Cox¹

¹Gold Coast University Hospital, Southport, QLD, Australia

Receiving a cancer diagnosis can be devastating for any individual and their family and feelings of fear, anger, loneliness, and guilt can be expressed at varying levels of intensity and at different times along the disease trajectory, from diagnosis and beyond.

Now consider dealing with these emotions alongside the extra layer of complexity that the disease being treated has a poor prognosis—how do you absorb information, keep your sanity and consent to therapy when your mind has thousands of tabs open and no answers to close any of them down? Or you simply shut down and cannot take in anything being said to you—how can you be this sick when you don't feel that unwell?

As Clinical Nurse Consultant for patients with primary CNS tumors, a significant number of my patients start life in the cancer world with some of the poorest prognosis in Oncology.  Using real scenarios and quotes from patients that I have had the pleasure of working with over the last 10 years, I will explore some of the differing situations I have experienced and how my role as specialist cancer nurse has supported patients and their families at such a vulnerable time of their lives.

121 | “Not if but when”: Managing fear of cancer recurrence in poor prognosis cancers

Joanne Shaw¹

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

Managing fear of cancer recurrence or progression (FCR/P) is one of the most common unmet needs among cancer patients and survivors. While some fear is an adaptive in response to a cancer diagnosis, for 60% of people FCR/P reaches clinically significant levels and for 20% FCR/P becomes severe. FCR/P is characterized by persistent worry, preoccupation with bodily checking for signs of cancer, frequent need for reassurance from hospital services and future planning difficulties. Left untreated, high FCR/P persists over time and can adversely affect screening and follow-up behaviours, is associated with increased anxiety and depression, poorer quality of life and higher healthcare utilization. While FCR/P is experienced across cancer types, those with poor prognosis tumours and more advanced disease report higher FCR/P as treatment for longer time and frequent monitoring contribute to uncertainty and fear. The content of fears also differs. For example, people with ovarian and brain cancers report greater existential concerns and death anxiety. There are now interventions with efficacy in treating FCR, including psychologist delivered interventions for those with severe FCR and online interventions for people with moderate FCR. However, these interventions have been evaluated with early-stage cancer patients previously treated with curative intent. Further research is required to determine the duration of effect and optimal dosing to inform stepped care models. The effectiveness demonstrated amongst cancer-free survivors has also not been replicated in trials with people with active disease, where fear of progression (FoP) is more prominent. The reported poor engagement and high attrition rates across these studies highlight an urgent need for interventions better tailored to the experiences of those with poor prognosis and the increasing number of people living long term with advanced disease due to targeted and immunotherapies.

122 | Impact of a national oncology mentorship program on burnout and professional fulfilment in medical oncology

Jia (Jenny) Liu^{1, 2, 3}, Udit Nindra^{4, 5, 6}, Rhiannon Mellor^{7, 3, 8}, Gowri Shivasabesan¹, Bethan Richards⁹

¹St Vincent's Hospital, Darlinghurst, Darlinghurst, NEW SOUTH WALES, Australia

²St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

³Garvan Institute of Medical Research, Darlinghurst, NSW

⁴Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia

⁵School of Medicine, Western Sydney University, Sydney, NSW

⁶Ingham Institute for Applied Medical Research, Liverpool, NSW

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

⁸School of Medicine and Health, University of New South Wales, Randwick, NSW

⁹Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, NSW

Background: Burnout and low professional fulfilment is noted amongst the medical oncology workforce globally. Mentorship has a positive influence on wellbeing and career planning. The Australian National Oncology Mentorship Program (NOMP23) endorsed by the Medical Oncology Group of Australia (MOGA) (www.moga.org.au/NOMP) was designed to evaluate the impact of a 1-year mentorship program on professional fulfilment and burnout.

Methods: NOMP23 was a single-arm prospective cohort study which recruited oncology trainees (mentees) and consultants (mentors) using MOGA emails and snowballing. Participants completed baseline and end of program surveys. Mentee/mentor pairs were orientated to the program virtually and met at least three times throughout 2023. The primary outcome was improvement in professional fulfilment using the Stanford Professional Fulfilment Index (SPFI). Key secondary outcomes were changes in burnout on the Maslach Burnout Index (MBI); anxiety/depression (PHQ4); and regret towards oncology as a career choice.

Results: A total of 112 participants enrolled −86 (77%) completed the baseline and 63 (56%) completed the end of program survey. Demographics have been previously reported.¹ At baseline, 82% of mentees and 77% of mentors were classified as burnt out which reduced to 57% and 51% at the conclusion of NOMP23, a reduction of 25% and 26%, respectively (p < 0.01). Baseline professional fulfilment improved from 0% to 21% in mentees, and from 5% to 34% in mentors (p < 0.01). Significant reduction in feelings of regret toward oncology as a profession was seen for mentees and mentors between baseline and the conclusion of NOMP23 (p < 0.01), but there were no changes in rates of anxiety or depression.

Conclusions: NOMP23 demonstrated that a centrally coordinated, low-cost mentorship program is feasible and may reduce burnout and improve professional fulfilment. Mentorship programs, alongside multifactorial institutional, state-based, and national interventions to improve wellbeing, can help ensure a sustainable oncology workforce.

Nindra et al, (2024) JCO Oncology Practice 20(4):549-557

123 | It's not yogapenia: Effective interventions to support wellbeing

Rhea Liang¹

¹Gold Coast University Hospital and Bond University, Southport, QLD, Australia

Interventions to address wellbeing are often enacted in atheoretical and linear ways that limit their effectiveness within complex healthcare systems. While undoubtedly well intended, this has had the effect of imbuing “wellness” interventions with negative value, seen in emerging terms such as “wellness façade” and “toxic positivity.” In this presentation I explore the distinction between wellness and wellbeing, briefly summarize the literature examining the effectiveness of workplace wellness interventions, and provide some suggestions from my own personal practice.

124 | Singing in the RAIN: A reflective practice to promote joy

Matthew Links¹

¹Bond University, Robina, QLD, Australia

Learning to be well, when working in a resource-limited and stressful heath system is a major task for all health professions. Reflective practice is a key strategy to enable us to identify ways with coping with the variety of stressors we encounter. The RAIN framework is a mindfulness practice that connects Recognition and Acceptance to Investigation and Nurturing yourself. In this session we will demonstrate how this works to connect to the joy in our practice and crowdsource some wisdom on how to apply the framework to team conflict.

125 | Using patient-reported outcomes (PROs) for symptom monitoring

Julia Lai-Kwon¹

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

Patient-reported outcome (PROs) can be used at the individual patient level for a number of different purposes, including for screening for and assessing concerns and unmet needs, symptom monitoring, and shared decision making.  There is now a high-quality evidence base supporting the use of electronic PROs (ePROs) for symptom monitoring between clinic visits in people receiving systemic treatment for cancer, including improvements in symptom control, quality of life, patient satisfaction and self-efficacy and overall survival, as well as reductions in emergency department presentations and hospitalizations. ePRO symptom monitoring is now considered a key component of quality cancer care and is recommended by major oncology professional groups, such as the European Society for Medical Oncology (ESMO) and reimbursed as a “digital therapeutic” in France and the United States.

However, implementing ePRO symptom monitoring in routine clinical care is not straightforward. Successful implementation requires early engagement with key stakeholders, close attention to selecting clinically relevant PROs and patient-reported outcome measures (PROMs), careful selection of software (including electronic medical record integration), integration into existing workflows, and managing cultural change. 

We will discuss examples of successful implementation of ePROs for symptom monitoring from around the world, highlight key lessons in the design and implementation of ePRO symptom monitoring, and discuss how we can apply these learnings from overseas to drive the uptake of ePRO symptom monitoring in the Australian healthcare context.

126 | Integrating PROMs in comprehensive cancer survivorship care

Jordana McLoone¹, Signorelli C¹, Wakefield C.E¹, Mazariego C¹, Johnston K¹, Baldwin R¹, Elias J¹, Taylor N¹, Cohn R.J¹

¹UNSW, Kensington, NSW, Australia

Engage is a comprehensive, remote-delivered telehealth program designed to educate, empower, and engage childhood cancer survivors to self-manage their health after cancer. As part of Engage, we developed an extensive and complex patient-reported outcome measure (PROM) tool called the Health and Lifestyle Assessment (HLA). The HLA is an innovative PROM solution that ensures assessment is (a) tailored to the individual, using smart logic to reduce response burden, (b) supports diagnostic capabilities, not just the report of known disease, (c) encompasses all body systems, reflecting the broader impact of cancer therapies, and (d) goes beyond medical assessment to include health behaviors, psychosocial concerns, family history, family planning, medication use, and more. The development of the Health & Lifestyle Assessment was guided by a multidisciplinary team of experts and creates a systematic framework to serve as a solution to support personalized, distance-delivered comprehensive survivorship care.

This symposium will address the following: (1) Can comprehensive PROMs be integrated in survivorship care programs to guide care in real time? (2) What is the acceptability of lengthy and complex Patient-Reported Outcomes (PROs)? (3) Do complex medical PROMs require additional nurse validation to ensure accuracy and comprehensiveness? (4) What care pathways are necessary to ensure that identified patient concerns are adequately supported? (5) Do clinicians feel they have the necessary information to provide effective care?

Initial findings suggest that the HLA is acceptable to survivors, is acceptable to nurses for integrated use within the busy clinic setting, and acceptable to clinicians involved in multidisciplinary meetings, effectively supporting the remote provision of comprehensive survivorship care. Our ongoing research seeks to refine the HLA Engage and establish it as a cornerstone of remote survivorship care, ensuring that cancer survivors receive the comprehensive care they need, regardless of geographical or logistical barriers.

127 | PROs & Machine Learning/AI

Georgina Kennedy^{1, 2, 3}, Joanna Fardell^{1, 3, 4, 5}, Geoff Delaney^{1, 3, 6}

¹Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, NSW, Australia

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

³UNSW School of Clinical Medicine, Sydney, NSW, Australia

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

⁵Western Sydney Youth Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia

⁶Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia

A majority of studies investigating the use of patient-reported outcomes (PROs) for prognostic models in oncology report an independent and statistically significant predictive value of their inclusion for overall survival. This frequently outperforms physician recorded performance status, and generalizes across cancer clinical domain as well as study methodology.

Although the evidence supporting their value for prognostication is compelling, the mechanistic relationships between PROs and these outcomes of interest are nuanced, multivariate, and frequently latent. Understanding these interactions requires the characterization of interactions across different time scales and domains, both within and external to the health system. We also see a wide chasm between the theoretical impact of PRO-based predictive modelling and what is practically deliverable in routine care due to both data and engagement barriers, meaning that this promise is yet to be borne out in practice. It follows that the effective use of patient reported outcomes for predictive modelling, and furthermore translation of these models into care, requires a maturation of data capture, harmonization, and analytic practices. These improvements must transcend challenges both inherent to the general use of routinely collected observational data to drive care, as well as specific to the integration of PROs in clinical workflows and systems.

In this session, we will present generalized requirements for the data supply chain specific to the use of PROs in machine learning and AI models. We will specifically address issues affected by the dual models of PRO capture (i.e., prospectively captured registry data vs. real-time clinically deployed instruments) and their respective use-cases. We will also detail the relationship between patient reported variables and the content of clinical letters, notes, and extended naturalistic data capture through the advancements in natural language processing functionality.

128 | PROs in Clinical Quality Registries and beyond

Sarah Weller¹

¹Movember, Melbourne, Victoria, Australia

The integration of patient-reported outcomes (PROs) into cancer care is increasingly important, yet achieving standardized adoption across Australia remains challenging. PROs provide valuable insights and data for personalizing treatment, early symptom management, and ongoing monitoring, all of which are crucial for understanding system performance and improving quality of life and outcomes for patients. This presentation will discuss two key initiatives in Australia that use PROs data to enhance cancer care: the Prostate Cancer Outcomes Registry (PCOR-ANZ) and the Real World Evidence Network for Cancer.

Clinical quality registries (CQRs) have demonstrated the value of integrating PROs into cancer care by collecting baseline and follow-up PROs data and providing benchmarked reporting. Since 2015, PCOR-ANZ has collected PROs from over 127,000 participants across 270+ hospitals and nearly 400 clinicians. This data has been instrumental in identifying trends in clinical practice, measuring treatment outcome variations, and assessing adherence to clinical guidelines and standards. PCOR-ANZ produces annual reports including benchmarked quality indicator reports at both hospital and clinician levels, public national performance summaries, consumer reports, and starting in 2024, a report on inequities and disparities. These reports are used to enhance the quality of prostate cancer care in Australia. As CQRs evolve to include real-time data access, on-demand reporting and improved data automation, they present an opportunity to drive transformation across cancer care.

The Real World Evidence Network for Cancer initiative is a collaboration between Movember and Cancer Australia and part of the Australian Cancer Plan. This initiative involves stakeholders from across the cancer sector, including clinical care delivery, CQRs, research, patient advocacy, private health and health departments. The goals of this initiative are to establish a core set of general PROs and experience measures for national use, and to create a national benchmarking platform for PROs. By standardizing PROs collection and monitoring at a national level, this project aims to drive quality improvement and optimize cancer outcomes across Australia.

129 | CUP overview, new developments in refining a diagnosis

Linda Mileshkin¹

¹Peter MacCallum Cancer Centre, East Melbourne, Australia

Content not available at time of publishing.

130 | The role of the nurse specialist in supporting the patient and family after a CUP diagnosis

Sarah McLean¹

¹Peter MacCallum Cancer Centre, Bentleigh East, VIC, Australia

There are 2500 new diagnosis of Cancer Unknown Primary (CUP) in Australia each year (Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: cancer of unknown primary site, AIHW, Canberra, December 2017.). The survival outcome of CUP is generally poor and there is no consensus for treatment (Kang, et al., 2021).  A diagnosis of CUP is a devastating diagnosis for patients and  their families. There is uncertainty regarding the diagnosis, the optimal treatment, and ultimately the likely prognosis. This creates significant anxiety and worry in patients who have no support groups or “tumour streams.” These patients have often been seen by multiple specialists or had innumerable scans and procedures before getting to a tertiary center with a Cancer Unknown Primary service.

The CUP nurse specialist role plays a vital part in helping patients and their families navigate the complexities around their diagnosis, the delays in treatment while a primary is being investigated, and ultimately the treatment approach where there is often minimal evidence base. CUP nurse specialists are integral in Cancer Unknown primary services to provide timely access to specialist treating teams and therefore improved outcomes for this unique patient group. They provide the emotional support to patients and families who often don't have the support groups that are available for cancers with a known primary.

132 | Cancer of Unknown Primary–Shining light into the unknown

Ganessan kichenadasse¹

¹SA Health, Adelaide, SA, Australia

Content not available at time of publishing.

133 | ReViTALISE–Addressing disparities in cancer outcomes in regional Victoria through regionally-led telehealth-enabled health services research

Donna Long¹, Ian Collins ^{2, 3}, Samuel Harris⁴, Javier Torres⁵, Wasek Faisal⁶, Vanessa Wong^{6, 7}, David Campbell^{8, 3}, Kurt Lankovic⁹, Tricia Wright¹⁰, Krishna Rachakonda¹¹, Peter Gibbs^{7, 13, 12}, Meinir Krishnasamy^{14, 12}, Jennifer Philip^{16, 15}, Oliver Klein^{2, 17}, Irene Blackberry¹⁸, Christopher Steer^{1, 19, 10}, Craig Underhill^{1, 19, 18}, Tennille Lewin¹⁴, Jhodie Duncan¹⁰, Monica Green²⁰, Miriam Ferres²¹, Kathleen Wilkins²²

¹Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

²Southwest Healthcare, Warrnambool, Vic, Australia

³Deakin University, Geelong, Vic, Australia

⁴Bendigo Health, Bendigo, Vic, Australia

⁵Goulburn Valley Health, Shepparton, Vic, Australia

⁶Grampians Health, Ballarat, Vic, Australia

⁷Walter and Eliza Hall Institute, Parkville, Vic, Australia

⁸Barwon Health, Geelong, Vic

⁹Cancer Trials Australia, Parkville, Vic, Australia

¹⁰Latrobe Regional Hopsital, Traralgon, Vic, Australia

¹¹Mildura Base Public Hospital, Mildura, Vic, Australia

¹²The University of Melbourne, Melbourne, Vic, Australia

¹³Western Hospital, Footscray, Vic, Australia

¹⁴Peter MacCallum Cancer Centre, Parkville, Vic, Australia

¹⁵St Vincents Hospital, Fitzroy, VIC, Australia

¹⁶The University of Melbourne, Melbourne, Vic, Australia

¹⁷Olivia Newton-John Cancer Research Institute, Heidelberg, Vic, Australia

¹⁸Latrobe University, Wodonga, Vic, Australia

¹⁹UNSW School of Clinical Medicine, Rural Clinical Campus, Albury, NSW, Australia

²⁰Regional Trials Network, Albury-Wodonga, Vic, Australia

²¹Barwon Health, Geelong, Vic, Australia

²²Regional Trials Network Victoria, Albury-Wodonga, Australia

ReViTALISE aims to address regional inequities of access and improve cancer outcomes, utilizing telehealth to enable health services research across a regional network.

Funded by the Medical Research Future Fund (MRFF) Rural, Regional and Remote Clinical Trial Infrastructure Fund and awarded to the Regional Trials Network—Victoria (RTN-Vic). The RTN-Vic created a project that involves seven interconnected Initiatives in areas of unmet need for regional populations, partnering with Peter MacCallum Cancer Centre, University of Melbourne, La Trobe University Wodonga, and the Walter and Eliza Hall Institute.

ReViTALISE key activities:

-Establishing new and expand existing RTN-Vic sites: enabling clinical trials at Mildura Public Hospital for the first time and a major expansion of capacity and capability at Latrobe Regional Hospital, in partnership with TrailHub Alfred

-Expanding trial portfolios: registry, immunotherapy, rare cancers, palliative and supportive care, and Older Australians with cancer trials.

-Improving access to clinical trials for First Nations People.

-Improving research literacy in the regional workforce with the establishment of a Regional Research Teaching Hub

-Building and consolidating networks of research active clinicians across regional centers.

-Establishing an advisory committee of regional people with lived experience of cancer (Every VoiceCAN)

The ReViTALISE project recently conducted a mid project review (self-audit) to inform progress to date and identify opportunities for the remaining 2 years of the program.

The aim of this symposium is to share key learnings from this ambitious and impactful program that may prove to be a watershed moment in the development of cancer services in regional Australia.

Speakers will outline the key learnings from each program and enablers of success to date.

Conclusion: This is an innovative project addressing important areas of unmet need in regional populations with cancer, developed and led by the regions that can inform future service delivery in regional Australia.

134 | Working towards equitable age-friendly care among older adults in regional  cancer care

Irene Blackberry¹, Tshepo Rasekaba¹, Stacey Rich², Nicole Webb³, Jenny Boak^{4, 1}, Mmakgomo Raesima¹, David Brereton¹, Christopher Steer^{2, 5, 1}

¹Latrobe University, Wodonga, VIC, Australia

²Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

³Albury-Wodonga Health, Albury, NSW, Australia

⁴Bendigo Health, Bendigo, VIC, Australia

⁵UNSW School of Clinical Medicine, Rural Clinical Campus, Albury, NSW, Australia

Aim: The 2023 Australian Cancer Plan highlights the disparities in cancer outcomes for older adults and people living in rural and remote areas. The plan's Health Equity framework recognizes the importance of optimized treatment and support that is tailored to personal contexts. Our team has been working toward tailored and optimized treatment and support for regionally based older adults diagnosed with cancer through the adoption and implementation of age-friendly oncology practices such as geriatric assessment.

Methods: We applied the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) to design multiple key projects that have been undertaken over the previous 3 years, with more in development or currently underway. Input from people with lived experience of cancer has been a cornerstone of our work and has led to the development of innovative solutions to implementing age-friendly supportive care.

Results: The approach taken yielded two iterations of an innovative assessment method for older adults based on the 4Ms method of age-friendly care (Mentation, Medication, Mobility, and what Matters). Both iterations of the assessment were found to be acceptable to both patients and clinicians, and their implementation was feasible at a regional cancer center. In line with i-PARIHS principles, we have undertaken Roadshows to other cancer centers to present the evidence base for implementation and have engaged site champions. As a result, planning for a multi-site implementation study is now underway.

Conclusion: By utilizing rigorous implementation methods, engaging a complex change management process, and working with older adults with lived experience of a cancer diagnosis, changes in practice are achievable. Our experience has taught us that there is enthusiasm for appropriate assessment of older adults in cancer care, and providing a practical example combined with engaging site champions is key to leveraging that enthusiasm.

135 | Increasing immunotherapy clinical trial knowledge and access in rural, regional, and remote Victoria

Samuel Harris¹, Ian Collins ^{2, 3}, Damon Parker⁴, Narelle McPhee^{1, 5}, Oliver Klein^{2, 6}

¹Bendigo Health, Bendigo, Vic, Australia

²Southwest Healthcare, Warrnambool, Vic, Australia

³Deakin University, Geelong, Vic, Australia

⁴Regional Trials Network Victoria, Albury-Wodonga, Australia

⁵Monash University, Clayton, Vic, Australia

⁶Olivia Newton-John Cancer Research Institute, Heidelberg, Vic, Australia

Aim: At the time of establishing the ReViTALISE program, regional access to immunotherapy studies was low compared to metropolitan cancer services. As a result, there was a perceived gap in knowledge of immunotherapy and the management of side effects among regional cancer and non-cancer clinicians. This  ReViTALISE initiative aimed to address these gaps.

Methods: Regional clinicians worked with Olivia Newton-John Cancer Research Institute (ONJCRI) to open teletrials according to COSA methodology.  An education plan was developed co-designed with regional health care workers and supported by ReViTALISE @research

Results: This project has enabled an increase from baseline the number of high-quality immunotherapy clinical trials opened and an increase patient recruitment across RTN-Vic, contributing to multiple publications in international journals and conference presentations. The education program has led to an increase in the number of regional clinical staff trained in immunotherapy side effects and the development of an immunotherapy toolkit and patient held immunotherapy alert care. An immunotherapy registry trial in rare cancers has been developed, led by regional medical oncologists with Bendigo Health acting as trial sponsor and with input from VACCHO and ReViTALISE initiative attempting to improve clinical trial access for First Nations people with cancer. Further grant applications have been leveraged and more high-quality trials are in development.

Conclusion: The expansion of immunotherapy clinical trials in regional Victoria, and the concomitant engagement with and training of regional clinicians will provide better regional health outcomes and a sustainable regional skilled immunotherapy clinical trial workforce.

136 | Increasing regional cancer registry trial access and participation in regional Victoria

Wasek Faisal¹, Peter Gibbs^{3, 4, 2}, Vanessa Wong^{1, 3}, Damon Parker⁵, Craig Underhill^{6, 8, 7}

¹Grampians Health, Ballarat, Vic, Australia

²The University of Melbourne, Melbourne, Vic, Australia

³Walter and Eliza Hall Institute, Parkville, Vic, Australia

⁴Western Hospital, Footscray, Vic, Australia

⁵Regional Trials Network Victoria, Albury-Wodonga, Australia

⁶Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

⁷Latrobe University, Wodonga, Vic, Australia

⁸UNSW School of Clinical Medicine, Rural Clinical Campus, Albury, NSW, Australia

Aim: Addressing the geographical disparity in clinical trial access is crucial for advancing cancer care and reducing health inequities. By increasing registry trials in rural, regional, and remote (RRR) areas, we enhance access to research opportunities, improve patient outcomes, and promote inclusivity in medical research. Pursuing registry clinical trials, a pragmatic trial design, could increase trial numbers, increase participation of regional patients, and increase trial engagement with regional clinicians.

Methods: We implemented regionally designed Registry trials to advance cancer care in rural, regional, and remote (RRR) areas as part of the MRFF funded REVITALISE project Regionally led registry trials and participation in metropolitan led studies were pursued.

Results: An average of two new registry trials open have been opened at participating regional cancer center per year. The Option Trial represents a pioneering effort in regionally designed and led trials, focused on managing oligoprogression in patients receiving immuno-oncology treatment. The Bolder Trial addresses a critical gap in geriatric oncology research by focusing on tailored treatment approaches for elderly breast cancer patients in RRR areas. Patient enrolment for interventional registry trials ALT-TRACC, REAL-PRO, and EX-TEM with Melbourne leads have exceeded that of metropolitan Melbourne. We continue to explore new registry trial concepts and continue engagement with and training of regional clinicians around registry clinical trials.

Conclusion: The expansion of registry trials in regional Victoria, and the concomitant engagement with and training of regional clinicians, has created new trial opportunities. This has increased overall trial activity, provided trial participation opportunities for regional clinicians including trial leadership, supports education and sustainability of a regional skilled clinical trial workforce, and should drive better regional health outcomes.

137 | Building a virtual bridge to equitable health services research training in regional Victoria

Tenille Lewin^{1, 2}, Heather Cameron², Craig Underhill^{3, 4}, Meinir Krishnasamy^{1, 5}

¹Peter MacCallum Cancer Centre, Parkville, Vic, Australia

²Regional Trials Network Victoria, Albury-Wodonga, Australia

³Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

⁴Latrobe University, Wodonga, Vic, Australia

⁵University of Melbourne, Parkville, Vic, Australia

Aim: Delivery of care closer to home is a cornerstone of the Victorian Cancer Plan. For regional cancer patients, this policy initiative assumes equity of opportunity for care, treatment and research participation, compared with metropolitan patients. We set out to develop and implement a virtual health services research (HSR) training resource to equip regional health care professionals with the knowledge and tools to lead HSR with and for regional patients.

Methods: A multi-phased project was undertaken to build, refine, and deliver the resource. Phase 1: in-depth interviews and focus groups with key regional stakeholders, a comprehensive scoping review, and environmental scan to identify existing HSR training programs. Phase 2: engagement with national key stakeholders to establish collaborative relationships, to gain understanding of existing HSR training opportunities, and to identify gaps that the new virtual resource could fill. In Phase 3, data from Phases 1 and 2 were used to build the resource. The project Steering Committee provided feedback on all stages of resource development.

Results: Phase 1 data provided information to inform the content and function of the virtual resource. Phase 2 data identified 168 freely available HSR resources and eight key stakeholders who are currently delivering clinical trials education and HSR education. Of those delivering HSR training, none had capacity to expand their programs and agreed to collaborate with @research to facilitate greater access for regional health professionals. Phase 3 saw delivery of @research, (https://www.research.regionaltrialsnetwork.org/)—a virtual HSR platform that includes over 70 accessible research tools and templates to support novice to expert HSR researchers develop, implement, and evaluate HSR projects.

Conclusion: The collaborative approach taken to the development of @research has delivered a virtual platform to support growth of HSR among regional Victorian health professionals, scaling potential to deliver research-informed care closer to home.

138 | Improving Aboriginal and Torres Strait Islander people's access to cancer clinical trials in Yorta Yorta Country regional Victoria

Monica Green¹, Leah Lindrea-Morrison ¹, Javier Torres², Craig Underhill^{3, 4}

¹Regional Trials Network Victoria, Albury-Wodonga, Australia

²Goulburn Valley Health, Shepparton, Vic, Australia

³Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

⁴Latrobe University, Wodonga, Vic, Australia

The Medical Research Future Fund has provided multi-year funding to the ReViTALISE project, a large body of work aimed at increasing access to clinical trials (CTs) in regional areas of Victoria, Australia.  The Aboriginal and Torres Strait Islander Cancer Clinical Trial Access Initiative (“the Initiative”) is one of the key components of ReViTALISE.

Aims: The Initiative aims to improve access to cancer CTs for Aboriginal people in a defined area in regional Victoria, with a view to identifying strategies, activities and approaches that are potentially transferrable and scalable.

Methods and Progress to Date: The Initiative is working with a range of stakeholders including community members and organizations as well as health care providers. A Steering Committee has been established with strong Aboriginal membership including an Aboriginal Co-Chair, members from Aboriginal community-controlled health organizations and Aboriginal consumers, alongside non-Aboriginal health professionals and researchers. A literature review highlighted a range of critical factors and enabled identification and synthesis of potentially useful strategies to increase participation of Aboriginal people in CTs in a regional setting.

Study design has been guided by co-design principles, community consultation, an Environmental Scan of relevant activities, literature review and discussions with other ReViTALISE streams. Work is being undertaken in two main areas: (1) Yarning with community to understand knowledge of and perspectives about cancer CTs, followed by co-design of appropriate resources; and (2) co-designing and conducting an education campaign for cancer health professionals to improve their understanding of barriers to and facilitators of CT participation by Aboriginal people with cancer. The team aims to build strong relationships with consumers and community to inform and guide study design, implementation and dissemination. Identification of benefits that matter to community as a result of the work will be a key consideration.

Key learnings to date will be presented.

139 | Improving equity of access to palliative and supportive care trials by establishing a regional network

Jennifer Phillips ^{2, 1}, Miriam Ferres^{3, 4}, Ian Collins^{5, 4}, David Campbell^{3, 4}, Brian Le⁶, Ahmed Nagla⁷, Peter Eastman^{3, 4}

¹St Vincents Hospital, Fitzroy, VIC, Australia

²University of Melbourne, Parkville, Vic, Australia

³Barwon Health, Geelong, Vic

⁴Deakin University, Geelong, Vic, Australia

⁵Southwest Healthcare, Warrnambool, Vic, Australia

⁶Melbourne Health, Parkville, VIC, Australia

⁷Latrobe Regional Hopsital, Traralgon, Vic, Australia

Aims: Participation in clinical trials has been associated with improved patient outcomes. Yet in regional Victoria, there are few clinical trial active palliative care services or opportunities for trial participation. Palliative and Supportive Care Program of Revitalise aims to increase trial availability, participation and capability for regional palliative care services.

Methods: A series of strategies were adopted to increase trial and research activity including:

Mapping current research capabilities of palliative care services.

Establishing and mentoring clinical trial fellow roles who, in turn, will mentor and support regional palliative care services.

Establishing a network of research active clinicians across Victoria to increase knowledge, provide support, increase knowledge, and enhance relationships

Establishing and implementing a portfolio of trials of varying complexity from phase 4 post-marketing to more complex phase 2/3 trials.

Developing clinical trials tailored to be delivered in regional palliative care services.

Results:  From an initial census of services, clinical trial activity was limited to one regional palliative care service. The census highlighted high levels of interest and enthusiasm to develop research capability. Accordingly, the Victorian Clinical Trials Palliative Care Collaborative Group was established and meets second monthly with educational opportunities, and encourages new relationships with the broader research and cooperative trials community.

Phase 4 trials are a useful way to introduce clinical trials, with one site achieving the most successful recruitment status nationally. The broader impact of this research activity has included the enhanced standing of palliative care in the health service. Current palliative care specific clinical trial development is underway.

Conclusion: Despite significant clinical demands, regional palliative care services are interested in being involved in research and clinical trials. Support for infrastructure can enhance trial participation for patients, increase research capability for clinicians but also increase the standing of palliative care in the academy.

140 | Establishment of the ReViTALISE Consumer Group “Every VoiceCAN”

Kathleen Wilkins¹, Damon Parker¹, Donna Long¹, Craig Underhill^{2, 3}

¹Regional Trials Network Victoria, Albury-Wodonga, Australia

²Border Medical Oncology, Border Medical Oncology Research Unit, Albury, NSW, Australia

³Latrobe Regional Hopsital, Traralgon, Vic, Australia

Aim: To develop a consumer-led network to support and empower consumers to actively contribute to the initiatives of the ReViTALISE (Regional Victorian Trials Alliance: Linkages, Innovation, Special Populations, Equity) Project.

Methods: The ReViTALISE program scoped out successful consumer-led advisory committees and asked for advice and guidance such as the Victorian Comprehensive Cancer Centre Alliance Consumer Involvement Manager, the Co-Operative Trial Group (ANZGOG) Consumer Chair. Key clinical stakeholders were engaged to secure buy-in for a consumer network within the Regional Trials Network—Victoria (RTN-Vic), and members of the ReViTALISE network of Initiatives and independent research advisory committee.

Results: ReViTALISE has successfully facilitated and supported establishment the Every VoiceCAN committee, with terms of reference, a program logic, and roadmap for engagement, consumer recruitment, and emplacing consumers in the steering committees of each ReViTALISE Initiative.  Other projects outside of ReViTALISE are now requesting Every VoiceCAN input into project design and development.

Conclusion: Every VoiceCAN is a consumer run and led initiative that engages with ReViTALISE clinicians and administrators to bring about effective and mutually beneficial change in communication and understanding between health practitioners, cancer clinical trial participants, carers and families.

141 | Monitoring the impact of cancer for Queenslanders: A comprehensive review of lung, pancreas, Merkel cell, and brain cancer

Euan Walpole^{1, 2}, Michael Allen ³, Bryan Burmeister⁴, Jasotha Sanmugarajah^{5, 6}, Rick Walker^{2, 7, 8}, Bryan A Chan^{9, 6}, Jon Clark¹, Danny Youlden¹, Pardeep Dhanda¹, Nathan Dunn¹, Margot Lehman^{2, 8}, Alison Bolton¹⁰, Morgan Windsor¹¹, Tracey Guan¹, Artika Nath¹, Lauren Buckley¹, Michael Stuart^{7, 12}, Liam Coulthard^{7, 8}, Lauren Green^{13, 7}, Annabelle Harbison⁷, Siddhartha Kusukuntla⁷, Eliza Kurth⁷, Robert Campbell^{7, 8}, Phoebe Woodrow¹, Shabnam Gujadhur⁵, Julie Moore¹, Victoria Donoghue¹, Danica Cossio¹

¹Cancer Alliance Queensland, Brisbane, Queensland, Australia

²Princess Alexandra Hospital, Brisbane, Queensland, Australia

³Sunshine Coast University Hospital, Birtinya, Queensland, Australia

⁴GenesisCare, Fraser Coast, Queensland, Australia

⁵Gold Coast University Hospital, Gold Coast, Queensland, Australia

⁶School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia

⁷Queensland Children's Hospital, Brisbane, Australia

⁸School of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁹Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

¹⁰Queensland Cancer Control Safety and Quality Partnership, Lung Cancer Subcommittee, Queensland Health, Brisbane, Queensland, Australia

¹¹The Prince Charles Hospital, Brisbane, Queensland, Australia

¹²College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

¹³Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

The symposium aims to raise awareness about cancers with poorer outcomes.  The source of population data for these presentations 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.

The focus is on four challenging cancer types—lung, pancreas, Merkel cell, and brain and their impact on our community. We will discuss relevant clinical indicators, areas of inequity, including Aboriginal and Torres Strait people and the impact of socioeconomic variation.

Lung Cancer: The leading cause of cancer-related deaths worldwide, lung cancer poses significant challenges. We will examine quality indicators for Non-Small Cell Lung Cancer across 28 elements from diagnosis, treatment and outcomes.

Pancreatic Cancer: Often diagnosed at advanced stage, pancreatic cancer presents a poor prognosis. Equity of treatment is crucial for this aggressive disease, ensuring that all individuals achieve optimal outcomes.

Merkel Cell Carcinoma: A rare and aggressive skin cancer, with a high risk of spreading if not diagnosed early. We will analyse Merkel Cell Carcinoma in Queensland and examine the variation in diagnosis, treatment, recurrence, and survival.

Brain Cancer: Tumors affecting the brain in the adolescent and young adult population pose a significant burden to their quality of life. We will identify the unique neurocognitive and psychosocial needs of this cohort and their overall outcomes.

142 | Do patient characteristics influence the first-line chemotherapy regimen for adenocarcinoma of the pancreas?

Michael Allen ^{1, 2}, Bryan A Chan^{1, 3}, Euan Walpole^{4, 5, 2}, Jon Clark⁴, Danny Youlden⁴, Pardeep Dhanda⁴, Nathan Dunn⁴, Danica Cossio⁴

¹Sunshine Coast University Hospital, Birtinya, Queensland, Australia

²Queensland Cancer Control Safety and Quality Partnership, Systemic Therapy subcommittee, Cancer Alliance Queensland, Brisbane, Queensland, Australia

³School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia

⁴Cancer Alliance Queensland, Brisbane, Queensland, Australia

⁵Princess Alexandra Hospital, Brisbane, Queensland, Australia

Aims: Most people with pancreatic cancer are diagnosed at a late stage when surgery is not feasible. Three main chemotherapy regimens are in use for this group: FOLFIRINOX including Oxaliplatin, Irinotecan and Fluorouracil (OIF); Gemcitabine with nab-Paclitaxel (GP); and Gemcitabine (Gem) alone. These regimens offer different levels of complexity, effectiveness, and tolerability. Our aim was to investigate whether any key demographic characteristics influence the first line chemotherapy received.

Methods: Data was obtained from the population-based Queensland Oncology Repository, which brings together clinical, treatment, and demographic information from multiple sources. The study cohort comprised Queensland residents diagnosed with pancreatic adenocarcinoma between 2018 and 2022 and who did not have curative surgery and received OIF, GP, or Gem. The likelihood of receiving a particular chemotherapy regimen was determined by fitting multivariable Poisson models, adjusted for patient, clinical and facility characteristics. Three-year unadjusted all-cause survival was assessed using Kaplan-Meier analysis.

Results: Of the 792 people in the study cohort, GP was the most common type of first-line chemotherapy (58%), followed by OIF (27%) and Gem (15%). People aged 65 years and over (p < 0.001), those from areas with middle or disadvantaged socio-economic status (p = 0.009), and people diagnosed with stage IV disease (p = 0.01) had a lower likelihood of receiving OIF. There was also possible evidence that First Nations’ people were less likely to be treated with OIF (p = 0.06). Three-year survival for OIF was 10% (95% CI 6−15) compared to 8% (4%−14%) for Gem and 3% (1%−5%) for GP (p < 0.001).

Conclusion: Equity of treatment for pancreatic cancer patients is crucial for this aggressive disease, ensuring that all individuals achieve optimal outcomes. Although survival was very poor within the palliative care setting irrespective of the chemotherapy regimen received, our results show that people from lower socio-economic areas and First Nations people were less likely to receive more complex chemotherapy.

143 | Variation in Merkel cell carcinoma outcomes: A Queensland perspective on a rare and aggressive skin cancer

Bryan Burmeister^{1, 2}, Phoebe Woodrow³, Shabnam Gujadhur⁴, Artika Nath³, Julie Moore³

¹GenesisCare, Fraser Coast, Queensland, Australia

²Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Cancer Subcommittee, Brisbane, Queensland, Australia

³Cancer Alliance Queensland, Brisbane, Queensland, Australia

⁴Gold Coast University Hospital, Gold Coast, Queensland, Australia

Aims: Queensland has the highest incidence of Merkel cell carcinoma (MCC) in Australia with a rate of 2.2 per 100,000. MCC is a rare, highly aggressive skin cancer with a high risk of spreading if not diagnosed early. This analysis aims to describe the epidemiology of MCC in Queensland and examine variations in diagnosis, treatment, recurrence, and survival.

Methods: This retrospective population-based analysis used data from the Queensland Oncology Repository (QOR). A comprehensive review was undertaken, and specific pathological information was collected for people diagnosed with MCC from 2012 to 2021. Follow up time was up to 31^st December 2022. Kaplan-Meier method was used to calculate survival and recurrence.

Results: Of the 1064 people diagnosed with MCC over the ten years, 68% were male, 1% were First Nations peoples, and the median age at diagnosis was 78 years (range 26–105). The most common primary locations were the face, ears and neck accounting for 42% of cases. Approximately 30% with a known stage at diagnosis had an advanced tumor stage. Radiation therapy (RT) treatment utilization for all MCC cases was 58%. The median time for MCC-specific survival was 40 months; and the 5-year survival rate improved from 39% (95% CI, 35−44) to 46% (95% CI, 41−52) between 2012–2016 and 2017–2021. Factors associated with death included increasing age, higher comorbidity burden, and advanced stage (all p < 0.001). Approximately one-third of the cases experienced a recurrence, with the median time to recurrence being 16 months.

Conclusion: While MCC is a rare skin cancer, incidence in Queensland is high. Encouragingly, survival is improving due to advances in histological diagnostic techniques and treatments. Age, comorbidity burden, and advanced stage were all predictors of poorer survival. Further analysis will be conducted to examine influences of overall stage and the use of immunotherapy therapies.

144 | Clinical practice indicators for Queenslanders with NSCLC: How do we compare?

Jasotha Sanmugarajah^{1, 2, 3}, Bryan A Chan^{4, 2, 3}, Margot Lehman^{5, 6, 2}, Alison Bolton², Morgan Windsor^{2, 7}, Danica Cossio⁸, Nathan Dunn⁸, Tracey Guan⁸, Artika Nath⁸, Danny Youlden⁸

¹Gold Coast University Hospital, Gold Coast, Queensland, Australia

²Queensland Cancer Control Safety and Quality Partnership, Lung Cancer Subcommittee, Queensland Health, Brisbane, Queensland, Australia

³School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia

⁴Sunshine Coast University Hospital, Birtinya, Queensland, Australia

⁵Princess Alexandra Hospital, Brisbane, Queensland, Australia

⁶School of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁷The Prince Charles Hospital, Brisbane, Queensland, Australia

⁸Cancer Alliance Queensland, Brisbane, Queensland, Australia

Aims: Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality in Queensland. Our aim was to examine quality indicators for NSCLC in Queensland to assess performance across 28 elements from diagnosis, access, treatment and outcomes.

Methods: De-identified unit record data were sourced from the population-based Queensland Oncology Repository, which contains linked data from multiple sources. Eligible people were diagnosed with NSCLC between 2012 and 2021, with follow-up on treatment and mortality available to 31 December 2022. Each quality indicator, changes between 2012 and 2016 to 2017 and 2021 were assessed by fitting a multiple Poisson regression model, adjusted for key demographic and clinical covariates.

Results: Records were included for a total of 20,449 individuals. Significant improvements over the study period were observed for several indicators, including: review by a multidisciplinary team (56% in 2012–2016 compared to 62% in 2017–2021; p < 0.001); receipt of any cancer treatment (74%–79%; p < 0.0001); radiation therapy for inoperable early-stage NSCLC (76%–81%; p = 0.02); concurrent chemo-radiotherapy for stage III disease (41%–53%; p < 0.001); and intravenous systemic therapy (IVST) for metastatic NSCLC (44%–50%; p < 0.001). Two-year survival from the time of surgery improved from 85% to 90% (p < 0.001). In contrast, there was a decrease in people from rural/remote areas receiving their first treatment within 30 days of diagnosis (48% to 44%; p = 0.01). People treated at private facilities had a median wait time to first treatment of 22 days (IQR 11–39), compared with people treated at public facilities, 39 days (IQR 23–57) and 22% of people who received intravenous systemic therapy for NSCLC died within 30 days of their last treatment.

Conclusion: Ongoing monitoring of quality indicators offers essential benchmarking to identify variation in practice and improvements in care, providing important information for clinicians and Queenslanders with lived experience of lung cancer, to drive consistent, evidence-based care.

145 | Lost in Transition: the burden of brain tumors in the adolescent and young adult (AYA) population

Rick Walker^{2, 1, 3, 4}, Lauren Buckley⁵, Michael Stuart^{1, 6}, Liam Coulthard^{1, 3}, Lauren Green^{7, 1}, Annabelle Harbison¹, Siddhartha Kusukuntla¹, Eliza Kurth¹, Danica Cossio⁵, robert A campbell^{1, 3, 8}

¹Queensland Children's Hospital, Brisbane, Australia

²Princess Alexandra Hospital, Brisbane, Queensland, Australia

³School of Medicine, University of Queensland, Brisbane, Queensland, Australia

⁴Queensland Cancer Control Safety and Quality Partnership, Youth Cancer Subcommittee, Cancer Alliance Queensland, Brisbane, Queensland, Australia

⁵Cancer Alliance Queensland, Brisbane, Queensland, Australia

⁶College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

⁷Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

⁸Queensland Cancer Control Safety and Quality Partnership, Brain Cancer Subcommittee, Cancer Alliance Queensland, Brisbane, Queensland, Australia

Background: While 5-year relative survival for Central Nervous System (CNS) cancers in the Australian adolescent and young adult (AYA) population has improved over time, the significantly increased survival in common AYA cancers like melanoma, thyroid, and leukemia overshadow poorer outcomes for CNS cancers. As one of the leading causes of cancer-rated deaths and morbidity in AYAs, CNS tumors require improved clinical management.

Aim: The aim of this retrospective analysis was to review epidemiology and outcomes of CNS tumours (low and high grade) in the Queensland AYA cohort 2014–2022. Surgical quality indicators, comorbidities, engagement with psychosocial support, and surveillance mechanisms were investigated.

Method: De-identified unit record data were sourced from the population-based Queensland Oncology Repository, containing linked data from multiple sources. Eligible people were 15–24 year olds diagnosed with a primary brain tumor. Children aged 7–14 years diagnosed with a primary brain tumor and who survived to transition into the AYA cohort were also included. Treatment and surveillance information were available for each patient.

Results: Three hundred ninety-seven AYAs met criteria for the analysis. 75% of patients with high-grade tumors and 97% with low-grade tumors had survived up to 31 December 2022.

58% of the cohort proceeded to resection of their tumour. 33% of the cohort had at least one comorbidity post treatment (gross motor deficit, cranial nerve deficit or endocrinopathies).

Of the cohort 6% had a genetic syndrome; 4% had more than one cancer diagnosis, and 8% identified as First Nations people.

Conclusion: There is one new diagnosis of a CNS tumour per week in the AYA cohort of Queensland. AYAs with CNS tumours have poorer outcomes and unique neurocognitive and psychosocial needs compared to AYAs with non-CNS cancers and the general AYA population. This warrants specific focus on improving consistency and quality of their care and treatment. 

147 | Digital Health underpinning AI in Healthcare

David Hansen¹

¹CSIRO—Australian e-Health Research Centre, Herston, QLD, Australia

The promise of digital health in improving health outcomes has been a long time coming, with the focus being on electronic health records over the past 20 years. Now, we have a number of Artificial Intelligence technologies that are revolutionizing how data is captured and processed.

In this talk, we will discuss the key trends in digital health which are enabling the use of AI technologies in healthcare. We will go on to look at how AI technologies—from traditional machine learning and natural language processing techniques to new generative AI technologies—are being used in healthcare to improve the quality of decision making.

148 | Artificial Intelligence and the Diagnostic Revolution – how AI is transforming radiology

Catherine Jones¹

¹I-MED, Royal Brisbane and Women's Hospital, Newstead, QLD, Australia

Publish consent withheld

149 | Artificial Intelligence in Healthcare Plenary: Using Curate.AI in patient care–Optimising dosing and patient longevity

Dean Ho¹

¹National University of Singapore, Singapore, SINGAPORE

Patient treatment is often guided by snapshots of data, ranging from blood tests to images. However, longitudinal data and corresponding biomarker changes can provide key insights that can be harnessed to modulate patient dosing to optimize efficacy over time. This strategy may even further elucidate changes in combination therapy drug synergy which can be dose- and time-dependent, as well as patient-specific. This talk will address our development of the CURATE.AI workflow, which uses prospectively acquired small data sets to dynamically adjust drug doses. Contrary to conventional approaches, this workflow does not use pre-existing big/population data to treat individuals. Instead, it uses only a patient's own data to guide only their own treatment. Beyond clinical validation, we will also discuss the role of behavioral sciences, hospital/patient stakeholder engagement, and design toward workflow implementation.